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42 | EYEWORLD DAILY NEWS | MAY 6, 2019 ASCRS SYMPOSIA ASCRS ASOA ANNUAL MEETING by Vanessa Caceres EyeWorld Contributing Writer Editors' note: Dr. Kleinmann has financial interests with Hanita Lenses. Dr. Kohnen has financial interests with Johnson & Johnson Vision, Allergan, Bausch + Lomb, and other ophthalmic companies. Dr. Orlich has financial in- terest with Johnson & Johnson Vision, Ivantis, and other ophthalmic companies. Dr. Tipperman has financial interests with Alcon and Diopsys. Dr. Yeoh has financial interests with Alcon, Johnson & Johnson Vision, Carl Zeiss Meditec, and other ophthalmic companies. Drs. Domene, Rajan, and Raviv have no related financial interests. dothelium, and avoid radial tears, Dr. Kohnen advised. Although some surgeons may consider using femtosecond laser-assisted cataract surgery (FLACS) to lower posteri- or capsule rupture rates, recent re- search found the rupture rate was about the same for both FLACS and manual cataract surgery when they were performed by an experi- enced surgeon, he reported. Jorge Domene, MD, Mon- terrey, Mexico, discussed sub- luxated lenses. Management will include a three-piece haptic lens, a capsular tension ring, a simple fixation ring, double-fixation ring, and intracapsular surgery with a sulcus-fixated IOL, all depending on the degree of subluxation. the bottle height, and place one or more iris hooks, Dr. Orlich recommended. If you have an errant capsu- lorhexis, an older but still effec- tive technique called can opener capsulotomy can be effective, said Richard Tipperman, MD, Bala Cynwyd, Pennsylvania. Once the "can opener" is performed, there no longer will be a bag, so the IOL will likely end up in the sulcus, even though it looks like you are placing it in the bag. "Three-piece IOLs should be used in these instances," Dr. Tipperman said. Use of a single-piece IOL in- creases the chance of uveitis-glau- coma-hyphema syndrome. Mohan Rajan, MD, Chennai, India, discussed rock-hard cata- racts. A good preop assessment, use of peribulbar or parabulbar anesthesia, a 5.5 mm to 5.75 mm rhexis done with trypan blue, min- imal hydrodissection, a high phaco power, and use of vertical chop or Karate chop are some pearls, Dr. Rajan said. For an unstable lens, Guy Kleinmann, MD, Rehovot, Israel, presented options with different iris hooks to help improve man- agement. Tal Raviv, MD, New York, focused on what to do if the pupil comes out midway through a case. Plan to use intracameral epinephrine or phenylephrine as well as a dispersive or viscoad- aptive ophthalmic viscosurgical device, he advised. You could use hooks, but be aware that they will add extra surgical time and cost. Knowledge of a chop technique is also valuable, he said. Broken posterior capsules are another possible complication of cataract surgery, said Thomas Kohnen, MD, PhD, Frankfurt, Germany. Risk factors that make capsule rupture more likely in- clude pseudoexfoliation, diabetes, and renal failure, he said. Plan to deepen the bottle, protect the en- K nowing how to navigate the tricky parts of cat- aract surgery can make you a better surgeon, and that's exactly what presenters covered during Sunday morn- ing's "Surgical Essentials: Getting You Out of Trouble in Cataract Surgery." The symposium was spon- sored by the Alliance of Cataract and Refractive Specialty Societ- ies, which includes ASCRS, the Asia-Pacific Association of Cata- ract and Refractive Surgeons, the European Society of Cataract and Refractive Surgeons, and the Latin American Society of Cataract and Refractive Surgeons. Ronald Yeoh, MD, Singa- pore, kicked off the session with tips on how to handle soft cat- aracts, which he termed "catar- mush" and "neither-here-nor- there cataracts." Just like rock-hard cataracts pose challenges, so do soft cataracts, which tend to have more resistance to forces and can be hard to occlude and grip. Use a Karate prechop if the cataract is no more than 2+, hydrodelineate and lollipop, and perform quick stop and chop for "catarmush" cataracts, Dr. Yeoh advised. However, if there is a soft enough nuclei and the patient is under 30 years old, you can go in and aspirate without even performing phaco, Dr. Yeoh added. Claudio Orlich, MD, San Jose, Costa Rica, discussed lens iris diaphragm retropulsion syndrome, which is more likely to occur in patients with pseudoexfoliation, myopia, and inadequate pupil dilation. To help avoid lens iris diaphragm retropulsion syndrome, do not use topical intracameral an- esthesia in high-risk cases, provide good pupillary dilation, decrease Here's how to avoid cataract surgery pitfalls Dr. Rajan discusses managing rock-hard cataracts.

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