Eyeworld Daily News

30 | EYEWORLD DAILY NEWS | MAY 7, 2019 ASCRS SYMPOSIA ASCRS ASOA ANNUAL MEETING by Ellen Stodola EyeWorld Senior Staff Writer/ Meetings Editor decentered and tilted, the posteri- or capsule was open and there was zonulysis. Dr. Findl proceeded by explanting the IOL, removing the bag, and doing an anterior vitrec- tomy, and he scleral fixated the IOL using the Yamane technique. At 4 days postop, Dr. Findl said the VA was good and there was one loose suture. At 3 weeks postop, he noticed the patient had quite a bit of astigmatism, and at 2 months postop, two sutures were explanted but the pressure was fine. However, just 2 days after this, Dr. Findl said the patient had severe visual problems, including hemorrhage, which didn't resolve, and he had to do irrigation and pars plana vitrectomy for blood removal. He then shared a video of his surgery, which started with him unable to see the lens or a red reflex. He was finally able to see the lens and red reflex, but he noticed the pupil was very dilated. He proceeded as planned with a pars plans vitrectomy but said the patient did not look good at the end of the case. Though the lens was well-centered, Dr. Findl couldn't find the iris at all. Participants in the session were genuinely confused how the iris could just disappear. If the iris is gone, he had an injury, Dr. Masket said. But Dr. Findl said his patient continued to deny that he had a prior injury, though he noted that there were likely other health factors at play that he was unaware of. In the end, Dr. Findl said the patient had clear vision, though with some halos and glare, and no astigmatism. The pressure was fine, the IOL was centered, and the retina was attached, he said, noting that he ordered an artificial iris for the patient. Editors' note: The session participants have financial interests with various ophthalmic companies. to use it sooner rather than later because it can help stabilize the bag during the removal of the cataract. Dr. Donnenfeld proceeded with his case and used a one-piece lens but still had to deal with iris dialysis. He noted that it's import- ant not to put a suture in the cen- tral iris but rather to go as far into the periphery as you can without button-holing. The case ended with a pretty round pupil, he said. Dr. Findl shared a case that was quite perplexing that he called "the eight-ball surprise." His patient was a 60-year-old male who had cataract surgery several years before. He also had trauma to the left eye, though he denied the trauma. He had visual problems, and Dr. Findl saw him about 6 months after these prob- lems began. He noted that the visual acuity was good. Just before the surgical date, one haptic was in the anteri- or chamber. The patient had a single-piece lens and the capsule was very disorganized and there was obviously a rupture and dehiscence. So the IOL was that's exactly how he proceeded. He first made a Hoffman pocket, filled the eye with viscoelastic, and began the vitrectomy. He didn't need to irrigate because he wanted to soften the eye and didn't want to hydrate the vitreous. There are certain circumstances when he doesn't use irrigation, and in this case, Dr. Donnenfeld said the viscoelastic will keep the anterior chamber full. He continued with a capsulor- hexis and did normal hydrodissec- tion before moving on to phaco. He questioned other session participants about their pearls for doing phaco on a lens that may not have zonular support. Dr. Knorz said he would po- tentially use a capsular tension ring to get less movement and make the vitrectomy safer. Meanwhile, Dr. Koch stressed that great hy- drodissection is important so that any manipulation of the nucleus is gentle on the zonules. When to put in a capsular tension ring was also discussed, with Dr. Donnenfeld saying he tries to not put it in until he has to and Dr. Fine saying he likes "T he Perfect Save," a sym- posium of challenging cases managed by international experts, took place on Monday afternoon. The session was moderated by Eric Donnenfeld, MD, Rockville Centre, New York, and Stephen Slade, MD, Houston. Other session participants included Oliver Findl, MD, Vi- enna, Austria, Roberto Zaldivar, MD, Mendoza, Argentina, John Vukich, MD, Madison, Wis- consin, Edward Holland, MD, Cincinnati, Douglas Koch, MD, Houston, Kerry Solomon, MD, Mt. Pleasant, South Carolina, Michael Knorz, MD, Mannheim, Germany, Sam Masket, MD, Los Angeles, and I. Howard Fine, MD, Eugene, Oregon. Dr. Donnenfeld shared a case of a complex cataract extraction and iridoplasty. It was a post-trau- matic eye, and the patient had a large iris dialysis and fairly intu- mescent cataract. There was also vitreous and zonular dehiscence in the anterior chamber. Dr. Donnenfeld asked other session participants what their thought process for this case would be. Dr. Solomon said that the vitreous in the anterior chamber needs to be managed, and because it looked like a dense lens, he said to consider multiple options to remove it. Dr. Findl suggested having capsule hooks waiting just in case. Dr. Fine said he would use viscoelastic to sequester as much as possible and do a pars plana vitrectomy. Dr. Donnenfeld joked that Dr. Fine had ruined his case because International experts examine management of challenging cases Dr. Findl shares a complicated case where the patient had severe iris issues.

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