Eyeworld Daily News

ASCRS SYMPOSIA ASCRS ASOA ANNUAL MEETING by Rich Daly EyeWorld Contributing Writer Masket underscored removing OVD from behind the IOL to avert capsule block syndrome or artificially induced myopia. "Use all of these tools avail- able to you to do the best thing for that patient," Dr. Masket said. Also presenting at the session was Claudio Trindade, MD, Belo Horizonte, Brazil, who up- dated attendees on a new pinhole sulcus implant for the correction of irregular corneal astigmatism. In a published case series, Dr. Trindade and colleagues implanted the device in pseudophakic eyes of patients with irregular corneal astigmatism. The technology is based on the understanding that total ocular aberrations become more unfavorable as pupil di- ameter increases, while reducing the pupil aperture minimizes the effect of ocular aberrations because the paraxial light rays are less susceptible to imperfections of the optical system. Among the 21 patients included in the study, statistically significant improvement occurred in both corrected and uncorrected distance visual acuities. The medi- an CDVA improved from 20/200 preop to 20/50 in the first month postop and remained stable over the following months. Manifest refraction remained unchanged. Meanwhile a subject visual per- formance questionnaire showed a perception of improvement in all of the tested working distances. No major complications were observed but one case presented with decentration of the device. Overall, Dr. Trindade and his colleagues concluded that the intraocular pinhole device performed well in patients with irregular astigmatism caused by keratoconus. They found marked improvement in visual function and high patient satisfaction. Editors' note: Drs. Masket and Trin- dade have financial interests with various ophthalmic companies. "Those options are usually the least well accepted," Dr. Masket said. The advantages of laser refractive surgery and piggyback IOLs include no need to know the cause of the error in order to correct it. Among laser sur- gery options, Dr. Masket prefers LASIK over PRK because it pro- vides a quicker return of vision, it doesn't hurt, and it does not require extended postop use of drops. One drawback is that the patient has to wait for the cataract incision to heal before LASIK can be performed. Surgeons opting to use piggyback lenses need to select among available lenses, where they will place it, and how will they determine the power. Dr. Masket prefers the use of silicone lenses —instead of acrylic—because it is going to be placed in the sulcus. Surgical pearls for piggyback lens placement include the use of folding forceps with low power lenses because the inserters are more likely to damage them. The option of removing, replacing or repositioning the IOL does not address known optical errors, but it does offer the advantage of a faster postop re- covery. However, this is the most challenging among the surgical options, especially if the posterior chamber is open. Surgical pearls for such replacement procedures include avoiding inducing hyperopia in high myopes. Three-piece lenses are easy to remove and should be rotated clockwise in the plane of the lens. They can be bisected with scissors. Dr. Masket urged removing lenses with the loop-optic junction com- ing out first. Otherwise, flailing loop-optics can damage endothe- lium, the iris capsule, and other structures in the eye. Another pearl is that it is worthwhile, even in reoperations, to clean lens epithelial cells to prevent later capsule fibrosis. Dr. more predictable," Dr. Masket said. The most important response to the postop discovery of a wrong power IOL is to find out its cause, Dr. Masket said. Remea- sure the patient and recheck that there was no identification-related mistake. "You must discuss it with the patient," Dr. Masket said. "It's much better that he hears it from you than the person down the street." Clinical options include spec- tacles, contact lenses, laser refrac- tive surgery, a second piggyback IOL, remove or reposition the implanted IOL. However, most patients will not consider the first two options. W rong power IOLs are a major driver of IOL exchange and an underlying cause may be head- ed for a solution. All formulae assume effective lens position (ELP) postop, and this frequently presents challenges in short eyes, Sam Masket, MD, Los Angeles, said at Monday's EyeConnect Live: Anchorman Edition symposium. "There's good reason to believe that a capsulotomy-sup- ported lens can in fact make ELP Can surgeons improve predictability of effective lens position? Attendees learned that a capsulotomy- supported lens is likely to make effective lens position more predictable. 42 | EYEWORLD DAILY NEWS | MAY 7, 2019

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