Eyeworld Daily News

ASCRS SYMPOSIA T oday is the last day of the Annual Meeting, but there are still plenty of clinical pearls you can take home. "The Best of ASCRS—presented in Spanish" is spon- sored by the Latin American Society of Cataract and Refrac- tive Surgeons and will be held from 8 to 9:30 a.m. in room 4. "X-Rounds: Cataract Surgery to the Max" is a fast-paced session that features the latest and greatest in refractive cataract surgery. Leading surgeons will discuss new advances in cataract sur- gery, femtosecond laser cataract surgery, refractive IOLs, and case management. It takes place in room 20D from 10 to 11:30 a.m. Final symposia cover hot issues for anterior segment surgeons Miscellaneous pearls: Sri Ganesh, MD, Bangalore, India Dr. Ganesh described a novel technique for posterior capsule rupture rescue. When no vitreous is coming forward through the rent and when you are on I/A, Dr. Ganesh proposes remaining in the eye with your instruments and using the I/A handpiece to create what he called the "vacuum rhexis." This should only be done when the PCR is less than 3 mm; when it is created during I/A; when there is no vitreous loss; and using coaxial I/A, Dr. Ganesh stressed. By keeping instruments in the eye, it prevents shallow- ing of the anterior chamber and subsequent vitreous prolapse. In a series of 12 eyes, this technique has shown no extension of the tear, no vitreous loss, and 100% planned IOL placement in the bag. Editors' note: The speakers have no financial interests related to their comments. E xperts from four inter- national cataract and refractive surgery societies gathered at the TOPGUN symposium Monday afternoon to give their most essential pearls for cataract surgery. David Chang, MD, moder- ator, Los Altos, California, said there is nothing exotic in this session, rather practical pearls that you can take back and apply in your practice. Experts in four categories gave their essential pearls and the audience voted on who they thought was the best instructor. Following all the pre- sentations, the audience voted on the best team. Team Pan Am-Blyopes, which included experts from ASCRS and the Latin American Society of Cataract and Refractive Surgeons was voted the best team. Experts from the Asia-Pacific Association of Cataract and Refractive Sur- geons and the European Society of Cataract and Refractive Sur- geons represented the Crazy Rich Eur-Asians team. Following are brief highlights from the instructors who won in each category. Phaco pearls: Arnaldo Espaillat, MD, Santo Domingo, Dominican Republic Dr. Espaillat presented several pearls in his presentation "Phaco diversity." To avoid the Argentin- ian flag sign in intumescent white cataracts, stain with trypan blue, insert a cohesive OVD, and pinch through the corneal limbus with a needle, aspirating milky fluid the same time you penetrate the capsule, he said. Another tip he provided was to chop the nucleus into eight pieces, using torsional ultrasound in pulse mode. Dr. Espaillat injects dispersive OVD frequently to protect the corneal endothelium. If you see white, milky material near the phaco tip, Dr. Espaillat said it is likely occlusion with viscoelastic and nuclear material; stop doing phaco. This pause will help avoid corneal burns. In post-RK eyes with eight incisions, Dr. Espaillat said to do a 2.2-mm scleral tunnel and a 1-mm side port through the corneal lim- bus between radial cuts. IOL pearls: Ronald Yeoh, MD, Singapore Dr. Yeoh gave several pearls for injecting single-piece IOLs. First, he highlighted several things that can go wrong, such as the plunger going under the IOL, a trailing haptic stuck in the cartridge, and lens stuck in the incision (Winnie the Pooh syndrome). Dr. Yeoh then provided his four essential tips for implantation. 1) Load the IOL true with ad- equate OVD in the cartridge. Loading the IOL true, he explained, means following the picture of the IOL on the cartridge. 2) Depress the optic to create con- cavity to receive the haptics. 3) Watch the IOL as it travels down the injector cartridge. 4) Maintain adequate forward pressure in wound-assisted implantation. Complex case pearls: Kendall Donaldson, MD, Plantation, Florida Dr. Donaldson gave her tips for pars plana vitrectomy. Plan in advance for these cases, when pos- sible. Recognize when there might be a broken posterior capsule with an intact hyaloid versus when there might be vitreous prolapse. Viscoelastic should be used to avoid shallowing on the anterior chamber and further vitreous prolapse. Stain with triamcinolone to visualize vitreous. Vitrector settings should be set at the high- est cut rate with irrigation/cut/ aspirate for vitreous. The vitrec- tor should be inserted 3.5 mm posterior to the limbus with or without a trocar. Always visualize the port and do not vitrectomize through the primary incision. IOL options include a three-piece IOL in the sulcus or consider optic capture. Suture the wound closed and use acetylcholine chloride. Never sweep vitreous and be sure to monitor postop. by Liz Hillman EyeWorld Senior Staff Writer TOPGUN symposium provides essential cataract pearls The Pan Am-Blyopes, a team of experts from the U.S. and Latin America, takes the title of best team at the TOPGUN symposium. 26 | EYEWORLD DAILY NEWS | MAY 7, 2019

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