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28 EW SHOW DAILY Sunday, April 21, 2013 ASCRS Symposia Session looks at videos of complications that can arise when performing surgery by Ellen Stodola EyeWorld Staff Writer Panelists speak about challenging video cases at a symposium that discussed different challenges and complications that can arise when doing a variety of surgeries. H andling complications that come up during surgery can be difficult, and in the "Challenging Video Cases for the Young Surgeon" session, a panel discussed videos of some of the problems that can arise during surgery and possibilities for dealing with them. The panel included Sherman W. Reeves, MD, Minneapolis, Clara C. Chan, MD, Toronto, Edwin S. Chen, MD, San Diego, Sumit (Sam) Garg, MD, Irvine, Calif., Preeya K. Gupta, MD, Durham, N.C., Jeremy Z. Kieval, MD, Lexington, Mass., Ken Y. Lin, MD, Irvine, Calif., Leejee H. Suh, MD, New York, and Elizabeth Yeu, MD, Houston. One of the topics the panel addressed was a broken haptic in a cataract case. Dr. Reeves introduced Did you know ... Every minute: 571 new websites are created, Google has more than 2,000,000 search queries, brands and organizations on Facebook receive 34,722 likes Source: Domo a case he did, which he described as a perfect cataract case, with a crystal clear cornea. However, he said when he was inserting the IOL, something went horribly wrong, which was a broken haptic. Dr. Reeves said this type of problem is something that residents don't generally get a lot of training in. When addressing ways to remedy the complication, Dr. Chan said she would be curious to explore the possibility of simply amputating the broken haptic. She would like to see what would happen if you put the lens at a 12 and 6 o'clock position with the broken part at 12 o'clock and cleaned everything up to see how it would center before making a decision of whether or not to explant. "I think that the biggest concern would be a late migration of the lens depending on the bag and how it centers on the bag," said Dr. Garg. The treatment plan also depends on where the break of the haptic is on the eye, Dr. Garg said. If the break is close to the optic, it has to be addressed, but if it is on the periphery, you can often just leave it in place. Dr. Gupta and Dr. Reeves both stressed that injecting another lens underneath the problem lens is a tactic that could end up helping the surgeon. Dr. Reeves said it could help establish an acrylic barrier between the surgeon and the capsule, and it is not likely to have a second lens with the exact same problem as the first. He said it's worth it for a surgeon to create that extra level of protection. The panelists agreed that when something like this happens, it is absolutely necessary to disclose it to the patient. "You have to disclose this to the patient, even if everything ends up being the same, you want to make sure that you're forthright with them," Dr. Garg said. Another case discussed by the panel was what to do when dealing with a vertical gas breakthrough during a femto flap procedure. Two cases were looked at, one in which the vertical gas breakthrough happened peripherally, and one in which it was more centrally located. Dr. Gupta said it's important to remember the value of screening patients beforehand and looking for any sort of anterior stromal scars or irregularities because presence of these could increase the likelihood of vertical gas breakthrough. Dr. Chan said if this happened peripherally, there is the option to recut the ring to make it a bit smaller, and this could solve the problem. In this particular instance, the surgeon lifted the flap and went around the peripheral area and did not end up with much of a problem. However, in the case with the vertical gas breakthrough more centrally located, it needs to be addressed differently. Dr. Reeves said discretion is the best option if your vertical gas breakthrough is more central. EW Editors' note: Dr. Chan has financial interests with Alcon (Fort Worth, Texas), Allergan (Irvine, Calif.), and Bausch + Lomb (Rochester, N.Y). Dr. Reeves has financial interests with Bausch + Lomb. The other physicians have no related financial interests.