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10 | EYEWORLD DAILY NEWS | JULY 25, 2021 ASCRS ANNUAL MEETING DAILY NEWS T he "Complications by Proxy" symposium, spon- sored by the Young Eye Surgeons (YES) Clinical Committee, sought to "show some of the common complications that we all see," said Sumit "Sam" Garg, MD. Albert Cheung, MD, discussed the Argentinian flag sign. In cases of intumescent lenses, Dr. Cheung said a lens thickness of more than 5.5 mm and an anterior chamber of less than 2.2 mm increase the risk of radial extension of the capsulorhexis. When the Argentinian flag sign occurs, what's next? Dr. Cheung shared the following steps: 1) Limit further exten- sion to the posterior capsule by performing gentle (or no) hy- drodissection; manually remove cortical material. 2) Remove the remaining lens material with I&A if the nucleus is soft or a chop technique if denser. 3) Limit changes in anterior chamber depth by maintaining a well- formed chamber. 4) Maintain capsular support by using a three- piece IOL in the sulcus with optic capture or a single-piece PCIOL in the bag. Naveen Rao, MD, presented on cataract surgery in the nanoph- thalmic eye. His case involved a 75-year-old woman whose first eye had an axial length of 20.24 mm and anterior chamber depth of 2.2 mm. Dr. Rao said he used topical and intracameral lido- caine, but after the injection of lidocaine, the eye became rock YES symposium covers common complications hard and the iris prolapsed. He tried to burp out fluid but it wouldn't come out. He made a uniplanar incision to try to re- move fluid and the iris came out of that incision. Dr. Rao tried to sweep the iris back in but it continued to come out. In retrospect, he said he should have put in an iris hook posterior to the incision. He even- tually made a superior incision and successfully inserted the IOL. The patient ended up with signif- icant iris damage and later had a pupilloplasty to address photo- phobia. Dr. Rao used what he learned with this eye on the patient's second eye. This time the patient was on general anesthesia and mannitol, but the iris prolapsed again. He abandoned that incision right away without touching the iris, created a superior temporal incision, put in the IOL, and later swept the iris back in with the blunt I/A tip. This eye turned out much better, he said. In these cases, Dr. Rao said to consider general anesthesia, preoperative IV mannitol, an iris hook under the main incisions, and suturing of the wounds. Joey Hsia, MD, discussed stent placement. How do you know when it's in the right place? He offered the following implantation tips for correct stent placement, specifically for the Hydrus Micro- stent (Ivantis): 1. Have an en face view of trabec- ular meshwork. 2. Angle the bevel tip parallel with the trabecular meshwork. 3. Avoid a steep approach of engagement. 4. Pay attention to the position of inlet after deployment (some- times the inlet position really tells you if you're in the right plane). Though not a common com- plication, Allison Jarstad, DO, shared two videos where the trailing haptic of a three-piece IOL got tangled with a Malyugin ring. In both cases, the ring was cut to free it from the haptic. "I had never seen this com- plication before, then there were two in a row, and I wanted to make people aware of that," she said. "Be cautious. … I don't know how it got caught up, but it's something that can happen." Editors' note: Dr. Cheung, Dr. Rao, Dr. Hsia, and Dr. Jarstad have no relevant financial interests. Dr. Cheung speaks about the Argentinian flag sign, risk factors, and how to handle it when it occurs. Source: ASCRS

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