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8 | EYEWORLD DAILY NEWS | JULY 25, 2021 ASCRS ANNUAL MEETING DAILY NEWS three-piece IOL if the stability of the bag is questionable. The pa- tient in this case recovered well, he added. Dr. Szigiato's final pearls were to avoid cortical cleanup at the equator with a high vacuum; focal zonular dialysis less than 3 clock hours can be safely addressed with a capsular tension ring (for zonular damage greater than 3 clock hours, he suggested consid- ering capsular tension segments or a Cionni/Malyugin CTR for scleral fixation and placing a three-piece IOL); and ensure good fill of the capsular bag with OVD for smooth CTR insertion. Florence Cabot, MD, shared a case of cataract surgery in a nanophthalmic eye. The patient was a 70-year-old female with nanophthalmos and hyperma- ture brunescent cataracts in both eyes. On the first eye, Dr. Cabot noted an issue where the red reflex was very dark. There was some concern for suprachoroidal hemorrhage, but the case pro- ceeded. With still no red reflex, a light pipe had to be used to guide the IOL into the capsular bag. Posterior exam showed no suprachoroidal hemorrhage or retinal detachment and confirmed the presence of trypan blue in the vitreous. With the second eye, Dr. Cabot said that trypan blue was used to stain the anterior capsule before putting in iris hooks, and this case had a nice red reflex. Also during the session, Luis Silva Alvarez, MD, shared a case of the Yamane technique with NGENUITY (Alcon). The patient had exfoliation syndrome with a dislocated PMMA IOL that had been implanted 30 years ago. Timothy Page, MD, shared a case of a scleral fixated subluxat- ed toric lens, which he was tasked with repositioning, despite hesi- tations. The plan was to fixate on the topographical axis, he said. Dr. Page had to be particularly cognizant of the fact that the lens was very loose and dangling by a couple zonules. Eric Rosenberg, MD, shared a case of a traumatic cataract and iridodialysis. The patient had a traumatic cataract from a paint- ball injury. Dr. Rosenberg shared an approach using CEIOL and the "in-N-out" technique. He used phaco and this novel, adjustable suture flange technique, which uses sutures, a 27-gauge needle, and low-temperature electrocau- tery. The video "Nightmare to Dream Vision" by Arun Gulani, MD, was also shared. Dr. Gulani's patient had vision that was count fingers, and the patient had a host of other problems, including cataract and Fuchs. Dr. Gulani performed INTACS surgery and several months later did cataract surgery, eventually restoring the patient's vision. The winner of the Golden Ap- ple Award, voted by the audience, was Dr. Rosenberg. Editors' note: The speakers have no relevant financial interests. Surgeons share challenging cases in video competition A Saturday afternoon symposium was a vid- eo-based competition that presented challeng- ing cases. The best video of the session won the Golden Apple Award. Kevin Miller, MD, moderat- ed the session, with panelists Quentin Allen, MD, Nicole Fram, MD, Jonathan Rubenstein, MD, Nick Mamalis, MD, Warren Hill, MD, David Chang, MD, Kendall Donaldson, MD, Huck Holz, MD, Mitchell Weikert, MD, and Robert Weinstock, MD. The first presenter of the session, Andrei-Alexandru Szigi- ato, MD, shared a case of a white cataract with weak zonules. The patient was a 75-year-old woman with decreased vision and an intumescent cataract, he said. The case started with using trypan blue and dispersive OVD and proceeded well, with little lique- fied material to aspirate, the lens turned with minimal hydrodissec- tion, and the nucleus was cracked into two pieces and removed. The case proceeded with re- sidual cortex removal with an I/A cannula. There was poor visibility behind the anterior capsule, Dr. Szigiato noted, and the surgeon went fishing for cortex but instead caused zonular dialysis. He stressed the importance of being extremely careful reaching to the equator of the bag during cortical removal and of using a very low vacuum setting. A capsular tension ring was placed with a bit of difficulty. He said that surgeons may want to consider placing a

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