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APRIL 24, 2022 | EYEWORLD DAILY NEWS | 15 ASCRS ANNUAL MEETING DAILY NEWS IOL in the bag and removed the sili- cone oil. Six months after surgery, this patient's IOL is still well centered in the bag. There is some nasal fibrosis. Humberto Salazar III, MD, PGY-3, shared a case involving an IOL scaf- fold. It started with a 60-year-old man with a dense combined cataract in his left eye. The case was going well, with successful removal of the first two quadrants. "Once I started to rotate the sec- ond half, there was posterior chamber rent I hadn't noticed," Dr. Salazar said, adding that this rent propagated, and the entire posterior capsule blew out. He stayed calm, injected viscoelas- tic, brought the phaco tip out, and used viscoelastic to push the lens pieces in front of the iris. From there, he sutured his wound and through a paracentesis used a vitrector to try to break up the lens pieces. This was unsuccessful, so he pushed the pieces into the angle and performed a vitrectomy. Then he opened the main wound, placed more viscoelastic, and inserted a single-piece IOL within the sulcus, creating an IOL scaffold. With this barrier between the vit- reous cavity and anterior chamber, Dr. Salazar said he was able to phaco out the remaining pieces. Overall, the eye had a good outcome with this tech- nique, he said. Editors' note: The speakers have no financial interests related to their comments. During the panel discussion Michael Greenwood, MD, said that the key with the rhexis in these cases is to make it big enough but not too big. He said this is a great case if you have access to femto as well. Margaret Wang, MD, PGY-4, shared "Running with Scissors," a case of a white cataract with capsular fibrosis that ended up with an anterior capsule rent. The patient was 40 years old and developed a white cataract 2 years after vitrectomy with a full silicone oil fill. Dr. Wang began the case with trypan blue and placed iris hooks. She made the wound, took out the Healon (sodium hyaluronate, Johnson & Johnson Vision), and restained. Pre- operatively, she said, the decision was made not to decompress, "and those were famous last words." She started her rhexis with a cystotome, and an an- terior rent occurred. The goal became preventing it from extending poste- riorly. She used intraocular scissors to begin the flap within the rent. She said the rhexis was a little truncated because of the stickiness of the anterior capsule. For phaco, she used a divide and conquer technique and was careful not to propagate the anterior rent. The cataract was easy to crack and no hydrodissection was needed. Once the first quadrant was removed, she said she felt more comfortable, and her hook was under the quadrants the entire time. After cortex removal, Dr. Wang said the posterior capsule was intact, so she went forward inserting a single-piece T he Young Eye Surgeons (YES) Clinical Committee sympo- sium Good to Great: Working Through Complications Video Symposium took attendees through topics like zonular loss/weakness, cataract under corneal scarring, use of an IOL scaffold in the setting of PCR, posterior polar cataract, small incision cataract surgery, and other complicated cases. YES Clinical Committee Chair Zaina Al-Mohtaseb, MD, said that this has always been her favorite sym- posium. This year it was set up with members of the Clinical Committee presenting cases as well as residents. Soroosh Behshad, MD, a YES Clini- cal Committee member, shared a video about how to handle zonular loss. His case involved a patient with Marfan syndrome. The lens looked stable on exam, and phacodonesis wasn't as ob- vious as it was in the OR, he said. Dr. Behshad said he knew he would need to suture the capsular bag to the sclera, and he was trying to preserve the capsular bag, which he said is an ideal situation in patients with Marfan syndrome. One pearl is to use a lot of viscoelastic with these patients, Dr. Behshad said. He added a capsular tension hook and began gentle hydrodissection to prevent trauma, and phacoed with a chopping technique to avoid further stress on the bag. He made sure to keep a second instrument under the phaco tip to prevent the bag from coming up, continuously injecting more viscoelastic. Dr. Behshad went forward with careful cortical removal, placed a CTR to further stabilize, and at this point, he noticed something strange with the iris. He discovered a piece of nucleus underneath. After removing that, he was able to secure the capsular bag with an Ahmed segment. One pearl here, Dr. Behshad said, is to make sure you leave the suture ends long to confirm that you can bury the knot. He then placed a single-piece IOL because the bag was stable. Good to Great Surgeon symposium The decision was made preop to not decompress in the case of a white cataract, "and those were famous last words." —Margaret Wang, MD