Eyeworld Daily News

10 | EYEWORLD DAILY NEWS | APRIL 24, 2022 ASCRS ANNUAL MEETING DAILY NEWS went in with 25-gauge retina forceps to attempt to peel the dense plaque off the posterior capsule. "I elected to try this move, as I wasn't sure if the dense posterior plaque tissue would further proliferate after the surgery," he said in his video presentation. The patient had been referred in from far away, and Dr. Christenbury wanted to do as much as possible at the time of the case. The plaque peeled off nicely from the poste- rior capsule. He noted he was concerned after the ruptured globe injury that he had some epithelial ingrowth or down growth through the wound that caused this very large posterior plaque on the surface of the lens that was not the result of a capsule rupture. Dr. Chris- tenbury implanted a 3-piece IOL, which was nicely centered at the end. Bruno Trindade, MD, PhD, shared a case of a patient who ultimately had to have 13 surgeries and seven IOLs before he was able to see well. When Dr. Trindade first saw his 70-year-old patient, he had a long history of ocular surgeries, but the patient was complaining of progressive decreased vision in the right eye. He had a transillumination defect caused by a decentered, sharp-edged sulcus IOL. Dr. Trindade also noted primary IOL calcification in the patient. The patient was taken to surgery where Dr. Trindade decided to ex- change both of his lenses. The first lens in the sulcus came out easily, but the primary lens in the bag was more dif- ficult. After finally removing that lens, the capsular bag was compromised, so Dr. Trindade took the bag out as well, did anterior vitrectomy, and put in a hydrophobic 3-piece IOL and fixated it to the sclera using the Yamane tech- nique. One month after surgery, the patient was happy, he said, noting that the explanted IOL had central calcifi- cation on the anterior surface. This is a well-known complication of hydrophil- ic lenses. Dr. Trindade then turned his attention to the patient's left eye, but because of the difficulties in the right eye, he had high hopes of limiting sur- gery to the decentered sulcus IOL. But 7 months later, the patient came back complaining of decreased vision in the left eye, and the primary lens was showing an opacification that wasn't present 7 months prior. The patient was taken to the OR yet again, and Dr. Trindade had an issue with the primary lens because of compromised zonules, which prevented dissection of the lens from the bag. He removed the whole thing as one and did a fixation to the sclera. He said it's important to beware of sulcus IOL implantation, as it may eventually lead to problems in the long term, especially in zonulopathy patients. He added that hydrophilic acrylic IOLs may calcify over time, especially after sequential surgeries. Timothy Page, MD, presented a case of capsular bag reconstruction with a Tyrolean traverse. He was placing a lens in the capsular bag on a patient who had a history of retinal detachment. The referring surgeon en- countered zonular dialysis in a previous case, and the capsular bag was fibrotic 2 months out. He used dispersive OVD to reshape the capsular bag. Dr. Page went on to discuss how he used an Ahmed capsular tension segment and described other techniques he used to get through the case. Also during the session Haripri- ya Aravind, MD, shared a case of a severely subluxated cataract using a Cionni ring. She noted that there were areas where the zonules were notice- ably absent or weak. She utilized hooks to stabilize the bag, and she also used hydrodissection and phaco with a slow motion technique. She said that since the zonules are weak, the bag tends to collapse, so it's important to use gentle aspiration of the cortex. She showed how she later utilized the Cionni ring and created a Hoffman pocket. Eric Rosenberg, DO, shared his case of a "snow globe cataract," a type of cataract that panelists later said they had never seen before. It seemed to have pieces swirling around in the eye. Dr. Rosenberg first noted that the patient had been referred to him for this unknown type of cataract and had high IOP and a painful red eye. The patient also had a history of diabetes, and he said this could have been one of the contributing factors to this type of cataract. Editors' note: The speakers have finan- cial interests with a variety of ophthal- mic companies. continued from page 8 Dr. Miller, with panelists Kendall Donaldson, MD, Sumitra Khandelwal, MD, Nick Mamalis, MD, Huck Holz, MD, and Richard Tipperman, MD, at the complicated cases video symposium.

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