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8 | EYEWORLD DAILY NEWS | APRIL 24, 2022 ASCRS ANNUAL MEETING DAILY NEWS consider an extended course of postop topical steroids/NSAIDs. Combined surgery for ERM/cata- ract gives patients their best potential visual outcome, Dr. Weng concluded. It is safe, and doing both surgeries together is no harder than doing them separately, she said. Editors' note: Dr. Do has financial inter- ests with Allergan, Alimera, Apellis, and Bausch + Lomb. Dr. Weng has financial interests with Alimera, Allergan, DORC, Genentech, Novartis, Regeneron, and REGENXBIO. Dr. Weng said that the introduction of 27-gauge instrumentation and cut rates up to 20,000 cpm in the past few years have helped with this. The risk of retinal tear or detachment is less than 2%, and the risk of endophthalmitis is between 0.03–0.11%. There is no evi- dence that combined surgery increases the risk of postop CME, she added. Another argument against com- bined surgery is that doing both surgeries at the same time make each surgery more difficult, but Dr. Weng shared her final reason for combining procedures. Reason 3: With simple modi- fications, it's easy to optimize the outcomes of both surgeries. Dr. Weng said you should have a preop discussion of wound place- ment with the other surgeon and limit retrobulbar block to 3 cc and apply globe pressure immediately afterward. She suggested considering placing an infusion line first to avoid prolapse of the iris later on. She mentioned suturing the main corneal wound and sclerotomies. She also said to go easy on wound hydration, check the IOL placement before closing up, and continued from page 6 suspicious the opacity in the nasal posterior lens was a violation of the posterior capsule. He used this tech- nique instead of hydrodissection, and the nucleus came out easily without a lot of phaco energy. He went in with I/A to try to aspirate posterior plaque. The posteri- or capsule was intact, and plaque was strongly adherent to it, so he started using viscoelastic to go behind the plaque. Intraocular scissors were then used to detach the plaque, and he capsule. The whole bag seemed to be falling apart, Dr. Safran said. It ex- tended through the bag, and the lens decentered and started to sink into the vitreous. He had to then take out the lens because it couldn't be placed in the capsular bag. To clean up, Dr. Safran used the Yamane procedure to finish and save his case with a different IOL. But the case was successfully completed, and the patient was 20/40 uncorrected and happy at 1 week postop. Dr. Safran was able to do the right eye of the patient 1 month later, and he was able to place a Symfony in that eye. Joseph Christenbury, MD, present- ed on posterior capsule membrane peel after cataract surgery. The patient in his case had a white cataract, and the capsule was stained with trypan blue. He used a 27-gauge needle to perform decompression of the intumescent white cataract. The patient had a rup- tured globe repair 3 months prior and was referred to Dr. Christenbury. When he started the capsulorhexis, the rhexis ran out beneath the incision, so he went in to make another nick in the anterior capsule and completed the rhexis from the other side. The rhexis was successful, and Dr. Christenbury used viscodissection because he was T he Complicated and Challeng- ing Cases in Cataract Surgery Video Symposium was moderat- ed by Kevin M. Miller, MD. Pre- senters shared a variety of video cases, with audience members voting for the best case at the end of the session. It was Steven Safran, MD, who took home the top prize. He shared his "disaster" case of a 14-year-old boy who had come from a long distance with bilateral ectopia lentis. The left eye was longer than the right eye, and he planned to use a Symfony toric (Johnson & Johnson Vision) to correct astigmatism to give good depth of focus. He made the initial capsulorhex- is and used iris retractors to provide counter traction. Dr. Safran was able to mark the eye for the correct toric axis and injected the lens into the capsular bag and rotated it into position. At this point, he noticed that the rhexis had too much overlap, so he planned to just tear it a bit. He made a small nick to start the tear, but it was going away from him, so he made a nick on the other side to connect for a complete tear. He was able to complete the tear, but as he was watching, the tear kept going and began to extend around the CTR and into the posterior Audience vote for best teaching case in complicated cases video session Dr. Safran, with Dr. Miller, receives the Golden Apple Award for his case presentation. continued on page 10

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