Eyeworld Daily News

10 | EYEWORLD DAILY NEWS | MAY 7, 2023 ASCRS ANNUAL MEETING DAILY NEWS With lasso techniques and fixating the IOL/bag complex to the scleral wall, issues can occur due to zonulopathy. Using the anterior vit- rectomy approach, there is minimal to no prolapse of the vitreous into the anterior chamber, and you're working right under the IOL/bag complex, she said. She also noted secondary IOL implantation techniques where she stays largely anterior: iris-su- tured IOL, anterior chamber IOL, and intrascleral haptic fixation of an IOL. She also noted that a pars plana vitrectomy may be particularly challenging in young patients with a strongly adherent vitreous where the posterior hyaloid may not be able to be easily lifted from the vitreous base. There are some cases where Dr. Venkateswaran will advocate for a full pars plana vitrectomy: complete posterior dislocation of the intraocu- lar lens; high axial length, pathologic myopia; presence of retinal pathol- ogy; and in those with a history of prior retinal detachment or retinal tears in the operative eye or fellow eye. In conclusion, Dr. Venkateswaran said that each case is unique. Secondary IOL implantation is chal- lenging as each case is different and requires different plans, she said. Customize what you will do based on the patient's history, anatomy, and vision goals, she said. Editors' note: Dr. Venkateswaran has financial interests with a variety of ophthalmic companies. Dr. Weng has financial interests with a variety of ophthalmic companies. presence of a retina specialist allows for immediate intervention should the IOL dislocate posteriorly. Her last point was that Dr. Shin Yamane used the pars plana vitrecto- my approach when using his Yamane technique for flanged intrascleral intraocular lens fixation with double needle. Further research compar- ing outcomes between pars plana vitrectomy and anterior vitrectomy only for scleral-fixated IOL surgery is warranted, she added. In the second half of the debate, Nandini Venkateswaran, MD, took the opinion "Anterior Vitrectomy is Sufficient in Secondary IOL Surgery." She first noted that it's important to balance the right case with the right approach. No surgery is with- out risk, she said, and undergoing secondary IOL implantation surgery has risks, as does undergoing a pars plana vitrectomy. She noted instances from the literature with risks during pars plana vitrectomy, including instances of iatrogenic peripheral retinal breaks, postoperative retinal detachment, and intraoperative reti- nal detachment. She then discussed the cases in which she advocated for an ante- rior vitrectomy. These include IOL exchange in the setting of an open posterior capsule; a lasso technique (fixating the IOL/bag complex to the scleral wall); secondary IOL implantation techniques like iris fixation, anterior chamber IOL, and sometimes scleral-fixated IOLs; and patients in whom a pars plana vitrec- tomy can be challenging. When doing an IOL exchange in the setting of an open posterior capsule, Dr. Venkateswaran said to consider a pars plana assisted ante- rior vitrectomy to access the vitreous posteriorly. I n a retina symposium on Satur- day morning, surgeons debated whether to use complete pars pla- na vitrectomy or anterior vitrecto- my in secondary IOL surgery. Christina Weng, MD, advocated for complete pars plana vitrecto- my. She started out by noting that scleral-sutured and scleral-fixated IOL techniques are often utilized in the absence of sufficient capsular support. Whether scleral-fixated IOLs should be performed in conjunction with a pars plana vitrectomy versus anterior vitrectomy only remains unclear, and the data is limited and mixed, Dr. Weng said. Her first point in favor of using pars plana vitrectomy was that it minimizes potential vitreoretinal traction. Regardless of which scler- al fixation technique is used, there is significant manipulation near the vitreous base where the vitre- oretinal adhesion is strongest, Dr. Weng said. Pars plana vitrectomy removes vitreous in those areas, preventing inadvertent dragging of vitreous, she said, but in an anterior vitrectomy-only approach, there is no way to examine the retina, and iatrogenic tears may be missed, she said. "There's no way of visualizing what may be happening in this del- icate area [with anterior vitrectomy only]," she said. Dr. Weng also said that pars pla- na vitrectomy may optimize postop outcomes. Vitreous hemorrhage is not infrequent after scleral-fixated IOL surgery, she said, and access to the vitreous cavity via pars plana vitrectomy permits clearing of any heme/debris before closure. She not- ed a study that showed, in a series of scleral-fixated IOL surgery, complete pars plana vitrectomy was associated with less IOP elevation postoper- atively. Additionally, she said that Retina topics debated on Saturday

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