Eyeworld Daily News

MAY 7, 2023 | EYEWORLD DAILY NEWS | 7 ASCRS ANNUAL MEETING DAILY NEWS months after cataract surgery after having been told by two specialists that the Crystalens (Bausch + Lomb) is pushing against the iris below, causing UGH. She was recommended for lens exchange and endothelial keratoplasty. Dr. Safran noticed a gap be- tween the lens and iris when doing gonioscopy. When looking closely, he noticed foreign material in the angle that he suspected was a remnant of a Dexycu (EyePoint Pharmaceuticals) implant. The original surgeon re- moved the implant, and the patient's eye quieted down, but the patient re- turned to Dr. Safran again 4 months later complaining of decreased vision and glare. The iris was retracted, and Dr. Safran noticed a band of adhesions on gonioscopy. The patient was looking through the hinge of her Crystalens implant rather than the optic. He pulled the iris out of the in- ferior angle in surgery and then tried to correct the iris and get the pupil into the correct shape. He added that he's seen a few cases since where patients have had iris atrophy and cornea involvement associated with Dexycu implants. Editors' note: The speakers have finan- cial interests with various ophthalmic companies. T his year's winner of the Golden Apple Award was Ashvin Agarwal, MD. He presented a case of traumatic iridodialysis with aphakia. His case involved a 65-year-old woman who had a case of ocular injury. To begin, Dr. Agarwal first cre- ated a conjunctival peritomy. Then he created scleral flaps. He did a sclerotomy behind the limbus under the scleral flaps. He then began an anterior vitrectomy and identified the iris defect. The iris defect was opened to make sure it was in the right direction. Dr. Agarwal used glued IOL implantation. He used the handshake technique to externalize both haptics, and a Scharioth pocket was created, and the haptics tucked. Anterior vitrectomy was continued. He renoticed the iris defect at this time and used a single pass four throw pupilloplasty to ensure its sta- bility. Then he placed a trocar in the anterior chamber to do iridodialysis repair. In iridodialysis, the needle can sometimes get caught in the corneal lamina, he said. This helps elevate the issue of corneal lamellar tissue being involved in the suture while doing this iridodialysis repair. An- choring both sides of the iris defect was also critical to stabilize the root of the iris, Dr. Agarwal said. He did a single pass four throw pupilloplasty for the pupil repair that helped to close the pupil size down to the right size. He used a fibrin glue to close up all the flaps that had been created during the procedure at the end of the case. Ahmed Assaf, MD, PhD, asked "How could this happen?" in his case, which started with him using phaco for a white cataract. He stained with trypan blue and punctured the ante- rior capsule with a 27-gauge needle to aspirate the emulsified cortex. This was followed by rhexis formation and quick chop technique. Every- thing was going fine in the case until Dr. Assaf noticed that the posterior capsule was gripped by the phaco tip. He had a torn posterior capsule, with significant part of nucleus having fallen into the anterior vitreous. He kept the phaco tip inside the eye and injected dispersive OVD to prevent collapse of the anterior chamber. Dr. Assaf then used two instru- ments to try to retrieve the nucleus from getting into the posterior vitre- ous, but he was unsuccessful. He also noticed that he had an intact pos- terior capsule between the nucleus and the instruments he was using. He had to sacrifice the posterior capsule and open it. He noticed that there was zonular weakness and tried to convert to a posterior rhexis but failed due to massive zonular weakness. He then brought the fallen part of nucleus into anterior chamber above the iris plane and used injec- tion of a 3-piece IOL into anterior chamber to act as a scaffold. He continued phaco after lower- ing the bottle height and reduction of fluidics and ultrasound settings. He used pars plana anterior vitrectomy for cortical remnants and cleared the anterior chamber to make it ready for placement of the IOL into the sulcus. The haptics of the IOL were placed into the sulcus, followed by optic capture into the rhexis. Dr. Assaf encountered another issue because the IOL was consider- ably tilted. He was unable to get it into place. His preferred technique of intrascleral haptic fixation would be challenging, so he sutured the haptics of the IOL to the iris. Steven Safran, MD, shared a case he called "pupillonasty," in which a 70-year-old woman was referred 2 Golden Apple Award presented for best complicated cataract video case Dr. Agarwal (center) won the Golden Apple Award and posed with panelists at the cataract complications video session.

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