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APRIL 7, 2024 | EYEWORLD DAILY NEWS | 17 ASCRS ANNUAL MEETING DAILY NEWS YAG vitreolysis is effective for 70–95% of floater types, Dr. Chu said. He mentioned studies that have shown success, as well as safety. Editors' note: Dr. Chu has no financial interests related to his presentation. You are better able to visualize the posterior vitreous, there is higher power (while maintaining safety and control), and more shots. This Ultra Q Reflex technology has coaxial illumination, which allows for visual- ization beyond the posterior capsule. It also has the ability for "on and off" axis visualization, which is helpful for those and anterior floaters. It has shorter and more efficient laser ener- gy, which allows for a non-linear rise in energy with minimal disruption of surrounding tissue. The Ultra Q Reflex YAG laser has a 3-nanosecond pulse, Dr. Chu said. There is also not enough time for heat to be accumulated, so increasing the number of shots will not increase accumulation energy. The unique re- flex illumination mirror briefly moves out of the laser pathway during firing and ensures that the laser beam is never obstructed, he presented. The slit lamp illumination tower can therefore be used coaxially, in addi- tion to the typical off-axis position. Dr. Chu also offered pearls for this technology. There is a "safe zone," he said, adding to only laser the floater if you see it. If the retina is in focus when the floater is in fo- cus, don't do it, he emphasized. Use off-axis to help guide the posterior lens. If you can't see the floater while off-axis, you are well into the middle of the vitreous. Some floaters cannot be treated, Dr. Chu added. Dr. Chu said that the two main types of treatable floaters are floaters resulting from PVD and floaters re- sulting from vitreous degeneration. The following types of floaters are contraindicated for vitreolysis: • Asteroid hyalosis • Floaters peripheral to the central visual axis to the point they are not treatable • Floaters that are too big and could not be eliminated with reasonable power (a reasonable number of shots or less than five treatment sessions) • Floaters that are located less than 3 mm from the lens or retina or in the posterior third of the vitreous in front of the macula continued from page 14 D uring the YES program- ming on Saturday, one symposium focused on working through compli- cations, with presenters sharing videos and discussing how they handled complicated cases and panelists commenting. Eric Weinlander, MD, shared a case of a traumatic cataract and iris repair. The case was a 67-year-old man who was a fish- erman and took a sinker in the eye. The patient had traumatic mydriasis and traumatic cataract. Dr. Weinlander said there was zonular dialysis, and he used trypan to make sure there was no vitreous prolapse. He filled the eye with viscoelastic and tampon- aded the area of zonular loss. He was trying to be as atraumatic as possible and taking his time to get a circular rhexis centered on the lens. He used capsular hooks in area of zonular loss. "With phaco, I'm trying hard to minimize rotation and excessive separation," he said, adding that he used crack and cross chop. Phaco went well, and before coming out of the eye with the phaco tip, he filled with viscoelastic to ensure there wasn't vitreous prolapse through the zonular dialysis. With the 3–4 hours of zonular dialysis from trauma, Dr. Weinlander used a capsular ten- sion ring in the bag and cleaned up the cortex. He carefully re- moved his capsule hooks. Go through the main wound, he said, adding that he used a capsular tension ring, taking care to go slow and not grabbing any redundant capsule. He used a single-piece IOL in the bag. When Dr. Weinlander got to the iris cerclage, he joked it was the "fun, difficult part." But he felt comfortable and began splitting into quadrants and going paracentesis to paracente- sis. The first pass went well, as did the second. He was able to dock and come out of the main wound. With one last section, to get better ergonomics, he backed the needle out of the paracentesis and finished the cerclage. But Dr. Weinlander realized that the Prolene was unattached, so he had cut it somewhere. He had to go back in and find the cut end of the Prolene. But it hap- pened again! He had three out of four quadrants done and had no needles left to finish the cer- clage. Dr. Weinlander ended up externalizing the cut end of the Prolene through the paracentesis to finish it off. Editors' note: Dr. Weinlander has no relevant financial interests. Working through complications

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