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20 | EYEWORLD DAILY NEWS | APRIL 7, 2024 ASCRS ANNUAL MEETING DAILY NEWS S ymposia topics covered during Saturday afternoon sessions included cataract surgery and all the subspecialties as well as glaucoma pearls." Cataract surgery in patients with oculoplastic disease N. Grace Lee, MD, presented on cataract surgery in patients with oculoplastic disease. She noted several oculoplastic considerations: eyelid malposition, eyelid lesions, lacrimal drainage, and thyroid eye disease. Ptosis is one common issue when thinking about eyelid malpositions. Dr. Lee said that, if mild, she would recommend eyelid surgery after cat- aract surgery. There's anywhere from 0–20% chance of developing ptosis after cataract surgery, she said. Dr. Lee said after confirming no cicatricial etiology of entropion, she would recommend correction of entropion first. She recommended correcting ectropion prior to cata- ract surgery to optimize the ocular surface. You may need to consider waiting 2–3 months after eyelid surgery before stretching the eyelids with a speculum, she said. When considering eyelid lesions, Dr. Lee said benign-appearing eyelid lesions can wait until after cataract surgery. But lesions located in the margin may warrant excision prior to cataract surgery because they can cause ocular surface or tear film irregularities. Any suspicious lesion must undergo incisional biopsy first, she said, adding that it's important to keep an eye out for potential life-threatening entities. Considering thyroid eye disease (TED), Dr. Lee said that she would strongly urge smoking cessation and urgent management of TED with systemic medications or surgical de- compression. When the orbital exam is improved and stable, she said you can consider cataract surgery. In summary, Dr. Lee said that upper eyelid malpositions can usu- ally wait until after cataract surgery. Laxity of the lower eyelids should be addressed before cataract surgery, however, there is likely no increased risk of endophthalmitis. Malignant or suspicious lesions should undergo biopsy and treatment before cataract surgery, she said. It's important to repair lacrimal drainage problems before cataract surgery, she said. If TED is active, it should be treat- ed first, she stressed. Dr. Lee also said to consider counseling TED patients about refractive surprise after cataract surgery. In general, she suggested allowing 2–3 months of healing from oculoplastic/eyelid surgery before scheduling cataract surgery. Editors' note: Dr. Lee has no relevant financial interests. Glaucoma pearls Panelists in an afternoon glaucoma session shared pearls on a number of topics. Here are a few MIGS pearls: • Sarah Van Tassel, MD: Use MIGS as an opportunity to reset. She said to work hard to reduce or elimi- nate drops. It's also a great time to deploy SLT or sustained release, if the patient is not at his or her goal. If needling to add back drops, op- timize simplicity, tolerability, cost, and efficacy. • Kuldev Singh, MD: Choose proce- dures based on safety and efficacy, not reimbursement. • Douglas Rhee, MD: Not all MIGS devices are the same. Evidence shows that the Hydrus (Alcon) has better IOP control and, in the lab, better enhancement outflow. • Lorraine Provencher, MD: Dr. Provencher specifically discussed how to avoid hyphemas. Intraop- eratively, she said to use reverse Trendelenburg, leave the final IOP in the mid 20s, and if you get heme coming from the nasal work, leave a strip of dispersive OVD in the nasal angle. In the first 24 hours, Dr. Provencher is strict with patients, and she said cataract plus MIGS is not the same as cataract. She asks patients to sleep with the head of the bed elevated 30–45 de- grees. She has strict postop lifting precautions and institutes shield use for no rubbing. Editors' note: The panelists have finan- cial interests with various ophthalmic companies. Symposia cover glaucoma pearls and cataract surgery in patients with various issues Dr. Lee discusses cataract surgery in patients with oculoplastic disease. Source: ASCRS

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