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APRIL 7, 2024 | EYEWORLD DAILY NEWS | 25 ASCRS ANNUAL MEETING DAILY NEWS vitreous in the anterior chamber. She preplaced wounds and placed Kenalog in AC to highlight vitreous. She performed vitrectomy behind the posterior capsule remnants. She marked the limbus and placed MX60E IOL into the AC, taking spe- cial care to make sure haptics rested on the peripheral iris. She adjusted the tension to make sure the IOL was well centered and there was no slack in the suture. When the IOL was stabilized, she placed her vitrector behind the IOL, removed all the residual posteri- or capsule so the visual axis was clear, and flanged the ends to push them into the sclera and cover with epi-scleral tissues. Next, she looked at the iris to see if there was extra iris tissue for repair. She did an iri- doplasty using 10-0 Prolene sutures. The patient was seeing well on day 1 postop and the IOL optic was in good position, but the pupil was still irreg- ular. After putting a gonio lens on, the superior haptic was caught in the iris. She explained this to the patient scheduled for a revision. Editors' note: Dr. Trindade has no relevant financial interests. Dr. Safran has financial interests with Haag-St- reit and Johnson & Johnson Vision. Dr. Amin has financial interests with Alcon. T he Golden Apple Award was given for the best teaching case during the "Complicated and Challenging Cases in Cat- aract Surgery Video Symposium." Bruno Trindade, MD, PhD, won the award for his case, "Everything, Everywhere, All at Once." Dr. Trin- dade's case was a 57-year-old patient with a combination of problems. She had combined RK and AK in the past and had irregular cornea and high corneal astigmatism. She was com- plaining of decreased vision in both eyes and had a large mesopic pupil. Dr. Trindade used multiple strat- egies to solve the patient's problems. He used a high cylinder toric IOL to correct the regular component of the corneal astigmatism. He removed the central guttae. This must be per- formed carefully to not disturb the stromal fibers. Following, he implant- ed an intraocular pinhole. After surgery, he could see corne- al edema in an otherwise quiet eye, so he started the patient on ripasudil. Several weeks later, the patient had vision that she never had before and was seeing 20/30 J2 uncorrected. Small aperture implants can improve vision in irregular astigmatism, Dr. Trindade said, adding that toric IOLs may be beneficial in certain cases. A combination of procedures is possible and are usually necessary to help these complex patients. Steven Safran, MD, shared a patient referred to him in 2018 for sterile melt after FLACS arcuate incision. He stabilized with plugs/ serum tears/lubrication/doxycycline/ steroids/valacyclovir, and the prob- lem resolved. But Dr. Safran said the patient came back 4 years later very unhappy with his vision. He was hyperopic with against- the-rule astigmatism being caused by this incision. He also has a severely pitted IOL after YAG. This has caused severe glare. The lens haptics were in the capsular bag, but the anterior/ posterior capsule fused. It was very difficult to see the edge of the rhexis, except over haptics, Dr. Safran said. The patient was also bothered by worsening of floaters. Ideally, you would place a higher power toric lens in this case, Dr. Safran said, but it was hard to imag- ine how that would be possible after extensive YAG treatment. He decided to place three 23-gauge pars plana trocars. The goal was to take out the pitted lens. He used a LASIK cannula to try to reopen the capsular bag, but the anterior and posterior capsule were fused, so it was hard to separate. He switched to a 30-gauge needle, bevel down. He used disper- sive viscoelastic, then cohesive and started separating the anterior and posterior capsule from each other. He managed to get the lens out. He injected viscoelastic between the anterior and posterior capsule to create some space and injected single piece acrylic toric lens into the capsular bag remnant. The lens was centered and well supported. He went through the pars plana to remove the Soemmerring's ring material from behind the lens using a vitrector with the cutter on first and then off to aspirate the material. He cleaned up the vitreous floaters and any cortical or lens material that fell posterior during the lens exchange. Abha Amin, MD, shared a case of a double flanged fixation of an MX60E IOL. The patient was an 85-year-old woman referred for secondary IOL placement in the right eye. The right eye was aphakic post-complicated cataract extraction. Dr. Amin placed a vitrectomy port because she knew there was Complicated and challenging cataract videos Dr. Trindade (third from left) won the Golden Apple Award for best teaching case. He poses with panelists of the session. Source: ASCRS

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