Eyeworld Daily News

Challenging cases for the young surgeon explored Monday, April 28, 2014 ASCRS Symposia by Ellen Stodola EyeWorld Staff Writer T he ASCRS Young Physicians and Residents Clinical Committee sponsored a symposium that looked at challenging video cases for the young surgeon. The session featured a number of difficult surgical cases, and physicians on the committee offered pearls and tips for handling the cases. The session was moderated by Elizabeth Yeu, MD, Norfolk, Va. Others involved in the session were John P. Berdahl, MD, Sioux Falls, S.D., Clara C. Chan, MD, Toronto, Edwin S. Chen, MD, San Diego, Sumit (Sam) Garg, MD, Irvine, Calif., Preeya K. Gupta, MD, Durham, N.C., Jeremy Z. Kieval, MD, Lexington, Mass., Bryan S. Lee, MD, Seattle, Ken Y. Lin, MD, Irvine Calif., and Charles H. Weber, MD, Salt Lake City. Dr. Yeu first addressed survey results from residents about surgical experience, indicating that residents feel there are gaps in education in certain areas and techniques. She said there is a need to increase the understanding and exposure of young physicians to advanced refractive cataract and laser vision correction technology. "We have to address the fact that with laser vision correction surgery, about half of residents had no formal curriculum in their train- ing. Our job now is to provide vari- ous programs and symposia to fill in these gaps," she said. Topic covered complicated cataract cases including small pupils, capsular tension rings and segments, dislocated lens, various IOLs, IOL exchange and white cataracts. The surgeons discussed using iris hooks versus Malyugin Rings (MicroSurgical Technology, Redmond, Wash.). Dr. Chan said she tends to use iris hooks, and physicians can use viscoelastic to dissect any iris scarring off the lens, which she said comes off fairly eas- ily. In terms of making the entry point, she uses a 25-gauge needle on a syringe, which makes a round entry point and helps the iris hooks to slide in easier. Dr. Chan usually uses four or five iris hooks. For iris retraction, all panelists said they prefer the Malyugin Ring; however, Dr. Chan pointed out that it depends on the case. For example, for a shallow anterior chamber, iris hooks may be better because there may be less room to maneuver the Malyugin Ring. It may be better to use the iris hook for an extremely floppy iris because the Malyugin Ring may not be enough to hold it, and it could flip back onto the Malyugin Ring; this could be a big problem. The surgeons gave their opin- ions on 3-piece IOL insertion. "I'm a big fan of 3-piece IOLs," Dr. Garg said. "I think they're very versatile." All of his residents use 3-piece IOLs at least several times so they're familiar with the injection. Not understanding the orientation of the leading haptic is the most common mistake at the beginning and often discourages people from using 3-piece IOLs, Dr. Gupta said. EW Dr. Yeu moderated the "Challenging Video Cases for the Young Surgeon" symposium.

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