Eyeworld Daily News

EW SHOW DAILY 12 Tuesday, April 29, 2014 ASCRS Symposia Soosan Jacob, MD, Chennai, India, started with the case of a patient with a small pupil and pseu- doexfoliation glaucoma complicated by nervous, unintentional head nodding that worsened as the patient got more nervous. She began the case with stab in- cision glaucoma surgery, proceeding to cataract surgery by creating a rhexis larger than the pupil. As ex- pected given the patient's condition, the pupil began to constrict, and she responded by inserting iris hooks. Removal of the nuclear pieces and the cortex, she said, was child's play. However, as she inserted the IOL, the haptic snagged on the cap- sule, and the patient's head started nodding even more: The patient had 90 degrees of zonular dialysis. The patient's head, said Dr. Jacob, started nodding at 7.9 on the Richter scale. "My heart was thumping 9.9 on the Richter scale." She managed to insert the IOL and opted to stabilize the capsule with a capsular tension ring (CTR). She initially inserted the CTR the wrong way—at the point of dialysis, moving away—she reoriented the CTR, directing it toward the point of dialysis, and managed to insert it under the rhexis edge. However, though now stable, the rhexis remained decentered. It was at this point that Dr. Jacob decided to use a technique she had recently been contemplating: She inserted a capsular hook through a sclerotomy, passing it under the iris and using it to pull the capsule into position. She then created a scleral tunnel into which she tucked the capsular hook haptic, sealing it off with fibrin glue. She completed the stab incision glaucoma surgery and glued the flap down. At 1 month after surgery, the pa- tient had best corrected visual acuity of 20/20 with no phacodonesis. Amar Agarwal, MD, Chennai, India, later took the stage in place of Athiya Agarwal, MD, Chennai, India, who was unwell at the time of the symposium. The patient had a traumatic injury, in this case resulting in a sub- luxated cataract with iridodialysis. Dr. Agarwal said he began the case by opening the conjunctiva with a proper flap instead of making Hoffman pockets. He then proceeded to suture the iris to Breathtaking view Haag-Streit's LED powered Slit Lamps BQ 900 ® , BP 900 ® and BM 900 ® deliver the sharpest, brightest and most homogeneous slit ever. Durable and economical The LED powered slit lamp lasts for a lifetime and will save up to 60% energy. Imaging Easily adjustable background illumination for optimal results. www.haag-streit.com The BQ 900 ® stands for excellent optics, versatility and ease of use. The standard for those requiring advanced slit lamp microscopy. The BQ 900 ® stands for excellent optics, versatility and ease of use. The standard for those requiring advanced slit lamp microscopy. Slit Lamp BQ 900 ® Sophisticated microscopy – fascinating versatility See us at ASCRS '14 Booth #333 A series of unfortunate events wins 'Best Teaching Case' by Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer "Complicated and Challenging Cases in Cataract Surgery Video Symposium," moderated by Rosa Braga-Mele, MD, Toronto. T he ASCRS Cataract Clinical Committee received 50 video submissions of which 8 were presented at the

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