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EW SHOW DAILY 22 ASCRS Symposia Monday, April 20, 2015 any instrument over the injector can be enough to keep the lens from having enough open space in which to flip the wrong way. EW Editors' note: Dr. Gupta has financial interests with Bio-Tissue (Doral, Fla.) and TearScience (Morrisville, N.C.). Drs. Garg and Kieval have financial interests with Abbott Medical Optics (Abbott Park, Ill.) and Allergan (Irvine, Calif.). Dr. Burger has financial inter- ests with Alcon (Fort Worth, Texas). Dr. Weber has no related financial interests. illustrated the possibility that a lens can "pop out" of the injector. The misinjection severed a haptic of the IOL and required use of a second replacement lens. Sumit (Sam) Garg, MD, said sometimes such plunger-type injec- tors don't allow as much control as screw-type injectors. Berdine M. Burger, MD, has prevented similar problems by having a technician turn the dial on the injector while she inserted a second instrument to prevent the injected lens from flipping upside down and to guide it. Just placing by Rich Daly EyeWorld Contributing Writer Gupta, MD, is cutting off the hap- tics of "sticky" lenses. "It's a very simple maneuver and it really decreases the tension that you are putting on the bag," Dr. Gupta said. "Even if you can't free them up and take them out of the eye, they are of no visual signifi- cance." Such an approach is consis- tent with the need for surgeons to prioritize preserving the bag when explanting lenses, instead of making sure they retrieve the haptics, Dr. Gupta said. Additional steps for pre- serving the bag include applying vis- coelastic right under the rhexis edge, as close to 360 degrees as possible. Creating the space to inject the vis- coelastic and completely coating the IOL provides a layer of protection between the IOL and the bag. Challenges involving IOLs during explantation include the inability of forceps to grab the lens, especially silicone lenses, which can benefit from stabilization with a Sinskey hook. In an IOL exchange case where a single-piece acrylic lens required exchange due to positive dysphotop- sia, Charles Weber, MD, discussed his basic approach of freeing the lens and dialing it up into the ante- rior chamber. He used microinstru- mentation to hemisect the lens with little force due to the thinner design of acrylic lenses. Dr. Weber slightly enlarges his typical 2.4 mm phaco wound to as much as 3 mm. The video of the insertion of a replacement 3-piece silicone lens A n experienced ophthal- mic surgeon may have seen unusual IOL compli- cations numerous times, but young surgeons are hungry to gain such insights. The desire to disseminate knowledge of surgical pearls in cataract, IOL, and refractive surgical procedures drove the annual clin- ical symposium sponsored by the ASCRS Young Eye Surgeons Clinical Committee. The session covered a range of issues—from basic concepts to unusual complications—through review of a series of challenging surgical video cases. Preferred IOL replacement techniques were among the unusu- al IOL situations that members of the clinical committee addressed. Jeremy Kieval, MD, usually folds the lens in the anterior chamber. Dr. Kieval has evolved from an earlier lens removal technique that came across 180 degrees with a cyclodial- ysis spatula and used a lens folder to fold over the cyclodialysis spatula. His new approach uses a McPherson forceps and pronated wrist with counter traction and cyclodialysis in the side port; he then puts traction on top of the lens and supinates his wrist, which automatically folds the lens and allows removal through the incision. "I find this is much faster and easier than putting scissors in where there is a very thin bag," Dr. Kieval said. Another way to protect the bag during lens removal, said Preeya K. Young surgeons' IOL replacement challenges addressed Dr. Kieval describes a technique that automatically folds IOLs for easy extraction through an incision during replacement procedures. Congratulations to one of today's ASCRS Clinical Survey raffle winners, Dr. Saman.

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