Eyeworld Daily News

EW SHOW DAILY 40 Sunday, May 8, 2016 by Vanessa Caceres EyeWorld Contributing Writer P earls for better capsulor- hexis creation, irrigation/ aspiration, dense cataract management, and more were part of Saturday's "Phaco Fundamentals" course, which was geared toward clinicians newer to cataract surgery. One foundational area of cat- aract surgery is capsulorhexis, said presenter Ken Rosenthal, MD, Great Neck, New York. "If your rhexis goes bad, you're in for a rough ride," he said. When he trains residents, 1 of the last things he has them do is cre- ate the capsulorhexis. He has them start practicing this skill in the lab. Some pearls that Dr. Rosenthal shared for better capsulorhexis include: • The size should be 5 to 5.5 mm. • Avoid involvement of the zonules. • Use an ophthalmic viscosurgical device (OVD) to help provide a better grip. Dr. Rosenthal also reviewed steps for cortical cleaving hydro- dissection and said that surgeons should elevate the tip of the cannu- la, inject under the capsule, inject aiming superiorly, and put a gentle downward pressure on the nucleus. A good understanding of fluidics is another key component of phaco, said Gary Foster, MD, Fort Collins, Colorado, presenting for Uday Devgan, MD, Los Angeles. "The amount of fluid coming in the eye needs to be the same as that com- ing out," Dr. Foster said. This can be challenging because ophthalmic surgeons are working in such a tight space. One fluidic-related problem that can occur is surge. "If your out- flow is greater than your inflow, you get surge, and that can rupture the capsule," Dr. Foster said. An understanding of fluidics is linked to an understanding of 2 different kinds of pumps used in phacoemulsification, peristaltic versus venturi. Dr. Foster also shared a few pearls related to power modula- tion, noting that surgeons should use power only when necessary, and they should match their stroke length to the nuclear resistance. Otherwise, it's wasted power. He recommended only delivering power when nuclear material is at the tip. Another area of cataract surgery that may seem simple is irrigation and aspiration, said Nick Mamalis, MD, Salt Lake City. However, that's not always the case. "Often, when we finish phaco, we breathe a sigh of relief," he said. "Yet half the time, I find residents tear the capsule during irrigation and aspiration." Dr. Mamalis shared the follow- ing pearls for better irrigation and aspiration: • During cortex removal, make some space. Go adjacent to the subincision, take out a little, and that creates some space. • Make the subincision first. • Work around the eye. Although bimanual cortex removal may not be as common nowadays, it still is a useful ap- proach to practice and be able to use if necessary, Dr. Mamalis said. Another fundamental part of phacoemulsification is knowing how to approach a dense cataract, which creates its own challenges, said Abhay Vasavada, MD, Ahmed- abad, India. Nucleus division and the removal of divided segments are 2 crucial steps with dense cataract removal. Dr. Vasavada recommend- ed sculpting as deep as you can, going slow, and considering the use of techniques such as the multilevel chop if necessary. EW Editors' note: The physicians have no financial interests related to their comments. Meeting Reporter Seasoned surgeons share pearls for better phaco procedures Shuttle Routes 2016 Official Hotel Shuttle Routes *BOLD denotes official shuttle pickup location. Also may serve as pickup location for other hotels listed, as indicated. Routes Hotels Pickup Location 1-RED WESTIN CANAL PLACE CANAL STREET ENTRANCE NEW ORLEANS MARRIOTT CURBSIDE LOBBY Hotel Monteleone At Marriott, Canal Street W French Quarter At Marriott, Canal Street RENAISSANCE ARTS 701 RESTAURANT (old Lucy's) Travel Time to Convention Center: 15 minutes 2-YELLOW OMNI ROYAL CRESCENT CORNER OF CAMP & GRAVIER SHERATON NEW ORLEANS CURBSIDE CANAL STREET Courtyard Marriott Downtown At Sheraton, Canal Street JW Marriott At Sheraton, Canal Street LE MERIDEN MOTHER'S RESTAURANT Doubletree At Mother's Restaurant Windsor Court Hotel At Mother's Restaurant Loews Hotel At Mother's Restaurant Travel Time to Convention Center: 20 minutes 3-BLUE INTERCONTINENTAL HOTEL ON POYDRAS AT ST. CHARLES ROOSEVELT WALDORF ASTORIA BARONNE STREET ENTRANCE Renaissance Pere Marquette At Roosevelt, Baronne Street Entrance HYATT REGENCY GROUP LOBBY ENTRANCE Travel Time to Convention Center: 20 minutes 4-GREEN ASTOR CROWNE PLAZA CURBSIDE CANAL STREET Royal Sonesta At Crowne Plaza, Canal Street RITZ CARLTON CURBSIDE CANAL STREET Courtyard Marriott Iberville At Ritz Carlton, Canal Street Hyatt French Quarter At Ritz Carlton, Canal Street Travel Time to Convention Center: 25 minutes 5-ORANGE OMNI ROYAL ORLEANS CURBSIDE LOBBY, ST. LOUIS STREET FOUR POINTS SHERATON F.Q. CORNER OF BOURBON and TOULOUSE Travel Time to Convention Center: 25 minutes W-Walk Hotels Hilton Riverfront Omni Riverfront Embassy Suites Courtyard Marriott Conv Center Marriott Convention Center Springhill Suites Downtown Residence Inn Convention Center Hyatt Place Convention Center Hilton Garden Inn Convention Center Hampton Inn Convention Center Dr. Foster addresses attendees at the "Phaco Fundamentals" course.

• Cover