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EW SHOW DAILY 34 ASCRS Symposia Sunday, May 7, 2017 like www.astigmatismfix.com can provide degrees of rotation to prop- erly reposition the lens, based on information about the lens type and its current axis. "It will minimize the residual astigmatism. … If you're happy with the residual astigmatism and you're happy with the spherical equivalent, then you can rotate that lens," he said. "I like to have less than 0.75 remaining if I'm going to consider rotating it." When it comes to rotating the lens, mark its current axis and how- ever many degrees away it should be rotated. Later, Dr. Garg discussed a case of phaco burn that occurred with- in seconds of starting surgery on a 55-year-old patient with a dense cataract and hand-motion only vision. This can happen, he said, in dense lens cases where you don't get enough flow around your sleeve or if viscoelastic clogs your probe. "If you hear the occlusion bell and you're just starting … or see a plume, that is a bad sign, you stop. Those are two big signs that it's over- heating in the eye," Dr. Yeu said. Dr. Garg said in the case of burns, there is no longer structural integrity left in the collagen of the tissue. As such, he recommends using long, mattress sutures to close the wound, but the wound might still leak. In that case, one could advance the conjunctiva or close it with glue, the latter of which was what he did. The patient did pretty well in the end, but Dr. Garg noted that he kept the glue on for several weeks, and left the sutures even longer after that. Dr. Al-Mohtaseb pointed out the importance of recognizing when to step in to close a wound with glue, rather than continuing to loop sutures that aren't working. The session also covered cases of multifocal IOLs, posterior capsule tear, and others. EW Editors' note: Drs. Lee, Al-Mohtaseb, Yeu, Ciralsky, Berdahl, and Garg have no financial interests related to their comments. by Liz Hillman EyeWorld Staff Writer to have a stable anterior capsule. "If you get that, then you have a place for this lens," he said. Dr. Al-Mohtaseb also noted that the key is to never let the chamber collapse, and offered the pearl of waiting longer for cataract surgery in these cases, allowing for fibrosis. "You can get a more stable and easier surgery if you allow that cap- sule to fibrose," Dr. Yeu encouraged. Going forward with the surgery, Dr. Ciralsky said she removed the cortex from everywhere except the penetrated area, then put OVD on that area. Dr. Ciralsky said a tear was present, leading her to perform a vitrectomy. She placed a three-piece lens in the sulcus with optic capture. Changing gears, John Berdahl, MD, Sioux Falls, South Dakota, discussed the issue of residual astig- matism with a toric lens. "Residual astigmatism is a really common problem after cataract surgery," Dr. Berdahl said. In these cases, options include laser vision correction or rotating the lens. For the latter, resources and used bimanual I/A. The tech- nique, he said, is similar to how he handles posterior polar cataracts. When placing a capsular tension ring (CTR), Dr. Lee noted the impor- tance of using enough viscoelastic. Zaina Al-Mohtaseb, MD, Houston, chimed in with the pearl of making sure you viscodissect before placing the CTR. When it comes to the I/A in a case of zonulopathy, Elizabeth Yeu, MD, Norfolk, Virginia, modera- tor of the session, said it's important to pull tangentially, putting low stress on the zonules, compared to pulling toward the center. Dr. Yeu noted that a three-piece lens with sulcus placement could be safer in these cases as well. In the end, Dr. Lee said the patient was 20/20 postop week 2. Jessica Ciralsky, MD, New York, presented the case of a 63-year-old with wet AMD who was referred to her by a retina specialist after inad- vertent needle penetration during an anti-VEGF injection. Sumit "Sam" Garg, MD, Irvine, California, said in a case like this, it's important Presentations focus on how to get yourself out of sticky surgical situations A symposium sponsored by the ASCRS Young Eye Sur- geons Clinical Committee on Saturday presented challenging video cases involving cataract surgery, IOLs, and other complex situations to show those in training and early in prac- tice how to rescue these cases for the best chance of an overall positive outcome. Bryan Lee, MD, Los Altos, California, presented the first case of a 71-year-old with rapid cataract progression after vitrectomy and macular hole repair. There was con- cern over a wrinkle in the anterior chamber, an anterior capsule plaque, and the posterior capsule had limit- ed view. Dr. Lee said he started the capsulorhexis away from the plaque, performed hydrodelineation only due to zonulopathy, viscodissected, Challenging video cases for young eye surgeons Dr. Al-Mohtaseb offers several pearls and presents a case of posterior capsule tear during a Young Eye Surgeon's symposium.

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