Eyeworld Daily News

EW SHOW DAILY 6 Wednesday, May 10, 2017 with the epithelium, once the eye becomes dry or opaque, edema may appear. That is when he will dehy- drate and then rehydrate to reach the appropriate amount of clearness. "That's so foreign to me, but that's the beauty of these courses we give. We teach each other subtle things," Dr. Osher said. Another situation Dr. Osher shared is a patient who woke up during surgery. This raises issues regarding the role of anesthesia during surgery. "It's our responsibil- ity to keep the patient awake. It's a fine line," Dr. Osher said. Surgeons want patients to feel comfortable without getting sleepy. This often involves giving more guidance to the person doing anesthesia. "When [the person doing anesthesia] walks in the room, we have an obligation to say, 'I want my patients complete- ly awake so I can talk to them,'" Dr. Osher said. Ultimately, the patient had a normal surgery and staved off any damage of her ocular structures. "You'd be hard pressed to know we had a real problem," he said. Also participating in the panel were Graham Barrett, FRANZCO, Perth, West Australia, Richard Pack- ard, MD, Windsor, United Kingdom, Fernando Trinidade, MD, PhD, Brazil, and Abhay Vasavada, MD, Ahmedabad, India. EW Editors' note: Dr. Malyugin has finan- cial interests with Alcon (Fort Worth, Texas), Bausch + Lomb (Bridgewater, New Jersey), Carl Zeiss Meditec (Jena, Germany), and other companies. Dr. Osher has financial interests with Al- con, Clarity Medical Systems (Pleasan- ton, California), Omeros (Seattle), and Carl Zeiss Meditec. by Vanessa Caceres EyeWorld Contributing Writer A closer look at befuddling cases Descemet's right off," he said. For this reason, Dr. Osher advised other surgeons to not even think about injecting in the tunnel. "If we don't pay attention to how carefully we manage Descem- et's, this can still happen," he said. Another case presented by Dr. Osher had several factors to make surgery difficult. The patient had nanophthalmos, Fuchs' dystrophy, acute glaucoma, and used tamsu- losin. He also happened to be an attorney. So, it may not have been much of a surprise that a little corneal edema developed, especially because the patient previously had an angle closure glaucoma attack. Dr. Malyugin shared his ap- proach to treating a nanophthalmic eye with corneal edema. Starting spotted. Boris Malyugin, MD, PhD, Moscow, Russia, said he checks the paracentesis in case a chip or cortex material has moved there. Although this was not a case formally presented at the session, Dr. Osher said he once treated a female patient who had lost a contact lens 8 years before. When Dr. Osher put in a lid speculum 8 years later, the contact lens was found superiorly. In another case example given by Dr. Osher, a patient inexplicably had postop corneal edema. When Dr. Osher further examined the curvilinear line between 12 and 5 o'clock, a Descemet's detachment was seen. "When I injected the ophthalmic viscosurgical device, and this was in the early 1980s, I let it go in the incisional tunnel. I cleaved T here are some cases you perform as a surgeon that seem straightforward—and then something happens that makes it go wrong, requiring some detective work after- ward. Those are just the kinds of cases discussed at a symposium titled "Fascinating Cases: A Detective's Perspective." Robert Osher, MD, Cincinnati, shared perplexing cases he has treated and asked a panel of seasoned surgeons what they thought went wrong. One case Dr. Osher shared had localized corneal edema at 3 months postoperatively despite a beautiful surgery. Panelists speculated that a chip of edema may have been present at some point but just not Dr. Osher shares fascinating ophthalmic cases he has encountered. Visit NIDEK Booth #447 Visit NIDEK Booth #447 AL-SCAN OPTICAL BIOMETER AL-SCAN OPTICAL BIOMETER

• Cover