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EW SHOW DAILY 38 ASCRS Symposia Sunday, April 15, 2018 by Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer tient, Dr. Crandall sutured the lens to the iris. If he had operated on the patient later, he said he would have used the Yamane technique. Dr. Schallhorn commented that iris fixation actually makes sense in this case to avoid violating the vitreous, and Dr. Garg noted how it would be handled differently if the patient had been younger, in which case concerns such as the risk of CME would be foremost in mind. Instead of presenting a case, Dr. Zavodni switched gears and pre- sented a few femtosecond cataract surgery pearls. For going under the laser, he recommended choosing a cooper- ative patient with wide palpebral fissures. The surgeon should be care- ful with head and eye positioning to prevent lens tilt. He noted that for docking the Ks definitely matter, with steeper Ks creating a greater chance of creating corneal folds on docking. When it comes to the capsu- lotomy, Dr. Zavodni said surgeons should be prepared for non-free floating caps. They don't occur very often but they do occur, he said; the most important thing is to recognize that a cap is not free floating before continuing with the rest of the procedure. He also said surgeons should be prepared for miosis. Femtosecond laser energy tends to cause prosta- glandin release in the eye, stimulat- ing pupillary contraction. EW Editors' note: The physicians have no financial interests related to their comments. are easy to place in an open capsule. She described what to do to bring the iris back through the wound—by first depressurizing the eye, the iris can easily be swept back into the wound. Second, iris hooks allow sub-in- cisional insertion; she recommended inserting posterior to the wound so that it remains well clear of the phaco tip. Third, iris hooks create such small punctures that they can be removed after viscoelastic removal and the iris will not prolapse during irrigation/aspiration. In the second case, Dr. Al- Mohtaseb described the manage- ment of posterior polar cataract. The issue with posterior polar cataracts is the risk of posterior capsule defects. Thus, she said, if there's any concern of a cataract being posterior polar, it should be treated as one. Dr. Al-Mohtaseb makes the rhexis a little bit smaller to give her the option to perform capture of the lens in the sulcus in case of a posterior capsule rupture. She recommended avoiding hydrodis- section, instead hydrodelineating to minimize fluid volume and said never to leave the eye without put- ting something in; inject viscoelastic prior to removing instruments. She added that counseling for lens choice is particularly important when a patient with a posterior po- lar cataract wants a premium IOL. In the third presentation, Dr. Crandall showed a case from several years ago of a 70-year-old patient who was hit with an arrow in the eye at 17 or 18 years old. For this pa- York, David Crandall, MD, Detroit, Samuel Lee, MD, Sacramento, California, Claudia Perez-Straziota, MD, Beverly Hills, California, Leela Raju, MD, New York, Naveen Rao, MD, Burlington, Massachusetts, Julie Schallhorn, MD, San Francis- co, Charles Weber, MD, Salt Lake City, and Zachary Zavodni, MD, Salt Lake City. The symposium was moderated by Sumit "Sam" Garg, MD, Irvine, California. Most of the audience was in practice (45%) with most of the remaining in their third year of res- idency (32%); 91% practiced in the United States. Dr. Schallhorn presented the first case, listing the reasons she loves iris hooks for dealing with a floppy iris. First, iris hooks are her go-to for post-rhexis insertion because they A video-based Young Eye Surgeon (YES) sympo- sium Saturday afternoon featured a mix of routine and complex clinical and surgical case vignettes pertaining to cataract, IOL, iris, and refractive surgery. The symposium focused on highlighting concepts and funda- mentals for young surgeons at the beginning of their training, often leading to discussions of more complex management approaches. Panelists took turns to discuss how they handled each case, including their personal surgical approaches, providing tips and pearls particularly relevant to the young surgeons in the audience. Panelists included Zaina Al- Mohtaseb, MD, Houston, Berdine Burger, MD, Charleston, South Carolina, Jessica Ciralsky, MD, New YES videos mix it up with routine and complex cataract cases Dr. Al-Mohtaseb describes the management of posterior polar cataract.

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