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17 EW SHOW DAILY 2018 ASCRS•ASOA Annual Meeting, Washington, D.C. by Erin L. Boyle EyeWorld Contributing Writer you won't destroy the retina, and you'll be able to think more clearly." Dr. Yeu presented two cases, including a 78-year-old patient with poor vision in his right eye following blunt eye trauma 20 years ago. The patient had a 4++ brunes- cent, nearly mahogany lens that was dislocated, with 6 clock hours of zonular loss and no view of the retina. She outlined pearls for the best management of loose lenses, including managing vitreous pro- lapse around areas of zonulysis and planning for alternative options and IOLs "if one cannot be safely placed in the capsular bag due to compro- mise." Techniques in this case can be IOL exchange, scleral, or iris fixa- tion; other options include using an anterior chamber IOL or leaving the patient aphakic, staging for a future secondary IOL. "Vitreous lost, vitreous found" was how Dr. Donnenfeld described the phaco case he presented, in which he said showed the impor- tance of the use of triamcinolone, one of his pearls in the course. "I think we grossly underuti- lize triamcinolone in our operating room," he said. "I've had the most complex eyes where I've been in the eye for long periods of time with lots of manipulation, and the next day, these eyes are almost always crystal clear because the corticosteroid has such a positive effect on the corneal epithelium." EW Editors' note: Dr. Amar Agarwal, Dr. Donnenfeld, Dr. Fram, and Dr. Yeu have financial interests with various ophthalmic companies. Dr. Ashvin Agarwal and Dr. Jacob have no related financial interests. B e prepared for the unex- pected in potentially wild phacoemulsification cases, instructors said at the "My Wildest Day in the OR: Techniques to Prevent it from Hap- pening Again" course. "We always show these crazy cases and these crazy techniques, but you have to make sure you do what's in your comfort zone," said Nicole Fram, MD. Dr. Fram, along with course instructor Soosan Jacob, FRCS, and co-instructors Elizabeth Yeu, MD, Eric Donnenfeld, MD, Amar Agar- wal, FRCS, and Ashvin Agarwal, MD, showed videos of their wildest cataract cases in the OR and shared pearls on handling the unexpected. Dr. Ashvin Agarwal described how he performs vitrectomy-assisted phacoemulsification in posterior capsule rupture cases and how pos- itive pressure has occurred unex- pectedly in some cases. Dr. Fram said those examples, in combination with the others presented, demon- strated how important it is to pre- pare for anything to happen in the operating room prior to surgery. "[This] highlights the fact that you have to have your plans A, B, and C and hopefully never get to Z before you get into the OR, and that way nothing can throw you off," she said. "So if you always know where everything is, the nurses know where everything is, just in case any- thing happens, you're ready to go. I think the anxiety happens when you're not emotionally prepared to sit there for 2 hours and clean up your mess. "There's nothing wrong with cleaning it up and coming back an- other day," she continued. "I think that's a take-home point because if you do that, you won't destroy the iris, you won't destroy the cornea, How to handle your wildest phaco cases Dr. Yeu presents two "wild" phaco cases, including one of a blunt eye trauma case from 20 years ago.

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