Eyeworld Daily News

EW SHOW DAILY 32 ASCRS Symposia Monday, April 16, 2018 by Lauren Lipuma EyeWorld Contributing Writer flange that's too long can be difficult to push into the scleral tunnel. If the flange is too long, Dr. Yamane recommends enlarging the entry site of the tunnel using the 30-gauge needle. Using the miLOOP and addressing iris defects William Wiley, MD, Cleveland, de- scribed to attendees how he uses the miLOOP device as a rescue in cata- ract cases where the nucleus is diffi- cult to break up. The miLOOP makes challenging cases easy, by making the first crack more manageable and allowing the surgeon to rotate the nucleus and chop it a second time, if needed, Dr. Wiley said. "Even if you're not using it on every case, it's a good tool to have in your bag," he said. Brandon Ayres, MD, Phila- delphia, offered attendees a simple pearl for treating iris defects: cover them up. When patients report experienc- ing glare, it's easy to see the source of the glare is an iris defect if the defect is large enough, Dr. Ayres said. But when the defect is small, it may not be as obvious that the iris is the problem. A simple trick to determine if the iris is causing the glare is to use a black marker to place a mark over the defect, Dr. Ayres said. If the mark reduces the patient's symptoms, the defect is likely the culprit, he said. In those cases, it's simpler and safer to cover the defect with a corneal tattoo rather than performing a peripheral iridotomy. The tattoo procedure takes less than a minute, Dr. Ayres said, and often resolves the patient's symptoms. EW Editors' note: Drs. Ayres, Fram, Gold- berg, Gupta, Rocha, and Wiley have no financial interests related to their comments. fixing an IOL to the sclera when the capsule can't support it. Dr. Yamane's method uses a 30-gauge needle to externalize the haptics of a three-piece IOL and uses heat to fix the haptics inside the sclera. Nicole Fram, MD, Los Angeles, rec- ommends practicing the technique first on a SimulEYE device (InsEYEt, Westlake Village, California) until surgeons feel comfortable perform- ing it on patients. In addition to practicing, Dr. Fram recommends reaching out to mentors to help you prepare. Karolinne Rocha, MD, Charles- ton, South Carolina, reached out to Dr. Yamane himself when she was learning the procedure. Dr. Yamane told her surgeons need to perform the technique four or five times to master it, so practicing is a must, she said. Surgeons can control the length of the haptics by cutting down the longer side, according to Dr. Ya- mane. A flange that's too small can potentially dislocate the IOL, while a skills. She even used it to help teach herself Descemet's membrane endo- thelial keratoplasty (DMEK). "If you're willing to invest the time in yourself, doing new things helps you build that satisfaction for growing, learning, and developing yourself," Dr. Gupta said. But being the very first to adopt a new technology does not neces- sarily make you great as a compa- ny, said Damien Goldberg, MD, Torrance, California, who presented during the session. "You have to have the right people ... and have a leader who is humble but deter- mined," Dr. Goldberg said. "The next thing is to use technology as a tool to implement your culture and implement the changes you want to make. It's not something that defines what you are as a company or as a practice." Mastering the Yamane technique Shin Yamane, MD, Yokohama, Japan, developed a technique for L earning new surgical tech- niques and keeping skills up to date can make you a better surgeon, but they can also improve your practice, according to presenters at Saturday's "Taking Your Practice from Good to Great: Clinical and Practice Insights 10 Years Out" symposium. In this session, presenters discussed why it's important for surgeons to continue learning new skills and gave attendees pearls for adopting two innovative new surgical procedures, the Yamane IOL fixation technique and using the miLOOP device (Iantech, Reno, Nevada) to fragment the nucleus. "It's easy to stay comfortable in what you're used to doing, and it takes a little bit of courage and self confidence to try something new, but you're your best investment," said Preeya Gupta, MD, Durham, North Carolina, who moderated the session. Dr. Gupta said she uses tools as simple as YouTube to learn new Pearls for taking a practice from good to great Dr. Rocha gives pearls for performing the Yamane technique.

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