Eyeworld Daily News

EW SHOW DAILY 24 ASCRS Symposia by Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer While demonstrating the partic- ular utility of the femtosecond laser in complicated cataract cases, Dr. Taravella cautioned that femtosec- ond laser capsulorhexes are funda- mentally different from those cre- ated manually—the rim created by laser is such that too much pressure exerted by a capsule retractor can create a split in the residual capsule. Meanwhile, the video "Phacoemulsification of an Ozurdex Implant in the Crystalline Lens" demonstrated the management of a rare complication that may become more frequent in the near future as more patients receive Ozurdex (Al- lergan, Dublin, Ireland) implants. In addition to the peculiarities of the case itself, the symposium panelists remarked on the perfect capsulorhexis performed by the vid- eo's producer, Kristin DiDomenico, MD, Bala Cynwyd, Pennsylvania. Her precise execution of a textbook technique is perfect material for educating young ophthalmology residents. At the same symposium, Toshi- hiko Ohta, MD, Izunokuni, Japan, demonstrated a new technique he developed for managing posterior capsule rupture. The technique is a sequential combination of pars pla- na anterior vitrectomy, a posterior assisted levitation (PAL) technique using viscoelastic injection, the IOL scaffold technique, and IOL optic capture. Dr. Ohta compared the tech- nique—which utilizes viscoelastic injection PAL technique to push the lens material anteriorly, allowing insertion of an IOL into the bag, further containing the lens materi- al in the anterior chamber—to the eruption of a volcano, the technique is appropriately called the Mt. Fuji Technique. EW Editors' note: The physicians have no financial interests related to their comments. Restaining with trypan blue confirmed his suspicion—the anteri- or capsule remained unscathed. The anterior capsule was so tough, Dr. Hart had to employ a bi- manual technique to provide coun- tertension with micrograbbers before he was able to puncture it with the sharpest tool in his toolbox—a diamond blade. Again, he completed the rhexis with microscissors. He was then able to proceed routinely, beginning with hydrodis- section. The remaining lens material was soft and easily aspirated. Histopathology revealed that the material he had initially thought was the anterior capsule was actually a layer of fibrovascular connective tissue, which stained minimally but also prevented proper staining of the true anterior capsule. Creating the first rhexis left a rim of minimally stained fibrovascular tissue simulat- ing the anterior rhexis rim, with the true anterior capsule remaining the same white as the lens material it contained. Extensive fibrous metaplasia— known to occur in eyes with silicone oil in the vitreous cavity—had oc- curred on the surface of the capsule, which also thickened and dramat- ically toughened the lens capsule to the consistency of shoe leather. While Dr. Hart was unable to collect the fluid that simulated escaped lens material after his initial rhexis, he posited that it was either dissolved fibrous tissue or inflammatory fluid that had accumulated between the fibrous tissue and the anterior capsule. Dr. Hart garnered the most audience votes despite going up against truly formidable competi- tion, including "Complex Cataract with Femtosecond Laser Assist." In this video, Michael Taravella, MD, Aurora, Colorado, used a femto- second laser to create a rhexis in a traumatically dislocated lens. De- spite significant tilt and the support of just a few zonules, the laser was able to create a near-perfect rhexis; a manual capsulorhexis in this case would have been extremely difficult. dure. However, from the beginning, he noted clues that the case would be anything but routine. Staining the capsule with trypan blue, he noted minimal staining. Nevertheless, he proceeded to at- tempt bent needle capsulotomy, not- ing significant movement indicating weak zonular support. He managed to puncture the tough material on the surface of the lens, releasing white fluid, and pro- ceeded to create a rhexis. The tissue was so tough he had to perform the rhexis with microscissors. All his attempts to chop and debulk the cataract were ineffective, even using phacoemulsification at full power. He wondered, was the anterior capsule still intact? J ohn Hart, MD, Farmington Hills, Michigan, was award- ed the coveted "Golden Ap- ple" teaching award for his video "Impenetrable?" Dr. Hart presented the video at Monday morning's symposium on "Com- plicated and Challenging Cases in Cataract Surgery Video Symposium," the highlight of the ASCRS Cata- ract Clinical Committee's scientific program. In the video, Dr. Hart manag- es the case of a 24-year-old type 1 diabetic patient. The patient had previously undergone pars plana vitrectomy with silicone oil twice for vitreous traction. Dr. Hart said he initiated the op- eration as if it were a routine proce- Tuesday, April 17, 2018 Dr. Hart awarded Golden Apple for 'Impenetrable?' Moderator Richard Hoffman, MD, (right), presents Dr. Hart the Golden Apple. Dr. Hart won the coveted teaching award for his educational video titled "Impenetrable?" on the management of a cataract complicated by extensive fibrous metaplasia.

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