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EW SHOW DAILY 6 by Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer The perfect save: Challenging cases managed by international experts F or "The Perfect Save," a challenging cases sympo- sium, the International Intraocular Implant Club (IIIC) put together an "ex- traordinary cast of who I consider some of the best ophthalmologists in the world as well as some of my best friends," said moderator Eric Donnenfeld, MD, Rockville Centre, New York Founded in 1966 by Sir Harold Ridley, the inventor of the IOL, the IIIC is an invitational society whose membership consists of the best of the best cataract surgeons from all around the world. "We've invited them to be with us today to discuss complications and management of the most difficult cases," Dr. Don- nenfeld said. Thomas Kohnen, MD, Frank- furt, Germany, joined Dr. Donnen- feld as moderator, and the panel consisted of Stephen Slade, MD, Houston, Richard Lindstrom, MD, Minneapolis, Matteo Piovella, MD, Monza, Italy, Warren Hill, MD, Mesa, Arizona, Roberto Zaldivar, MD, Mendoza, Argentina, and Jack Holladay, MD, Houston. They were later joined by Graham Barrett, MD, Perth, Australia, Edward Holland, MD, Cincinnati, and Douglas Koch, MD, Houston. Dr. Koch's "perfect save" was a case he called "Toric torture." The patient was an ophthalmologist who had cataract surgery 2-and-a-half years prior to consulting Dr. Koch. On presentation, the patient had a dislocated 2.0 D toric lens that had been implanted with a capsular ten- sion ring (CTR). Initially, Dr. Koch thought it would be a routine case, and he tackled it like any dislocated lens in an eye that already had a CTR—he would bring the lens back into posi- tion, passing the suture around the CTR, then sew it to the sclera. He didn't even use Gore-Tex, opting for a more standard 9-0 prolene suture with a 26-gauge needle; he thought Gore-Tex was unnecessary as he did not expect erosion in that setting, and polypropylene sutures were easi- er to maintain on the scleral surface. Dr. Koch therefore proceeded with his routine IOL repositioning technique, rotating the IOL and get- ting it quite close to where the IOL needed to be. He went on to secure the other side. However, upon tightening the suture, the IOL once again snapped out of position. Apparently, the patient had a dead bag—a capsular bag with no integrity at all—and the CTR simply ripped through it, probably through the needle puncture. Nevertheless, Dr. Koch man- aged to save the case, performing a scleral suture loop IOL reposition- ing, although he wasn't quite happy having to make four more holes in the eye. John Hovanesian, MD, Laguna Hills, California, who Dr. Donnen- feld said had just been invited into the IIIC, presented an equally illumi- nating case on the "Management of a Challenge after a KAMRA Inlay." A patient who had previously been implanted with the KAMRA inlay (AcuFocus, Irvine, California) presented with blurring of vision, the right eye more than the left. On examination, her inlays were well centered with no haze, though she had small posterior subcapsular © 2015 Novartis 6/15 VIS15002JAD DUOVISC ® OVD IMPORTANT PRODUCT INFORMATION DESCRIPTION: DUOVISC ® Viscoelastic System is designed to give two Viscoelastic materials with different physico-chemical properties that can be used differently and/or sequentially to perform specific tasks during a cataract procedure. DUOVISC ® Viscoelastic System consists of VISCOAT ® Ophthalmic Viscosurgical Device and PROVISC ® Ophthalmic Viscosurgical Device. CAUTION: Federal (USA) law restricts this device to sale by, or on the order of, a physician. DESCRIPTION: VISCOAT ® (Sodium Chondroitin Sulfate – Sodium Hyaluronate) Ophthalmic Viscosurgical Device INDICATIONS: VISCOAT ® OVD is indicated for use as an ophthalmic surgical aid in anterior segment procedures including cataract extraction and intraocular lens (IOL) implantation. VISCOAT ® OVD maintains a deep anterior chamber during anterior segment surgeries, enhances visualization during the surgical procedure, and protects the corneal endothelium and other ocular tissues. The viscoelasticity of the solution maintains the normal position of the vitreous face and prevents formation of a flat chamber during surgery. WARNINGS: Failure to follow assembly instructions or use of an alternate cannula may result in cannula detachment and potential patient injury. PRECAUTIONS: Precautions are limited to those normally associated with the surgical procedure being performed. Although sodium hyaluronate and sodium chondroitin sulfate are highly purified biological polymers, the physician should be aware of the potential allergic risks inherent in the use of any biological material. ADVERSE REACTIONS: VISCOAT ® OVD has been extremely well tolerated in human and animal studies. A transient rise in intraocular pressure in the early postoperative period may be expected due to the presence of sodium hyaluronate, which has been shown to effect such a rise. It is therefore recommended that VISCOAT ® OVD be removed from the anterior chamber by thorough irrigation and/or aspiration at the end of surgery to minimize postoperative IOP increases. Do not overfill anterior chamber. ATTENTION: Please refer to the directions for use for a complete listing of indications, warnings and precautions. DESCRIPTION: PROVISC ® (Sodium Hyaluronate) Ophthalmic Viscosurgical Device INDICATIONS: PROVISC ® OVD is indicated for use as an ophthalmic surgical aid in the anterior segment during cataract extraction and intraocular lens (IOL) implantation. Ophthalmic viscoelastics serve to maintain a deep anterior chamber during anterior segment surgery allowing reduced trauma to the corneal endothelium and surrounding ocular tissues. They help push back the vitreous face and prevent formation of a flat chamber during surgery. PRECAUTIONS: Postoperative increases in intraocular pressure have been reported with sodium hyaluronate products. The IOP should be carefully monitored and appropriate therapy instituted if significant increases should occur. It is recommended that PROVISC ® OVD be removed by irrigation and/or aspiration at the close of surgery. Do not overfill anterior chamber. Although sodium hyaluronate is a highly purified biological polymer, the physician should be aware of the potential allergic risks inherent in the use of any biological material; care should be used in patients with hypersensitivity to any components in this material. Cannula assembly instructions should be followed to prevent patient injury. ADVERSE REACTIONS: Postoperative inflammatory reactions such as hypopyon and iritis have been reported with the use of ophthalmic viscoelastics, as well as incidents of corneal edema, corneal decompensation, and a transient rise in intraocular pressure. It is therefore recommended that PROVISC ® OVD be removed from the anterior chamber by thorough irrigation and/or aspiration at the end of surgery to minimize postoperative IOP increases. Do not overfill anterior chamber. ATTENTION: Please refer to the directions for use for a complete listing of indications, warnings and precautions. Advancing CATARACT SURGERY DuoVisc ® VISCOELASTIC SYSTEM Dr. Koch describes a case he handled of toric IOL dislocation where he had to reposition multiple times. continued on page 10 Are you a fan of EyeWorld? Like us on Facebook at: Facebook.com/EyeWorldMagazine

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