EyeWorld Asia-Pacific September 2012 Issue

32 EWAP CAtArACt/IOL September 2012 DATE MEETiNg VENUE January 17-20 Joint Meeting of the 28th Congress of APAO and 71th Annual Conference of AIOS www.aios.org Hyderabad, India March 30-31 2nd Biennial Scientific Meeting of INASCRS www.inascrs.org Jakarta, Indonesia April 19-23 ASCRS-ASOA Symposium & Congress (ASCRS-ASOA) www.ascrs.org San Francisco, USA June 27-29 28th Annual Meeting of the Japanese Society of Cataract & Refractive Surgery (JSCRS) www.congre.co.jp Tokyo, Japan July 6-8 2013 India Intraocular Implant & Refractive Society Annual Meeting (IIRSI) www.iirsi.com Chennai, India July 11-14 26th APACRS Annual Meeting – A Global Focus on the Anterior Segment www.apacrs.org Singapore October 5-9 XXXI Congress of the ESCRS www.escrs.org Amsterdam, Netherlands October 28-31 Asia ARVO 2013 www.arvo.org New Delhi, India November 16-19 Annual Meeting of American Academy of Ophthalmology (AAO) www.aao.org Chicago,USA CALENDAR OF MEETINGS 2013 Lacking circumferential zonular tension, a lax posterior capsule tends to cling to epinucleus and cortex that is being aspirated, and redundant capsular folds can be easily ensnared by the aspirating instrument or snagged by a capsule polisher. While removing cortex, inadvertently aspirating the more pliant anterior capsule may cause a zonular dialysis. Effective hydrodissection is crucial because the more easily lens material separates from a floppy capsule, the less likely it is for the capsular folds to be aspirated. As mentioned above, continually reinflating the capsular bag with a dispersive OVD is an excellent strategy for removing cortex from a floppy bag as well. Placing both the anterior and posterior capsule on stretch prevents a pliant posterior capsule from trampolining toward the aspiration port. In this situation, cortical aspiration can be performed either with or without irrigation (dry technique). Dispersive agents are preferable to cohesive viscoelastics because they better resist aspiration (Figure 4). Finally, stripping the cortex tangentially rather than radially helps to distribute the tractional force across as large an area of zonules as possible. Bimanual I/A instrumentation provides several advantages in the presence of weak zonules. The ability to alternate between two aspirating ports improves access to the sub-incisional cortex, which can be particularly challenging to remove if the capsulorhexis diameter is small and the posterior capsule is lax (Figure 5). A dual incision system also means that the aspirating port never needs to turn toward the capsular fornix. It can be kept facing the cornea and away from the posterior capsule virtually at all times. Without a constraining infusion sleeve, the surgeon is better able to reach across to the opposite equatorial quadrants where the aspirating port can be safely buried within fluffs of cortex before vacuum builds (Figure 4). This further lessens the risk of aspirating the pliant peripheral or posterior capsule. Finally, in the presence of a zonular dialysis, the ability to dissociate the irrigating and aspirating tips can help to prevent misdirection of irrigating fluid through the zonular defect (Figure 5). If capsule retractors are used, placing a capsular tension ring can usually be delayed until the cortex has been removed. One must be careful not to snag or tear posterior capsular folds with the leading tip of a CTR during its insertion. Fully expanding the capsular bag with OVD prior to injecting the ring is critical for this reason. Brian Little, FRCS, described the fish tail method of reducing zonular stress when inserting a ring without an injector. 1 Using an injector has the advantage of introducing the CTR into the capsular bag without excessively stretching the capsulorhexis. One can either load the ring manually with a reusable metal injector or use a pre-loaded, disposable plastic injector from Morcher (Stuttgart, Germany) or FCI Ophthalmics (Marshfield Hills, Mass., USA). The injector tip should be positioned as far peripherally within the bag as possible in order to minimize lateral displacement of the capsular bag as the ring emerges. If used, capsular retractors should be left in place to counter the lateral decentering forces of the CTR as it is injected. In fact, an additional advantage of capsular retractors is to reduce the potential for zonular damage caused during insertion of a CTR. The retractors can then be removed prior to IOL implantation. EWAP Editors’ note: Dr. Chang is clinical professor, University of California, San Francisco, and in private practice, Los Altos, Calif., USA He has no financial interests related to this article. Contact information Chang: dceye@earthlink.net Phaco - from page 31