EyeWorld Asia-Pacific September 2013 Issue

14 September 2013 EWAP FEAturE Preplanning - from page 13 Bordewick said. Dr. Pettey also uses trypan blue as needed. He’ll then approach with a soft-shell viscoelastic technique and take extra care to assess for zonular stability. Copious viscoelastic in dense cataract cases makes surgical management easier as well, said Dr. Kim. “I’ll have multiple Viscoats [chondroitin sulfate and sodium hyaluronate, Alcon] ready to open, sometimes even three or four. After I phaco two or three pieces, I’ll coat the cornea and put it in the bag to keep the bag down,” she explained. Dr. Kim advised to continue with the use of viscoelastic even if you’re about ready to finish the case. That’s just the time when you might make an error. “The bag can be so floppy, it can come up to your phaco tip,” she said. Pulling out one more time, even for a remaining small piece, and filling up the bag again can help avoid this, she said. Use of a dispersive viscoelastic in patients with dense cataracts helps to protect the corneal endothelium, Dr. Bordewick said. “I don’t hesitate to use dispersive viscoelastic above and below the fragments I’m removing. Sometimes the posterior plate is difficult to split. If you take viscoelastic with a cannula and a protective sleeve, you can inject visco under that plate and move it forward away from the posterior Removal of dense cataract Source : Jeffrey Pettey, MD capsule. Then it’s safer to remove it,” she said. You should also consider using a CTR if necessary to make sure the lens is well centered, said Dr. Kim. Burned by phaco burns? The surgeons interviewed have not experienced phaco burn that often, although it’s always a risk, said Dr. Bordewick. “It’s obviously a concern because you’re typically using higher settings and more phaco energy. I use phaco in short bursts and add some chopping to that to minimize the amount of heat,” she said. Dr. Pettey had a phaco wound burn referred to him not long ago, and he followed the advice of Majid Moshirfar, MD , professor of ophthalmology, University of Utah, Department of Ophthalmology and Visual Sciences, and in practice, John A. Moran Eye Center, Salt Lake City. “When the wound edges are fish- mouthed, you need something to fill the void created by wound edge contracture. My last case had a large wound gape, and rather than suture down the edges tight with resultant 10 or fewer diopters of cylinder, I suspended the amniotic membrane in the wound to act as a filler and reduce the tension required for suturing,” said Dr. Pettey. The patient was happy with the outcome and had a surprisingly good uncorrected visual acuity EWAP Editors’ note: The physicians have no financial interests related to this article. Contact information Bordewick: eyestuff3@new.rr.com , dbordewick@baycare.net Kim: 408-851-4012, evasterbunny@gmail.com Pettey: 801-581-2352, jeff.pettey@hsc.utah.edu CALENDAR OF MEETINGS 2013/2014 DATE MEETing VEnUE October 5-9 XXXI Congress of the ESCRS www.escrs.org Amsterdam, Netherlands November 16-19 Annual Meeting of American Academy of Ophthalmology (AAO) www.aao.org Chicago, USA MEETing 2014 February 6-9 72nd Annual Conference of the All India Ophthalmology Society (AIOS) www.aios.org Agra, India April 2-6 XXXIV International Congress of Ophthalmology (WOC 29th Asia-Pacific Academy of Ophthalmology (APAO) 118th Annual Meeting of the Japanese Ophthalmological Society (JOS) www.woc2014.org Tokyo, Japan April 25-29 2014 American Society of Cataract & Refractive Surgery (ASCRS) Annual Meeting www.ascrs.org Boston, USA July 5-6 2014 Indian Intraocular Implant & Refractive Surgery meeting www.iirsi.com Chenai, India July 11-13 29th Annual Meeting of Japanese Society of Cataract & Refractive Surgery (JSCRS) Fukuoka, Japan September 13-17 XXXII Congress of the European Society of Cataract & Refractive Surgery (ESCRS) www.escrs.org London, UK October 18-21 Annual Meeting of American Academy of Ophthalmology (AAO) www.aao.org Chicago, USA November 13-16 27th Asia-Pacific Association of Cataract & Refractive Surgeons (APACRS) Annual Meeting www.apacrs.org Jaipur, India December 11-12 4th Biennial Scientific Meeting of the Asia Cornea Society www.acs2014.tw Taipei, Taiwan