EyeWorld Asia-Pacific December 2015 Issue

19 December 2015 EWAP FEATURE be a sutured CTR or CTS,” he said. “If the area of dialysis is large (more than 4–5 clock hours) and the CTR is not sutured in place, a simple CTR will succeed in centering the IOL in the short term but eventually the entire IOL/ capsular bag/CTR complex can dislocate,” Dr. Henderson said. Dr. Safran recommended suture support for the capsular bag/IOL complex be performed at the time of cataract surgery if the zonules are compromised and it’s likely the patient will require a “secondary surgical intervention for dislocation or symptomatic pseudophacodonesis at a future date otherwise.” If once the IOL is in place and the OVD removed “things look stable without significant pseudophacodonesis,” he may forsake suturing, especially in an older, less active patient. “I find it difficult to know exactly how many clock hours of zonules are missing or damaged because I can’t always directly inspect them, so I go by how the capsular bag feels to me during rhexis formation, phacoemulsification and the amount of stability that is present once the IOL is in place and the viscoelastic removed. If in doubt I’ll lean toward adding suture support,” he said. Dr. Ahmed said if the clock hours of dialysis are superior or if the bag is “very mobile,” then he’ll suture, and he errs on the side of caution in cases of pseudoexfoliation where he’s quicker to use and suture a segment. “The tissue in those eyes is very poor; pseudoexfoliation affects all the zonules and it’s not necessarily a localized issue,” he said. Finally, these experts agreed watching patients carefully for the first month is recommended, and perhaps be a bit quicker to use a laser to disrupt anterior capsule contraction after 1 month. EWAP Editors’ note: Dr. Ahmed has financial interests with Alcon (Fort Worth, Texas), Abbott Medical Optics, and Bausch + Lomb (Bridgewater, NJ). Dr. Cionni developed the modified Cionni ring (Morcher, Stuttgart, Germany). Dr. Henderson has financial interests with Alcon, Abbott Medical Optics, and Bausch + Lomb and developed the Henderson ring (Morcher). Dr. Safran has no financial interests related to this article. Contact information Ahmed: ike.ahmed@utoronto.ca Cionni: +1-801-266-2283 Henderson: BAHenderson@eyeboston.com Safran: safran12@comcast.net