EyeWorld Asia-Pacific December 2015 Issue

25 December 2015 EWAP FEATURE Managing ‘catarocks’: Better surgery on dense lenses, intumescent cataracts by Vanessa Caceres EyeWorld Contributing Writer AT A GLANCE • When available, a femtosecond laser can help with capsulotomy creation in a white or brown cataract. If the laser is not available, staining with trypan blue can assist with visualization. • Surgeons must use caution to avoid the Argentinian flag sign in white cataracts. • An ideal OVD will stay in place during surgery and make the procedure safer. • Preop testing can help detect other problems in these eyes that may be hard to visualize. Medications such as steroids and NSAIDs are best given for a longer time period than in other patients. Hypermature white cataract. According to Dr. Donaldson, this patient would benefit from femtosecond laser pre-fragmentation. Source: Kendall E. Donaldson, MD Surgical pearls for increased safety, smoother procedures M anaging a complex cataract case may try physicians’ patience, but there are some ways to make surgery and postop management of these cases go more smoothly. Careful consideration of the capsulorhexis, ophthalmic viscosurgical device (OVD) use, femtosecond laser use when available, and pre- and postop diagnostics and management will go a long way toward a better surgery. Here are some ways to better manage a dense lens or an intumescent or brunescent cataract. Capsulorhexis tips One reason to carefully create your capsulorhexis in a white cataract is because the capsule is more friable and under pressure due to capsular distension syndrome, said Kendall E. Donaldson, MD , associate professor of ophthalmology, Bascom Palmer Eye Institute, Miami. In a dense brunescent cataract, visualization is often difficult, Dr. Donaldson said. This is why Dr. Donaldson prefers use of femtosecond laser technology in both circumstances. “Increased speed of capsulotomy creation increases the safety of the capsulotomy and prevents the potential extension of an anterior capsular tear, known as the Argentinian flag sign,” she said. “For the dense brunescent cataract, the femtosecond laser eliminates this challenge by creating a perfectly centered, round capsulotomy, which then facilitates the rest of surgery.” Although Stephen S. Lane, MD , medical director of Associated Eye Care, and adjunct clinical professor, University of Minnesota, Minneapolis, also favors femtosecond laser use for a capsulorhexis in these cases, he advises capsule staining with trypan blue if this is not possible, especially with a white lens. “I think it’s become the standard of care to reduce complications. It allows you to perform a much more predictable and secure capsulorhexis,” he said. continued on page 26