EyeWorld Asia-Pacific December 2016 Issue

December 2016 EWAP FEATURE 17 based system works well, she said, because you can build vacuum without occlusion, and minimal phaco power is needed. High vacuum can help to efficiently remove the nucleus, Dr. Dhaliwal said. She noted that technique may need to be modified in these soft lens cases. Physicians can’t think they’ll do a divide and conquer on these lenses because they’ll end up bowling it out, she said. In nearly all of her cases, Dr. Dhaliwal said she uses a stop and chop technique. Dealing with a ‘bowl’ The “bowl” effect occurs when the physician is unable to effectively draw the entire piece of the nucleus out of the capsular bag, Dr. Yeu said. “If I notice that the lens is soft and sticky, leading to a ‘bowl’ effect of the first few attempts, I will switch to the Koch spatula and perform a reverse chop in order to lift the pieces out of the capsular bag,” she said. “If a bowl has been created, coming out of the eye and performing a viscodissection of the epinuclear shell and removing its adhesions to the capsular bag can be exceedingly helpful.” This will make it a safer procedure, and depending on the density of the epinuclear bowl or shell that is left, the removal may be completed with the I/A handpiece, Dr. Yeu added. Additionally, coaxial I/A ports tend to be larger than that on the bimanual port and can be more effective at aspirating the soft lens through, she said. Additional tips Dr. Dhaliwal noted that when a surgeon is operating on soft cataracts or performing a clear lensectomy in a refractive lens exchange, patient selection prior to surgery is incredibly important. Although these cases can be gratifying, Dr. Dhaliwal cautioned that for highly myopic patients, there is clear literature stating that these patients have a higher rate of retinal detachment after cataract surgery or lensectomy. This can be a devastating complication for the patient, so Dr. Dhaliwal warned about the importance of being aware of the risks and educating the patient. EWAP Editors’ note: Dr. Dhaliwal has financial interests with Bausch + Lomb (Bridgewater, New Jersey). Dr. Yeu has financial interests with Abbott Medical Optics (Abbott Park, Illinois), Alcon, and Bausch + Lomb. Dr. Hardten has no financial interests related to his comments. Contact information Dhaliwal : dhaliwaldk@upmc.edu Hardten : drhardten@mneye.com Yeu : eyeulin@gmail.com