EyeWorld Asia-Pacific December 2019 Issue

EWAP DECEMBER 2019 13 FEATURE D ense white cataracts and mature brunescent cataracts can make surgery particularly challenging, yet the reward comes once patients can see again. “Patients with bilateral brunescent cataracts are typically at hand motions and are the happiest of patients [after surgery]. They go from being unable to live alone to being able to drive,” said Zaina Al-Mohtaseb, MD. bottom that makes cracking `ˆvwVՏÌ]» À° Ƃ‡ œ…Ì>ÃiL Ã>ˆ`° “In addition, there is very little cortex and thus less protection of the posterior capsule.” Trypan blue can help to visualize the capsule which is often hard to see, also a deep phaco groove allows for a quicker procedure, said Doug Katsev, MD. Use of a femtosecond laser with mature brunescent cataracts is potentially helpful to soften the dense cases. There is a short learning curve and the device is very helpful,” she said. She recommended practicing with ̅i “ˆ ""* wÀÃÌ œ˜ iÃà `i˜Ãi cases so that it can be visualized. Dr. Gayton said to proceed with caution when using the miLOOP in dense cases with little to no cortex. “You can perforate œÀ Ìi>À ̅i V>«ÃՏi >˜`ɜÀ disinsert zonules,” he said. For nuclear disassembly of a mature brunescent case, make Better management of brunescent and dense white cataracts by Vanessa Caceres EyeWorld Contributing Writer AT A GLANCE • Both mature brunescent cataracts and dense white cataracts present with unique surgical challenges. • Devices such as the miLOOP can help during surgery with mature brunescent cataracts. • The femtosecond laser can potentially help with both types of cataracts, but surgeons should keep in mind the limitations of the laser and follow their personal comfort level. • Provide patients, even those with dense white cataracts, with all possible IOL and astigmatic correction options. Contact information Al-Mohtaseb: zaina1225@gmail.com Gayton: jlgayton9@gmail.com Kang: pkang@edow.com Katsev: katsev@aol.com Raviv: tal.raviv.md@gmail.com Visco: dvisco@eyesofyork.com This article originally appeared in the September 2019 issue of EyeWorld. +V JCU DGGP UNKIJVN[ OQFKƂGF CPF CRRGCTU here with permission from the ASCRS Ophthalmic Services Corp. White cataract with a planned toric; a round complete capsulotomy is critical to refractive success. Source: Tal Raviv, MD EyeWorld spoke with several Ãi>ܘi` ÃÕÀ}iœ˜Ã ̜ w˜` œÕÌ how they manage these types of cataracts. Mature brunescent cataracts A higher risk of complications >˜` `ˆvwVÕÌ ÛˆÃÕ>ˆâ>̈œ˜ >Ài two challenges associated with mature brunescent cataracts. Mature cataracts can be dark brown, red, white (with or without a liquid component), or black, said Johnny Gayton, MD. “Many of the mature cataracts have a leathery plate at the lens nucleus and results in less ultrasound energy usage for lens removal, Dr. Al-Mohtaseb said. Dr. Katsev said that the femto laser can help to use less energy, but he does not think its use is a must. One device that some surgeons have found helpful is the miLOOP (Carl Zeiss Meditec), which provides energy-free lens fragmentation. This is especially helpful for cataracts with a dense, leathery plate, Dr. Al-Mohtaseb said. “It helps crack the lens, which is one of the hardest parts in phacoemulsifying these a deep groove, and be sure to hydrodissect to allow the lens to split easily, Dr. Katsev advised. Dr. Al-Mohtaseb shared four pearls for nuclear disassembly: • Widen the initial groove when sculpting. • Use the stop-and-chop technique to decrease ultrasound energy usage. • Use the Nagahara phaco chopper to chop the lens into small pieces as much as possible, then use phaco to remove the pieces. • Phaco in the capsular bag as much as possible. %TCEMKPI VJG FGPUG PWENGWU YKVJ VJG ƂDGTU HTQO VJG RQUVGTKQT RNCVG Source: Zaina Al-Mohtaseb, MD