EyeWorld Asia-Pacific December 2019 Issue

62 EWAP DECEMBER 2019 DEVICES “In a patient that has had some traumatic dialysis, I am still able to ÕÃi ˆÌ]» À° >V œ˜>` Ã>ˆ`° The precaution on miLOOP’s use in cases of zonular weakness was common among surgeons treating such patients. “It can be used on most any cataracts except cases with overt zonular weakness, where there ˆÃ «…>Vœ`œ˜iÈÃ]» À° 7ˆiÞ said. “That said, it can be used successfully in pseudoexfoliation cases that have not developed ÌÀÕÞ œœÃi ✘Տið» Dr. Wiley said in cases of loose zonules, passing the loop behind the lens may further weaken the zonules. “This can be detected when engaging the loop prior to ÀœÌ>̈˜} ̅i œœ« Li…ˆ˜` ̅i i˜Ã]» Dr. Wiley said. “If the zonules are loose the miLOOP can be aborted ܈̅œÕÌ V>ÕȘ} `>“>}i°» Dr. MacDonald has found miLOOP is safer in pseudoexfoliation cases than the use of standard «…>Vœi“ՏÈwV>̈œ˜° “It is a gentler force when you are putting the miLOOP in >˜` ˆÌ½Ã ˜œÌ ÃÌÀiÌV…ˆ˜} ̅i L>}]» Dr. MacDonald said. “When you are cracking the nucleus, inward forces are being created, so miLOOP is not straining the zonules at all, and it is probably more zonular friendly than any divide and conquer or chopping ÌiV…˜ˆµÕi°» A challenge Dr. MacDonald has found with the device came when teaching surgeons who are hesitant to put something into the capsule and allow it to Lˆ˜`Þ w˜` ̅i Ü>Þ° “That is the one piece of the i>À˜ˆ˜} VÕÀÛi ̜ ՘`iÀÃÌ>˜`]» Dr. MacDonald said. “If you follow the directions, you’re not going to pierce the capsule. The material has been polished, and it is very smooth and is not }œˆ˜} ̜ ÀÕ«ÌÕÀi ̅i V>«ÃՏi°» The second issue is that sometimes when surgeons cut the nucleus and it is very dense, the lens tries to pop into the anterior chamber. Dr. MacDonald uses a second instrument in such cases to hold the nucleus back while she is cutting it. FLACS use Dr. Wiley said he has successfully used miLOOP with Zepto (Mynosys Cellular Devices), with the combination providing capsulotomy and lens fragmentation results that rival those provided by the use of a femtosecond laser. “The miLOOP is more effective at lens fragmentation when compared to femto since it can bisect the lens from equator to equator, where the femto only fragments the lens in its central VœÀi]» À° 7ˆiÞ Ã>ˆ`° Dr. Garg does not think that the use of miLOOP in combination with an automated capsulotomy device will replace FLACS. “With FLACS we are able to ÌÀi>Ì Vœ˜Vœ“ˆÌ>˜Ì >Ã̈}“>̈Ó]» Dr. Garg said. “Combining miLOOP with automated capsulotomy does not treat >Ã̈}“>̈Ó°» Drs. MacDonald and Wiley said they have used the miLOOP on all types of cataracts, although Dr. Garg was unsure the miLOOP would get around an extremely large cataract, but to date has not had any issues with respect to this. In terms of anterior chamber prolapsed lens prevention, Dr. Garg generally stabilizes the lens with a second instrument (chopper/spatula) when performing a bisection. If prolapse is not prevented, Dr. MacDonald puts viscoelastic into the eye, puts the lens back into the insertion guide and i“ՏÈwið EWAP Editors’ note: Dr. Garg is medical director of the Gavin Herbert Eye Institute, University of California, Irvine, and has interests in Carl Zeiss Meditec and Johnson & Johnson Vision. Dr. MacDonald is associate professor at Tufts University School of Medicine, Boston, and has interests in Carl Zeiss Meditec and Perfect Lens. Dr. Wiley is assistant clinical professor at University Hospitals/Case Western Reserve, Cleveland, and has a relevant interest in Carl Zeiss Meditec. Phacomorphic glaucoma and cataract surgery – from page 59 include: IOP in excess of 35 mmHg, a sluggish, irregular pupil, corneal edema, injection of conjunctival and episcleral vessels, shallow AC, lens enlargement and forward displacement, and unequal cataract formation between the two eyes. The development of phacomorphic cataract is more common in smaller hyperopic eyes with a larger crystalline lens and shallower anterior chamber. The angle closure episode can be triggered, for instance, by dim light causing pupil dilatation. Angle closure may also be caused by the encroachment of the lens spatially and the pressure from behind the lens. Zonular weakness from advanced age, trauma, or due to exfoliation can play a causative role as well. Although the surgery was well managed, a number of factors could have complicated it. “ This case was rare, given that zonular dehiscence is often managed with intracapsular cataract extraction with aphakia and secondary lens implantation. Furthermore, it is common practice to perform extracapsular cataract extraction or even intracapsular cataract extraction with trabeculectomy for the management of lens-induced glaucoma. However, we managed to perform conventional «…>Vœi“ՏÈwV>̈œ˜ ÃÕÀ}iÀÞ ÜˆÌ… intraocular lens implantation in the bag successfully and ՘iÛi˜ÌvՏÞ]» À° *>«>˜`ÀiœÕ said. EWAP Editors’ note: Dr. Papandreou practices at Urgent Eye Clinic, Lister Hospital, Stevenage, UK, and declared no relevant ƂPCPEKCN KPVGTGUVU