EyeWorld Asia-Pacific March 2019 Issue

67 March 2019 EWAP DEVICES (below 14 D) do not necessarily require a change in lens power. “As you move a lens into the sulcus, the lens power effectively increases, so you will need to decrease the lens power accordingly,” he said. “In patients with lens powers between 18 and 23, I usually take 0.5 D off the lens power. If the lens power is above 24, I take 1 D off the lens power as I move it forward.” Michael Greenwood, MD, Fargo, North Dakota, said that he would use optic capture in patients who have a posterior capsule break. “If I’m planning to implant a lens in the sulcus of a patient who has a nicely centered capsulotomy with good anterior capsule support, I’ll put the lens in the sulcus and optic capture the optic. The reason for optic capture is that it stabilizes the lens, so I don’t have to worry about that lens dislocating or moving in the future,” he said. Learning curve According to Dr. Garg, placing a lens in the sulcus is not commonly performed. “I encourage our residents to practice placing three- piece lenses in intact capsular bags because placing a three-piece lens into the bag requires a little more nuance and sort of gymnastics with the haptics and how the lens acts in the eye compared with a one-piece lens. A one-piece lens is usually forgiving and goes into the eye easily. With a three-piece lens, depending on the model that you’re using, you have to twist and turn as you go in to make sure that it comes out in the right orientation. I would recommend practicing on eyes when things have gone well,” he said. Dr. Garg also recommended practicing with different three-piece lenses. “With some lenses, there can be a little bit more pressure getting through the wound. In an eye with a capsular tear, putting pressure on the wound can sometimes promote vitreous coming forward. I recommend enlarging the wound a little bit so that when you go into the eye, you’re not causing any undue pressure,” he said. Dr. Greenwood agreed, noting that it requires a different skill set to put a lens in the sulcus. “You don’t want it to be your first time or your staff’s first time using a three-piece IOL when it’s in the heat of the moment and you’re a little nervous because you had a complicated cataract, it’s taking a little longer, and the patient is a little less comfortable. Make sure that you and your staff are comfortable loading and injecting three-piece IOLs,” he said. Dr. Yeu added that new sulcus- based technologies are needed. “It would be helpful to use sulcus- based technologies to create zero accommodation or a pinhole effect to improve presbyopia correction in someone who is already pseudophakic. There are options that we have not explored with current technologies, but it is a procedure that we generally reserve for when we are either fixing a refractive miss or because there’s a capsular bag compromise. But I do think the sulcus space holds potential for ways that we can help patients in the future once we have technologies that are compatible with living in the sulcus space,” she said. EWAP Editors’ note: Dr. Garg has financial interests with Johnson & Johnson Vision and Carl Zeiss Meditec. Dr. Yeu has financial interests with Johnson & Johnson Vision. Dr. Greenwood has no financial interests related to this article. Contact information Garg: gargs@uci.edu Greenwood: Michael.greenwood@ vancethompsonvision.com Yeu: eyeu@vec2020.com 9LHZV IURP $VLD 3DFLÀF Pannet PANGPUTHIPONG, MD ,QVSHFWRU *HQHUDO 2IÀFH RI 3HUPDQHQW Secretary 0LQLVWU\ RI 3XEOLF +HDOWK 7KDLODQG +6681-9118134 SDQQHWS#KRWPDLO FRP I Q D FDVH ZLWK SRVWHULRU FDSVXODU WHDU LPSODQWLQJ D WKUHH SLHFH ,2/ LQ WKH VXOFXV LV VDIH ZKHQ WKHUH LV HQRXJK FDSVXODU VXSSRUW PRUH WKDQ RI WKH DQWHULRU FDSVXOH 0\ ,2/ RI FKRLFH ZRXOG EH D WKUHH SLHFH ELFRQYH[ PP IROGDEOH DFU\OLF RSWLF ZLWK PRGLÀHG & ORRS KDSWLFV DQG RYHUDOO OHQJWK RI PP ,QFLVLRQ VL]H VKRXOG EH PDWFKHG ZLWK WKH ,2/ FDUWULGJH XVXDOO\ PP RU PRUH ,QMHFW GLVSHUVLYH 29' WR ÀOO WKH DQWHULRU FKDPEHU DQG RSHQ WKH VSDFH EHWZHHQ WKH DQWHULRU FDSVXOH DQG WKH LULV , SUHIHU WR LQMHFW WKH OHQV VORZO\ LQWR WKH DQWHULRU FKDPEHU ÀUVW WKHQ ELPDQXDOO\ PDQLSXODWH WKH KDSWLFV DQG WKH LULV XVLQJ WZR /HVWHU ,2/ PDQLSXODWRUV WR SODFH WKH KDSWLFV LQWR WKH VXOFXV RQH E\ RQH $YRLG D ÁDW DQWHULRU FKDPEHU DIWHU LPSODQWDWLRQ RWKHUZLVH WKH ,2/ PD\ EH GLVSODFHG , SUHIHU WR OHDYH VRPH GLVSHUVLYH 29' LQ WKH DQWHULRU FKDPEHU DQG JLYH RUDO DQWL JODXFRPD PHGLFDWLRQ V WR SUHYHQW WKH ,23 IURP ULVLQJ RU IRUP WKH DQWHULRU FKDPEHU ZLWK DQ DLU EXEEOH (GLWRUV· QRWH 'U 3DQJSXWKLSRQJ GHFODUHG QR UHOHYDQW ÀQDQFLDO LQWHUHVWV