CATARACT 26 EWAP SEPTEMBER 2022 in eyes with posterior polar cataracts,” he said. “It can also be used to define the shallowness of an anterior chamber or document the presence of iridocorneal adhesions.” Dr. Miller said that he’s selective as to when he’ll use AS-OCT preoperatively. He’ll only use it preop if a posterior polar cataract is present. Intraoperatively, he’ll use it as part of the process of performing FLACS. Postop, Dr. Miller listed five possible applications for AS-OCT: 1. Look for/document the presence of retained lens fragments in the anterior chamber 2. Identify Descemet’s membrane detachments in eyes with edematous corneas 3. Document the presence of capsular block 4. Look for epithelial or fibrous ingrowth 5. Look for IOL tilt and/or decentration e added that he finds Figure 3. Intraoperative OCT showing pseudoexfoliation material on the anterior lens surface. Figure 4. Layer of fluid revealed behind the nucleus and a small layer of residual lens cortex after hydrodissection, imaged by intraoperative OCT. identifying Descemet’s membrane detachments to be especially helpful when he can’t figure out why it is taking so long for an eye to recover from surgery. Abhay Vasavada, MD, said he relies on anterior segment OCT freµuently, finding it useful in cases of chronic angle closure glaucoma, pseudoexfoliation, eyes with zonulopathy, posterior polar cataract, and pediatric cataract (if the child can sit for it). “I think the modern technology of the anterior segment OCT is helping in different scenarios where cataract surgery is done. With a shallow anterior chamber, for example, in many of these there are loose zonules, which can lead to the forward movement of the zonular-capsular bag. If you can see on anterior segment OCT, you are prepared for your strategy because sometimes, even if you do in-the-bag IOL implantation, because the zonules are weak or loose, the IOL remains forward, and sometimes that shallowing of the chamber can lead to so-called angle glaucoma,” Dr. Vasavada said. In eyes with known chronic angle closure glaucoma, he said anterior segment OCT can show and validate the change— space created and ciliary body rotation—from preop to postop. “You can see the restoration to some extent of the anterior segment anatomy,” Dr. Vasavada said. Dr. Vasavada added that he’s used AS-OCT for a long time in cases of posterior polar cataract. For these, it can help determine the location and extent. If it’s unclear on slit lamp exam if it’s a plaque or posterior polar cataract, Dr. Vasavada said AS-OCT can provide that additional assurance. “I think if you want to deliver the best care … it is useful to incorporate anterior segment OCT,” he said, adding that there is an increasing trend in the use of this technology in the context of cataract surgery. Intraoperative potential Ronald Yeoh, MD, shared some of his insights about intraoperative OCT for cataract surgery. He said intraoperative OCT was introduced several years ago as a tool for vitreoretinal surgeons to assist in peeling the epiretinal membrane and internal limiting membranes from the macula, as well as to assist corneal surgeons as they visualize corneal layers during lamellar surgery. “It was interesting that in the marketing literature provided, there was no mention of its use in cataract surgery, despite the
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