VisionBlue, which has been shown to contain only 0.4%. Dye impurities are commonly analyzed, and Dr. Srinivasan said surgeons may see differences in pH values, osmolality values, and varying ranges of purity (86-97%). Papers have even published cases of toxic anterior segment syndrome from generic trypan blue dye. Furthermore, there are no international standards in place for anterior segment intraocular dyes. “Clinicians should be aware of the varying concentrations and impurities in commercially available trypan blue and be vigilant when making their choices,” Dr. Srinivasan warned. On a different note, Lee Mun Wai, MD, brought up a controversial topic: immediate sequential bilateral cataract surgery (ISBCS). There are many reasons surgeons do not do ISBCS, Dr. Lee explained, including increased risk to the patient. “Tradition has taught us the risks of bilateral surgery, which is why we stay away,” he said. However, Dr. Lee argued that ISBCS can be done safely and offers a wide range of benefits: faster visual rehabilitation, patient convenience (fewer clinic visits), cost savings to both patient and surgical center, and reducing the carbon footprint of cataract surgery. “We need to make sure the complication rate is low,” Dr. Lee said. Dr. Fam, the chair of this session, chimed in: “You also need to have protocol so you don’t put the wrong lens in the wrong eye.” Additionally, Dr. Lee recommends treating each eye as a separate “patient.” Finally, the COVID-19 pandemic pushed surgeons to reconsider ISBCS. “COVID-19 taught us to reduce infection exposure risk,” Dr. Lee said, and thus ISBCS fits the bill as a more efficient and less expensive procedure that ensures less contact between the patient and healthcare professional. Cataract Complications can be Managed Managing or preventing negative dysphotopsia can be achieved with a reverse optic capture, said Shail Vasavada, MD, during The Network is Down — Managing Cataract Complications symposium. “Reverse optic capture of single-piece IOLs is possible, although 3-piece IOL design is more suitable for the procedure,” he said, “and the patient will require more postoperative anti-inflammatory and intraocular pressure treatment.” Generally speaking, most patients “get used to negative dysphotopsia,” he said, adding he has only done a reverse optic capture in 3 patients to correct negative dysphotopsia. Posterior capsule rent (PCR) risk in cataracts with weakened posterior capsule occurs anywhere form 4% to 36% in people with polar cataracts but is becoming more common in iatrogenic cataracts, said David Lubeck, MD, which he dubbed “the new polar.” Patients who undergo intravitreal injections run a 1.88% to 3% risk of developing PCR. He recommends waiting at least 6 months after a posterior capsule perforation before surgical correction. Among the surgical considerations: no hydrodissection/ hydrodelineation, delaminate the anterior/mid and posterior nucleus, strip the peripheral cortex 50% of the way in for 360°, and viscodissect the central posterior cortex with a dispersive viscoelastic. “If the capsule is open and vitreous is forward of the posterior capsule, perform a complete anterior vitrectomy,” he said. Hungwon Tchah, MD, PhD, said the effect of FLACS on IOL tilt and centration when compared to conventional cataract surgery is unknown. His retrospective study compared a FLACS device (n=110 eyes) to outcomes with conventional surgery (n=78 eyes) about 3 years after surgery. At baseline, there were no statistical differences between the groups. There were no statistical differences between eyes or between treatments in terms of IOL tilt (p=0.171) after 3 years, but there was “wider scatter in the left eye and a wider distribution in the conventional group,” Dr. Tchah said. “This means FLACS provides a more predictable result after surgery.” IOL tilt toward the inferotemporal direction was seen in both eyes regardless of method used. “IOL tilt is also significantly correlated with the crystalline lens tilt,” he said. There were statistical differences in IOL decentration, with FLACS producing a 160±100 mm tilt compared to 240±150 mm with conventional surgery (p=0.002). A statistical difference in decentration was evident in the conventional group that had one-piece haptics (0.21±015 mm) compared to three-piece haptics (0.31±0.14mm) (p=0.027), but there were no differences in the FLACS group (p=0.370). An Explosion of New Lens Implants NEXUS CoNNECtiNg EvEryoNE & EvErythiNg
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