Ronald Yeoh, MD, chair of the symposium, said. “IIIC is about innovation,” Sri Ganesh, MD, said. The IIIC is a club of committed cataract and anterior segment surgeons founded by Sir Harold Ridley, the inventor of the IOL. At this year’s symposium surgeons presented challenging situations along with their refined tips and tricks for various particular situations. Posterior capsule rupture (PCR) was a hot topic during the symposium and presents as a challenge with IOL placement. Delayed visual rehabilitation and an increase in cost of treatment are some implications of PCR. Dr. Ganesh provided strategies to prevent nucleus and fragment drop, termed the IOL scaffold technique, during phacoemulsification. “Using the IOL scaffold technique provides an elegant surgery,” Dr. Ganesh said, though a 3-piece IOL must be used as the scaffold. Not only are 3-piece IOLs becoming uncommon in today’s surgical world, but the surgeon must also be skilled. “One can damage the haptics when doing phaco,” Dr. Ganesh said. A temporary rescue device, the safety net device, may help. Dr. Ganesh showed two versions of the safety mesh with a net-like structure and one with a circular-like structure. These safety mesh devices allow the surgeon to manage PCR without extending the clear corneal wound and to provide thorough anterior vitrectomy and cortical clean up while minimizing vitreal loss, ultimately preventing devastating complications of nucleus drop. “Despite tremendous technical and technological advancements, PCR can happen during any surgical procedure,” Bryan Hung-Yuan Lin, MD, said. This unexpected occurrence can be managed with a few strategies, including early detection of the rupture, adequately removing residual nucleus fragments and cortical material, and checking the vitreous strands, Dr. Lin suggested. He said these “helpful techniques can lead to a final visual outcome looking similar to an uncomplicated case.” Additionally, he said, “The aspiration rate must be very slow and intraocular pressure should be maintained below 30 mmHg. And be sure to refill dispersive ophthalmic viscoelastic whenever there is not enough tamponade.” Top Gun: Simplifying Cataract Techniques Some surgeons make surgery look so simple or use a shortcut that make others wonder why they hadn’t thought about it first. This year’s Top Gun — Top Cataract Surgery Tips brought together 17 of the world’s leading cataract surgeons to share some of their subtle tips and maneuvers that can make surgery just a bit easier. “This is not about showing complicated surgery,” said symposium co-chair Ronald Yeoh, MD. “It’s about showing how great a teacher you can be.” The grand prize this year was a solid state drive“so you can save all your videos for next year’s submissions,” said symposium co-chair Ronald Yeoh, MD. This year’s grand prize was awarded to Filomena Ribeiro, MD, PhD, for her tips on how to easily insert iris hooks. Iris hooks are often used to expand small pupils and are typically placed via their own small incisions to hold the iris tissue out of the way during surgery. Dr. Ribeiro recommended “painting” with blue dye as one tip. But her primary pearl was to place the hook on the needle itself, thereby eliminating one step to the iris hook insertion. Once the needle/hook combination is inside the eye, simply remove the needle and the hook will already be inserted, she said. This year’s runner-up was Chee Soon-Phaik, MD, for her video on battling Soemmering’s ring. “It’s a complex case with a simple pearl,” she said. She advised surgeons to perform an adequate anterior vitrectomy and then use an IOL cartridge to keep the corneal incision rounded to enable infusion pressure to hydroexpress the entire ring in a controlled manner into the cartridge. “The IOL cartridge is already on your operating table and widely available,” she said. Dr. Chee was previously voted a winner at the ASCRS 2023 Top Gun for the same pearl. Pearls from Surgical Videos Attendees at the industry- sponsored video surgery symposia learned from experts about the safety and efficacy of NEXUS CoNNECtiNg EvEryoNE & EvErythiNg
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