EyeWorld India December 2013 Issue

27 EWAP CAtArACt/IOL December 2013 handling these cases, he said, is preparation. Initial assessment should include a search for bulges and folds in the anterior capsule that may indicate zonulysis; if imaging is available, it should be used. Also bear in mind the possibility of laser peripheral iridotomy complications in angle closure cases; LPI may have breached the capsule. 10. Concluding the session, Dr. Barrett had a very simple tip: In cases where a tough capsule presents problems with the rhexis, or if for some reason such as in Dr. Steinert’s case the rhexis needs to be reinitiated, the right scissors can be very useful. Dr. Barrett recommends disposable 25-gauge scissors in these cases. top of the top The session placed practicality and utility as the most important qualities for determining the value of a pearl; three presenters presented pearls that the audience deemed most useful. First, Chee Soon Phaik, MD , Singapore, focused on what she perceived to be a recurring fear for cataract surgeons—the worry, she said, about the posterior capsule letting the surgeon down. In these cases, and in the cases Dr. Chee presented, whether they involve a dropped nucleus, a freely rotating lens, or a decentered multifocal IOL, anterior capture can save the day by helping in capturing an implant. Second, Dr. Pangputhipong described a phaco technique that does not rely on hydrodissection as much as others do. Performing hydrodissection, he said, risks hydrorupture; in some cases, such as those involving posterior polar cataracts, it can’t be performed safely at all. Unfortunately, most nuclear disassembly techniques, he said, need hydrodissection because they require good nuclear rotation. To minimize the need for hydrodissection, Dr. Pangputhipong suggested using a triangular crack pattern for conventional phaco or an x-pattern for femtosecond phaco. These patterns allow the surgeon to remove the first fragment without having to rotate the lens. Removing the first fragment then frees the rest of lens for rotation, obviating the need for hydrodissection. Finally, Abhay Vasavada, MD , India, received the most votes for his tip on managing a rupture in the posterior capsule. When a rupture occurs, he recommended injecting viscoelastic before retracting instruments, and using preservative-free triamcinolone to visualize and assess vitreous prolapse. He said surgeons should remember to manage fluid dynamics—lowering parameters including not just vacuum and flow but the bottle height—and should access the vitreous through a pars plicata or pars plana approach since the aspiration forces from a frontal approach, even if you place the tip of the vitrector posterior to the capsule, will cause the vitreous to prolapse anteriorly and enlarge the tear. The 26th APACRS annual meeting was held at the newly revamped Suntec Singapore International Convention & Exhibition Centre and ran from 11 to 14 July 2013. EWAP