EyeWorld India December 2014 Issue

15 December 2014 EWAP FEATURE Dr. Green has “been using intracameral epinephrine for all known cases with a history of tamsulosin use, even if that use was several years prior to the cataract surgery. I think it’s very important to identify these cases.” If epinephrine is insufficient, she’ll move to using iris retractors. Hidden lens fragments Retained lens fragments “can be very easily overlooked. Surgeons can be distracted by the small pupil and lens removal; our train of thought concentrates on what we perceive to be the most difficult aspect of the surgery,” Dr. Gupta said. Spend extra time vacuuming with a push/pull technique and have a high suspicion for hiding fragments, she recommended. The key, Dr. Green said, “is observing the anterior chamber with the final irrigation and aspiration (I/A) after implantation of the IOL. Carefully irrigate around the anterior chamber; I certainly take more time and more effort than I normally would in a standard case.” Dr. Summerfield advised surgeons to “clean up as you go along,” even if surgeons are using a femtosecond laser for some aspects of the surgery. “Check the wound, hydrate through the wound at the end of the case, and double check retained fragments aren’t there,” he said. If he’s concerned about lens fragments, he’ll “take a cannula with just balanced salt solution and flush through the main incision, let it all circulate through the eye, and ‘whirlpool’ in there to flush out anything that may be stuck.” Dr. Green will “intentionally use Miochol-E [acetylcholine, Novartis, Basel, Switzerland] to gently irrigate small fragments around into the angle to aid me in flushing out any additional nuclear fragments.” “Look at the actual configuration of the iris,” Dr. Gupta said. “If you use a chop technique where you’re fractionating the lens into a lot of small pieces or if the cataract is dense, sometimes the phaco machine will shatter the small-to- medium-sized pieces. I have a low threshold to look under the iris, while my irrigation handpiece is in the eye, to make sure nothing’s trapped. Even tenting the iris with the irrigation handpiece, while you have the irrigation on but not the aspiration, you can use the I/A tip to lift up the iris enough to clear a fragment. That will swirl the fluid around in the anterior chamber to flush that space where a lens fragment could potentially be retained.” She’s particularly careful with any cataract grade 3 or higher. “Irrigating a little longer than normal will help you discover those hiding places,” Dr. Green said. EWAP Editors’ note: The physicians have no financial interests related to their comments. Contact information Green: largreen@lifebridgehealth.org Gupta: preeya.gupta@duke.edu Summerfield: michaelsummerfield@gmail.com MORIA S.A. 15, rue Georges Besse 92160 Antony FRANCE Phone: +33 (0) 1 46 74 46 74 - Fax: +33 (0) 1 46 74 46 70 moria@moria-int.com - www.moria-surgical.com THE MORIA OPTION FOR SBK Make your own comparisons between the One Use- Plus and a femtosecond laser in terms of capital investment, disposables per patient, and annual maintenance. www.moria-surgical.com Think Thin Thin, 100-micron, planar flaps Accuracy and predictability equivalent to Femto-SBK Smoother stromal bed No femto-complications … At a fraction of the cost