EyeWorld India December 2014 Issue

22 December 2014 EWAP FEATURE dislocation or endophthalmitis in 5 years of follow up. Sutured- related complications are decreased compared with sclerally sutured IOLs. Pseudophacodonesis which happens in AC IOLs as well as sutured scleral-fixated IOL are decreased to minimum by the glued IOL method. Moreover, fewer posterior segment complications were observed in glued IOL eyes as compared with anterior chamber or scleral-fixated IOLs. In a long- term study of glued IOLs, there has been no significant optic tilt noted. The continuous iris touch seen in iris claw or iris-sutured IOLs is totally absent in glued IOLs as the IOL is placed away from the iris plane. Therefore, the chronic subclinical uveitis noted in eyes with IOL-iris contact is not there after glued IOL. Eyes with subluxated cataract, primary lens removal with glued IOL is preferred to capsular tension ring (CTR) to prevent postoperative IOL tilt. We have noted eyes with a history of operated subluxated cataract with CTR presenting with late IOL dislocation. Therefore, the glued IOL technique is preferred in eyes with intraoperative or preoperative zonular dehiscence. EWAP Editors’ note: Dr. Agarwal pioneered the glued IOL technique. He is a consultant for STAAR Surgical (Monrovia, Calif., U.S./Nidau, Switzerland); however, neither he nor Dr. Kumar have any financial interests related to their comments. Contact information Agarwal: +91-44-2811-6233; dragarwal@vsnl.com Kumar: susruta2002@gmail.com that this would be off-label use, but the advantage is that this type of suture tends to not biodegrade. Postoperative medication regimen Dr. Davidson uses the same postoperative medication regimen that he would use for cataract surgery. This includes an antibiotic 4 times a day, a nonsteroidal 4 times a day, and a steroid 4 times a day. “I’ll use that for the first week and then taper the nonsteroidal and the steroid over the next 2 to 3 weeks,” he said. The exact regimen will depend on the patient, the amount of inflammation, the procedure, and any existing issues the patient has. Dr. Lee uses a regimen of an antibiotic, steroid, and NSAID; however, he usually has his patients continue with these medications for several months after surgery. Dr. Afshari said that she also uses a combination of steroids, antibiotics, and NSAIDs. Steroid use varies for these patients, and the amount of corneal edema is taken into consideration. “I keep them on steroids longer than an average cataract patient because it is more of a complex surgery,” she said. Vitrectomy Surgeons need to consider how to proceed when performing a vitrectomy. In some cases, retina specialists may assist, depending on the type of case. Dr. Davidson said that sometimes he performs anterior vitrectomies and sometimes he will do a combined case with a retina specialist. If it is truly just an anterior chamber problem but there is vitreous coming up into the anterior segment, he handles it. However, for issues like the lens dangling into the vitreous cavity or a lens that has fallen in back of the eye, he calls a specialist. “I usually do my own subtotal vitrectomy with infusion through a paracentesis and the vitrector through the limbus or pars plana,” Dr. Lee said. “However, I’m fortunate to have retina colleagues who are available and willing to help if a complete vitrectomy is needed.” Dr. Afshari said she will perform an anterior vitrectomy on her own. “If it’s a pars plana vitrectomy, I do it combined with a retina colleague.” How to improve Reading articles, watching videos, and attending training sessions and courses are good ways of improving techniques for secondary IOL implantation, Dr. Afshari said. “Many of these cases are not routine,” she said, so these are not necessarily procedures that physicians have experience with. “One great way to get experience with iris suturing is to start with pupilloplasties, perhaps on your cataract patients who have intraoperative floppy iris syndrome,” Dr. Lee said. “Certainly if you have access to a wet lab, it’s very helpful to go and practice suturing if you haven’t sutured for a while,” Dr. Davidson said. It’s also useful to watch videos, he said. Memorizing the procedure ahead of time is helpful, Dr. Davidson said, because it helps to be able to visualize what to do so you are not trying to remember the next step during the surgery. Performing a number of surgeries in a short time helps one become familiar with the procedure, as does having an assistant with an extra set of hands while you are learning the technique. Dr. Davidson added that it is important to be familiar with a number of techniques for secondary IOLs. “I don’t think there’s one technique that’s good for every patient,” he said. “You have to have several techniques in your armamentarium so that you can customize it depending on what that patient’s needs are and what the patient’s anatomy is like.” EWAP Editors’ note: Drs. Davidson, Afshari, and Lee have no financial interests related to their comments. Contact information Afshari: naafshari@ucsd.edu Davidson: Richard.Davidson@UCDenver.edu Lee: leemd@uw.edu Methods - from page 18 Glued - from page 21