EyeWorld India December 2018 Issue

should be carefully rotated out of the capsular bag and into the an- terior chamber where the surgeon can convert to a small incision ex- tracapsular approach, she said. “Other techniques such as sheets glide placement to keep fragments from falling posteriorly or IOL scaffold have been advo- cated,” Dr. Fram said. “However, these strategies require complex surgical maneuvers that may not be in the comfort zone of all surgeons. A retina specialist can always perform a planned vitrec- tomy at a later data and remove the lens fragments in a safe man- ner.” After the vitrectomy is com- plete and remaining lens mate- rial is removed, IOL placement depends on capsular support and the location of the capsular tear. If there is enough peripheral support (around 210 degrees), Dr. Hovanesian said there is enough to put the optic and haptics fully in the bag. But typically, he, Dr. Weber, and Dr. Fram said, provid- ed there is a round capsulotomy, placement of a three-piece IOL in the sulcus with optic capture occurs. Dr. Hovanesian pointed out that one should take into ac- count any power adjustments that might need to be made should the optic be placed in the sulcus. He mentioned the formula on doctor- hill.com, the website of Warren Hill, MD . Generally, the higher power the lens, the more adjust- ment that needs to be made, Dr. Hovanesian said. In the absence of capsular support, Dr. Fram said an ante- rior chamber IOL could be used, continued on page 40 EWAP CATARACT/IOL 39 December 2018