EyeWorld India December 2018 Issue

with measurement for placement including white-to-white plus 0.5–1 mm. “The surgeon should avoid ex- tending the clear corneal incision and move superiorly for a fresh scleral tunnel measuring 6 mm as this will reduce iris prolapse and irregular corneal astigmatism,” Dr. Fram explained. “Acetylcho- line chloride should be placed, and a mid-peripheral SPI can be made with the vitrector (100 cut rate and 700 vacuum). The ACIOL can then be placed carefully using the help of a sheets glide. Alterna- tively, one can perform intrascle- ral or scleral suture fixation, de- pending on surgeon experience.” Dr. Weber performs a dilated exam of the posterior segment within the early postopera- tive course, but his medication instructions remain the same as an uncomplicated case. Dr. Hov- anesian said he treats the patient longer with steroids and NSAIDs. Dr. Fram said she instructs pa- tients to call if they experience extreme pain or discomfort post- operatively, as it could indicate high intraocular pressure. The physicians said they are forthright with the patient after surgery about what happened. Preoperatively, Dr. Hovane- sian discusses the odds of compli- cations with his patients. There is a 1 in 1,000 chance that a major complication could occur and a 1 in 100 chance for a minor but not vision-threatening complica- tion. The situations meriting an anterior vitrectomy fall into the latter camp. “I usually refer back to our conversation before surgery,” Dr. Hovanesian said, adding that he explains that while he tried to keep the lens capsule as intact as possible, a complication occurred that required additional steps to the cataract surgery. He tells patients, “I think you’re going to do well, but it may take longer for you to achieve that final vision than a normal person. I wish that it didn’t happen, but I’m happy with the way things turned out.” As a final pearl of advice, Dr. Weber recommended young surgeons get to know the different vitrectomy settings and seek out videos of the various vitrectomy techniques. Dr. Fram pointed out that there are tools for practicing anterior vitrectomy with Simul- EYE (Westlake Village, California). All in all, Dr. Hovanesian said, what makes a good surgeon is how the surgeon handles the vitreous loss. “The measure of a skilled surgeon is someone who keeps their head about them and diligently pursues getting all of the vitreous, getting all the lens material, getting a round pupil, and getting the patient a good result from surgery even when things go poorly,” he said. EWAP Editors’ note: The physicians have no financial interests related to their comments. Contact information Fram: nicfram@yahoo.com Hovanesian: drhovanesian@harvard- eye.com Weber: charles.weber@gmail.com Alcon Page: 10 , 11 www.alcon.com Hoya Surgical Optics Page: 44 , 45 www.hoya.com Oculus Optikgeräte Page: 20 , 21 , 65 www.oculus.de ASCRS Page: 2, 71 www.ascrs.org APACRS Page: 5, 24 , 27 , 36, 39 , 56 , 61 , 72 www.apacrs.org EyeWorld Page: 7, 12 www.eyeworld.org Index to Advertisers Preparing for anterior – from page 39 40 EWAP CATARACT/IOL December 2018