FEATURE EWAP DECEMBER 2023 15 “They may also need further surgery for retained fragments. As such, patient education is important so they may seek immediate and appropriate care for any postoperative complications. These patients should also be scheduled for close follow-up to monitor for complications and ensure a safe recovery,” Dr. Rai said. Overall, Dr. Rai said that patients with astigmatism can benefit from a well-placed toric IOL, and even in the setting of some capsular complications, it is still possible, depending on a few factors, to deliver the best possible uncorrected distance visual acuity to patients. EWAP Editors’ note: Dr. Rai is Residency Program Director, Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada, and has interests with Alcon and Bausch Health. Dr. Rubenstein is Professor and Chairman, Department of Ophthalmology Rush University Medical Center Chicago, Illinois, and has interests with Alcon. A compromised...planned- from page 10 the patient can have an excellent outcome,” Dr. Kim said, adding that he’s been referred patients like these and they have done well after surgery. More advice on avoiding complications Dr. Kim said it’s important to practice intrascleral haptic fixation on artificial eyes, by attending skills transfer courses, and/or by finding and working with an experienced mentor. “I would also be cautious and selective when choosing which technique. Whether you try Dr. Yamane’s original technique or some other variant, ask yourself, does this cause undue stress on the haptics? Although the PVDF haptics are strong, they are not indestructible, so I would be wary of techniques that exert significant stress on the haptics. Are you having trouble with certain steps such as cannulating the trailing haptic? Find a safe technique that flattens the learning curve,” Dr. Kim said. Dr. Kim said many surgeons have personalized the intrascleral haptic fixation technique with their own approach. He said he began using the Sensar IOL (Johnson & Johnson Vision) a few years ago when access to the CT LUCIA 602 was limited. “With my modifications to the technique, I have been able to completely transition to the Sensar with excellent results despite the delicate PMMA haptics because of my gentle approach,” he said. “Since I use the Sensar and not the CT LUCIA 602 as my primary IOL, I have been able to avoid the recently described rotisserie optic tilt complication. The surgeons who adopted my techniques in response to this problem have informed me that it has helped them switch to the Sensar. To be clear, the PVDF haptics of the CT LUCIA are the most forgiving, thus the best IOL to use when learning the technique. However, once you master it, I would strongly advise trying other IOLs so you aren’t trapped with just one lens.” EWAP References 1. Yamane S, et al. Flanged intrascleral intraocular lens fixation with double-needle technique. Ophthalmology. 2017;124:1136–1142. 2. Scoles D, Wolfe J. Laser to the Rescue. American Academy of Ophthalmology ONE Network. Dec. 15, 2022.www.aao. org/education/1-minute-video/laser-torescue-2. Editors’ note: Dr. Kim practices with Professional Eye Associates, Dalton, Georgia, and declared no relevant financial interests. Dr. Pettey is Clinical Vice Chair, Moran Eye Center, University of Utah, Salt Lake City, Utah, and has interests with Carl Zeiss Meditec. Dr. Nakatsuka is Assistant Professor, Glaucoma / Cornea / Anterior Segment, Moran Eye Center, University of Utah, Salt Lake City, Utah, and declared no relevant financial interests. ADVERTISER LISTING Alcon Page 28 - 31 www.alcon.com Johnson & Johnson Vision Page 16-19 www.jjvision.com Oculus Page 12 www.cornealbiomechanics.com APACRS Page 2, 4, 6, 7, 35, 46, 47, 48 www.apacrs.org
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