More than a dozen videos in the “Get H.I.P. – Cataract” symposium showcased countless pearls. Panelist Nicole Fram, MD, said there were at least three things that she learned from the videos that she’ll take back to the OR and implement next week.
The pearls that were voted winners from the session are below.
CTS-My Way: Vellam Vivekanandan, MD
Dr. Vivekanandan showed how he places a CTR before a CTS, first using a combo dispersive-cohesive viscoelastic to tilt the bag posteriorly before a sclerotomy to avoid puncturing the bag. He uses a spatulated needle attached to a 7.0 Prolene suture, which he designed.
The cauterized flange of the suture is always beneath the central eyelet of the CTS, he said, and the inner flange should be larger than the CTS eyelet. The 1 mm of the externally flanged suture should be buried below Tenon’s to plug sclerotomy.
Source: ASCRS
Inverted IOL Implantation Hack with No Capsular Support: Ahmed Assaf, MD, FRCS
Dr. Assaf said that reverse optic capture can be tricky for toric IOLs, so he highlighted a technique where the IOL can be inverted to make optic capture easier. This technique was first introduced by William Wiley, MD. The cylinder power of the lens remains the same, but the spherical power needs to be reduced to achieve emmetropia.
The recommended size for the capsulorhexis to use this technique is around 5 mm in diameter. Panelist Rosa Braga-Mele, MD, asked why he used a single-piece IOL and not a 3-piece IOL. Dr. Assaf said sometimes toric lenses and some enhanced monofocal lenses are only available in a single piece.
When asked about cases of UGH or iris chaffing, he said there was none.
Seesaw Technique—Bidirectional Rotating Technique for Toric IOLs: Jun Hun Lee, MD
Dr. Lee said one challenge with toric IOLs is that they can only be rotated in a clockwise direction. The seesaw technique he described allows for bidirectional rotation, reducing surgical time and increasing precision.
The technique involves using an irrigation needle under the lens as a pivot point to tilt and rotate the lens in either direction with a second instrument. He said it is effective for various types of toric lenses.
Panelist Richard Tipperman, MD, said when he first saw this video, he smiled. “It’s so slick … and addresses an issue we see from time to time.” Dr. Braga-Mele said it was a technique she would be trying.
Spiral CTR Injector—David Chang, MD
Dr. Chang said we’ve all probably had the problem where a CTR puts too much stress on already weak zonules. The Shimowake injector (Katena) is a spiral CTR injector that has a fixed anterior hook over which he drapes the leading eyelet. This allows the device to bear the force of the coiled eyelet as the CTR opens, minimizing stress on the zonular apparatus.
Dr. Chang said it works for all brands of CTRs and is reusable. “I’ve done at least 30 cases of this,” he said, noting that he uses it for every CTR insertion now.
Financial disclosures
Assaf: None
Braga-Mele: Alcon
Chang: Alcon, Centricity Vision, Johnson & Johnson Vision, RxSight, Zeiss
Fram: AbbVie, Alcon, BVI, Johnson & Johnson Vision, Centricity Vision, LayerBio, MST, New World Medical, Ocular Therapeutix, OSRX, RxSight, Zeiss
Lee: Alcon, Hoya, Lumenis, Zeiss
Tipperman: Alcon, BVI
Vivekanandan: None
