FACING THE CHALLENGE: COMPLEX CATARACTS
When to Block, Sedate, or Go General
By Kevin M. Miller, MD
Dr. Miller’s approach to anesthesia care in complex cataract surgery is to apply common sense and to use the patient’s circumstances, the condition of the eye, and any concurrent systemic comorbidities or high-risk characteristics to guide the decision-making process. With regard to complex cases, Dr. Miller notes that topical anesthesia is appropriate when the procedure will be relatively short and will involve little manipulation of the iris, ciliary muscle, and sclera. Alternatively, injection anesthesia is better when patient discomfort is likely due to ocular manipulations, and general anesthesia is most appropriate in infants, children, and uncooperative adults.
Fixating an IOL Without Capsular Support
By Lisa Brothers Arbisser, MD
Although there are no definitive data that indicate the overall superiority of one fixation strategy over others, Dr. Arbisser suggests that all surgeons should have a backup plan and a backup lens available for every cataract procedure. She also offers her favored approach for repair of bag-lens subluxation: an ab externo, scleral, sutured lasso technique.
MOVERS AND SHAKERS
By Rochelle Nataloni
Ten movers and shakers shaping the cataract and refractive surgery subspecialties are profiled: Richard L. Lindstrom, MD; Marguerite McDonald, MD; Vance Thompson, MD; Robert K. Maloney, MD; Audrey Talley Rostov, MD; Iqbal “Ike” K. Ahmed, MD; Richard M. Awdeh, MD; William F. Wiley, MD; Gary Wörtz, MD; and Stephen G. Slade, MD.
Optimize the Ocular Surface
By W. Barry Lee, MD
Dr. Lee recounts two recent surgical cases to highlight the importance of ocular surface optimization in achieving good postoperative outcomes. In the first, severe inspissation of the meibomian glands was discovered during the preoperative examination of a 52-year-old man scheduled for corneal transplantation. Dr. Lee performed a LipiFlow (TearScience) treatment and proceeded with the deep anterior lamellar keratoplasty 4 weeks later. Six months after the LipiFlow treatment, there were no signs of meibomian gland inspissation, and the keratoplasty was stable. In the second case, a peripheral Salzmann nodule was found during slit-lamp examination of a 72-year-old woman scheduled for cataract surgery. Dr. Lee noted that, had the nodule not been removed prior to surgery, the patient could have experienced a hyperopic surprise.