CataraCt Surgery PhaCo PearlS

june 2013 CataraCt & refraCtive Surgery today 19 AlAn S. CrAndAll, Md I would plan on using iris hooks to keep the iris from interfering with phacoemulsification, so I would create two extra paracenteses. If the astigmatism were regular, I would implant a toric IOL. If the astigmatism were irregular, I would not address it initially. Given the amount of trauma to the eye, my primary concern would be zonular weakness, and I would plan to use a capsular tension ring (CTR). After performing cataract surgery with a low-flow technique, I would administer a miotic agent to reduce the pupil’s size as much as possible and then place a 10–0 Prolene suture on a double-armed STC-6 needle (both from Ethicon, Inc.). To ensure that I engaged the edge of the torn iris, I would use micrograspers to hold the iris and to avoid the anterior capsule. Next, I could either create a fornix-based peritomy or use Hoffman pockets and place the STC-6 needle where the iris’ root should be, which is approximately 1 to 1.5 mm posterior to the limbus. The advantage of Hoffman pockets is that the knot is already buried, but the peritomy would be technically easier. I would probably use Hoffman pockets to save the conjunctiva in case a glaucoma procedure were needed later. I would likely need three double-armed sutures. Because the iris in the area of the dialysis will not function, it is possible that some form of pupilloplasty may be needed. It might not be necessary, however, because the iris is superior and under the eyelid. Less surgery is often a better option, and I would avoid the pupilloplasty unless it were obviously required. UdAy devgAn, Md Although this patient suffers from issues related to the traumatic damage to the iris he sustained 40 years ago, he is fortunate that we ophthalmologists have the ability to remove his cataract, neutralize his astigmatism, and repair his iris all at once. The preoperative photographs show that the patient has about 4 clock hours (120o) of iridodialysis with no zonular dialysis. The surgeon must protect this section of the iris during cataract surgery by using two iris hooks to suspend the iris tissue and expand the pupil. A relatively routine cataract surgery can then be carefully performed with a well-formed 5-mm capsulorhexis to hold the IOL securely in place. Cataract iridodialysis, a visually Significant Cataract, and Corneal astigmatism