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Innovations | Nov 2010

Eyetube.net Presents Practical and Challenging Cases

Eyetube.net is fortunate that many outstanding clinicians have contributed videos of practical and challenging procedures that are helpful whether you are a beginning or experienced surgeon. Use the search box to find videos on numerous types of surgical practices as well as on new techniques and devices. This month’s article focuses on a few top videos that were recently added to Eyetube.net.

Placing a Piggyback IOL
One video that immediately caught our attention was submitted by Jeffrey Whitman, MD. It showcases the simple, straightforward technique of placing a piggyback IOL in an eye with a Crystalens (Bausch + Lomb, Rochester, NY). You may find Dr. Whitman’s method helpful if you have considered using this technique, instead of laser vision correction or other approaches, to change the refractive error in pseudophakic eyes (Figure 1) (http://eyetube.net/?v=getef).

Exchanging a Multifocal IOL
Along the same theme, Allon Barsam, MD, and Eric Donnenfeld, MD, share their technique for an IOL exchange in an eye with a single-piece multifocal implant and an open posterior capsule. A small percentage of patients with multifocal implants end up with visual complaints. Often, an Nd:YAG laser capsulotomy can help resolve their dissatisfaction, but when patients continue to have problems, the next step is an IOL exchange.

The surgeon carefully exchanges the IOL and demonstrates a technique for freeing up the lens’ haptics as well as ensuring that vitreous does not come forward through the open capsule during the procedure. The process includes situating the replacement monofocal IOL in the eye prior to removing the multifocal implant. This video provides a straightforward outline of how you might wish to handle similar cases (Figure 2) (http://eyetube.net/?v=hogis).

Dismantling a Rock-Hard Cataract
A challenging but common problem for cataract surgeons is the rock-hard cataract. Marcos Gomez, MD, shares his microchop technique in which he slowly but safely disassembles the nucleus (Figure 3) (http://eyetube.net/?v=dapan).

Managing a Prolapsed Iris
Although new technologies such as the Malyugin Ring (MicroSurgical Technology, Redmond, WA) have proven to be effective in cases of intraoperative floppy iris syndrome, it is still helpful to understand the underlying mechanism for iris prolapse. As part of the Video Journal of Cataract and Refractive Surgery, David Langerman, MD, shares a primer on iris prolapse, the reasons that it occurs, and methods for avoiding it (Figure 4) (http://eyetube.net/?v=gifib).

Innovations for Challenging Cases
The last video that we would like to highlight is from Luis J. Escaf, MD; Victor Rojas, MD; Virgilio Galvis, MD; and Alejandro Tello, MD. They have developed an investigational technology called the Ultrachopper system. The phaco tip of the Ultrachopper is flat and angulated with a downward bend. When coupled with torsional energy, the instrument behaves like an ultrasonic knife. Although this technology may at first look intimidating, after reviewing the video, you may decide that it holds some promise for more challenging cases (http://eyetube.net/?v=lulin).

New videos are uploaded daily to Eyetube.net. They can provide you with fresh approaches to challenging situations and long-standing conditions. As always, we hope that Eyetube.net continues to help you enhance patients’ care.

Section Editor Richard M. Awdeh, MD, is the director of technology transfer and innovation and an assistant professor of ophthalmology at the Bascom Palmer Eye Institute in Miami. He acknowledged no financial interest in the products or companies mentioned herein. Dr. Awdeh may be reached at (305) 326-6000; rawdeh@med.miami.edu.

Section Editor William B. Trattler, MD, is the director of cornea at the Center for Excellence in Eye Care in Miami and the chief medical editor of Eyetube.net. He acknowledged no financial interest in the products or companies mentioned herein. Dr. Trattler may be reached at (305) 598-2020; wtrattler@earthlink.net.

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