Cataract
September 2023

by Mitchell Weikert, MD
Cataract Editor

As we approach the fall, the latest issue of EyeWorld follows another great ASCRS meeting. This time it was the ASCRS Summer Meeting: A Taste of ASCRS that took place a few weeks ago in Nashville, Tennessee. A little more intimate than the ASCRS Annual Meeting, the ASCRS Summer Meeting combined didactic lectures, breakout sessions, skills transfer labs, a dedicated curriculum for Young Eye Surgeon (YES) members, and plenty of opportunities for networking and social get-togethers.

The casual vibe of “Music City” blended well with the interactive format, spirited debates, and video-heavy case-based discussions. In addition to pearls offered for cataract and refractive surgery, our cornea, glaucoma, and retina colleagues got the chance to drop some knowledge on the audience. I encourage you to check out the next ASCRS regional meeting. These smaller scale meetings have a different flavor and benefit from the unparalleled opportunity for faculty and attendee interaction.  

The theme for this issue, “Complicated Cases,” is a natural offshoot of the Summer Meeting and covers capsular tension rings, toric IOL use with compromised capsules, and complications and management pearls associated with the Yamane technique for flanged intrascleral haptic fixation. The ins and outs of capsular tension rings (CTRs) are discussed by John Hart Jr., MD, and Yuri McKee, MD. Their comprehensive look addresses the many facets of CTR use, including how they work, who’s likely to need them, what products are available, when they should be implanted, techniques for their insertion, and potential complications associated with their use. In addition to zonular weakness, they provide insights into how CTRs may help prevent toric IOL rotation.

Amandeep Rai, MD, and Jonathan Rubenstein, MD, start off their toric IOL discussion with a refresher on the management of capsular tears. They provide tips for getting the cataract out safely and preserving capsule support. This is followed by a discussion on how to tailor IOL selection to the subsequent clinical scenario and when the use of a toric IOL is appropriate. They finish by exploring alternatives for astigmatism management, with an expanded focus on how corneal relaxing incisions fit into current surgical practices.

In the final “Complicated cases” article, D. Brian Kim, MD, Jeff Pettey, MD, and Austin Nakatsuka, MD, take a look at flanged intrascleral haptic fixation, a technique pioneered by Shin Yamane, MD, PhD, for IOL implantation in the absence of capsular support. After an overview of the surgical technique, these experienced Yamane surgeons delve into the various complications that can occur during and after surgery. In addition to examining how and why they occur, they also provide pearls geared toward prevention, such as optimizing IOL choice, increasing scleral pass consistency, and placement of peripheral iridotomies.