July 2018


Challenging cases and innovative solutions

Eric Donnenfeld, MD, chief medical editor

We all experience a challenging case from time to time that tests our surgical skills and ability to manage these difficult circumstances. When these cases present in my operating room, I often recall the wisdom of the surgeons who we spoke to for this issue of EyeWorld. Their insights coupled with modern advanced technology can often be the difference in surgical outcomes. For this issue, we interviewed some of the best surgeons in the fields of cornea, cataract, glaucoma, and refractive surgery. All anterior segment ophthalmologists will potentially deal with these situations during their careers. In this issue of EyeWorld, we learn how to turn challenging cases into happy postoperative patients.
Challenging corneal cases present to every ophthalmologist. Clara Chan, MD, EyeWorld Cornea editor, said ocular surface disease patients
can be the most difficult cases she sees, and her treatment options range from managing eyelid abnormalities to stem cell transplantation with
system immunosuppression. Amar Agarwal, MD, is one of the most
innovative ophthalmologists I have ever met. His videos are works of art, and it is worth visiting the ASCRS website to view them. His most challenging cases revolve around pseudophakic bullous keratopathy. He uses many
of his innovative solutions, including the glued IOL technique, PDEK, and single-pass four-throw pupilloplasty.
Rosa Braga-Mele, MD, EyeWorld Cataract editor, Kevin Miller, MD, and Richard Tipperman, MD, present three tough cataract cases and how they were managed. At some point in the OR, most of us will experience the Argentinian flag sign, TASS, and operating on a very young patient. These three experts all have a common theme: Have a plan, and have a back-up plan. Keeping the patient as well as the surgeon calm during the procedure can be as important as the surgical management itself.
Today cataract and corneal refractive surgery have merged as specialties. Neel Desai, MD, Daniel Durrie, MD, and I discuss the management of difficult refractive surgery cases and where the future of refractive surgery is heading. Refractive surgery has entered a new era with the ability to resolve refractive errors safely and effectively, as well as rehabilitate some of the most challenging eyes that in the past would have gone on to amblyopia or required a rigid contact lens or even a corneal transplantation.
I think that glaucoma patients are among the most challenging cases we see on a regular basis. Three exceptional glaucoma surgeons, Valerie Trubnik, MD, Nathan Radcliffe, MD, EyeWorld Glaucoma editor, and Robert Rothman, MD, share their experiences and wisdom on managing these difficult cases. They rely on surgical skill, intelligent decision making, and an abundance of exciting new technologies that have truly revolutionized the specialty of glaucoma.
EyeWorld salutes the physicians who have contributed to this issue and thanks them for their expertise and willingness to share their stories. While by their very nature challenging cases are the most difficult surgeries we perform, they can also be the most rewarding.

Challenging cases and innovative solutions Challenging cases and innovative solutions
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