Cornea Society News

WIN 2013

Cornea Society International Organization Advancing the treatment of corneal disease

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Winter 2013 Vo l 9 , N o . 1 News A Cornea Society publication Reporting from the 2012 AAO annual meeting, Chicago "Careful, honest, ethical" approach needed to perform new surgical techniques O phthalmologists need to prepare with care when learning a new technique to be ethically, legally, and medically ready to perform it for the first time. "A careful, honest, and ethical approach will distinguish the competent ophthalmologist as he or she learns a new technique," said Roberto Pineda II, MD, Boston. "The foregoing suggestions will help place the patient first, minimize the risk of complications, and allow the ophthalmologist to gain technical expertise with confidence." The American Academy of Ophthalmology has applicable rules of ethics on the subject, he said, with the first rule being competence, wherein an ophthalmologist must have specific training or experience to perform the procedure in question or be assisted by someone who has. The second rule is informed consent. Dr. Pineda said medical legal issues include whether physicians are covered by malpractice insurance for the new surgical technique, whether they should tell a patient if it is their first case, and if the consent process should be supplemented. When preparing for the first case, physicians should have all necessary equipment and material at hand, consider being proctored, choose an easy case, have a rehearsal, avoid any time pressure, and prepare for any potential complications, according to Dr. Pineda. Editors' note: Dr. Pineda has no financial interests related to his comments. Surgeons attending the 2012 AAO annual meeting partook in sessions covering topics such as premium IOLs and the top reasons for performing DMEK. Lens issues, complications dominate Refractive Subspecialty Day In a point-counterpoint discussion session, leading refractive surgeons offered their perspectives on everything from astigmatic correction to premium IOLs. Louis D. "Skip" Nichamin, MD, Brookville, Pa., started off the session by noting, "I am able to safely and reproducibly correct up to 3 D of astigmatism through the use of limbal relaxing incisions [LRIs]" based on a patient's age. At levels higher than that, he prefers to combine the use of toric IOLs with LRIs. "I believe we will all become increasingly dependent upon the excimer laser to reduce residual astigmatism following 'successful' implant surgery," he said. While surgeons are currently working on leaving patients with no more than 0.75 D of cylinder, "my prediction is that the bar will soon be raised to a level of 0.25 D, for both sphere and cylinder," Dr. Nichamin said. Albeit uncommon, inadequate capsular support can be a potential complication of cataract surgery, and the best approach is to suture a posterior chamber IOL, said Walter J. Stark, MD, Baltimore. He suggested suturing the IOL to the peripheral iris using a modified McCannel technique. "Doing this through a 3.5-mm incision gives the surgeon greater flexibility in treating patients with no capsule support," he said. Sadeer Hannush, MD, Philadelphia, prefers gluing a posterior chamber IOL to suturing it, using a modified technique originally described by Amar Agarwal, MD. "There's less risk of iris prolapse," he said, but acknowledged the technique does require surgical expertise. "Glued IOLs are a novel approach for PC IOL implantation," he said. "It avoids complications related to sutures, large incisions, and hypotony." continued on page 3

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