Go-to Techniques for Complex Cataract Cases

Three surgeons share the maneuvers they rely on to improve control, safety, and efficiency in eyes with soft or dense nuclei, during IOL exchange, and in eyes with intumescent white cataracts.

Rosa Braga-Mele, MD, MEd, FRCSC; Uday Devgan, MD, FACS; and H. Burkhard Dick, MD, PhD, FEBOS-CR

Cataract and Refractive Surgery Today

KEY TAKEAWAYS Pocket chop creates a central groove that improves visualization and lets surgeons control soft or dense nuclei without advancing a chopper blindly toward the equator The twist-and-out technique removes a foldable IOL through the original phaco incision by rolling the optic, avoiding intraocular cutting and incision enlargement For intumescent white cataracts, a two-OVD strategy indents the anterior capsule, lowers the pressure gradient, and supports controlled capsulorhexis formation Pocket Chop for Soft and Dense Cataracts Rosa Braga-Mele, MD, MEd, FRCSC Many new tools and phaco technologies have made cataract surgery easier to manage, particularly in challenging situations. One technique that works reliably well with newer technologies is pocket chop, which can improve efficiency and safety in eyes with a soft or dense cataract.1 The beginning of a central groove, or pocket, is created in the center of the lens. The phaco needle is then embedded in the pocket with no vacuum for soft nuclei or with high vacuum for dense nuclei (Figure 1). A chopper is advanced from the distal edge of the capsulorhexis toward the pocket to create a horizontal chop (Figure 2).

Conjunctivochalasis and Hyaluronic Acid in the Dry Eye Space

Eyetube

Co-hosts Jackie Garlich, OD, FAAO, and Jessilin Quint, OD, FAAO, sit down with Damon Dierker, OD, FAAO, on To the Point to talk about his approach to conjunctivochalasis. Dr. Dierker notes that he prefers to start the dry eye management process by addressing more common patient symptoms, such as inflammation. If symptoms persist, it’s time to introduce conjunctivochalasis as a diagnosis into the conversation. Dr. Dierker covers what to look for and different treatment options, including a more significant intervention that he has found success with: plasma-based conjunctivoplasty. Drs. Garlich and Quint then pick Dr. Dierker’s brain on hyaluronic acid, how he’s integrated it into his clinic, and patient candidacy.

Beyond One-Size-Fits-All: The Move Toward Personalized Vitreoretinal Therapy

By calculating the vitreous volume exact, clinicians can treat eyes with greater precision.

Andreas F. Borkenstein, MD

Retina Today

KEY TAKEAWAYS Because the vitreous cavity is not a uniform 4- to 5-mL reservoir, the author advocates for the use of the vitreous volume exact (VIVEX) to personalize intravitreal therapeutics. Using VIVEX-derived vitreous volumes of 2.98 mL, 5.12 mL, and 11.76 mL for small, emmetropic, and large eyes, the author’s model predicted an approximately fourfold difference in initial intravitreal concentration despite identical dosing. The vitreous cavity is a dynamic therapeutic compartment with meaningful biomechanical and pharmacokinetic properties. When the vitreous volume exact (VIVEX) concept was first introduced,1 its central message was simple: The vitreous cavity is not a uniform 4- to 5-mL reservoir, and intravitreal therapy is therefore not delivered into a standard compartment in every patient. We now know that vitreous volume varies substantially with axial length, ranging from approximately 2 mL in short hyperopic eyes to more than 10 mL in highly myopic eyes. If concentration is determined by dose divided by volume, identical intravitreal doses must inevitably produce different intraocular concentrations in different eyes. Since my 2024 article in Retina Today, this idea has moved from concept toward validation. In a first real-world clinical case series, VIVEX-predicted vitreous volumes were compared with intraoperatively measured volumes in 27 eyes undergoing vitreoretinal surgery. The correlation was strong (R = 0.961), the mean absolute error was 0.48 mL, and 89% of estimates were within ±1.0 mL of the measured volume. Most importantly, this study showed that individualized vitreous volume estimation is not only mathematically plausible but clinically usable.