REMOVAL OF IRIS PROSTHESES
In my last column, I talked about some of the international advancements in ophthalmology. Not everything that happens internationally is good. Here is a video demonstrating the quite controversial cosmetic iris prosthesis designed to change one’s eye color. A few US surgeons may see the ramifications of this procedure, which is being performed in Panama. This is a great example of prosthesis removal. You can see that it is relatively challenging to remove the prosthesis without damaging the endothelium, iris, and/or lens.
Recently, I had the opportunity to hang with Nate Radcliff, MD, and Hylton Mayer, MD. They were discussing the advantages of adding endoscopic cyclophotocoagulation (ECP) to the iStent Trabecular Micro-Bypass (Glaukos Corporation) for moderate to advanced glaucoma with the hope to delay or possibly eliminate the need for more invasive glaucoma techniques. Nate described to me his technique of using the ECP probe camera to guide the placement of iStent rather than using the gonio mirror. This is an ingenious approach that may prove useful when corneal pathology, anatomy, and/or patient positional challenges make the gonio mirror difficult to use.
The new Tecnis Toric (Abbott Medical Optics Inc.) is a great addition to the toric IOL category. When using intraoperative aberrometry (ORA with Verifye; WaveTec Vision), an ideal toric lens is readable quickly, adjusts easily in the eye, and stays put after it is placed. These characteristics may be defined by the IOL’s material. The optimal toric lens material opens quickly enough so that it can be read by intraoperative aberrometry for alignment; however, you want the material firm enough so that the haptics “move” with the lens during adjustment and not “bend” against the lens. When the haptics bend during adjustment, you may think that you have adjusted the position of the optic, but it may bounce back to the previous position as the haptics unbend. You also want the material “tacky” enough so that it will stay in the bag position in the short and long term, but you don’t want it so tacky that it is difficult to microadjust. So far, I have found the Tecnis’ material to work well with the new Verifeye platform. You can see the relatively quick opening of the lens allowing for quick reliable on the table readings. Furthermore, you can see that the lens is adjustable both in the clockwise and counterclockwise directions.