OSM560-April_DIGITAL_Layout 1 4/5/13 2:30 PM Page 90
O P H T H A L M O L O G Y
increased a patient's intraocular pressure, squeezing the viscoelastic
out, IV mannitol can "soften the pressure in the eye," she says. "It
works within minutes, it's very, very useful" for preventing capsular
injury or even repositioning a dislocated intraocular lens.
Dilation difficulties
As mentioned above, inadequate pupillary dilation can lead to capsular rupture, but even if it doesn't, it can make cataract removal more
difficult for the surgeon.
"There are all sorts of floppy irises," says Dr. Yeh. They can commonly result from zonular weakness or trauma — both of which can
be evidenced ahead of time by the appearance of pseudoexfoliation
— or the medications the patient is taking, and may or may not
remember to tell the surgeon about: Not just Flomax, but also certain
anti-depressants, anti-psychotics or multivitamins containing saw palmetto extract for prostate health.
When such pre-existing conditions hinder eyedrop dilation, mechanical dilation through capsular tension or Malyugin rings can clear the
way. "If you see those conditions, make sure there's a capsular tension
ring in the room," says Dr. Yeh. "I never operate without those on the
premise."
It may be advisable to have "Shugarcaine" on hand as well, she
notes. The combination of balanced salt solution (BSS), preservativefree lidocaine and preservative-free epinephrine (developed by the
8 8 | O U T PAT I E N T S U R G E R Y M A G A Z I N E | A P R I L 2 013
