APACRS 2021 Daily News (Saturday, 31 July 2021)

SNEC Instruction Course: How and when not to do MIGS An SNEC Instruction Course held Friday looked at the role of traditional surgery in the era of minimally invasive glau- coma surgery (MIGS) by looking at how and when not to perform MIGS. Manchima Makornwattana, MD, Thailand, kicked off the course by taking the question head on. Dr. Makornwattana said that glaucoma treatment is a life- long commitment and ranges from eye drops through laser treatments to traditional glaucoma surgery. When patients are given the choice, “100% will go for the eye drops”; however, in the long term patients run into problems with compliance and complications such as prostaglandin-as- sociated periorbitopathy (PAP), conjunctival fibrosis, bleph- aritis, and dry eye syndrome (DES). Meanwhile, laser treatments are effective but temporizing procedures at best and traditional surgery remains the gold standard but is delayed for as long as possible due to side effects and serious complications. EWAP Daily News - 2 Cordelia Chan, MD, Singapore, began the 2021 Master- Class on “Mastering Refractive Surgery Complications” with a presentation on how to react and safely manage intraoperative LASIK complications. Dr. Chan emphasized the importance of identifying at-risk patients preoperatively with assessments such as the slit-lamp exam, fundoscopy, squeezing upon instilling eye drops, and taking a patient history for claustrophobia and anxiety disorders. Although refractive surgery complications do not occur frequent- ly, suction breaks, vertical gas breakthroughs, flap tears, and gas bubbles in the anterior chamber can occur. Most intraoperative LASIK complications are related to the flap creation process and can be managed safely with minimal to no impact on a patient’s eventual visual outcome. Edward Manche, MD, USA, discussed the most common postoperative complication of LASIK: epithelial ingrowth. Through case studies, Dr. Manche showed his technique for removing epithelial ingrowth. First-line management is mechanical debridement for initial presentation, while ad- junctive therapies such as hydrogel sealant and fibrin glue are most promising for recurrence. Sri Ganesh, MD, India, presented on the management of SMILE complications which include black spots, suc- MasterClass: Mastering Refractive Surgery Complications tion loss, lenticules stuck to the cap, and lenticule tears. Suction loss can be caused by the sudden movement or squeezing of the eye, excess fluid around the cone, im- proper cone selection, or loose conjunctiva, as it is typical- ly avoided with proper head positioning and clear instruc- tions for the patient preoperatively. Mohamad Rosman, MBBS, MMed, FRCSEd, FRCOpth, FAMS, Singapore, discussed complications that can occur with implantable collamer lens (ICL) surgery. Although the results of ICL surgery are very good, potential postoper- ative complications include infection, increased intraoc- ular pressure (IOP), over- or undercorrection, and retinal detachment. In one case, a patient experienced retinal detachment after ICL surgery, noting onset of right eye floaters and blurring vision. The patient showed right eye macula-sparing rhegmatogenous retinal detachment on examination, underwent vitrectomy with pneumatic reti- nopexy for retinal detachment repair, and recovered. Finally, Rohit Shetty, DNB, FRCS, PhD, India, discussed the prevention and management of ectasia after refractive surgery. Dr. Shetty stated the importance of using imaging to manage ectasia. “The power of indices is so phenom- enal that sometimes it’s really overwhelming to see all the indices and make a judgment. But, if you put an effort [into analyzing the imaging], it works wonders,” he said. Dr. Shetty believes it is also important to understand epithelial mapping because it looks at how the cornea is reshaping, bulging, and changing.