APACRS 2021 Daily News (Sunday, 1 August 2021)

EWAP Daily News - 2 In a 90-minute session on Saturday designed to take full advantage of the virtual format and thematically inspired by the Netflix series The Queen’s Gambit, key leaders in ophthalmology from around the world were invited to pres- ent on new advancements in eye care practice. Using a precision pulse capsulotomy device (Zepto), David Chang, MD, USA, showed the audience complex case presenta- tions and his technique of utilizing Zepto in his patients. The device has a disposable phaco-like handpiece and is automated with a console. Zepto consists of a ring op- posed to the anterior capsule, and suction creates uniform capsular contact. Electrical nanopulses are delivered to the ring and the device mechanically cleaves the capsule at 360 degrees. Graham Barrett, MD, Australia, took the theme of chess, saying “strategy and choosing the right moves is import- ant in our world of biometry and predicting outcomes.” In utilizing IOL outcomes, his Barrett Universal Formula has proved to be an accurate method to predict IOL power and more recently, his toriCAM marker app provides accurate alignment for IOLs. The Grandmasters of Cataract Surgery In assessing toric IOL outcomes, Douglas Koch, MD, USA, urges us to ask, “how accurate are the formulas for hit- ting the predicted targets when analyzing toric IOL astig- matic outcomes?” With two variables to deal with, power or magnitude and meridian or axis, analyzing astigmatic outcomes can be complicated. Dr. Koch suggests using double angle plots and reporting scalar and vector predic- tion errors to achieve more accurate results. Regarding extended depth of focus (EDOF) lens, Damien Gatinel, MD, PhD, France, explains that there is now a trend towards non-diffractive EDOF IOLs with either aspheric design or wavefront focusing and that in the future, we should likely see further developments in multi- focality. Soon Phaik Chee, MD, Singapore, ended the session discussing her experience with intrascleral haptic fixation. Although she had some difficulty at first utilizing the Ya- mane technique of the “flanged IOL,” she ultimately re- turned to this technique because she had been given many cases that were complex: post retinal detachment surgery, endothelial keratoplasty (EK), and glaucoma eyes in which the conjunctiva needed to be spared. Using the Yamane technique, Dr. Chee was able to perform shorter surgeries and figured out how to center the IOL and avoid IOL tilt. Although Yamane recommends aligning horizontally, Dr. Chee finds it more successful to align the IOL vertically, be- cause a person who rubs his or her eyes can cause haptic erosion and exposure . “I’m big on imagination and visualization,” he said, describ- ing how he spends a lot of time in the wet lab, imagining and visualizing cases. He also advises his students to have a healthy respect for the laws of physics, understanding anatomy, instrumenta- tion, fluidics, and even what their hands do and how they do them. He presented a large number of cases including zonular dialysis, IOL subluxation with Marfan syndrome, and vari- ous forms of aniridia, congenital and traumatic. Each case required many different skills, so among the advice he gives students is to learn as many forms of suture ties as they can in addition to the use of various forms of microin- strumentation.