APACRS 2021 Daily News (Sunday, 1 August 2021)

EWAP Daily News - 4 TOP GUN – Cataract surgery tips In a symposium that is an annual highlight for the APACRS, experts provided practical surgical tips any surgeon can apply immediately upon returning to the operating theater. At the end of a program that moderator Chan Wing Kwong, MD, Singapore, described as “almost a rapidfire film festi- val,” the audience voted for the best tip. The runner-up in the poll was a tip from Hadi Prakoso, MD, Indonesia. He described an easy way to deal with a Marfan case when the standard options—a Cionni ring or Assia capsular anchor—are not available. Using a standard one- piece IOL, he cuts one haptic off, placing the haptic inside the capsular bag in a way that counteracts the decentra- tion of the bag. This simple procedure, he said, solves the unavailability of the Cionni ring; dealing with Marfan be- comes easier, cheaper, and gives a satisfying visual out- come. The winner was a tip from Teruyuki Miyoshi, MD, PhD, Japan. He described his FLUSH technique to manage the cortex after CTR insertion. It is difficult to remove residual cortex trapped in the space between the CTR and the cap- sular equator. Performing FLUSH, the residual cortex is lift- ed up to the anterior chamber, making it more convenient to aspirate using ordinary I/A. FLUSH creates a current un- der the IOL, which immediately spreads the capsular bag and flows into the anterior chamber. Residual substances in the capsular bag under the iris are pushed out where they can be seen and easily and directly removed with I/A. There is a mild learning curve to master FLUSH—placing the tip of the syringe under the IOL carefully with contin- uous flow and bringing the FLUSH needle or I/A close to the residual cortex—but with the anterior chamber filled with viscoelastic, FLUSH safely removes residual cortex. Furthermore, in cases where infusion misdirection syn- drome occurs, immediately stop I/A, implant the IOL, then FLUSH to safely remove residual cortex. transcription errors, is configurable to the surgeon’s pro- cess and saves time per plan, automatically integrates various toric IOL formulas and calculations, integrates EMR for postop visits, and analyzes outcomes. Another high-tech device that helps achieve precision outcomes is intraoperative aberrometry which has been shown to refine cylinder power selection in over half of cases. “Refractive astigmatism management is an essential foun- dation to providing high-quality uncorrected vision,” Dr. Yeu concluded. “While it can be achieved with modern formulas, analogue, inefficient, and low-tech…[h]igh-tech preoperative and intraoperative devices and instruments can increase surgeon efficiency, precision, and outcome accuracy.”