EyeWorld Asia-Pacific June 2012 Issue

June 2012 7 EWAP NEWS & OPINION other option is capsular support, done with a capsular anchor. Prof. Assia designed this device, which anchors the anterior capsule to the sclera wall. Surgical options for intraocular lens subluxation are the same as the crystalline lens: removing it entirely and replacing it with an alternative or attempting to preserve it. “If you want to exchange the lens, one needs a very large incision,” Prof. Assia said. “It makes for a very unstable wound and may cause a high astigmatism.” Prof. Assia’s preferred solution is to reposition the IOL. “Some excellent results can be achieved if you refixate the lens,” he said. “If the IOL is out of the bag, it’s better to fixate it to the iris. If it’s in the bag, it’s better to fixate it to the sclera.” Both types of fixation can be performed with a closed system technique. For iris fixation, Prof. Assia favors a four-point fixation. Although it takes a few extra minutes, it makes the procedure much safer. Prof. Assia also recommends using the capsular anchor for this procedure, calling it a “great option” because the diameter of the anchor is about 2.5 mm and all the surgeon needs is a pocket entry. “Lens subluxation is a surgical challenge,” he said. “Using modern instrumentation and surgical techniques, an excellent surgical outcome can usually be achieved.” Masterclasses: Featuring femto This year’s APACRS Masterclasses offered a variety of educational opportunities for attendees, but femtosecond was the new star for the yearly classes. “Without doubt, the flavor of the month (or year!) is femto- laser assisted cataract surgery,” said veteran Masterclass faculty member Ronald Yeoh, MD, Singapore National Eye Centre. “This new modality in cataract surgery has taken the world by storm since its introduction a year or so ago. We, therefore, felt that it was opportune to run the first Masterclass in femto-laser cataract surgery in Asia in Shanghai. Indeed, the number of registrations for this class far exceeded any of the other Masterclasses.” There were six Masterclasses offered this year: “Femtophaco Cataract Surgery”; “Posterior Segment Updates for Anterior Segment Surgeons”; “Optimizing Outcomes in Toric IOL Implantation”; “Tips and Pearls for Successful Femtosecond LASIK Flap Creation with Different Femtosecond Platforms”; “The Ideal Phacotrabeculectomy”; and “ReLEx and SMILE”. “The Masterclass program was conceptualized as a series of high- level instructional courses run by recognized experts in the field,” Dr. Yeoh said. “The topics covered are usually at a more advanced level than basic instructional courses.” Surgeons considering converting to a femtosecond- phaco cataract platform attended the video-based session on the topic. The faculty, Chee Soon Phaik, MD, Michael Knorz, MD, Vincent Lee, MD, and Dr. Yeoh, took turns sharing their experiences with the technology, as well as offering usage pearls and advice about new complications that may arise. They also discussed the costs and benefits of adopting the new platform in practice. In the corresponding vitreoretinal Masterclass, Ang Chong Lye, MD, Li Xiaorong, MD, Lee Mun Wai, MD, Lee Shu Yen, MD, Ong Sze Guan, MD, and Ian Yeo, MD, gave anterior segment surgeons updates and tips on how to assess and manage cataract patients who also have retinal diseases such as diabetic retinopathy, macular degeneration, and other retinal vascular disorders. Surgeons who wanted to get optimum outcomes when implanting toric IOLs attended a session with Dr. Yeoh, Guo Haike, MD, and Tetsuro Oshika, MD, where the physicians discussed such topics as patient selection, marking the patient before surgery, and alignment of the steep meridian. In another femtosecond class, experts covered the basics of creating a femtosecond LASIK flap with the IntraLase (Abbott Medical Optics, Santa Ana, Calif., USA) and VisuMax (Carl Zeiss Meditec, Jena, Germany) platforms. Attendees watched videos on possible complications, including suction loss, flap tears, uncooperative patients, and more. The afternoon sessions focused on phacotrabeculectomy and the refractive lenticule extraction (ReLEx) femtosecond laser surgery procedures. In the first session, an expert panel consisting of Ho Ching Lin, MD, Shamira Perera, MD, and Prof. Yao offered suggestions on how to select patients for the procedure, as well as how to manage those patients preoperatively. Finally, Donald Tan, MD, Cordelia Chan, MD, and Wang Yan, MD, discussed different surgical techniques used in the all- in-one femtosecond laser refractive procedure, including SMILE (small incision lenticule extraction) and pseudo-SMILE. CSCRS: Sophisticated surgery The 2012 APACRS meeting’s Combined Symposium of Cataract and Refractive Societies (CSCRS) gathered together a “very sophisticated group of surgeons” from all over the world, enlisting the very best representatives from the three participating societies— APACRS, the American Society of Cataract and Refractive Surgery (ASCRS), and the European Society of Cataract and Refractive Surgeons (ESCRS)—to explore this meeting’s theme of the “Sophisticated Surgeon”. Specifically, the symposium was designed to break down and examine each stage of what the symposium’s chair Prof. Barrett called “the very best way to do what [cataract and refractive surgeons] do”, i.e., looking at the strategies of the sophisticated surgeon Before, During, and After surgery. “There was a time when the U.S. was where new things were born,” said R. Doyle Stulting, APACRS - from page 5 continued on page 8