EyeWorld Asia-Pacific September 2012 Issue

48 September 2012 EWAP GLAUCOMA MasterClasses (Afternoon) MC06: Femto Flap Creation MC01: Femtophaco Cataract MC02: Glued IOL MC03: From FLEx to SMILE WL01: Basic Phaco with KITAROWetlab System Core Instructional Courses (Morning) CIC01: Phaco Fundamentals CIC02: Retinal Updates for Anterior Segment Surgeons CIC03: Ocular Trauma 11:00 AM - 01:00 PM 01:30 PM to 03:00 PM 03:30 PM to 05:00 PM 08:30 AM to 10:00 AM - All Core Instructional Courses and MasterClasses will be held at SUNTEC Singapore (included in meeting registration) - All Hands-on Wetlab sessions will be held at the Singapore National Eye Centre (separate charge applies) ORGANISED BY: AND CIC04: Optimizing Outcomes in Toric IOLs CIC05: Tips & Tricks for Successful Pterygium Surgery CIC06:What the Refractive Surgeon Needs to Know about Glaucoma 10:45 AM to12:15 PM MC04: Finer Points in IOL Fixation MC05: Advanced Biometry WL02: Basic Phaco with KITAROWetlab System WL03: Basic Phaco with KITAROWetlab System 12 July 2013 (Friday) WL04: Corneal Lamellar Surgery and Keratoplasty 04:00 PM - 06:00 PM Hands-onWetlab by the Asia Cornea Society and the Cornea Society Log on to www.2013apacrs.org for registration. 01:45 PM - 03:45 PM 03:45 PM - 05:45 PM Learn expert techniques from the best practitioners with our new series of Core Instructional Courses, MasterClasses and Hands-on Wetlabs! Hands-onWetlab 11 July 2013 (Thursday) 11 July 2013 (Thursday) Current recommendations Presently, Dr. Friedman recommends that if glaucoma is well controlled, even on medicines, it’s probably reasonable to take out the lens and see where the pressure ends up. “I would be cautious in the first 24 hours to try to make sure that pressure control is ideal, and the way you can do this is to consider giving oral Diamox [acetazolamide, Duramed Pharmaceuticals, Pomona, NY, USA] at the end of surgery,” he said. Using mannitol at the end of a case is another way to reduce pressure, he added. Dr. Friedman said he would not do a combined procedure for patients with controlled glaucoma, even to get patients currently on glaucoma medications off them. “I much prefer internal procedures so I might try that with a trabectome,” he said. The only time he does a combined surgery is when the cataract is really bothering the patient and creating a problem with glaucoma control, Dr. Friedman said. Dr. Chang has similar recommendations. For most ocular hypertensive or glaucoma patients with mild to moderate disease, he prefers to perform cataract surgery alone and to perform the glaucoma surgery, if necessary, once the eye has completely recovered from the cataract surgery, he said. “In my hands, this sequence yields better long-term success for the glaucoma surgery than a combined procedure. However, if a patient has severe glaucoma and is likely to have significant progression due to postoperative pressure spikes after cataract surgery, then a combined procedure would be more appropriate,” he added. Dr. Chang also said that minimally invasive glaucoma surgery may be a good temporizing procedure between medical therapy and traditional trabeculectomy in patients for whom the risk of trabeculectomy complication is high and in whom a modest IOP- lowering effect would suffice in controlling their glaucoma. EWAP References 1. Chang TC, Budenz DL, Dang T, Iwach AG, Kim WI, Li C, Liu A, Radhakrishnan S, Singh K. Long-term effect of Is cataract - from page 47 phacoemulsification on intraocular pressure using phakic fellow eye as control. Journal of Cataract & Refractive Surgery 2012;38(5):866-870. 2. Friedman DS, Bass EB, Congdon N, Jampel HD, Kempen JH, Levkovitch- Verbin H, Lubomski LH, Quigley H, Robinson KA. Surgical strategies for coexisting glaucoma and cataract; an evidence-based update. Ophthalmology 2002;109:1902-191. Editors’ note: Drs. Chang and Friedman have no financial interests related to this article. Contact information Chang: tachenchang@hotmail.com Friedman: 410-955-6052, david. friedman@jhu.edu