EyeWorld Asia-Pacific June 2015 Issue

65 EWAP NEWS & OPINION June 2015 statement, validates the negative. As a consequence of this, researchers should be open to any outcome any given study produces: if you’re certain of the outcome, Dr. Foulds said, it’s probably not worth undertaking. Grace under pressure At the live surgery symposium Sunday morning, Dandapani Ramamurthy, MD , India, demonstrated “superior surgical skill,” said Terry Kim, MD , U.S. Dr. Ramamurthy was operating on a 56-year-old patient with cataract, nuclear sclerosis 3+, using the Verion image guided system (Alcon, Fort Worth, Texas) and with a plan to implant a ReSTOR toric IOL (Alcon). The procedure was broadcast live from the operating theater of SNEC. At first the operation proceeded uneventfully. After a prerecorded video in which Dr. Ramamurthy demonstrated how the Verion platform is used for preop planning using a separate unit for image capture on which the various measurements in relation to ocular surface landmarks (primarily iris features and limbal vessels) are acquired, the surgeon proceeded with the operation. He began with two sideports— Dr. Ramamurthy prefers the bimanual I/A technique—and a 2.2-mm main port incision. After injecting viscoelastic to protect the endothelium, he proceeded with the capsulorhexis, aiming for a slightly smaller 5.5-mm rhexis following the 5.7-mm guide overlay. Dr. Kim, speaking from the panel on stage at the Suntec Singapore Convention & Exhibition Centre, noted how refreshing it was to see the lack of ink markings, which also saves some steps preop. Dr. Ramamurthy used a prechopper to divide the lens, then proceeded with phacoemulsification, successfully removing all the fragments with a CDE of 3.54. It was when he shifted to bimanual I/A that he noticed a slight complication: an anterior capsule rent. Fortunately, Dr. Ramamurthy said with complete calm as he almost casually continued with the case—barely slowing his pace though visibly increasing the precision of his movements—the rent is not along the intented axis of the IOL. He turned the Verion overlay on to show the desired lens axis; sure enough, the rent was offset by several degrees from the IOL axis. Inserting the IOL using the Intrepid AutoSert IOL injector (Alcon), Dr. Ramamurthy paused once or twice to reorient the injector to allow the IOL to unfold into position without touching the rent. Robert Ang, MD , Philippines, speaking from the panel, said the gentle unfolding of AcrySof platform IOLs was an advantage in cases like this. Dr. Kim agreed, adding that Dr. Dandapani’s successful maneuvering is a testament to the control the Autosert allows the surgeon during invention—as well as the surgeon’s skill. “You embody ‘grace under pressure,’” Dr. Kim said. He wondered when the rent had occurred as it was difficult to see in real time. He guessed that Dr. Ramamurthy’s tip had caught on the rhexis during I/A. Dr. Ramamurthy think this possible, but believes it more likely he had accidentally cut the anterior capsule during prechop. In any case, calmly deciding that the capsule integrity remained in spite of the rent, Dr. Ramamurthy completed the operation without further mishap. Chee Soon Phaik, MD , Singapore, also encountered some difficulty in one of her live surgery demonstrations Sunday morning— which isn’t all that surprising: Dr. Chee, said Ronald Yeoh, MD, Singapore, from the panel, tended to choose the most difficult cases for the audience’s education—and entertainment. Operating on a 64-year-old patient high myope (an eye with an axial length of 26.70 mm) with a posterior polar cataract proved even more complicated than Dr. Chee expected, simply because there was no way to be sure of the density of the posterior polar cataract, and she had expected a softer cataract. Nonetheless, Dr. Chee demonstrated characteristic skill as she slowly worked her way through the cataract. In this case, Dr. Chee used the Victus femtosecond laser platform (Bausch + Lomb, B+L, Bridgewater, N.J.), presectioning the cataract using the spider pattern. After completing the rhexis, she proceeded with viscodissection, injecting dispersive viscoelastic under the anterior capsule up to the equator and proceeding with peripheral chop, first debulking the cortical material, leaving the central portion for last. At the same live surgery symposium, Mohan Rajan, MD , India, used the Stellaris PC platform (B+L) to operate on a cataract, nuclear sclerosis 3+ in a 69-year- old patient. It was difficult to tell which he was most excited about: the Stellaris (a “fantastic machine,” he said), the “amazing” enVista IOL (B+L) he implanted, the fact that he was operating in SNEC for the first time—praising the facilities and staff—or that it was his 100th live surgery. In any case, Dr. Rajan’s delight was infectious. “Of all the live surgeries I’ve done, I will keep this for posterity,” he said. Live surgery was also performed by Allan Fong, MD , Singapore, and the panel was moderated by Ti Seng Ei, MD , Singapore. EWAP Editors’ note: The live surgery sessions were sponsored by Alcon and B+L.