EyeWorld Asia-Pacific March 2015 Issue

3 EWAP CONTENTS March 2015 Letter from the Editor Dear Friends T he occurrence of endophthalmitis after cataract surgery remains our deepest fear. In this issue we discuss the various options for prophylaxis and in particular examine the use of intracameral antibiotics. The landmark study performed by ESCRS several years ago clearly showed a benefit from the prophylactic use of intracameral antibiotics and their use is common practice in Europe and the Asia-Pacific. Recent surveys in the U.S. show an increasing trend to using intracameral antibiotics but the usage remains significantly less in other regions. This is partly related to the lack of commercially available preparations of cefuroxime and surgeons’ concern about the potential for TASS from improperly prepared formulations. Nevertheless direct injection of moxyfloxacin prepared from topical Vigamox (Alcon, Fort Worth/Hünenberg, Switzerland) is used quite frequently in the U.S. as an alternative. Personally, I had been using antibiotics in the infusion, either vancomycin alone or combined with gentamycin, for many years prior to the recent popularity of intracameral cefuroxime, although there are theoretical reasons why direct injection may be preferred there are many surgeons who successfully use this strategy for prophylaxis and the broad spectrum is attractive. The numbers required for direct comparison of different modes of delivery of intracameral antibiotics as well as different formulations are enormous and it is unlikely that further study will be carried out. Individual surgeons therefore have to make their choice based not only on evidence but their experience in preventing this most serious complication. Although much rarer than endophthalmitis, unexpected refractive outcomes are far more frequent. The challenges of unusually short and long eyes have largely been addressed with modifications of axial length and newer formulae. Toric lenses are particularly challenging as one has to consider the magnitude and axis of the required cylinder correction in addition to the spherical equivalent power. The role of the posterior cornea has largely been ignored in calculations and this can be addressed by regression-based nomograms or direct measurements with devices capable of measuring the posterior cornea. An alternative is the calculator I have developed, which contains an integral calculation of the posterior cornea providing a greater predictability with toric intraocular lenses. The toric cam app and axis marker I have developed are a simple but effective solution to improving alignment of intraocular lenses on the correct axis and I hope our readers will find both the calculator and toric cam approach helpful in their practice. Warmest regards Graham Barrett Chief Medical Editor EyeWorld Asia-Pacific EYEWORLD ASIA-PACIFIC EDITORIAL BOARD C HIEF MEDICAL EDITOR Graham BARRETT, Australia MEMBERS Abhay VASAVADA, India ANG Chong Lye, Singapore CHAN Wing Kwong, Singapore CHEE Soon Phaik, Singapore Choun-Ki JOO, Korea Hiroko BISSEN-MIYAJIMA, Japan ASIA-PACIFIC CHINA EDITION Editors-in-Chief ZHAO Jialiang ZHAO Kan Xing Deputy Editor HE Shouzhi Assistant Editor ZHOU Qi ASIA-PACIFIC INDIA EDITION Regional Managing Editor S. NATARAJAN ASIA-PACIFIC KOREA EDITION Regional Editor-in-Chief Hungwon TCHAH Regional Managing Editor Chul Young CHOI Hungwon TCHAH, Korea John CHANG, Hong Kong Johan HUTAURUK, Indonesia Kimiya SHIMIZU, Japan Pannet PANGPUTHIPONG, Thailand Prin ROJANAPONGPUN, Thailand Ronald YEOH, Singapore S. NATARAJAN, India YAO Ke, China Y.C. LEE, Malaysia