EyeWorld Asia-Pacific September 2015 Issue

55 EWAP NEWS & OPINION September 2015 Live reports from the 28 th APACRS Annual Meeting in Kuala Lumpur, Malaysia by EyeWorld Staff Wednesday, 5 August 2015 The first day of the APACRS annual meeting began with symposia specifically highlighting glaucoma topics, the APACRS MasterClasses series, wetlabs, and several other sessions. At the wetlab sessions, attendees had the opportunity to experience realistic cataract surgery simulated using the KITARO phaco wetlab system. ‘Misadventures,’ MSICS among new MasterClasses MasterClasses offered for the first time at this meeting focused on complications during cataract surgery and the essential, but often overlooked, technique of manual small incision cataract surgery (MSICS). There are 2 surefire ways to avoid complications during cataract surgery, according to Arup Chakrabarti, MD , Kerala, India: Not operating at all, and living in denial about complications. However, Dr. Chakrabarti, was speaking to a roomful of cataract surgeons at “Phaco Misadventures,” one of the new MasterClasses. “All of us operate, all of us have complications,” he said. “Ego should never come into it.” The MasterClass covered 7 types of “misadventure”: phaco burns, capsular mishaps, open posterior capsule situations, iris prolapse, zonular loss, IOL rescue, and “potpourris” of complications. Dr. Chakrabarti presented one of his own cases of phaco burn. In what would otherwise have been a routine case, the fluid infusion had stopped, filling the anterior chamber with air bubbles instead of BSS. Dr. Chakrabarti said that air bubbles occur sporadically in routine cases, generally absorbed during phaco. He had not taken into account the possibility of what actually occurred in this case: the phaco handpiece had completely dried out. Without fluid to dissipate the heat generated by the handpiece, phaco caused a burn at the incision. Dr. Chakrabarti managed the case by migrating superiorly to create a new corneal incision through which to continue the procedure. The additional incision meant that he also had to be careful not to allow the anterior chamber to shallow. Frequent injections of dispersive OVD avoided further complication. Finally, Dr. Chakrabarti augmented the leaky phaco burned incision with sutures. Initially, the patient experienced high astigmatism postop, but the astigmatism eventually went down and the patient’s visual outcomes were otherwise good. Dr. Chakrabarti went on to describe 3 cases in which the surgeon should be particularly vigilant against phaco burns. First, in patients with deep-set eyes, surgeons should approach from the temporal side to avoid a too-vertical placement of the phaco handpiece. Second, the presence of cloudy lens milk in the anterior chamber suggests aspiration is not sufficient; therefore, aspiration might also not be sufficient for heat dissipation. In these cases the surgeon should increase aspiration. Finally, as in Dr. Chakrabarti’s case, surgeons should be wary of occlusion blockage. A second new cataract surgery MasterClass highlighted an oft overlooked technique in cataract surgery. More than just an “alternate to phaco in many communities,” Sanduk Ruit, MD , Kathmandu, Nepal, said that the technique—manual small incision cataract surgery (MSICS)—should be a mandatory skill for cataract surgeons in addition to phaco. The continued on page 56