EyeWorld Asia-Pacific September 2015 Issue

61 EWAP NEWS & OPINION September 2015 nowadays and we have to make use of them, he said. Examinations with the many technologies available will give the patient actual proof of what he or she does have or doesn’t have. Those diagnostics are the same ones that will help you postoperatively, Dr. Cabrera said, because if you have an unhappy patient, you can use the diagnostics to show them the actual results. Dr. Cabrera again stressed the importance of really counseling the patient prior to surgery and explaining all possible results. If you don’t mention something that the patient experiences later then it becomes a complication, he said. But if you have discussed it with them before then it’s an expectation. Saturday, 8 August 2015 The final day of the APACRS annual meeting had 3 main symposia and several free paper sessions. ‘Court Martial’ session judges presenters on handling a variety of cases The first session was the “Court Martial” session, during which a judge and jury voted on whether presenters were “guilty” or “not guilty” in the way they handled a number of different situations. This year, Abhay Vasavada, MD, Ahmedabad, India, served as the judge, with jury members Pannet Pangputhipong, MD , Bangkok, Thailand, Sri Ganesh, M D, Bangalore, India, S. Natarajan, MD , Mumbai, India, Johan Hutauruk, MD , Jakarta, Indonesia, Jalal Ahmed, MD , Dhaka, Bangladesh, Ritika Sachdev, MD , Delhi, India, and M. Nazrul Islam, MD, Dhaka, Bangladesh. Chitra Ramamurthy, MD, flap. It’s important to completely remove the epithelium from the undersurface of the flap, she said, because if you’re going to put it back, it could result in epithelial ingrowth. Another important thing is to remove 1 to 2 mm of epithelium from around the flap area. In these situations where there is a badly displaced flap, Dr. Mohan said, normally you want to put a suture in, which she did. The patient was doing well postoperatively. In her second case, Dr. Mohan had a flap shift with striae on the third day postop. There was also an exposed stromal bed. Before removing the flap, all epithelial cells on the surface of the stroma were completely removed. The striae were quite dense, Dr. Mohan said, and the whole flap was twisted toward the upper side. She decided to remove the epithelium completely. It’s impossible to remove striae without removing the epithelium, she said, because it tends to grow into the crevices. Dr. Mohan opted to put in sutures, and pre and post op results were excellent for her patient. During the “trial” portion, the “prosecutor,” Dr. Biswas, tried to Coimbatore, India, served as the “defense” for those presenting their cases, and Partha Biswas, MD, Kolkata, India, was the public prosecutor. Sujatha Mohan, MD , Chennai, India, was the first presenter on trial, detailing cases of displaced flap. The first case had a displaced flap with the stroma exposed and was referred to Dr. Mohan for management. After removing the epithelium from the stroma, she tried to unscroll the undermine Dr. Mohan’s decision- making. I think the suturing was absolutely unrequired because the flap striae very well aligned to the stromal bed, he said. She could have just placed a contact lens over this eye, Dr. Biswas said. But Dr. Ramamurthy defended the decisions in this case. “She has done a great job,” Dr. Ramamurthy said. And this is a “textbook picture of how a displaced flap needs to be repositioned.” Dr. Mohan was constantly conscious of epithelial ingrowth, the defense argued. An opinion from audience member Fam Han Bor, MD , Singapore, also offered support for the presenter. He said he believes she did a great job because if you don’t stitch this well, there will likely be a chance of ingrowth and flap displacement again. In this case, 6 of 7 jury members said they believed the presenter was “not guilty.” And the judge also ultimately decided that she was not guilty. Don’t discard! Towards ‘bespoke’ medicine Modern society has often been criticized for its wastefulness, yet it isn’t likely to have occurred to the average ophthalmologist just how wasteful their respective practices can be—much less given a thought continued on page 62