EyeWorld Asia-Pacific September 2015 Issue

63 EWAP NEWS & OPINION September 2015 Dr. Shetty offered further incentive: “Always believe that the spur of the moment ideas are the only ones that win the Nobel Prize....and I think one of these could be the pathbreaking work for many of you.” Top gun: The best of the best In Saturday’s closing session, top gun surgeons from around the region competed to give attendees the best pearls for cataract and refractive surgery. Through video presentations, each surgeon presented a practical tip distilled from years of experience that attendees can bring home and use immediately in their next visit to the operating room. Dr. Hutauruk opened the session with a pearl for performing iridectomies when implanting phakic IOLs. Most surgeons perform a laser peripheral iridotomy 1-2 weeks before phakic IOL implantation, but these are often difficult to perform in Asian eyes because of the dark iris, he said. In these cases, he prefers to perform a surgical iridectomy during implantation of the lens. Using scissors to create the iridectomy can lead to a larger opening in the iris than expected, so Dr. Hutauruk presented his method of performing an iridectomy with a vitrectomy probe. Set the vitrectomy mode to “I/A cut,” use a cutting speed of 500, and a vacuum of 300, 400, or 500 for a 20G, 23G, or 25G probe, respectively, he said. Laser refractive surgery is 99% boredom and 1% terror, said Khairidzan Mohammed Kamal, MD , Kuala Lumpur, Malaysia. When performing LASIK with a microkeratome, the 1% of patients who cause terror in the surgeon are those that have small eyes or interpalpebral fissures, are sensitive to light or touch, are anxious, or who exhibit intraoperative blepharospasm. These issues can be a “recipe for disaster” during the microkeratome pass, Dr. Kamal said. In these cases, Dr. Kamal advised attendees to be prepared preoperatively to switch to surface ablation to avoid disaster. Hungwon Tchah, MD , Seoul, South Korea, presented a pearl for lifting the flap during LASIK enhancements. Lifting the flap is a delicate procedure that can cause an epithelial tear that can lead to epithelial ingrowth if not done properly, Dr. Tchah said. The best way he has found to prevent epithelial tear, is to “unzip” the flap before lifting it. He makes a small opening in the peripheral area of the flap, opens it with a Sinskey hook, and then slowly unzips the rest of the flap from the initial opening. So far, Dr. Tchah said he has seen no cases of epithelial ingrowth when using this technique. Ekktet Chansue, MD , Bangkok, Thailand, offered a pearl for performing small-incision lenticule extraction (SMILE). The number one problem for beginner SMILE surgeons is dissecting the wrong plane, Dr. Chansue said. To make sure you dissect the right plane, after laser treatment, visualize the edge of the lenticule before you start dissection, he said. Finding the edge of the lenticule is the most important part of the surgery, he said, and if you can’t find it in 10 seconds, it isn’t there. Rather than searching around for it, point the hook up and try to find it under the cap, he said. During LASIK, the flap is reflected and laid on the superior sclera, but this is difficult to do in Asian eyes, said Chan Wing Kwong, MD , Singapore, because there is not enough room on the sclera. In these eyes, the flap ends up sitting on the speculum and often dries out. His pearl was to “tuck the flap” under the upper lid in these cases. Tucking the flap helps to eliminate flap desiccation that can occur and ensures full reflection of the flap during ablation. After replacing the flap, irrigate aggressively before concluding surgery, he added. Sri Ganesh, MD , Bangalore, India, closed the refractive portion of the session with a pearl for marking and compensating for cyclotorsion when correcting a cylindrical error during SMILE. At the conclusion of the presentations, the audience voted for their favorite surgical pearls. Dr. Ganesh had presented the best refractive surgery pearl for the second year in a row. Meanwhile, the tip presented by Y.C. Lee, MD , Ipoh, Malaysia, was voted best cataract surgery pearl of the meeting. There was one pearl, however, that was missing from the session: never leave your wingman. EWAP