EyeWorld Asia-Pacific December 2016 Issue

December 2016 EWAP NEWS & OPINION 61 MEETING reporter Reporting from the ESCRS Congress by EyeWorld Staff continued on page 62 Reporting from the 2016 ESCRS Congress, September 10–14, Copenhagen, Denmark O pening ceremony and Ridley Medal Lecture The opening ceremony included welcome addresses from the ESCRS president, David Spalton, MD , London, and the local host, Thomas Olsen, MD , Copenhagen. In the past year, ESCRS has had its two most successful meetings ever, Dr. Spalton said, referencing its Barcelona Annual Congress, which saw more than 8,000 delegates from 127 countries, and the Athens Winter Meeting, which had more than 2,000 delegates from 73 countries. Additionally, the ESCRS Congress is now the largest meeting outside the U.S., he said. He discussed the ESCRS’ charitable objectives, including education, training, research, and direct donations. “Training is at the heart of our work,” Dr. Spalton said, also mentioning the ESCRS observership program and exchange with ASCRS. To conclude his welcome address, Dr. Spalton acknowledged the death of Peter Barry, MD, earlier this year. Dr. Barry was a member of ESCRS since its inception, Dr. Spalton said, and was dedicated to the training and education of young ophthalmologists. In his memory, the ESCRS will have the Peter Barry ESCRS Travel Fellowship, which will give a trainee ophthalmologist the opportunity to study anywhere abroad for 1 year. The first award will be presented in 2017. José Güell, MD, PhD , Barcelona, Spain, presented the Ridley Medal Lecture on “30 years of ‘iris claw’ IOLs.” He described many studies, options, techniques, and advantages, particularly related to using the Artisan Aphakia IOL and Artisan/Artiflex phakic IOLs (Ophtec, Groningen, Netherlands). Dr. Güell discussed options for aphakia and inadequate capsular support, which include angle-supported IOLs, transscleral or iris-sutured PC IOLs, or iris- fixated IOLs. He then spoke about the concept of “iris claw,” which he said was first introduced by Jan Worst, MD, in the 1970s, and is implanted and then fixated to the iris. The Artisan Aphakia model shows that secondary iris claw IOL implantation in aphakic eyes appears to be an effective, predictable, and safe procedure, Dr. Güell said. The incidence of significant complications appears acceptable, with an endothelial cell loss around 2% per year, he added. Comparison of results with sclera-fixated IOLs is difficult, but most available data favors Artisan because of the surgical time and the severity of the complications. Additionally, Dr. Güell noted the need for prospective, long-term, multicenter studies for evaluating anterior vs. posterior fixation and irisfixated vs. sclera-fixated IOLs. Dr. Güell also discussed the “phakic” models of these lenses, or the Artisan/Artiflex IOLs used to correct a range of refractive errors on phakic eyes. In summary, he said that these are part of the standard surgical options for the correction of primary and secondary refractive errors. Despite some implantation difficulties, many of which are surgeon dependent, the Artisan/ Artiflex are Dr. Güell’s favorite phakic IOLs, and he expects that in the near future these could improve outcomes. Astigmatism management A symposium focused on astigmatism management in cataract surgery, with presentations on measuring astigmatism, calculating astigmatic correction, intraoperative aberrometry, managing irregular astigmatism, marking the axis, and correcting misaligned IOLs and astigmatic surprises. Douglas Koch, MD , Houston, spoke about measuring astigmatism. First, he questioned “What is the threshold for correction?” For monofocal IOLs, Dr. Koch said it could be anywhere from 0.5 to 0.75 D, but “multifocal IOLs are a different story,” he said. You need less than 0.5 D. “It doesn’t take much to disrupt the optical system of a multifocal IOL,” he said. Dr. Koch stressed the importance of figuring out your own results. Optimize your lens constants, he said, because patients will not see the benefit if the sphere is off. He also said to double check your measurements. Knowing the surgically induced astigmatism is critical. Examining at least three data points is key, Dr. Koch said, referencing optical biometry for power, topography for alignment, and glasses. “If you have discrepancies in your measurements, remeasure,” he said. To measure the anterior cornea, topography becomes important. Dr. Koch described using both reflection devices and elevation-based devices. Factoring in the posterior corneal astigmatism and being