EyeWorld Asia-Pacific September 2016 Issue

3 EWAP September 2016 Letter from the Guest Editor Dear Friends H ealthy controversy is a positive step in ensuring progress; it compels ophthalmologists to critically assess and refine their performance, enables innovators to come up with newer ideas and stimulate research to circumvent any controversial approach that may currently exist. As ophthalmic science continues to progress, a multitude of diagnostic and treatment options now exist. Each of these may work in a given setting, and the choice rests with the surgeon depending on several factors such as novelty, familiarity, availability, scientific basis and, lastly, the cost. It follows from this, that controversy inevitably arises as to the “best” intervention available. This issue discusses several such “Controversies”. The use of intracameral antibiotics is steadily rising among cataract surgeons worldwide. It has the definite promise of reducing risk of endophthalmitis 1 , and yet, there are several concerns that need to be addressed. Most of the intracameral antibiotics are not available as a commercial preparation, and issues related to pharmacy compounding, dilution errors surface from time to time. Intracameral cefuroxime is not available as a commercial preparation, except for a few countries. The recent emergence of a visually devastating complication (hemorrhagic occlusive retinal vasculitis (HORV) raises serious questions on the safety of intracameral vancomycin. Moxifloxacin, a fourth generation fluoroquinolone, appears to be safe and effective so far. The sterile, preservative free, commercially available moxifloxacin is becoming the choice of many surgeons. Personally speaking, I have been using intracameral antibiotics for a long time, and have shifted from vancomycin to intracameral moxifloxacin for the last 9 years. It is certain, that in the times to come, the use of intracameral antibiotics will be adopted by many more. We hope that we can get safer, more efficacious, and easier to use preparations in the future. Immediately Sequential Bilateral Cataract Surgery has always been a matter of great controversy. A lot of surgeons, in the more developed part of the world, have at least started closely looking at this option. The proponents of this approach cite convenience and cost-effectivity as some of the reasons favoring it. While this may be true for some of Western countries, it may not be relevant to other parts of the world. In the developing world, potential endophthalmitis remains a major safety concern with this approach. Secondly, in many parts of the world, we are still striving to achieve the goal of consistency in meeting our targeted refraction and visual outcomes. It seems logical to assess the technical, functional and refractive outcome in one eye so that it gives us a chance to modify the surgical plan/technique for the other eye. Having said that, there are few select situations, like those who need administration of general anesthesia or have high-risk systemic features, where immediate sequential bilateral cataract surgery does have a role. But, for the population at large, delaying the second eye surgery at least by a few weeks seems to be the preference of the majority. Astigmatism correction at the time of surgery is becoming an integral part of cataract management. Toric IOLs have been a game changer of sorts here. Compared to other options such as LRIs, incisional methods, and laser refractive surgery, they seem to offer more predictable and precise outcomes. Moreover, it is a part of routine cataract surgical procedure and does not involve additional learning skills or instrumentation for the surgeon. Finally, the frontier of refractive surgery is a fast progressing, exciting one. Modern-era LASIK has become one of the safest and most effective eye surgeries. And yet, there is a long way to go in terms of enhancing visual quality and reducing risks of side effects such as dry eye and ectasia. Newer treatment paradigms such as topography-guided procedures bring the hope of offering better visual qualities in a wider group of patients, including those with irregular corneas (e.g., keratoconus). At the same time, ReLex SMILE promises to be the next procedure on the horizon. It has a theoretical benefit of better preserving the biomechanical strength of the cornea and potentially reducing side effects such as dry eyes. However, it also has its own set of limitations, and at this point in time, we await more and more systematic, scientific studies for this procedure. Until then, LASIK remains the most widely sought after option for refractive surgeons. These are exciting times for clinicians and scientists. For, in the end, it is through a thorough dissection of controversial clinical and surgical modalities that we will find the path forward. Reference 1. ESCRS Endophthalmitis Study Group. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg. 2007;33:978–988. Warmest regards, Abhay Vasavada Guest 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 Ronald YEOH, Singapore S. NATARAJAN, India Sri GANESH, India YAO Ke, China Y.C. LEE, Malaysia