EyeWorld Asia-Pacific September 2018 Issue

amining the lens in the cartridge, pay attention to the orientation of the holes in the haptics to ensure that the lens orientation is correct. Respect astigmatism. Avoid using it in patients with significant higher order aberra- tions and untreated ocular surface disorders. Meanwhile, the live surgery symposium sponsored by Johnson & Johnson Vision was chaired by Dr. Fam together with Pannet Pangputhipong, MD , Bangkok, Thailand, Graham Barrett, MD , Perth, Australia, Ronald Yeoh, MD , Singapore, and Adisak Tri- navarat, MD , Bangkok, Thailand. Soon Phaik Chee, MD , Sin- gapore, and Mahipal Sachdev, MD , New Delhi, India, performed surgeries live from the Chiang Mai University Hospital during the ses- sion. The symposium showcased the CATALYS laser, the WHITESTAR Signature PRO phaco system, and TECNIS IOLs. Dr. Chee’s case was implanta- tion of a TECNIS lens. She first showed the pre-surgery laser process using the CATALYS laser. During discussion among panelists, Dr. Yeoh commented that the pupil looked slightly small and he ques- tioned how to handle a small pupil with the CATALYS. Dr. Fam said he sometimes finds himself in a situation when he can’t put the eye in the interface because an Asian eye might be too small. Then, you would have to use conventional phaco, he said. Most of the time, Dr. Fam makes sure the pupil is dilated before bringing it onto the CATALYS. Dr. Yeoh added that you need to dilate the pupils in the clinic ahead of time to make sure they dilate. Dr. Fam also said he will try to get the biggest CCC possible. Dr. Chee then went through the surgery where she implanted a Symfony lens, starting with the side port incision and noting that she uses a 2-mm incision. The lens was denser than it looked, Dr. Chee and panelists commented. Dr. Yeoh suggested starting with peristaltic vacuum and later switching to Venturi to move the fragments quickly. Following the successful sur- gery, Dr. Yeoh commented that the 8-segment fragmentation pattern helped make it easy to remove the cataract safely. Addressing post-surgery ques- tions from the panelists, Dr. Chee discussed how she prefers manual incisions to femtosecond incisions. “My manual incisions usually give me better comfort,” she said, noting that she usually doesn’t want to place the incision exactly at the horizontal meridian but prefers to offset it a bit. She noted that she usually observes each in- dividual patient and what she sees will help her determine placement for that particular patient. When using femtosecond incisions, Dr. Chee noted that an important factor is predictability. But she finds she doesn’t need the femtosecond incisions and that her manual incisions are self-sealing and safe for her patients. During the session, Dr. Sachdev also implanted a TECNIS Symfony lens. Finally, chairs Dr. Pangputhip- ong, Dr. Barrett, Dr. Yeoh, and Cesar Espiritu, MD , Manila, Philippines, led the video sym- posium sponsored by Alcon. Speakers on the program included Dandapani Rama- murthy, MD, Coimbatore, India, Michael Lawless, MD, Sydney, Australia, David Lubeck, MD, Homewood, Illinois, U.S., and Pichit Naripthaphan, MD, Bangkok, Thailand. Dr. Naripthaphan first shared a presentation on “Efficiency and Efficacy,” discussing elegance in dense nucleus removal. Show- ing surgical video, he particularly offered tips on how to maintain the chamber after implantation of a premium lens. Dr. Nariptha- phan suggested using a wet sponge to help maintain the anterior chamber when taking out I/A. In a premium lens, if the chamber collapses, the lens will pop out and the axis will rotate, he said. At the end of the surgery, he al- ways puts a protective coat of OVD on the surface. When you take out the speculum, be very gentle, he added. His take-home messages in- cluded a variety of tips: LenSx can make your life easier; Centurion with Balance Tip is superb for hard nucleus; and stromal hydration be- fore OVD removal can help better maintain the chamber. Dr. Ramamurthy shared several challenging cases and how he handled them. He particularly discussed a hard brown nuclear cataract, a soft cataract, and a post- traumatic subluxated cataract. During his case presentation, Dr. Ramamurthy noted the value of using the LenSx laser platform. You can tailor-make the rhexis exactly where you want it with the tech- nology, he said. There is no counter traction, so it may be challeng- ing to make the rhexis manually (particularly in the post traumatic subluxated cataract case). “The greatest advantage of the LenSx is the ability to make the rhexis exactly where you want,” he said. So, you have a well-centered lens and well-centered rhexis at the end of the surgery. Dr. Ramamurthy added that 31st APACRS – from page 67