EyeWorld Asia-Pacific December 2019 Issue

EWAP DECEMBER 2019 27 SECONDARY FEATURE by Shimada et al. published in the #OGTKECP ,QWTPCN QH 1RJVJCNOQNQI[ 2 The paper reported on the use of 10% povidone iodine, diluted {äÝ Ì ä°Óx¯] Ì ÀÀ}>Ìi Ìi ocular surface. The researchers irrigated every 20 seconds, resulting in a “very clean” and “bacteria free” surgical site. Dr. Oshika emphasized that at 0.25% povidone iodine, the solution is safe and effective in preventing endophthalmitis after more advanced end of the IOL evolutionary scale. Unfortunately, toric IOL misalignment may jeopardize these IOLs’ correcting effects in patients, Dr. Oshika said. i «ÀiÃiÌi` > Ã«iVwV case of a 54-year-old female pediatrician presenting with preoperative astigmatism of qÓ°nn >Ì £näc° 7Ì> «> to utilize toric IOL, targeting 85°, the patient actually postoperatively measured at Referring back to the case, Dr. Oshika resolved the female pediatrician’s astigmatism to qä°Çx ƂÝ £näc° A tip to reducing misalignment, Dr. Oshika said, is to wait until complete unfolding occurs as some lenses are very slow to open. In another study in which Dr. Oshika and his colleagues compared the incidence of repositioning surgery in three different toric IOLs, 4 he noted that unfolding time is “a very important factor affecting rotational stability >vÌiÀ ÃÕÀ}iÀÞ\» /i " Ã Ì>Ì unfolded more slowly tended to be very unstable; they would rotate while washout was being performed behind the lens. Furthermore, they found that the largest rotation occurred from the end of surgery to 1 hour after; after 1 hour, IOLs tended to remain very stable. Thus, they instruct patients not to walk around but instead remain at rest for 1 hour after surgery. There’s no need to have the patient lie down, Dr. Oshika V>Àwi`Æ>Û} Ìi ÃÌ > chair will do. These constitute Dr. Oshika’s ÌÀ` Ì>ii iÃÃ>}i\ Repositioning surgery is rare, but required in some cases; repositioning can be easily done under irrigation 1–3 weeks after primary surgery; resting 1 hour after surgery is critical to avoid misalignment. Dr. Oshika described ways to stabilize unstable toric IOLs. He cited a paper by Gimbel et al. in 2013, 6 which detailed how to stabilize unstable toric IOLs. ocular surgery. The effectiveness of povidone iodine depends on the amount of free iodine released by the solution—the most, he said, is released by a 0.1% concentration; a 0.25% dilution becomes further diluted to about 0.1% at the surgical site. This was his second take- i iÃÃ>}i\ ÌÀ>«iÀ>ÌÛi use of diluted povidone iodine solution is safe and effective to prevent endophthalmitis after ocular surgery. Toric IOL misalignment In the last few decades, surgeons have seen IOLs rapidly evolve. Toric IOLs are at the qx°ä ƂÝ £näcpÌi >ÃÌ}>ÌÃ had increased. Dr. Oshika then raised the question of how often repositioning surgery is performed, and when it should be done. In a “quick large-scale study,” 3 Dr. Oshika determined that surgical repositioning of toric IOLs was performed in 42 out of 6,431 cases (0.653%). Timing matters as well, with repositioning surgery performed 1 week after cataract surgery resulting in better outcomes >` iÃÃ Ã>}iÌ° 7i repositioning is performed immediately after cataract surgery, the IOL tends to rotate back to the misaligned position. He then went on to describe different optic capture ÌiVµÕiÃ\ «ÃÌiÀÀ V>«ÌÕÀi] which places the optic in the bag and the haptics in the sulcus; and reverse optic capture. For the latter, Gimbel further described the haptic tuck 7 as a useful technique in cases where the posterior capsule is broken. Dr. Oshika focused on reverse optic capture, being useful in the case of very unstable toric IOLs or a broken posterior capsule. Surgical videos in Dr. Oshika’s keynote showed very clear surgical techniques for reverse optic capture. /Ã Ü>ÃÃ w> Ì>ii iÃÃ>}i\ ,iÛiÀÃi «ÌV V>«ÌÕÀi is useful in cases of very unstable toric IOL or in case of broken posterior capsule. References 1. Oshika T, Ohashi Y. Endophthalmitis >vÌiÀ V>Ì>À>VÌ ÃÕÀ}iÀÞ\ vviVÌ v Li` the-lens washout. , %CVCTCEV 4GHTCEV 5WTI Óä£Ç ÛÆ{Î££®\£Îq£{äx° 2. Shimada H, et al. Reduction of Anterior Chamber Contamination Rate after Cataract Surgery by Intraoperative Surface Irrigation with 0.25% Povidone-iodine. #O , 1RJVJCNOQN Óä££Æ£x£\££q£Ç° 3. Oshika T, et al. Incidence and Outcomes of Repositioning Surgery to Correct Misalignment of Toric Intraocular Lenses. 1RJVJCNOQNQI[ 2018 >Æ£Óx£®\Î£qÎx° 4. Oshika T, et al. Comparison of incidence of repositioning surgery to correct misalignment with three toric intraocular lenses. 'WT , 1RJVJCNOQN Óä£ >À È\ ££ÓäÈÇÓ££nÎ{{È° `\ 10.1177/1120672119834469. [Epub ahead of print] x° Õi 9] />i>À> ] "Ã> /° ƂÝÃ Ã>}iÌ v ÌÀV ÌÀ>VÕ>À iÃ\ Placement error and postoperative rotation. Ophthalmology . 2017 -i«Æ£Ó{®\£{Ó{£{Óx° 6. Gimbel HV, Amritanand A. Reverse Optic Capture to Stabilize a Toric Intraocular Lens. %CUG 4GR 1RJVJCNOQNQI[ Óä£ÎÆ{\£Înq£{Î° 7. Gimbel HV. Haptic tuck for reverse optic capture of a single-piece acrylic toric or other single-piece acrylic intraocular lens. , %CVCTCEV 4GHTCEV 5WTI Óä£Æ{x\£Óxq£Ó°