EyeWorld Asia-Pacific September 2019 Issue

EWAP SEPTEMBER 2019 71 omy, capsule collagen is con- verted to amorphous collagen with increased elasticity. The miLOOP micro-interventional device, presented by Matteo Piovella, MD , offers advantages such as reducing phaco ener- gy by 53% and decreasing the rate of surgical complications. Gerd Auffarth, MD , discussed straylight, a veil of light over the retina due to scattered light from the eye optical media, which is proportionally dependent on glistenings. Lastly, Michael Knorz, MD , discussed patient satisfaction with trifocal IOLs: a “>œÀˆÌÞ œv «>̈i˜Ìà ՘Ã>̈Ãwi` after their surgical procedure experienced residual refractive error. In IOL exchange, Dr. Knorz recommended exchange in the `œ“ˆ˜>˜Ì iÞi wÀÃÌ] VœÀÀiV̈˜} vœÀ distance. UMAMI: Something for Everyone Proves to be Just That Topics discussed at this session Thursday ranged from opti- cal bench testing of extended depth of focus (EDOF) lenses compared to trifocals, to surgical pearls for implanting multifo- cal intraocular lenses (IOLs) in post-refractive surgery patient, ̜ ˜œÛi ÌÀi>̓i˜Ìà vœÀ yœ>ÌiÀð In comparison to trifocal IOLs, the optical performance of the EDOF IOLs was less suscep- tible to the effect of decentra- tion, said Chul Young Choi, MD . Although the two EDOF IOLs tested (Tecnis Symfony and AT LARA) share similarities in their œ«ÌˆV> «Àœ«iÀ̈iÃ] ºÌ…i “>ˆ˜ `ˆv - ference lies in their performance with respect to spherical aberra- tion,” he said. He recommends avoiding patients with larger pupil size when using EDOF lenses. In a retrospective case comparison of 228 eyes (158 patients) where 64 eyes had undergone previous refractive surgery (164 eyes had no previ- ous refractive surgery), Shmuel Levinger, MD , developed a formula for multifocal IOL calcu- lation in post-refractive patients ̅>Ì ˆÃ L>Ãi` œvv > “œ`ˆwV>̈œ˜ of the SRK/T calculation. In post-myopic patients with –1 D to –3 D, add 1 D to the SRK/T calculation, and if the myopia is > –3 D, add 1.5 D to the SRK/T IOL calculation. In the post-hy- peropic patient with +1 D to +3 D, reduce by 1 D the SRK/T cal- culation and for those with more than +3 D, use a reduction of 1.5 D to the SRK/T calculation. º œÀ «œÃ̇ÀivÀ>V̈Ûi «> - tients, target a refraction of micro monovision –0.5 D in the non-dominant eye to improve near vision,” he said. The incidence of posterior capsule rupture in posterior pole cataract can be as high as 36%, said Jeewan Titiyal, MD . In these instances, avoid hydro- dissection and use hydrodelin- eation to create a cushion of cortical matter. There is a role for optical coherence tomography (OCT) in posterior polar cataract, both in the preop and intraop portions. The decision to use hy- dro procedures should be based on the extent of opacity and posterior capsule status. In fem- tosecond laser, intraoperative OCT can be used to customize nucleotomy with adequate safe- ty margins to enhance safety. Mahbubur Rahman Chowd- hury, MBBS ] ÀiVœ““i˜`i` w˜> IOL placement for patients with astigmatism be about 20° off axis as the IOL will rotate during OVD removal. º7>ˆÌ vœÀ ̅i w˜> «œÃˆÌˆœ˜ - ing until the OVD is fully re- moved,” he said. When it comes to treating yœ>ÌiÀÃ] David Lubeck, MD , Ã>ˆ` Óä£Ç Ü>à > º…Õ}i» Þi>À >à À>ÃÃi V>ÃÈwi` yœ>ÌiÀ ÌÞ«ià based on origin; laser photo treatment concentrates on types 2 and 3 (from posterior hyaloid and from the vitreous stroma, respectively). The year 2012 marked ̅i ˆ˜ÌÀœ`ÕV̈œ˜ œv ̅i ,iyiÝ ÌiV…˜œœ}Þ Ìœ ÌÀi>Ì yœ>ÌiÀÃ] >˜` ˆ˜ÌÀœ`ÕVi` > “œÀi ivwVˆi˜Ì Li>“ «Àœwi ܈̅…ˆ}…iÀ «œÜiÀ discharges. Damien Gatinel, MD, PhD , Ã>ˆ` >À̈wVˆ> ˆ˜Ìiˆ}i˜Vi ˆÃ ºÀi - ally just human intelligence mul- tiplied by computer power.” The Pearl-DGS formula is a precision enhancement using AI and out- put linearization to predict the effective lens position and adjust for extreme biometric values. The formula uses six biometric ELP predictors, relies on the A-constant, and is compatible with all IOL models (as long as the SRK/T A-constant is known). The formula is available at www. iolsolver.com, and has been evaluated on 9,173 eyes. Plus, ̅i ÀiÃՏÌà œv ̅i wÀÃÌ iÞi V>˜ Li used to enhance the second eye predictions. Liliana Werner, MD, PhD , analyzed 28 explanted IOLs after posterior segment proce- dures. Of the explants, 25 had only pars plana vitrectomy with gas or silicone oil. Many of the explanted lenses did not have }>Ã] >˜` «À>V̈V>Þ º˜œ…ˆÃ̜ÀÞ of direct contact of air/gas/oil with anterior surface of the IOL.” The explants were not associat- ed with a particular IOL design or manufacturer. º-ÕÀ}iœ˜Ã ŜՏ` Li >Ü>Ài of this possible complication in pseudophakic patients with hy- drophilic acrylic IOLs,” she said. ORIGAMI: Combined cataract surgery Yusuke Oshima, MD , began this symposium discussing how combined surgery has the advantage of a clear view during the surgery even with the con- Ûi˜Ìˆœ˜> yœ>̈˜} i˜Ã° œÜiÛiÀ] combined surgery does require a skilled surgeon in both anterior and posterior segment surgery and the surgeon should be familiar with managing compli- cations postoperatively. In patients with diabetes, Nikolle Tan, MD , discussed how cataract surgery during the earlier stages of retinopathy is preferred due to fewer com- plications and improved visual outcomes. Furthermore, factors for poor visual outcome, such as diabetic macular edema and tractional or ischemic macu- œ«>̅Þ] ŜՏ` Li ˆ`i˜Ìˆwi` as early as possible. Jodhbir Mehta, MD , provided insight on the importance of proper surgical technique in pterygium surgery in reducing astigmatism postoperatively, while combining pterygium and cataract surgery “>Þ Li >ÃÜVˆ>Ìi` ܈̅È}˜ˆw - cant biometry error and unpre- dictability in outcomes.