EyeWorld Asia-Pacific September 2019 Issue

74 EWAP SEPTEMBER 2019 comprehensively restoring the ˜>ÌÕÀ> œÕÌyœÜ «>̅Ü>Þ]» *Àœv° 9>œ Ã>ˆ` ˆ˜…ˆÃ >LÃÌÀ>VÌ° º-ˆ˜Vi ˆÌ is a newly invented procedure, some techniques need to be improved and its safety needs to be evaluated as well as its ivwV>VÞ°» At his eye center, 55 cases of ABiC were combined with MICS, and the group evaluated IOP, the number of anti-glaucoma medications pre- and postoper- atively, corrected distance visual >VՈÌÞ] ۈÃÕ> wi` >˜` œ«ÌˆV `ˆÃV° Follow-up was at 1, 3, 6, and 12 months. Results showed the com- bination lowered IOP over the course of the follow-up. Other winners of the 2019 APACRS Film Festival: Cataract/Implant Surgery: Jae Yong Kim , runner up, º1ÃivՏ˜iÃà œv -ՏVÕÇ ˆÝ>Ìi` Standard Capsular Tension Ring in the Capsular Instability During Cataract Surgery” Atsushi Hirota , winner, º >VŽ‡ œÜ Þ`Àœ`ˆÃÃiV̈œ˜» Cataract Complications/ Challenging Cases: Hisaharu Suzuki ] À՘˜iÀ Õ«] º Creation and Evaluation of Complication Models using Slit Side View Cataract Surgery” Yoichiro Masuda , winner, º1˜iÝ«iVÌi` œÀ˜i> ˜`œÌ…iˆ - al Damage in FLACS” Refractive/Corneal Surgery: Sheetal Brar ] À՘˜iÀ Õ«] º œœÃÌ that SMILE: Enhancing the ‘WOW’ Factor with Refractive Lenticular Extraction” Chandra Bala ] ܈˜˜iÀ] º/…i DMEK Kite” General Interest: Pooja Khamar ] À՘˜iÀ Õ«] º œÜ Important is it to Have a Psychol- ogy Couch in Our Clinics?” Mami Kusaka ] ܈˜˜iÀ] º Repair of Iris Dialysis by Riveting with Double-Flanged Polypro- pylene Sutures” Saturday, 5 October 2019 ->ÌÕÀ`>Þ] x "V̜LiÀ] ̅i w˜> day of the meeting, featured ÃVˆi˜ÌˆwV ÃiÃȜ˜Ã œ˜ V…>i˜}ˆ˜} cataract surgery (IRON CHEF), cornea and anterior segment surgery, ÀivÀ>V̈Ûi V…>i˜}ià -1 "®] >˜ º>˜Þ̅ˆ˜} }œiû ÃiÃȜ˜ (CHANKO NABE), and the annu- > º/œ« >Ì>À>VÌ -ÕÀ}iÀÞ /ˆ«Ã» session (Wisdom of the Samurai). IRON CHEF: Challenging Cataract Surgery There are many challenges in «iÀvœÀ“ˆ˜} «…>Vœi“ՏÈwV> - ̈œ˜ >˜` ˆ˜ ̜`>޽à º Àœ˜…iv» session, surgeons presented multiple cases demonstrating a variety of challenges. In one phacolytic glaucoma case that Pannet Pangputh- ipong, MD , presented, there was cortical material inside the anterior chamber that he had to remove. Edema was pres- ent, scraping was performed, and dye was used to stain the V>«ÃՏi° ˜ˆÌˆ> y>«‡“>Žˆ˜} Ü>à `œ˜i] LÕÌ wLÀœÃˆÃ >««i>Ài` œ˜ the anterior capsule. In another one of his cases of phacomorphic-ciliary block glaucoma, Dr. Pangputhipong’s challenge was the chance of suprachoroidal hemorrhage and ivvÕȜ˜° º ˜ >`Û>˜Vi` V>Ì>À>VÌ surgery, we see complex prob- i“Ã]»…i Ã>ˆ`° º ̽à ˆ“«œÀÌ>˜Ì ̜ protect the corneal endotheli- um. It’s also useful to widen the incision on the inside because when you focus on the nucleus and try to phaco and chop, we are moving instruments forwards and backwards, which increases the chance for tear.” In one case performed by Abhay Vasavada, MD , an open- ing was made in the posterior capsule which was made big enough to accommodate the i˜Ã œ«ÌˆV° º7…i˜ ̅i «œÃÌiÀˆœÀ V>«ÃՏi ˆÃ ̜À˜]»…i Ã>ˆ`] ºÞœÕ must check in the end—is the vitreous phase disrupted and in the chamber? Always inject triamcinolone preservative-free to check and make sure there is no vitreous coming out.” Performing traumatic cat- aract surgery requires a clear strategy that adheres to the closed chamber technique. For Hisaharu Suzuki, MD , there are many complications in cataract surgery in the elderly ˆ˜VÕ`ˆ˜} Üi>Ž ✘Տ>À wLiÀÃ] corneal endothelial loss, myso- sis, and glaucoma. Again, Dr. Suzuki emphasized that preoper- ative preparation and a surgical «>˜ ˆÃ ˆ“«œÀÌ>˜Ì° º/ܜ v>V̜Àà should be considered in the sur- gical plan: the instruments and the phaco machine settings,” he said. For congenital cataract surgery, many problems arise which affect visual development with numerous complications, said Yun-e Zhao, MD . Posteri- or capsule abnormality makes «ÀœVi`ÕÀià `ˆvwVՏÌ] iëiVˆ>Þ ˆ˜ PCD and PFV cases. Her take- home points emphasized that lensectomy and vitrectomy can be performed to avoid cortex sinking in PCD cases and hemor- rhage in PFV cases. Corneal opacities pose another issue for posterior seg- ment surgeons. These opacities occur due to the light from the microscope being unable to enter the eye because of scatter- ing, resulting in poor red glow. By thinking outside the box, Mahipal Sachdev, MD , offered the chandelier illumination technique in which coaxial light shines onto the retina of the patient’s eye and illuminates it, «ÀœÛˆ`ˆ˜} ̅>Ì Ài` }œÜ° º/…i˜] you can do the surgery as if there is no corneal opacity,” said Dr. Sachdev. For Pichit Naripthaphan, MD , posterior capsule tears can be rescued with careful evalua- tion, maintaining A/C pressure, and making the posterior cap- sule opening round and strong. With IOL implantation, in-the- bag technique may be possible for certain cases. Finally, Morgagnian cat- aract surgery is challenging because the cataract should be removed as soon as possible, but surgeons hesitate because the procedure demands a high degree of skill and considerable experience, said Kiyoshi Ishii, MD . It can be done, though, and ºÃœÜ >˜` ÃÌi>`Þ Üˆ˜Ã ̅i À>Vi]» said Dr. Ishii. Challenges in cataract surgery will always present, but