EyeWorld Asia-Pacific September 2019 Issue

76 EWAP SEPTEMBER 2019 ranging from the pupil center to the corneal vertex or somewhere in between. º/…i ˆ`i> Vi˜ÌÀ>̈œ˜ «œˆ˜Ì is the visual axis but accurate œV>ˆâ>̈œ˜ ˆÃ `ˆvwVՏÌ]»…i Ã>ˆ`° º7i ˜ii` ̜ w˜` ܓi«>Vi LiÌÌiÀ ̅>˜ ̅i wÀÃÌ *ÕÀŽˆ˜i ÀiyiÝ°» He evaluated outcomes between the entrance pupil cen- ter (EPC) and coaxially sighted VœÀ˜i> ˆ}…Ì ÀiyiÝ - ,® ˆ˜ two groups of centration points: the 80% group was 80% from the pupil center to the CSCLR, whereas the 100% group was at the point of CSCLR. The 80% group had more eyes achiev- ing zero astigmatism and fewer eyes had residual astigmatism of >0.75 D (P=0.039), less under-correction (P=0.045), but ̅iÀi Ü>à ˜œ È}˜ˆwV>˜Ì `ˆvviÀ - ence of change in lines between groups. ˜ ŜÀÌ]…i Ã>ˆ`] ºÌ…i ۈÃÕ> axis should not be the CSCLR, but should be between the CSCLR and the entrance pupil center,” Dr. Chang said. Cordelia Chan, MD , in her presentation, said surgeons should go back to the surface if ̅iÞ Ü>˜Ì y>«iÃà «ÀœVi`ÕÀiÃ] less ectasia and dry eye, long- term visual outcomes that are excellent and similar to SMILE and LASIK, but also do not want to spend on a femtosecond laser or microkeratome. However, in her own practice, she prefers femto-LASIK. A pair of presentations on SMILE suggested the procedure can offer excellent predictability but a slower visual recovery than a wavefront-guided LASIK pro- Vi`ÕÀi° ˜ ̅i wÀÃÌ «ÀiÃi˜Ì>̈œ˜] Edward Manche, MD , did note ̅>Ì ˆ˜ ̅i 1°-° ܅iÀi…i «À>V̈V - es the SMILE procedure only re- cently gained approval at lower i˜iÀ}Þ iÛiÃ] ܅ˆV…º“>ŽiQÃR > huge difference in outcomes.” In the second of the SMILE presentations, Marcus Ang, FRCS, PhD , found SMILE achieved a good refractive predictability at 3 months and ̅>Ì Ã>viÌÞ] ivwV>VÞ] >˜` ÃÌ>LˆˆÌÞ were similar to LASIK at 3 and 12 months. However, patient satisfaction and comfort was slightly more uncomfortable during SMILE compared to LASIK (P=0.02). Matteo Piovella, MD , said more than 70% of his cataract patients are implanted with trifocal lenses. Beginning in ÕÞ Ó䣙] ºÜi >««Þ ˆ«ˆ œÜ treatment in 100% of our pa- tients who undergo trifocal lens implantation,” he said, with the only downside being patients have to have cataract surgery postponed for 45 days. With 3 years of follow-up in patients with previous laser vision cor- rection surgery and trifocal IOL implantation with the AT LISA Tri and Tri Toric, 96.3% are within 0.5 D of target. Shmuel Levinger, MD , said multifocal and trifocal lenses produce better outcomes than PresbyLASIK in people over 55 years of age, but PresbyLASIK is a viable option for those under 45 years old. In his hands, inlays are not a good solution for the em- metropic presbyope, and he has stopped implanting them altogether. Lastly, Kimiya Shimizu, MD, PhD, said that he only performs ICL surgery, even in patients with much lower levels of refractive errors (–2 D or –3 D); the KS-AquaPort is a phakic IOL with a central hole, which has eliminated the need for a laser peripheral iridotomy and has resulted in no cataract formation. When debating how to size an ICL, Dr. Shimizu said angle-to-angle at 0.5. CHANKO NABE: Anything Goes – How do we ensure optimal optical outcomes? ˜ ̜`>޽à º…>˜Žœ >Li» session, in which anything goes and any topic can be discussed, surgeons explored how we can ensure optimal outcomes for patients. Kensaku Miyake, MD , brought up the issue of periop- erative dry eye, and the core mechanism involves the reduc- tion of wettability which induc- ià Ìi>À w“ >˜` Vœ˜Õ˜V̈Û> >L˜œÀ“>ˆÌÞ° º -Ƃ à >Ài > double-edged sword in sup- pressing nociceptive and neu- ropathic pain” for dry eye after cataract surgery since they have both therapeutic and causative factors. Rebamipide can be used for 3 months postoperatively and preferred in selected cases in Japan. Ishtiaque Anwar, MD , spoke about the function of continuous curvilinear capsulor- hexis (CCC) is to provide safer phaco procedures, controlled endocapsular phaco, and stable IOL positioning. When rhexis is compromised, there is periph- eral extension to the equator >˜` Liޜ˜`° º v ̅i V>«ÃՏi ˆÃ yœ>̈˜}] ˆÌ…>à ˜œÌ }œ˜i Liޜ˜` the equator and it is safe to do phaco,” he said. However, if the capsule has gone beyond the equator, one must maintain a stable anterior chamber and inject OVD, positioning the IOL