EyeWorld Asia-Pacific December 2020 Issue

EWAP DECEMBER 2020 11 FEATURE Taking stock: The most important lessons in cataract surgery C ontinuing the APACRS Webinar reviewing cataract surgery essentials, Abhay Vasavada, MD, India took stock of the most important lessons he has learned in all his years performing cataract surgery. First listing some fundamentals, Dr. Vasavada said that cataract surgery needs to be refined for performance to achieve predictable immediate and long-term outcome. The aim of the surgery should be to make patients “Happy Happy,” achieving complete satisfaction with the results of the surgery by treating cataract surgery as refractive surgery, customizing results according to each patient’s lifestyle. He recommended devoting time for a thorough preoperative work-up, paying attention to details, applying imaging, and assessing the ocular surface, as well as for counseling, which he said affects cooperation and outcome management. Topical anesthesia is one aspect of the surgery that Dr. Vasavada says makes patients very happy with their experience while giving better control to the surgeon. Meanwhile, procedures and techniques for lens removal have evolved over the years making the process very predictable and safe. Posterior capsulorhexis More recently, Dr. Vasavada said that they are learning to utilize posterior capsulorhexis for better stability as well as a clear visual axis by capturing the optic through the posterior capsulorhexis while placing the haptics in the bag or in the ciliary sulcus in children and does not require an anterior vitrectomy. A posterior capsulorhexis can also be used when trauma to the eye has compromised the capsular bag. Importantly, it can also be considered when the posterior capsule is intact. Meanwhile, optic capture through the posterior and anterior capsulorhexis is recommended in extremely shallow eyes with advanced angle closure glaucoma. Hydrodelineation Speaking of compromise to the posterior capsule, Dr. Vasavada then described the important role of hydrodelineation in posterior polar cataracts and fragile posterior capsule. He said that while conventional hydrodissection (Figure 1) is good, sometimes there is inadvertent subcapsular hydrodissection resulting in Figure 1. Conventional Hydrodelineation Figure 2. Inside-out delineation Source (all): Abhay Vasavada, MD From the lecture by Abhay Vasavada, MD, India Research Director, IIadevi Cataract & IOL Research Centre Clinical Director, Raghudeep Eye Clinic, Ahmedabad