EyeWorld Asia-Pacific December 2020 Issue

EWAP DECEMBER 2020 13 FEATURE cells behind. Performing the POPS technique ending with a swiping movement, there is a better chance of completely removing the fibers and epithelial cells. OVDs The use of appropriate OVD, whether cohesive, dispersive, or viscoadaptive, in different scenarios has improved surgical performance. Using microincision forceps and scissors in particular, he said, they are able to perform a closed chamber technique under heavy cohesive viscoelastic or viscoadaptive viscoelastic in a very controlled fashion. He presented a case of an intumescent cataract in which using a heavy viscoelastic, closed chamber technique, and microincision forceps, allowed them to avoid Argentinian flag sign and create the desired size of the anterior capsule opening. Helpful tech Advanced phaco machines that allow torsional and ellipsoid phaco energy delivery along with improved fluidics and IOP control have been very helpful. In particular, Dr. Vasavada cited the concept of interrupted phaco energy delivery introduced by WhiteStar technology (Johnson & Johnson Vision). He also described how the gravity-based systems now improved with IOP sensing systems as found in systems such as the Centurion (Alcon) and Stellaris (Bausch & Lomb) allows surgeons to confine the lens removal process away from the corneal endothelium. In addition, for educational and evaluation purposes procedures can be documented using intraoperative OCT. PC rupture management For the management of posterior capsule rupture, Dr. Vasavada said that a pars plana approach makes outcomes predictable, staining the vitreous with triamcinolone is useful, and placing a trochar or sclerotomy helps achieve effective anterior vitrectomy and vitreous removal without impacting the rupture very much. The pars plana approach reduces the intraoperative vitreoretinal traction you can expect when dragging the vitreous out through a limbal vitrectomy; moreover, pulling the vitreous out this way, with the greater mass still in the posterior chamber pulled through the posterior capsule rupture risks extending the tear. Femto assist Femtosecond laser-assisted cataract surgery, Dr. Vasavada said, helps all levels of cataract surgeon and all kinds of cataracts including the difficult scenarios such as posterior polar cataracts. “In our hands we found that the posterior polar cataract rupture rate has gone down significantly using this femtodelineation in a white or intumescent cataract; FLACS is a great help,” Dr. Vasavada said. “Quite often it gives a floating capsule, and even if it doesn’t, it’s easy to convert it into a continuous rhexis once the intralenticular pressure is reduced with the laser openings.” Co-management Dr. Vasavada’s final lesson was that comanaging with other subspecialists—retina, cornea, glaucoma surgeons—“really has changed the outcome in difficult scenarios and we are able to achieve that desired outcome with appropriate IOL in almost everybody’s eye.” Dr. Vasavada said that cataract surgeon should be ready to cooperate and share cases with other specialists, reminding cataract surgeons that it’s patients who are “at the heart of all that we do.” EWAP Editors’ note: Dr. Vasavada receives grant research support from Alcon Laboratories. Follow us! The Next Generation NEW Pentacam ® AXL Wave The first device to combine Scheimpflug Tomography with Axial Length + Total Wavefront + Refraction + Retroillumination The new Pentacam ® AXL Wave is a reliable partner for your refractive and cataract practice, creating the best prerequisites for surgery, based on pre-op metrics, and providing post-op measurements for reliable monitoring, in just one device! With high-end hardware and software for optimum treatment and satisfied patients, the new Pentacam ® AXL Wave makes no compromises on quality. OCULUS Asia Ltd. Hong Kong pentacam.com/axl-wave • info@oculus.hk