bimanual procedures as they provide better eye control and visualization. Finally, she advised surgeons deal with problems as soon as they occur and “think out of the box for simple solutions,” which may be as simple as lowering the microscope. “Implement these techniques, and even difficult surgeries will not be difficult.” Making an award-winning movie does not have to be costly, said Samaresh Srivastava, MD. “It’s a lot of hard work,” he agreed, “but most importantly, you need an idea that can make a point.” He recommended filming every surgery “because you never know when the magic will happen.” Next, prepare a script so the film tells the story you envision. If movie-making is daunting, conducting meaningful research may not be, said Tin Aung, MD. Conducting research and getting that research published “can potentially impact many more patients than you could ever see in your own clinic.” He boiled down how to conduct meaningful research to a few key points: always ask questions and think about the bigger picture; plan and think about the study design and of potential collaborations; plan the research and how to reduce any potential bias; and give a substantial amount of time to planning and writing the protocol. “Many studies fail due to poor study design,” he said. Collaborate “with scientific partners. Both scientists and researchers need to understand each other’s needs. That’s what is really meant by translational research.” Phaco-MIGS for Angle Closure According to Prin Rojanapongpun, MD, using minimally invasive glaucoma surgery (MIGS) to treat primary angle closure disease (PACD) may always be controversial, but glaucoma specialists also need to remember that angle closure “is a surgical disease first.” Traditional first-line therapies (namely, trabeculectomy) are effective, but come with a high rate of complications. Lens extraction alone has shown promise (as in the EAGLE study), but “lens removal is not a definitive treatment for angle closure,” as post-surgical intraocular pressure (IOP) spikes can be commonplace. He presented his thoughts during the Angle Closure Surgery – New Insights symposium. “But combined phaco-trab is not necessarily a better option,” Dr. Rojanapongpun told attendees. “So what is safer?” He believes MIGS “offers better postop refractive stability [than filtering surgery] and allows surgeons the ability to implant both toric and multifocal intraocular lens (IOL).” The combination “may offer permanent, or at least long-term, solutions,” he said. “We are entering an era of interventional glaucoma,” Dr. Rojanapongpun said. “Some of these will be temporary measures, while others will be permanent.” During the same session, David Lubeck, MD, noted the MIGS timelines “are linked closely to our advanced IOL timelines as well,” and suggested MIGS can be successfully used in a multitude of glaucomas. For example, he noted, in those with mild-to-moderate primary open-angle glaucoma or narrow-angle glaucoma, medically controlled on 1 to 2 medications, he would recommend phaco in conjunction with a stent, but would recommend phaco-canaloplasty for those with severe uncontrolled glaucoma on up to 4 medications. Dr. Rojanapongpun suggested a surgical approach for patients with PACD and coexisting cataracts (regardless of whether or not IOP is medically controlled) is to perform phaco and keep the patient on medications. For patients without cataracts, however, medication and MIGS may be preferred. In short, Dr. Rojanapongpun said that phaco-MIGS in PACD is less controversial and offers “lots of potentials.” The combined surgery offers effective treatment in most PACD, with variable ranges of IOP-lowering capabilities depending on the surgery of choice and a variable duration of IOP control (“although long-term IOP control is not guaranteed”). Combined surgery also tends to have a better safety profile. “Performing angle MIGS trabecular surgery should only be done if the angle can be widely opened with phaco,” he said. “Subconjunctival MIGS is a safe option when used in combination with phaco, but bear in mind MIGS is less effective in lowering IOP than trabeculectomy.” But it may still be the best option when medication is an issue and trabeculectomy is not an appropriate approach. Dr. Lubeck concurred, noting “the evolution and implementation of MIGS should be considered along with phaco and IOL technology.” New trends and technology for infectious keratitis Artificial intelligence (AI) is a big buzzword these days, and Venkatesh Prajna, MD, told attendees just how AI is among the new trends in
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