9 EyeWorld Asia-Pacific | September 2024 by Christina Chintanaphol and Michelle Dalton The Perfect Save! The Perfect Save Teaches Techniques for Difficult Cataract Cases For its second year running at APACRS, the International Intraocular Implant Club (IIIC), a club of committed cataract and anterior segment surgeons founded by the inventor of the IOL Sir Harold Ridley, discussed challenging situations for cataract surgeons with emphasis on the idea of ‘The Perfect Save.’ World-renowned surgeons discussed challenges that ranged from techniques for avoiding posterior capsule rupture, to using IOL scaffold techniques during an IOL lens exchange, and also, one surgeon’s own experience with a Posterior Chamber (PC) IOL post-LASIK. Hiroko Bissen-Miyajima, MD, PhD (Japan) spoke about her own monocular cataract surgery in her post-LASIK eye. Although most ophthalmologists when polled say they would prefer a monofocal IOL, she opted for a diffractive IOL. “I am enjoying daily life without spectacles,” she said, while expressing her appreciation for being able to continue consulting and performing surgery without the use of spectacles. She can enjoy driving and “has a better understanding of how patients see.” But she said the surgery was not without some lessons learned. First, she had low astigmatism so did not opt for a toric lens. “Posterior corneal astigmatism should not be underestimated,” she said. “A toric model should have been considered.” Second, surgeons should consider the impact of the dominant eye. In her implanted eye, glare and halo are noticeable, but the effects of the dominant eye make the bilateral vision acceptable. Third, near vision should be assessed binocularly. Her implanted eye can read letters but is “somewhat weak in contrast.” Binocularly, however, letters are more easily read. Overall, she said her quality of vision is “better than expected,” and she would likely opt for another diffractive IOL in her other eye when the time comes. Paul G. Ursell, MBBS, MD, FRCOphth (UK) described the case of a dissatisfied patient with a toric IOL who was seeing 6/6 unaided shortly after surgery but noted slight disorientation which Prof. Ursell attributed to anisometropia. However, after the second eye surgery, visual acuity readings were still good and the toric lenses were on axis, but the patient remained unhappy. Opting to perform a lens exchange, Prof. Ursell discussed using an IOL scaffold to support small pupils and implanting the replacement lens underneath the scaffold before removing the initial lens. “Small pupils leave no room for instruments like iris hooks or rings,” he said. Using a scaffold alleviates potential issues and allows surgeons to remove the initial lens without concerns about iris prolapse. In post-radial keratotomy (RK) eyes, toric lenses can be considered, said Boris Malyugin, MD, PhD (Russia), but surgeons should be wary if IOL recommendations vary widely. “That should be a red flag for you to think about potential subsequent surgeries, although surgical outcomes can still be good.” Paul G. Ursell FEATURE Highlights from the 36th APACRS - 24th CSCRS Joint Meeting Chengdu, 2024 Hiroko Bissen-Miyajima Boris Malyugin
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