EyeWorld India December 2014 Issue

55 EWAP NEWS & OPINION December 2014 children,” he said. Keratoglobus is rare and may be associated with systemic features, Dr. Vaddavalli said. “Always, always assess the corneal thickness on slit lamp,” he said. When making side ports, start on the sclera, he advised. IOL power calculation is difficult in these cases, he added. Jewels of Jaipur - Perfect Cut, Perfect Clarity Live reports from the 27th APACRS annual meeting held from 13 to 16 November 2014 in Jaipur, India DAY 1, THURSDAY, 13 NOVEMBER 2014 ‘Bag to the Wall’: a MasterClass phaco technique The APACRS kicked off its 27th annual meeting by providing attendees with a “more advanced level of education” through the latest series of MasterClasses. In the MasterClass on “Microphaco and Advanced Phaco Techniques in Challenging Cases”, Cyres Mehta, MD , Mumbai, India, demonstrated a technique he developed to manage subluxated lenses, which he called the “Bag to the Wall” technique. In cases of “extreme subluxation,” as in patients with Marfan’s syndrome, Dr. Mehta said that surgeons have several options for implanting the IOL outside the bag, such as in the anterior chamber or the sulcus. However, there are “not very many options if you want to go in the bag.” His “Bag to the Wall” technique provides one such solution. The keystone to the technique, he said, is to do a very small rhexis. “Once you’ve made a 3–4 mm curvilinear rhexis, consider it done.” The actual “bag-to-the-wall” component comes in the IOL implantation phase. Dr. Mehta ties the trailing end of a 10-0 ethilon prolene suture to the midpoint of the haptic of a single-piece acrylic IOL, and the other end to a 1-inch straight needle. Inserting the needle through the main incision, he then passes it through the fornix, through the pars plana, and out through the sclera. The technique thus literally fixes the bag—with IOL inside it—to the wall. The full procedure was published in Annals of Ophthalmology and can be found described on the Ocular Surgery News website. In addition to the Microphaco MasterClass, the APACRS held 11 other MasterClasses at the Fairmont Jaipur Hotel: “Tips and Tricks in Pterygium Surgery,” “Intraocular Mirror Telescopic Implant for AMD,” “Optimizing Outcomes in Toric IOLs,” “Complex Cataract Surgery,” “Flawless Femto LASIK Flaps,” “Mastering Femtophaco Cataract Surgery,” “Essential Biometry,” “Retinal Updates for Anterior Segment Surgeons,” “Finer Points in IOL Fixation,” “Imaging Essentials for the Cataract and Refractive Surgeons,” and “Cornea Updates for Anterior Segment Surgeons.” Tips for achieving precision in cataract surgery highlighted The first APACRS Thursday symposium concentrated on an update on management of complications. It focused on ways to achieve precision in cataract surgery, with each presentation offering tips on dealing with one specific topic or issue. Pravin Vaddavalli, MD , Hyderabad, India, discussed cataract surgery in extreme corneal ectasia. He highlighted several specific cases when he dealt with this issue. The first was a 64-year-old woman whose surgery first began as a routine cataract surgery. However, when doing the surgery it became necessary to suture the wound because it had extended because of significant leakage. When looking at the patient postop, it became clear that she had a very thin cornea, with OCT indicating that she had only about 300 microns of corneal thickness in the periphery. However, she had seemingly normal topography. “Typically keratoglobus, which is what we diagnosed her with, presents in Athiya Agarwal, MD , Chennai, India, discussed “glued IOL in a sticky situation,” particularly highlighting pre- Descemet’s endothelial keratoplasty (PDEK). She showed a case of this, which used donor tissue from a 9-month-old eye. PDEK is an interesting alternative to the DMEK and DSEK procedures. Dr. Agarwal cited Harminder Dua, MD , Nottingham, UK, and Dua’s layer. In addition to 5 basic layers in the cornea, there is one more, Dua’s layer, that is about 10 to 15 microns thick and located in between the Descemet’s membrane and the continued on page 56