EyeWorld India December 2014 Issue

63 EWAP NEWS & OPINION December 2014 , Moscow, Russia, who spoke about the Malyugin Ring; and Suven Bhattacharjee, MD , who spoke about the Bhattacharjee Ring. Dr. Yeoh discussed how surgeons start to design new instruments. First, he said, it’s important to determine what your objectives are. These could include making money or becoming famous, but oftentimes, it’s to fulfill a medical need or void. The necessity for the Cionni Ring came out of the problem of dealing with lenses that had compromised zonules, Dr. Cionni said. This was a problem he was dealing with often, and more often than not, the patient was left aphakic or received an ACIOL. Dr. Cionni spoke about having his “ah ha” moment in an elevator at an ophthalmology meeting when he had the idea to use a capsular tension ring and just suture it to the side of the sclera. He then drew his design on a napkin and asked the company if they could make it. We wouldn’t even be talking about instruments and designs without Charles Kelman, who really began this process, Dr. Barrett said. He said that innovation of instruments comes purely from necessity. He draws his inspiration when he finds himself in a situation where a better technology is needed. Dr. Malyugin discussed the spirit of innovation and the inspiration behind the idea for the Malyugin Ring. This started with the T-26 model IOL, which was the first lens in the world with a yellow tinted optic, Dr. Malyugin said, and he thought that it was a good idea to further utilize the tissue- capturing mechanism. His first thought was to use it to create an IOL. But from that concept, he went further and thought that it was a good idea to use the tissue-capturing element with the ring that became the pupil expansion ring. In spite of square design of the ring, it actually provides a round pupil, he said. There is another point that captures and retracts the pupil when the thread is going from above the iris to behind the iris. It helps you not to overstretch the pupil tissue, Dr. Malyugin said. ‘Diamonds (Phaco) are Forever’ Updates on conventional cataract surgery were a major topic in the “Diamonds (Phaco) are Forever” session. With a lot of attention on the femtosecond laser, a large number of surgeons are actually still using conventional ultrasound-based phacoemulsification techniques. Topics such as phaco chop, postoperative phacodynamics review, posterior polar cataracts, fluidics, toric IOL implantation, perfecting cataract surgery, and mixing technology for ultimate outcomes were discussed. Dr. Chee, Singapore, discussed a prospective study to evaluate the visual outcomes and PCR rate in managing posterior polar cataracts (PPC). She first discussed posterior polar cataracts. This is a posterior polar opacity with an onion skin like appearance, she said. “It’s associated with an inherently weak posterior capsule with propensity to PCR.” The incidence of PCR varies from 0 to 36%. Some risk factors for PCR include the density of the nucleus and the size of the PPC opacity. “I think that technique is highly important when we manage these cases,” Dr. Chee said. This includes hydrodelamination and lowered parameters, numerous variants for soft nucleus, and manual delamination of the nucleus. Dr. Chee participated in a prospective, two-surgeon study at the Singapore National Eye Centre (SNEC). The aims of the study were to determine the safety of adopting a guideline for a surgical technique based on nuclear opacity grading, to compare the outcome of study eyes with controls drawn from a random sample of cataract cases performed at SNEC, and to determine the AS OCT features of PPC and whether they can be used to predict risk for PCR. The PCR rate found in the study following a suggested technique based on nuclear density was 3.0%. This was significantly lower than the SNEC rate, which was 34.8%, Dr. Chee said. The study PCR rate was among the lowest in literature, but may be surgeon-related, based on learning curve, skill, and details in the technique. It is surprising that almost all of the PCRs occurred in the soft nucleus, Dr. Chee said. It’s also important to emphasize the importance of slow motion phaco in the surgical technique. The purpose of a different technique for handling hard PPC is the difficulty in safely passing fluid into the nucleus without risk of capsular block and PC blow out. Though PCR may be inevitable, it’s important to delay its onset, Dr. Chee said. This could minimize the risk of vitreous loss and result in a safer surgery and better outcomes. This particular study suggests that even using the same technique, the factor of the individual surgeon is an important one to consider. Dr. Chee concluded that phacoemulsification in PPC is safe in trained hands, with an acceptable PCR rate of 3%. Patients can achieve excellent visual outcomes, she said. Dr. Donnenfeld, Rockville Centre, NY, U.S., highlighted optimizing refractive outcomes in cataract and refractive surgery, specifically speaking on the difference between peristaltic pumps and Venturi pumps. “The future of cataract surgery will be fluidics, not phacoemulsification,” he said. continued on page 63