EyeWorld India September 2016 Issue

September 2016 EWAP NEWS & OPINION 73 continued on page 8 continued on page 74 To minimize risk of both TASS and endophthalmitis, Dr. Espiritu said that practices should institutionalize recommended preventive measures, citing three critical steps in reprocessing— cleaning and decontamination, sterilization, and careful storage or return to the sterile field. Also at the symposium, Chul Young Choi, MD , Seoul, South Korea, presented the results of a prospective study utilizing developments in topography to evaluate postoperative changes in posterior curvature. Dr. Choi found that the difference between preoperative and six-months postop keratometric data on the posterior surface was not statistically significant. The posterior surgically induced astigmatism (SIA) in all participants (n=68) was 0.20±0.17@74; the posterior SIA in ATR astigmatism of posterior cornea (n=61) was 0.19±0.16@75. He concluded that “2.2-mm temporal limbo-corneal incision cataract surgery may have no clinically significant impact on posterior corneal surface especially in ATR astigmatism of the posterior cornea.” ‘Court-martialed’ surgeons present their cases to judge and jury Surgeons “charged with incompetence” were sent to answer for their cases at the APACRS “Court Martial in Ophthalmic Surgery” symposium. Bringing cases before supreme judge Gaurav Luthra, MD , Dehradun, India, and a panel of six honorable jury members was upright public prosecutor Partha Biswas, MD , Kolkata, India. Chitra Ramamurthy, MD , Coimbatore, India, provided defense counsel. The first defendant brought before the judge and jury, Pannet Pangputhipong, MD , Bangkok, Thailand, described a subluxated lens case conducted in 2008 where he tried to implant a capsular tension ring. When doing so, he found the lens moved. Dr. Pangputhipong said he tried to apply counter traction, but the whole lens moved almost 360 degrees, he said. At this point, he stopped surgery, removed the ring, extended the incision, and did a nuclear expression. After vitrectomy, Dr. Pangputhipong placed a scleral fixated IOL and the patient outcome in the end was good. So what went wrong? Dr. Pangputhipong hypothesized that his capsular tension ring size was too big and there was friction with his use of the injector. Dr. Pangputhipong also noted for the jury that at the time, Thailand only had plain capsular tension rings. Capsule hooks were also not available. “A CTR was placed without capsular hooks in a truly subluxated lens. No capsular hook to support this subluxated lens. He went ahead straight with the injector … with a larger CTR than was required. This is absolutely the wrong way,” Dr. Biswas, clad in a black court robe, said emphatically. Dr. Ramamurthy said her defendant’s message in this case was that he realized his mistake, pulled out the capsular tension ring, and removed the nucleus without the lens sinking. “The final outcome is what has to be seen,” she said, later describing the video as a teaching moment for the audience. Unfortunately for Dr. Pangputhipong, the supreme judge agreed with the prosecution, going against the majority of the jury, which had criticized Dr. Pangputhipong’s decision to use a capsular tension ring but still mostly voted him as not guilty. Dr. Pangputhipong received the mock noose. Next up, Chee Soon Phaik, MD , Singapore, took the stand. Her case was that of a woman with a decentered lens, which she could hardly see at the time of surgery. Dr. Chee expanded the pupil with iris hooks and used microforceps to grasp the capsule, which she said was fibrotic. Taking care to not grasp any vitreous, she removed the haptics from the capsular bag and brought the lens forward to fixate it. Keeping hold of the lens, she made another paracentesis and used 10.0 prolene sutures to hook around the lens on each side, only tightening the knot on either side after she was sure the lens was perfectly centered. Dr. Biswas accused Dr. Chee of going through unnecessary acrobatics when she could have used a glued or scleral fixated IOL. “Professor Chee, one of the best surgeons in the world, is guilty of propagating impossible techniques to our very normal surgical skills,” Dr. Biswas said.