EyeWorld India September 2016 Issue

September 2016 74 EWAP NEWS & OPINION 29 th APACRS - from page 73 In the end, Dr. Chee was praised for her surgical skill by the judge and jury. Cesar Espiritu, MD , Manila, Philippines, presented on his decision to use an anterior capsule IOL for a patient with a severely damaged iris, thinking it wouldn’t support an iris sutured IOL or iris clawed IOL. Dr. Espiritu received criticism for this choice by some in the jury, but in the end Dr. Luthra said that while it might not have been the best choice in this scenario, it doesn’t mean it was wrong. Thus he was found not guilty. Ritika Sachdev, MD , New Delhi, India, presented on a case of phacomorphic glaucoma where she performed a limited dry pars plana vitrectomy to decompress the globe for cataract surgery. Dr. Biswas criticized Dr. Sachdev for making a single vitreous port, using no infusion, and not making a complete vitrectomy. In the end, Dr. Luthra said Dr. Sachdev chose the right approach. Finally, Sri Ganesh, MD , Bangalore, India, was brought to the stand. His was a case of intraoperative iridodialysis in a routine phaco case. Calling it a “freak accident,” nearly half of the iris came into the phaco port. Instead of panicking and removing the phaco tip, Dr. Ganesh used his viscocannula to gently remove the entangled iris. He proceeded to place iris hooks, finish the cataract surgery, before performing an iridodialysis. Dr. Ganesh was found not guilty and offered this defense: “The only surgeon who has no complication is one who does not operate.” “What I want to demonstrate is, yes, some freak accidents can happen,” Dr. Ganesh said. “What is important is to keep calm in that moment.” ‘Top Gun’ session gives attendees many cataract surgery tips The “Top Gun” session was back again at this year’s APACRS meeting, with about a dozen surgeons from all over the world giving attendees tips that they can take home and utilize in their practices pertaining to a number of issues. The session was chaired by Graham Barrett, MD , Perth, Australia, Ronald Yeoh, MD , Singapore, Hadi Prakoso, MD , Jakarta, Indonesia, and Kerry Solomon, MD , Mount Pleasant, South Carolina. Topics such as astigmatism, repositioning an IOL, pseudoexfoliation, iris coloboma, subluxated lenses, circular cortical removal, the Argentinian flag sign, and the femtosecond laser were all discussed. “Late repositioning of a misaligned toric IOL is possible when using appropriate technique,” said Rudy Nuijts, MD, PhD , Maastricht, Netherlands. Always perform preoperative corneal topography, he added. Toric IOLs in keratoconus patients with cataracts may be a valuable treatment option, he said. Sri Ganesh, MD , Bangalore, India, highlighted a new technique for subluxated lenses when using a capsular tension ring (CTR). A CTR makes life much easier, he said, because it can center the bag and comfortably remove the nucleus. However, a CTR has issues when you’re removing cortex because it traps the cortex and makes removal difficult. How do you handle the cortex? Dr. Ganesh’s technique is called reverse cortical stripping for subluxated cataracts with a CTR. If the cortex is not attached to the CTR, he said, you can easily pull it and remove it. However, if it is, you can use this technique and go behind and catch the posterior cortex to remove it. He cautioned the importance of not catching the posterior capsule. Dr. Prakoso spoke about the Argentinian flag sign. To avoid this, he said to reduce intralenticular pressure by aspirating the liquefied cortex adequately. He also said to reduce intralenticular tension by reducing the pressure from outside the globe. Do not overfill the anterior chamber with OVD, and do not press the globe or lens during the continuous curvilinear capsulorhexis (CCC), he said. Alan Crandall, MD , Salt Lake City, discussed pseudoexfoliation syndrome and cataract surgery, particularly dealing with small pupils. He said it’s possible to phaco through small pupils but be sure to use techniques to reduce nuclear movement. Bimanual rotation may be used to reduce zonular stress, he said. Anterior lens epithelial sweep can reduce phimosis. Additionally, Dr. Crandall added that CTRs can be used if there is evidence of zonular weakness. EWAP