EyeWorld India June 2017 Issue

June 2017 68 EWAP NEWS & OPINION MEETING reporter APACRS Highlights at ASCRS in Los Angeles Reports from the 2017 ASCRS•ASOA Symposium & Congress, 5–9 May 2017, Los Angeles, featuring first-ever collaborations with APACRS CSCRS: Specialists reveal what they are now doing better Sunday morning featured a stellar international panel of specialists exchanging their pearls of wisdom on “Optimizing outcomes—what am I doing differently?” at the Combined Symposium of Cataract and Refractive Societies (CSCRS) sponsored by the Alliance of Cataract and Refractive Specialty Societies. Leading off the discussion was Graham Barrett, MD , Perth, Australia, who spoke on swept-source OCT and cataract surgery. According to Dr. Barrett, swept-source OCT, incorporated into the IOLMaster 700 (Carl Zeiss Meditec, Jena, Germany), which uses a swinging light source to measure axial length, central corneal thickness, lens thickness, and anterior chamber depth, can construct a 3D architecture of the anterior segment, using a scan depth of 44 mm and scan width of 6 mm. The technology has “huge implications” on how surgeons can now measure the cornea and its use in IOL power prediction. In contrast to classical keratometry and the Gaussian model that uses presumed values, “true” keratometry allows the use of actual, measured values. Dr. Barrett said that all existing power calculation formulas profited from true keratometry in terms of prediction accuracy. In his discussion on non- capsular IOL fixation, Sumit Garg, by Stefanie Petrou Binder, MD EyeWorld Contributing Writer and Liz Hillman MD , Irvine, California, highlighted the advantages and disadvantages of both iris- and scleral-fixated lenses. Iris-fixated lenses avoid scleral surgery, use small, self-healing incisions, and accommodate foldable IOLs; however, they require a normal anatomy and may cause pupil ovaling, among other disadvantages. Scleral-sutured IOL implantation can be quite time consuming and technically demanding, with the potential for suture exposure. Scleral tunnel with glued haptic fixation solves the problem of long-term suture degradation. The technique has shown no late complications so far, and minimal phacodonesis, a vital factor, according to Dr. Garg. However, scleral atrophy of tunnels may be an issue over time, with studies still too young to tell. The technique is the right option for the right patient, he said. Corneal crosslinking was a hot topic among panel members. With the application of the upgraded technique “accelerated crosslinking,” Thomas Kohnen, MD , Frankfurt, Germany, said it could reduce the procedure time from 18 to only 6 minutes. Using the Avedro (Waltham, Massachusetts) drug-device combination of riboflavin ophthalmic solution and UVA light, the higher intensity resulted in a shorter treatment time. Dr. Kohnen thinks that more data is needed regarding this relatively new and safe procedure that currently has follow-up data of 4 years. The photoactivation of riboflavin damages the RNA and DNA of bacteria, fungi, and viruses, according to Roberto Bellucci, MD , Verona, Italy, who uses corneal crosslinking in cases of infectious keratitis. He uses both the standard Dresden and the accelerated crosslinking methods, saying that when dealing with an infection, it may be wise to limit the crosslinking to the ulcer area. Other infections that he successfully treated with this method include Acanthamoeba keratitis, Staphylococcus epidermidis, and Pseudomonas aeruginosa. He suggested stopping quinolones, avoiding fluorescein stains, and considering viral keratitis a contraindication. When host keratocytes penetrate the donor graft (10% of cases), keratoconus can recur, even after a decade, necessitating a repeat graft or the use of intracorneal segments, he explained. Cesar Carriazo, MD , Barranquilla, Columbia, thinks that corneal lifting may be a promising new approach to treat keratectasia, the protrusion of a thin, scarred cornea. As refraction is limited even after crosslinking, it is vital to develop a refractive technique that does not reduce the optical zone or induce HOAs. The technique can be done with excimer using a crescentic mask or femtosecond laser that uses a special software for crescentic resection. This innovative idea produces a physiologic corneal shape and involves crescentic keratectomy and corneal flattening. At 30 months of follow-up, Dr. Carriazo reported a 400 µm difference in the anterior chamber depth and significantly improved visual results. Toric marking was the topic addressed by Samaresh Srivastava, MD , Ahmedabad, India, who thinks that manually marking the cornea may be less precise than automated options and more difficult to perform due to patient discomfort and