EyeWorld India June 2017 Issue

June 2017 EWAP NEWS & OPINION 69 continued on page 70 eye movements. He said the head and chin positioning were key for getting accurate toric markings. The panel felt that anatomy over function was always the “great debate,” and that some techniques, while good in concept, were not as good in reality. They agreed that doing both a manual and automated marking was wisest and oftentimes went with their manually marked axes when in doubt. Editors’ note: Drs. Barrett, Carriazo, and Garg have financial interests related to their comments. Drs. Bellucci, Kohnen, and Srivastava have no financial interests related to their comments. ASCRS, APACRS instructors share pearls at the inaugural TOPGUN symposium Just an hour south of Los Angeles in Miramar, California, is the legendary TOPGUN flight school, popularized by the 1986 film Top Gun. Instructors from both ASCRS and APACRS sought to bring the spirit of TOPGUN to a Sunday afternoon symposium. David Chang, MD , Los Altos, California, introduced this first- time symposium. “Only the most promising Navy pilots attend the TOPGUN flight school … trained there by the Navy’s best TOPGUN instructors to become elite fighter pilots,” Dr. Chang said. In this session, “it’s you who will be trained by TOPGUN phaco instructors to become elite cataract surgeons.” While fighter pilots are taught complex flight maneuvers, however, the ASCRS and APACRS TOPGUN instructors were asked to present “simple trade secrets that make their cases look effortless and smooth,” Dr. Chang said. In flight suits, hats, and aviator glasses, 14 instructors took to the stage to present their pearls. At the end of the symposium, the audience voted for winners in four categories (spoiler alert, APACRS swept all four). The Great Balls of Fire award, presented by Steven “Legs” Schallhorn, MD , San Diego, California, a real former TOPGUN student and later instructor, was given to Tetsuro “Samurai” Oshika, MD, PhD , Tsukuba, Japan, who presented his chamber maintenance technique called “goldfinger.” “If the chamber collapses, extensive hydration may be needed. My tip is to put your goldfinger on the eye,” Dr. Oshika said in his presentation. “When finished with I/A, just put your finger on the eye followed by injection of balanced salt solution.” Dr. Oshika said that once the chamber collapses, wound chamber architecture can be compromised and restoration takes time. Putting your finger on the wound allows the wound architecture to be maintained and the IOP increases. Graham Barrett, MD , Perth, Australia, a panelist in the session, called the idea “absolutely brilliant,” and offered two other tips: Hydrate your incision before you take out your I/A and take it out quickly. The Danger Zone award was presented to Soosan “Blade Runner” Jacob, MD , Chennai, India, for her daring capsular tension ring (CTR) insertion. Her pearls included inserting the CTR toward the zone of zonular dialysis; using pupil expanders and dilating the pupil to get a view; using microfoceps to grasp the CTR instead; releasing the CTR into the bag; using the CTR as late as you can and as early as you must; having a backup plan, such as capsular hooks; and considering scleral fixation in the form of a sutured ring or segment or a glued capsular hook, the latter which Dr. Jacob noted is an off-label use. The TOPGUN award, presented to the best overall instructor, went to Robert “Pacman” Ang, MD , Manila, Philippines, who spoke about an easy, readily available, and relatively inexpensive capsule marking technique. First, he explained the importance of a consistent and appropriately sized and centered capsulorhexis. Femto and digital markers can be expensive, not available to everyone, and sometimes not entirely easy to use. Instead, Dr. Ang suggested using an optical zone marker, typically used for refractive surgery. It creates a small indent that fades; it’s customizable in that you could buy several different sizes; and it’s easily accessible to everybody. The overall best instructor team award was presented to APACRS, which, in addition to Drs. Ang, Jacob, and Oshika, included John “Dragon” Chang, MD , Hong Kong, Soon Phaik “Spice Girl” Chee, MD , Singapore, Y.C. “Merlin” Lee, MD , Perak, Malaysia, and Michael “Gladiator” Lawless, MD , Sydney, Australia. Kerry “POTUS” Solomon, MD , Mount Pleasant, South Carolina, on the ASCRS team, presented video evidence of the benefit of using an aspirating speculum. Using model eyes and dye—one eye with a regular speculum and another eye with an aspirating one—Dr. Solomon showed how in various stages of cataract surgery, dye in the non- aspirating speculum was able to enter the eye in greater quantities. While in a clinical setting, surgeons might not think twice about the unintentional fluid entering the eye because they can’t see it, but “what are we introducing into the eye when we introduce this?” Dr. Solomon asked. Meibomian secretions, tear film debris, inflammatory mediators, and potentially microorganisms” could be entering the eye in this fashion. Dr. Solomon said an aspirating speculum could reduce this fluid. Another presentation from the ASCRS team came from Robert “Dangerous” Osher, MD, Cincinnati . “If you put an IOL into the eye, you should know how to take it out, otherwise, you’re dangerous,” Dr. Osher said, offering two techniques for lens removal in the case of a broken haptic. The Eguchi technique involves prolapsing the lens out of the bag into the anterior chamber, enlarging the incision to allow for scissors, which will be used to cut halfway through the lens. Rotate the lens 90 degrees and cut again to meet the first cut; remove the quadrant and the rest of the lens can then be explanted safely, Dr. Osher said. Another technique, the Ernest technique, also involves prolapsing the lens into the anterior chamber. Make a beveled penetrating stab incision 180 degrees away from the main incision and use a smooth spatula to come under the lens and use another instrument to fold the lens over it, explanting it in this configuration through the incision. Other members of the ASCRS team included Robert “Bo” Cionni, MD , Salt Lake City, Rosa “Rock Star” Braga-Mele, MD , Toronto, Mitchell “Cyclops” Weikert, MD , Houston, Richard “Slicer” Hoffman, MD , Eugene, Oregon , and Elizabeth “Slick Chopper Chick” Yeu, MD , Norfolk, Virginia. Editors’ note: Dr. Jacob has financial interests with Morcher (Stuttgart, Germany). The other physicians have no financial interests related to their comments. East Meets West symposium presents differing viewpoints How physicians from the East approach certain situations can be different from their counterparts in the West, and learning from each other was the point of Monday’s “East Meets West” symposium cosponsored by ASCRS and APACRS.