EyeWorld India December 2018 Issue

Alcon Surgical Video Symposium At the 2018 APACRS Annual Meeting, chairs Pannet Pangputhipong, MD , Bangkok, Thailand, Graham Barrett, MD , Perth, Australia, and Ronald Yeoh, MD , Singapore, as well as Cesar Espiritu, MD , Manila, Philippines, led a video symposium sponsored by Alcon (Fort Worth, Texas). Speakers on the program included Dandapani Ramamurthy, MD , Coimbatore, India, Michael Lawless, MD , Sydney, Australia, David Lubeck, MD , Home- wood, Illinois, and Pichit Narip- thaphan, MD , Bangkok, Thailand. Dr. Naripthaphan presented “Efficiency and Efficacy,” discussing elegance in dense nucleus removal. Showing a surgical video, he offered tips on how to maintain the chamber after implantation of a premium lens. Dr. Naripthaphan suggested using a wet sponge to help maintain the anterior chamber when taking out I/A. In a premium lens, if the chamber collapses, the lens will pop out and the axis will rotate. At the end of the surgery, he always puts OVD on the surface to protect the surface. When you take out the speculum, be very gentle, he added. His take home-messages included a variety of tips: the LenSx laser (Alcon) can make your life easier; Centurion (Alcon) with balanced tip is superb for hard nucleus; and stromal hydration before OVD removal can help better maintain the chamber. Dr. Ramamurthy shared several challenging cases and how he handled them. He discussed a hard, brown nuclear cataract, a soft cataract, and a post-traumatic subluxated cataract. During his case presentation, Dr. Ramamurthy noted the value of using the LenSx laser platform. You can tailor-make the rhexis exactly where you want it with this technology, he said. Particularly in post-traumatic subluxated cataract cases, there is no countertraction, so it may be chal- lenging to make the rhexis manu- ally. “The greatest advantage of the LenSx is the ability to make the rhexis exactly where you want,” he said. So you have a well-centered lens and well-centered rhexis at the end of the surgery. Dr. Ramamurthy added that ear- lier there was some controversy about the strength of the rhexis created with femto platforms. But now because of the lower energy levels and more precise focusing of the laser beam, there is significant evidence that these rhexis are equally strong, he said. Meanwhile, Dr. Lubeck shared information on achieving greater accuracy in less predictable eyes, showing a case presentation. He noted many advantages of the technology he used. With VERION (Alcon), the cap- sulorhexis and lens ablation can be centered on the visual axis, he said. Dr. Lubeck performed phacoemulsifi- cation at an IOP of 28, and he said he “wouldn’t have been able to conceive of doing this before Centurion.” Dr. Lubeck detailed how he utilizes the Innovations in refractive cataract surgery APACRS ORA intraoperative aberrometry sys- tem (Alcon) and the “rich amount of data” it provides. Lastly, Dr. Lawless shared some choices of advanced technologies to optimize patient outcomes. Dr. Lawless said that in his practice, the LenSx laser is fundamental in terms of accuracy and safety of the capsuloto- my. He added that using the Centu- rion system makes him comfortable because it can provide great chamber stability and safety. He thinks femto- second laser surgery is incrementally better than what he can do manually and that the Centurion system is the key to safe, controlled surgery. Dr. Lawless highlighted the ben- efit of using the VERION system, par- ticularly in toric cases, which are the majority of lenses that he implants. Once you have optimized the tear film and cut through the “noise,” the accuracy of good formulae is appar- ent, digital alignment makes sense, and small toric IOLs are meaningful. Dr. Lawless noted that he’s not a better surgeon than he was 5 years ago, but he’s getting better accuracy than he was 5 years ago, to the level that patients expect. He also briefly mentioned the Clareon lens (Alcon) with its injector, which he said is the best injector he’s used in terms of protecting the IOL and the wound. Dr. Lawless concluded by sum- marizing his seven essentials for happiness: 1. Safe surgery: Centurion chamber stability 2. Safety and accuracy – LenSx 3. A realistic conversation prior to surgery 4. Tear film optimization 5. Biometry with correct formulae 6. Toric IOLs in 90% of patients, which requires VERION and digital alignment 7. PanOptix trifocals in 25% of patients e news magazine of the Asia-Paci c Association of Cataract & Refractive Surgeons Michael Lawless, MD Michael Lawless, MD, Pichit Naripthaphan, MD, David Lubeck, MD, Graham Barrett, MD, Ronald Yeoh, MD, Dandapani Ramamurthy, MD, Pan- net Pangputhipong, MD, and Cesar Espiritu, MD Sponsored by Alcon Supplement to EyeWorld Asia-Pacific Winter 2019