EyeWorld India September 2018 Issue

she said. “No glue and no scleral flaps are required unlike conven- tional glued IOL technique.” Dr. Chee added that limited conjunc- tival peritomy is performed unlike the double-needle technique, and no sutures are used to secure the IOL. Dr. Chee stressed that there are special instruments and skills required for this technique. “Im- portantly, the surgeon must be able to train to perform adequate vit- rectomy to avoid retinal complica- tions,” she said. Surgical videos can be a valuable teaching tool to help master IOL fixation techniques. Another important topic highlighted in a MasterClass was optimizing outcomes with to- ric IOLs, featuring a faculty that included Tetsuro Oshika, MD, PhD, Tsukuba, Japan, Graham Barrett, MD, Perth, Australia, Ronald Yeoh, MD, Singapore, and Pichit Naripthaphan, MD, Bangkok, Thailand. Topics covered included preoperative considera- tion and patient selection, mas- tering the Barrett IOL Calculator, axial marking and implantation techniques, different toric IOLs and lenses, and managing complica- tions and difficult cases. In one highlight of the session, the MasterClass went ‘live’ online to use the Barrett Toric Calculator (BTC) “so that delegates learn to use it most efficiently in their prac- tices,” Dr. Yeoh said. He added that the “live” online use of the BTC was presented for the first time in a very successful instructional course at the 2018 ASCRS Annual Meeting in Washington, D.C., U.S. “The BTC is currently one of the most reliable tools for generat- ing precise astigmatic outcomes after lens implantation,” Dr. Yeoh said. “However, there are many nuances in using it efficiently.” He added that going live online allows for some of these nuances to be taught. “One of the most useful features of the BTC is the use of the Integrated K Calculator, which allows the surgeon to optimize his K values and axes from three differ- ent sources,” he said. “This trans- lates to more precise outcomes.” The course also covered axial marking and the many ways to make reference and axis markings. Surgeons were guided as to the most appropriate ways to do this. Cataract surgery and the retina A symposium presented by the Thai Retinal Society (TRS) featured various presentations relating to cataract surgery and the retina. Tharikarn Sujirakul, MD , Bangkok, Thailand, presented “All You Need to Know about Cataract Surgery in Retinal Dystrophy.” She said that the impact of cata- racts in retinal dystrophy patients is well known, and these patients may be more sensitive to lens opac- ity compared to normal patients. Higher intraocular light scattering can also occur, as well as compro- mised photoreceptor function. Dr. Sujirakul said some of the main concerns are if the patient’s vision will improve, if the cataract will quicken RP progression, and if there will be phototoxicity. Will the patient’s vision im- prove? Dr. Sujirakul said it will. There is significant visual improve- ment in terms of visual acuity or subjective vision in all patients, and patients with intact central ellipsoid line have a better post- operative visual outcome. Will the cataract surgery quicken RP progression? It won’t, said Dr. Sujirakul, adding that there is no difference in RP progression rate detected by spectral domain OCT or other function tests. She said that phototoxicity is also unlikely. There has been no worsening of vision or direct phototoxicity reported with the current surgical procedure. These patients may have a higher rate of zonular compromise and IOL subluxation. This can be de- tected in the preoperative, periop- erative, and postoperative period. Additionally, chronic inflamma- tion and increased inflammatory cytokines can cause this. Patients also have a higher incidence of rapid capsular contrac- tion syndrome, and some cases are reported as early as 2 weeks postop. Higher incidence of posterior capsular opacification (PCO) may also be a concern. Dr. Sujirakul said that 40–50% of patients require a YAG capsulotomy. This occurs more frequently with PMMA and silicone IOLs compared to acrylic material. These patients may have a more visually significant postop CME, which may be caused by pre- existing epiretinal membrane. Dr. Sujirakul shared some of the preoperative considerations for these patients. Careful examina- tion to detect zonular instability is important to plan surgery well, she said. Treating preexisting condi- tions that might limit a promising outcome is also important. Dr. Sujirakul highlighted IOL selec- tion for these patients. In terms continued on page 62