EyeWorld India September 2018 Issue

of focality, a monofocal may be preferred to a multifocal. Most papers advise to choose a monofo- cal to avoid light scatter, she said, as the photoreceptor may be compro- mised. She said that acrylic material is preferred to PMMA or silicone, and a three-piece lens is generally preferred to a one-piece. In terms of choosing a clear vs. yellow tinted color, Dr. Sujirakul said that the trend is to use more yellow, but there is no solid evidence. She also said to aim for plano or myopia. Important intraoperative considera- tions include minimizing photo- toxicity, minimizing stress on the zonules, and making every effort to prevent capsular contraction syndrome and posterior capsular opacity. Dr. Sujirakul detailed how to minimize capsular contraction syndrome. This includes larger ACC size (at least 5.5 mm), meticulous ACC polishing, using a three-piece IOL, possibly using a capsular tension ring, using multiple radial relaxing incisions, and good control of postoperative inflammation. Postoperative considerations include being more aggressive in inflammation control to avoid PC, capsular contraction syndrome, and IOL subluxation. Early detection of CME is important, and if there is CME, you can use topical steroids, NSAIDS, or local steroid injections. Low vision rehabilitation might be needed in some patients. Neuroimaging for ophthalmologists During a symposium presented by the Thai Neuro-Ophthalmology Society (TNOS), presenters shared information on neuroimaging for ophthalmologists. During the session, Nat- tapong Mekhasingharak, MD , Phitsanulok, Thailand, presented “I See Two of You! My Cataract Keeps Bothering Me!” He shared a case of an 87-year-old woman who developed double vision for 2 weeks. Her double vision would disappear when either eye was cov- ered. She also had hypertension that was well controlled. When evaluating a patient with a complaint of double vision, Dr. Mekhasingharak said that the first question to ask is if the di- plopia is monocular or binocular. Monocular diplopia is an optical abnormality associated with un- corrected refractive error, cataract, corneal surface irregularity, iris hole, or dislocated lens, he said. However, this patient’s double vision would disappear when either eye was covered, so she had binocular diplopia, he said. Binocular diplopia is caused by ocular misalignment, Dr. Mekhas- ingharak said. The diagnosis for this patient was partial third cranial nerve palsy with pupillary involvement. There may be numerous causes of third nerve palsy. She underwent emergency MRI and MRA but did not have cataract surgery. Kittisak Unsrisong, MD, Chiang Mai, Thailand, weighed in on the case, noting that MRI is tricky because you have to specify what you’re going to look at (the brain, the vessel, the cranial nerve, etc.). The clini- cal history is important for this, and without it, you could miss the abnormality. Dr. Mekhasingharak said that the patient was admitted to the neurosurgical ward, but she refused to get any further interven- tion after discussing risks and ben- efits. He noted that 2 months later, the patient’s symptoms improved, and 5 months later, she had no diplopia in primary position and had light limitation of upward and downward movement in the right eye. Dr. Mekhasingharak said that third cranial nerve palsy with pu- pillary involvement must urgently undergo vascular imaging because of the risk of aneurysm. Cataract for glaucoma patients A symposium presented by the Thai Glaucoma Society (TGS) discussed “How to Get Fantastic Cataract Results for Your Glaucoma Patients.” During the session, Boonchai Wangsupadilok, MD, Songkhla, Thailand, discussed being aware of preoperative shallow anterior chamber. A shallow anterior chamber is a pain for the surgeon, he said. There is limited space, risk of tissue injury, risk of lens capsule injury, and this can lead to fragments or nucleus drop. Preoperative evaluation is cru- cial for a good surgical result, Dr. Wangsupadilok said. This includes a comprehensive eye examination, anterior segment and angle imag- ing, and biometry. He said that anterior cham- ber shallowing may be caused by primary angle closure glaucoma or secondary angle closure glaucoma. 31st APACRS – from page 61