EyeWorld India September 2018 Issue

Dr. Wangsupadilok also offered some cues for shallow anterior chamber: inharmonious shallow anterior chamber, dynamic chang- ing of the anterior chamber depth, and very shallow anterior chamber. He also shared preoperative prepa- ration and surgical techniques and options that may be utilized in these cases. In terms of surgical techniques, Dr. Wangsupadilok suggested high inflow pressure, tight wounds, high molecular weight cohesive OVD, adjusted phaco technique to increase surgical space, CTR inser- tion if there is instability of the lens complex, IOL fixation if there is a very unstable lens, and anterior vitrectomy or lensectomy in some cases. In conclusion, Dr. Wangsu- padilok said that cataract surgery in shallow anterior chamber is a challenge. Many aspects need to account for risk and benefit for the patient, he said, and compre- hensive eye examinations, imag- ing, preoperative preparation, and appropriate surgical techniques are the keys for good surgical outcome. Boonsong Wanich- vecharungruang, MD, Bangkok, Thailand, discussed “Tips and Tricks in Pseudoexfoliative Glauco- ma.” He said that pseudoexfoliative glaucoma can involve not only the lens but possibly the cornea and retina as well. The anterior cham- ber can be deep or shallow, he said, and lens subluxation may occur, among other issues. Dr. Wanichvecharungruang offered several tips when dealing with pseudoexfoliative glaucoma. Don’t miss the subtle signs, he said. It’s also important to inform the patient of possible complications, as well as potential extra costs for additional devices that need to be used. These devices could include Kuglen hooks, iris retractors, CTRs, or other devices, Dr. Wanich- vecharungruang said. He went on to discuss the preoperative evaluation and cata- ract surgery in pseudoexfoliative glaucoma, particularly stressing some of the devices he likes to use in these cases. Visanee Tantisevi, MD, Bangkok, Thailand, discussed “Complexity in IOL Calcula- tion.” She specifically discussed intraocular lens power calculation in primary angle closure patients. These patients may have a shallow anterior chamber depth, crowded anterior segment, small corneal di- ameter, a thick and anteriorly situ- ated lens, and short axial length. She added that there are many IOL calculation parameters and then went on to discuss effective lens position (ELP). This is the main source of IOL calculation error, especially in primary angle closure eyes, due to discrepancy in the ratio of anterior chamber depth to axial length, Dr. Tantisevi said. She also stressed some of the benefits of phaco in angle closure glaucoma eyes. She added that IOL calculation for cataract surgery in glaucoma patients is not a simple task. Angle closure eyes or short eyes need more careful IOL selection, Dr. Tan- tisevi said. She added that newer intraoperative IOL measurement may play an important role. Pediatric cataracts Pediatric cataracts and the chal- lenges associated with these cases were the topic of a symposium presented by the Paediatric Oph- thalmology and Strabismus Society (POS). Wadakarn Wuthisiri, MD, Bangkok, Thailand, presented in the session on the topic of “Visual Rehabilitation in Paediatric Cataract.” Pediatric cataract is the most common cause of treatable child- hood blindness, she said, and it accounts for about 5–20% of blindness in children worldwide. However, she noted that a perfect surgical outcome is not necessarily equal to a good visual outcome. The key to obtaining a good visual outcome, she said, is surgical removal of the lens opacity, proper optical correction, and effective management of amblyopia. Dr. Wuthisiri then went through some treatment options for these patients, which could in- clude aphakic glasses, aphakic con- tact lenses, or intraocular lenses. For aphakic glasses, advantages include that they are safe, the power can be adjusted, and they are inexpensive. However, disadvantages include that there is restricted visual field, there may be image distortion and prismatic effect, aniseikonia and anisometropia, they are heavy, and they are cosmetically undesirable. Meanwhile, aphakic contact lenses have also become a popular option, Dr. Wuthisiri said. Ad- vantages include that they are relatively safe, the power can be easily adjusted, they are suitable for unilateral aphakia, and they have better visual field than glasses. However, disadvantages may in- clude noncompliance, contact lens loss or complications, and they are expensive. Dr. Wuthisiri also stressed the challenge of pediatric contact lens fitting in pediatric patients, which she noted is anatomically differ- continued on page 64