EyeWorld India September 2018 Issue

face disease—due to medications, blebs, MGD, scarring, etc.—the issue needs to be diagnosed and managed before using one of these lenses. Lenses with a higher likelihood of developing glistenings should be avoided for glaucoma patients, Dr. Chakrabarti said. Research has shown that glistening sever- ity increases with time and with chronic use of eye drops, which many glaucoma patients are using. Glistenings in glaucomatous eyes can alter visual performance by reducing contrast sensitivity and overestimating focal defects. Achieving Nirvana: Top cataract surgery tips The final session of the APACRS an- nual meeting was “Achieving Nir- vana,” which featured international presenters sharing surgical tips and maneuvers that attendees could take home and use in practice. Chairs of the session were Ronald Yeoh, MD , Singapore, Pannet Pangputhipong, MD , Bangkok, Thailand, and Graham Barrett, MD , Perth, Australia. Speakers at the session were Eric Donnenfeld, MD , Rockville Centre, New York, Thanapong Somkijrungroj, MD , Bangkok, Thailand, Chandra Bala, MD , Sydney, Australia, Gerd Auffarth, MD, PhD , Heidel- berg, Germany, Dr. Pangputhip- ong, Jeewan Titiyal, MD , New Delhi, India, David Lubeck, MD, Homewood, Illinois, Myoung Joon Kim, MD , Seoul, South Korea, Beatrice Cochener, MD, PhD , Brest, France, Johan Hutau- ruk, MD , Jakarta, Indonesia, Soon Phaik Chee, MD , Singapore, and Somdutt Prasad, MD , Kol- kata, India. Dr. Donnenfeld’s tip related to the issue of nuclear chips in the vitreous after cataract surgery and how to prevent these. Nuclear chips can sometimes be found floating in the back of the eye and can cause inflammation after surgery. How do they get into the vitre- ous? When you’re using a phaco probe and move it to one side, it occludes the irrigation on one side, Dr. Donnenfeld said. It creates irrigation flow that pushes things through the zonules and into the posterior chamber, and he said that 25% of patients who have cataract surgery today can be found to have these chips. To avoid this, Dr. Donnenfeld offered several tips. You can keep your phaco tip open and central. You can make the incisions a little larger, so it doesn’t occlude irriga- tion to the side. There are also new designs for phaco irrigation sleeves that have little elevations to pre- vent occlusion of flow to the side. Dr. Pangputhipong shared tech- niques for minimizing discomfort in high myopic eyes during phaco- emulsification. This discomfort may be caused by sudden change in IOP or if the bottle height is too high. The key solution, he said, is “slow motion irrigation.” The first technique Dr. Pangputhipong sug- gested for doing this is slow tip in- sertion: Use continuous irrigation; slowly insert the phaco or I/A tip; and allow the AC to inflate slowly. He also suggested pinching the irrigating line, adjusting the bottle height (lowering it to 30 cm and slowly raising it up), or using low phaco parameters. At the end of the symposium, the audience voted for the best tip. Dr. Chee won the vote with a technique for clear corneal sealing using the infusate. Presenting several videos of wound construction of different widths, Dr. Chee demonstrated the technique in which the BSS spewing from the silicone infusion sleeve of the irrigation handpiece is allowed to hydrate the incision. The incision is then held closed by pressing the incision lips together using a 30-G Rycroft cannula. The side port is sealed by pressing the incision. This technique, she said, avoids the need to inject BSS into the sides of the clear corneal incision, the conventional method for sealing the incision which creates huge areas of corneal whitening. She offered the following pearls: Ensure the correct incision plane and proportion for self-sealing incisions; seal the side port inci- sion first by massaging the external lip; use the infusate to hydrate the incision as described; for the main incision, because of internal gape, massage the external lip and appose the lips of the external wound; and always ensure adequate IOP. EWAP 31st APACRS – from page 69