EyeWorld India September 2019 Issue

70 EWAP SEPTEMBER 2019 APACRS LIM Lecture: The Quest for Safer and More Accurate Cataract Surgery, with Dr. Tetsuro Oshika º Ì >Ü>Þà Ãii“à ˆ“«œÃÈLi until it is done.” Nelson Mande- la’s wisdom remains true even in the world of ophthalmolo- gy—we have to keep on being challenged in clinical research and new technologies. Tetsuro Oshika, MD, began his keynote address discussing two signif- icant topics: endophthalmitis prevention and toric IOL mis- alignment. Regarding endoph- thalmitis prevention, washout of the anterior and posterior chamber after IOL implantation is of great importance. The two reasons, Dr. Oshika said, being prevention of IOP spike and infection prophylaxis. In a prospective study led by Dr. Oshika in 9,100 cataract surgery cases, the incidence of endophthalmitis was statistically È}˜ˆwV>˜ÌÞ…ˆ}…iÀ ˆ˜ V>Ãià ̅>Ì did not utilize the behind-the- lens washout method (3 out of 3,077 cases) than in cases that did utilize behind-the-lens (zero out of 5,294 cases). Sur- geons should do their best to at least achieve temporal asepsis intraoperatively, and one of the methods targeted to achieve that is povidone iodine irriga- tion. Dr. Oshika emphasized that at 0.25% povidone iodine, the solution is safe and effective in preventing endophthalmitis after ocular surgery. Second, toric IOL mis- alignment may jeopardize its correcting effects in patients, Dr. Oshika said. He presented > ëiVˆwV V>Ãi œv > x{‡Þi>À‡œ` female pediatrician presenting with preoperative astigmatism or –2.88 D at 180°. With a plan to utilize toric IOL, targeting 85°, the patient actually postoper- atively measured at –5.0 D Ax 160° with increased astigmatism. Dr. Oshika then raised the ques- tion of how often repositioning surgery is performed. In another paper, Dr. Oshika determined that surgical repositioning of to- ric IOLs was performed in 42 out of 6,431 cases (0.653%). Timing matters as well, with reposition- ing surgery performed 1 week after cataract surgery resulting in better outcomes and less misalignment. Referring back to the case, Dr. Oshika resolved the female pediatrician’s astig- matism to –0.75 D Ax 180°. A tip to reducing misalignment, Dr. Oshika mentioned, is to wait until complete unfolding occurs as some lenses are very slow to open. Finally, Dr. Oshika touched on reverse optic capture being useful in the case of very unsta- ble toric IOLs or a broken pos- terior capsule. Surgical videos in Dr. Oshika’s keynote showed very clear surgical techniques for reverse optic capture. Thursday, 3 October 2019 /…i wÀÃÌ `>Þ œv ̅i ÃVˆi˜ÌˆwV program, featured the society’s signature MasterClasses as well >à ÃVˆi˜ÌˆwV ÃiÃȜ˜Ã œ˜ VÕÌ̈˜} edge phaco and IOLs (KATANA), ºÀi>Ìi` ˆÃÃÕiû 1 Ƃ ®] Vœ“ - bined cataract surgery (ORIGA- ®] >˜` “>˜>}ˆ˜} >µÕiœÕà yœÜ ˆ˜ }>ÕVœ“> <1®° KATANA: The Cutting Edge in Phaco & IOLs Milind Pande, MD , began this symposium Thursday morn- ing by discussing the basics of toric IOLs (T-IOLs), highlighting that effective corneal plane toricity depends on centration, tilt, rotation, symmetry, post- operative anterior chamber depth, and intraocular lens (IOL) spherical equivalent (SE). With good quality measurements and y>܏iÃà ÌiV…˜ˆµÕi] ̜ÀˆV " à give results at about 75% <0.5D. Oliver Findl, MD , continuing the discussion, added that the main source of error in T-IOL calculations is the corneal mea- ÃÕÀi“i˜Ì° 1Ș} ̅Àii `ˆvviÀi˜Ì devices and at least two differ- ent measurement techniques may yield more accurate mea- surements. Moreover, in post refractive patients, using direct PCA measurements with the IOLMaster 700, which provides a Barrett True K TK value, provides more accurate values than other methods, according to Michael Lawless, MBBS, FRANZCO, FRACS . Sombat Srisuwana- porn, MD , touched on the Verion Image Guided System used in cases to measure, plan, and guide surgery. Among the different cases he presented, the Barrett formula is preferred due to it being more aggressive in measurements than what the Verion may calculate. Hungwon Tchah, MD , presented insights on the highly accurate femtosecond laser which may be used in femtosec- ond laser-assisted cataract sur- gery (FLACS), creating cleavage planes through photodisruption in translucent tissues. Femto- second laser can also be used in corneal or refractive applications Ƃ- y>« VœÀÀiV̈œ˜® œÀ VœÀ - neal lenticule extraction. Chee Soon Phaik, MD , discussed the `iÌ>ˆÃ œv ̅i Ƃ*-1 >ÃiÀ] > compact device mounted under the microscope but not inserted into the anterior chamber, which provides stronger capsulotomy than manual continuous curvi- linear capsulorhexis (CCC) and «>̈i˜Ì yœÜ ˆÃ ˜œÌ >˜ ˆÃÃÕi° ˜ selective thermal laser capsulot-