EyeWorld India June 2020 Issue

EWAP JUNE 2020 11 FEATURE ̅i ˆ˜ÌÀ>œ«iÀ>̈Ûi " /] œÕÀ group was able to describe the fascinating variations of the anterior interface from birth till adulthood and to evaluate ˆÌà >}ˆ˜} «ÀœViÃÃ]» Åi Ã>ˆ`° º Ì LiV>“i iۈ`i˜Ì ̅>Ì Ì…ˆÃ anterior interface changes over time and becomes bigger and bigger until it detaches from ̅i «œÃÌiÀˆœÀ V>«ÃՏi° /…ˆÃ process was called anterior ۈÌÀiœÕà `iÌ>V…“i˜Ì] ܅ˆV…ˆÃ the equivalent of the posterior ۈÌÀiœÕà `iÌ>V…“i˜Ì *6 ®°» 3 Corneal surgery Dr. Schallhorn uses intraoperative " / ˆ˜ > œv…iÀ >“i>À VœÀ˜i> V>ÃiÃ] ˆ˜VÕ`ˆ˜} -Ƃ ] Ƃ ] >˜` ° º Ì ˆÃ }Ài>Ì Ìœ Ãii ˆv ̅iÀi ˆÃ >˜Þ yՈ` ˆ˜ ̅i ˆ˜ÌiÀv>Vi ˆ˜ -Ƃ V>Ãià >˜` ̜ V…iVŽ if there are any peripheral Descemet’s remnants that are «ÀiÛi˜Ìˆ˜} ̅i }À>vÌ vÀœ“ >`…iÀˆ˜} £ää¯]» Åi Ã>ˆ`° º Ì ˆÃ ˆ˜Û>Õ>Li ˆ˜ Ƃ V>Ãià ̜ check the depth of your cannula before the big bubble and to ensure that all the stroma has been removed prior to placing ̅i }À>vÌ°» º ˜ÌÀ>œ«iÀ>̈Ûi " / ˆÃ…i«vՏ ˆ˜ > Vœ˜`ˆÌˆœ˜Ã œv VœÀ˜i> ÃÕÀ}iÀÞ]» À° />ÃÈ}˜œ˜ >}Àii`° œÀ >˜Þ ÀiÈ`Õ> ˆ˜ÌiÀv>Vi yՈ` ˆ˜ -Ƃ ] she and Dr. Findl described performing a corneal massage or creating venting incisions ՘`iÀ " / Vœ˜ÌÀœ° º9œÕ V>˜ Li sure that at the end of surgery ÞœÕ `œ˜½Ì…>Ûi yՈ` ˆ˜ÌiÀv>Vi between the transplant and ÀiVˆ«ˆi˜Ì VœÀ˜i>]» À° ˆ˜` Ã>ˆ`° /…i ÌiV…˜œœ}Þ ˆÃ >Ãœ ÕÃivՏ for orienting the rolled donor ̈ÃÃÕi `ÕÀˆ˜} ° º"˜Vi ޜսÀi ՘vœ`ˆ˜} ̅>Ì] ÞœÕ V>˜ see quite well whether it’s the Àˆ}…Ì Ü>Þ Õ« œÀ իÈ`i `œÜ˜]» Dr. Findl said. Retina ˜ÌÀ>œ«iÀ>̈Ûi " / «>Þà > major role in Dr. Findl’s retina V>Ãið /…i ÌiV…˜œœ}Þ >œÜà him to identify the presence of > ̅ˆVŽi˜i` “>VՏ>] i«ˆÀï˜> “i“LÀ>˜i] ̅ˆVŽi˜i` >˜`É or adherent internal limiting “i“LÀ>˜i ®] œÀ VÞÃ̜ˆ` “>VՏ>À i`i“>° ÕÀˆ˜} «iiˆ˜}] it allows him to see the tension …i½Ã «ÕÌ̈˜} œ˜ ̅i Àï˜>] allowing him to adjust his technique. º >ÃÌ LÕÌ ˜œÌ i>ÃÌ] ˆŽi ̜ use it for macular hole surgery LiV>ÕÃi Üi ˆŽi ̜ `œ ̅i y>« ÌiV…˜ˆµÕi] ܅iÀi Üi «ÕÌ > «>ÀÌ œv ̅i y>« œ˜ ̜« œv ̅i “>VՏ>À…œi] iëiVˆ>Þ vœÀ >À}i “>VՏ>À…œiÃ]»…i Ã>ˆ`° º œÀ that it’s quite nice because you V>˜ >VÌÕ>Þ Ãii ̅i y>«] >˜` when you’re introducing air into ̅i iÞi] ÞœÕ V>˜ Ãii >˜` Vœ˜ÌÀœ ̅i «œÃˆÌˆœ˜ œv ̅i y>« ՘̈ the very end when you have a Vœ“«iÌi >ˆÀ w°» Training, general applications œÀ ÌÀ>ˆ˜ˆ˜} «ÕÀ«œÃiÃ] À° Findl and Dr. Schallhorn both said their residents learn to operate using standard ÃÕÀ}ˆV> “ˆVÀœÃVœ«iÃ] ܈̅œÕÌ ˆ˜ÌÀ>œ«iÀ>̈Ûi " /° œÜiÛiÀ] ˆ˜ÌÀ>œ«iÀ>̈Ûi " / ˆÃ ÕÃivՏ vœÀ evaluating their performance. /…i ÌiV…˜œœ}Þ]…œÜiÛiÀ] ˆÃ º£ää¯ ÕÃivՏ vœÀ iÝ«iÀˆi˜Vi` Ronald Yeoh, FRCS, FRCOphth, DO, FAMS œ˜ÃՏÌ>˜Ì Þi -ÕÀ}iœ˜ E i`ˆV> ˆÀiV̜À] Þi E ,ï˜> -ÕÀ}iœ˜Ã Ƃ`° ƂÃÜVˆ>Ìi *ÀœviÃÜÀ Վi‡ 1- À>` i` -V…œœ] -ˆ˜}>«œÀi Þi i˜ÌÀi ASIA-PACIFIC PERSPECTIVES Ü>à `iˆ}…Ìi` ̜ Ài>` ̅i >À̈Vi ˆ˜ ܅ˆV…Àð -V…>…œÀ˜] />ÃÈ}˜œ˜] >˜` ˆ˜` iÝ̜i` ̅i ۈÀÌÕià œv ̅i ˆ˜ÌÀ>œ«iÀ>̈Ûi " / ˆ" /® ˆ˜ ophthalmic surgery. When looking at the accompanying literature œv “>˜Õv>VÌÕÀiÀà ܅œ “>Ži ˆ˜ÌÀ>œ«iÀ>̈Ûi " / ÃÞÃÌi“Ã] ˆÌ ˆÃ iۈ`i˜Ì ̅>Ì Ì…i “>ˆ˜ ̅ÀÕÃÌ ˆÃ ̜Ü>À`à VœÀ˜i> >˜` Àï˜> ÃÕÀ}iÀÞ° Ìà ÕÃi ˆ˜ lamellar corneal surgery and macular hole surgery are well recognized. À° />ÃÈ}˜œ˜½Ã ÕÃi œv ˆ" / ˆ˜ iÕVˆ`>̈˜} ̅i >˜ÌiÀˆœÀ ۈÌÀiœÕà v>ViÉ«œÃÌiÀˆœÀ V>«ÃՏi Ài>̈œ˜Ã…ˆ« ˆÃ v>ÃVˆ˜>̈˜} >˜` `i“œ˜ÃÌÀ>Ìià the under utility of this technology in an area of far greater surgical numbers: common or garden cataract surgery! "ÛiÀ ̅i «>ÃÌ viÜ Þi>ÀÃ]…>Ûi iÝ«œÀi` ̅i ÕÃi œv ˆ" / ˆ˜ standard phaco cataract surgery and feel that it is a most useful tool in Ìi>V…ˆ˜}] ÀiÃi>ÀV…] >˜` >à > ÃÕÀ}ˆV> >ˆ`° ˆÀÃ̏Þ] ˆÌ…i«Ã Õà ՘`iÀÃÌ>˜` surgical anatomy better; we can look at the various lens opacities ˆŽi VœÀ̈V> œ«>VˆÌˆiÃ] ˜ÕVi>À ÃViÀœÃˆÃ] «œÃÌiÀˆœÀ ÃÕLV>«ÃՏ>À] >˜` «œÃÌiÀˆœÀ «œ>À V>Ì>À>VÌð ÕÀˆ˜} ÃÕÀ}iÀÞ ˆÌÃiv] ̅i Ìi>Àˆ˜} œv >˜ >˜ÌiÀˆœÀ V>«ÃՏ>À y>« V>˜ Li ÃÌÕ`ˆi` ˆ˜ `iÌ>ˆ° ̅>à >Ãœ Lii˜ œv great help in understanding hydrodissection and hydrodelamination >à v>À >à ܅iÀi ̅i yՈ` «>˜ià >Ài° /…iÃi V>˜ Li ÃÌÕ`ˆi` LœÌ…ˆ˜ Ã̈ ˆ“>}ià ˆ}ÕÀi £® >˜` `ޘ>“ˆV>Þ >à yՈ` i˜ÌiÀà ̅i i˜Ã° Figure 1. After hydrodissection, YG ECP UGG VJG ƃWKF layer in the lens with a layer of soft lens matter remaining next to the posterior capsule. -œÕÀVi\ ,œ˜>` 9iœ…] , -] , "«…Ì…] "] Ƃ - "v }Ài>Ì ˆ“«œÀÌ>˜Vi ˆ˜ ÌÀ>ˆ˜ˆ˜} LÕ``ˆ˜} ÃÕÀ}iœ˜Ã ˆÃ ̅i ˆ" / demonstrating the shape of and how deep a phaco groove is prior to VÀ>VŽˆ˜}° œ“«iÌi œÀ ˆ˜Vœ“«iÌi ˜ÕVi>À VÀ>VŽˆ˜} >vÌiÀ Ƃ -] V…œ«] «ÀiV…œ«] iÌV° >Ài >Ãœ Üi Ŝܘ° Dr. Findl alluded to the usefulness of the technology in assessing the >“œÕ˜Ì œv "6 Ài“>ˆ˜ˆ˜} Li…ˆ˜` ̅i " >vÌiÀ ˆ“«>˜Ì>̈œ˜° /…i ˆ" / i>ÈÞ `i“œ˜ÃÌÀ>Ìià ̅i >“œÕ˜Ì œv "6 «ÀiÃi˜Ì LivœÀi >˜` >vÌiÀ "6 Ài“œÛ>° -ÌÕ`ˆià V>˜ Li `œ˜i ̜ Ŝ܅œÜ Vœ“«iÌi "6 Ài“œÛ> ˆÃ ˆv > ÃÕÀ}iœ˜ `œià ˜œÌ >ëˆÀ>Ìi Li…ˆ˜` ̅i " ° /…i ˆ˜Ìi}ÀˆÌÞ œv “>ˆ˜ >˜` È`i «œÀÌ ˆ˜VˆÃˆœ˜Ã ˆÃ Üi ˆÕÃÌÀ>Ìi` >à >Ài ̅i ivviVÌà œv…Þ`À>̈œ˜ œv ̅i ܜ՘`° ˆ˜>Þ] ̅i ˆ "/ ˆÃ œv >ÃÈÃÌ>˜Vi when complications occur; it can show shallowing of the anterior V…>“LiÀ] ̅i " ̜ÕV…ˆ˜} ̅i VœÀ˜i> i˜`œÌ…iˆÕ“] À>`ˆ> Ìi>Àà œv ̅i ] «œÃÌiÀˆœÀ V>«ÃՏ>À ÀÕ«ÌÕÀiÃ] " ÃÕLÕÝ>̈œ˜Ã] iÌV° LiˆiÛi ̅>Ì ÕȘ} ˆ" / ŜՏ` Li > ÀœṎ˜i ˆ˜ V>Ì>À>VÌ ÃÕÀ}iÀÞ° Editors’ note: Dr. Yeoh is a consultant for Alcon, Johnson & Johnson, and Zeiss.