EyeWorld India September 2021 Issue

A t the Zeiss Indus- try Symposium on Friday July 30, 2021 at the 33rd APACRS-SNEC 30th Anniversary virtual meet- ing, four key leaders in ophthal- mology came together to share their experiences and insight on advancements in cataract and refractive surgery. Driving Outcomes & Satisfaction ... Supplement to EyeWorld Asia-Pacific September 2021 APACRS in unhealthy eyes, which are very important signs of inflammation resulting in changes in the nerve plexus. Dr. Shetty’s NIRVANA study (Nerves, Impacting Refractive sur- gery, Vision, Aberrations, Neuro regeneration, & Adaptation) ob- served how healthy and unhealthy corneal nerves affect surgical outcomes. Once the epithelium starts showing signs of stress and inflammation, remodeling of the epithelium changes over time, experiencing, for example, loss of meibomian glands. In these unhealthy nerves, a different en- vironment is created and nerve re- generation does not work as well as in healthy corneal nerves. It is important to note that a poor oc- ular surface and a poorly shaped meibomian gland can impact the kind of healing that occurs. Comparing laser-assisted in situ keratomileusis (LASIK) and SMILE 6 months after surgery, surgeons can observe vision break up time (VBUT) and optical quality. With SMILE, one can see good qual- ity VBUT, but with LASIK, VBUT experiences a break in quality. Again with the ocular scatter index, there is more scatter with a patient 6 months after LASIK compared to less scattering with SMILE. These are important pa- rameters to observe because they can predict poor nerve regener- ation which leads to poor wound healing, poor optics, glares and halos, and ultimately an uncom- fortable feeling for the patient. In a recent paper by Khamar et al. (2020, Exp Eye Res) titled “Early biological responses in ocular tissue after SMILE and LASIK sur- gery,” Dr. Shetty explains that cor- neal nerves are what maintain the health of the eye and how one’s epithelium heals. “If you’re able to preserve and create less damage, you can make your patient more comfortable and increase visual outcomes,” he says. There has also been a debate on whether to cut corneal nerves vertically or horizontally. How- ever, from the panel discussion, Dr. Shetty says, “Personally, a horizontal or vertical cut doesn’t make a difference - once it’s cut, it’s cut.” Another question from the panel discussion was wheth- er steroids make any difference in how corneal nerves heal. Dr. Shetty said, “When you have poor healing, nerve growth factor changes create a lot of change on the ocular surface and steroids do not help much. In these cases, we have to look beyond steroids.” Cataract Tomography Made Easy Han Bor Fam, MD, Singapore The IOLMaster 700 is a very good biometer with telecentric keratometry and can provide helpful measurements such as Total Keratometry (TK). Together with its Central Topography, the IOLMaster 700 can provide anteri- or and total axial power maps of the cornea. The default power map provides 21 colors, which is sufficient for analyzing 90% of cases. In addition to the default map, there are also adaptive flat scales and extended scales. Han Bor Fam, MD, Singapore pre- sented clinical cases to showcase the abilities of the IOLMaster 700. In one patient, the cornea looked very flat from the Central Topog- raphy, which was suggestive of a post-LASIK cornea. Taking a proper patient history and using the intraocular lens (IOL) formula to calculate a proper power value allowed for the patient to be sat- The news magazine of the Asia-Pacific Association of Cataract & Refractive Surgeons Copyright 2021 APACRS. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, or publisher, and in no way imply endorsement by EyeWorld, Asia-Pacific or APACRS. Understanding Corneal Nerves and its impact on SMILE Surgery Outcomes Rohit Shetty, DNB, FRCS, PhD, India Rohit Shetty, DNB, FRCS, PhD, India began the symposium discussing corneal nerves and its impact on small incision lenti- cule extraction (SMILE) surgery outcomes. “We’re all aware of how delicate and how beautiful the whole plexus [of the eye] is. There’s a beautiful homeostasis in how the stroma connects to the epithelium,” says Dr. Shetty. Through confocal microscopy, one can see the difference be- tween healthy nerves and un- healthy nerves. Specifically, one can see the fragile white dendrites “ With SMILE, one can see good quality VBUT, but with LASIK, VBUT experiences a break in quality. ” Rohit Shetty, DNB, FRCS, PhD