EyeWorld India September 2021 Issue

FEATURE EWAP SEPTEMBER 2021 7 astigmatic outcomes?” Dr. Koch explains that it is more complicated for toric IOLs because the target is not zero due to the 0.5 diopter toric IOL steps. With two variables to deal with, power or magnitude and meridian or axis, analyzing astigmatic outcomes can be complicated. Dr. Koch suggests using double angle plots and reporting scalar and vector prediction errors to achieve more accurate results. A new category of IOLs are the extended depth of focus (EDOF) lens, and Damien Gatinel, MD, PhD, France, provided insight on the principles of these optics. EDOF IOLs offer better intermediate performance, less light scatter, and smaller halos than multifocal IOLs, though they lack in near (reading distance) vision. Dr. Gatinel explains that there is now a trend towards non- diffractive EDOF IOLs with either aspheric design or wavefront focusing and that in the future, we should likely see further developments in multifocality. Chee Soon Phaik, MD, Singapore, ended the session discussing her experience with intrascleral haptic fixation (ISHF). ISHF was first introduced in 2007 by Gabor Scharioth as a sutureless haptic fixation procedure in the scleral tunnel. In 2008, Amar Agarwal popularized ISHF and introduced the “glued IOL” technique, creating scleral flaps and scleral tunnels for a haptic tuck, glueing the flaps to secure The Zepto precision pulse capsulotomy device. Source: David Chang, MD the haptic. In 2016, Shin Yamane introduced the “flanged IOL” technique which is a transconjunctival intrascleral IOL fixation with a double-needle technique. The haptics are flanged by thermocautery. Dr. Chee started with the glued IOL technique, but found this technique to be “invasive with unnecessary scleral dissection, and I struggled with insufficient haptic length to tuck.” Dr. Chee took this opportunity to modify the technique using a scleral groove and got good results, though the procedure took 40 minutes with IO exchange. Moving on to the Yamane technique, Dr. hee had difficulty threading the haptic and preserving its form. Additionally, she experienced a decentered IOL and IOL tilt. However, Dr. hee ultimately returned to using the Yamane technique in 2019 because she had been given many cases that were complex\ post retinal detachment surgery, endothelial keratoplasty (EK), and glaucoma eyes in which the conjunctiva needed to be spared. Using the Yamane technique, Dr. Chee was able to perform shorter surgeries and figured out how to center the IOL and avoid IOL tilt. Although Yamane recommends aligning horizontally, Dr. Chee finds it more successful to align the IOL vertically, because a person who rubs his or her eyes can cause haptic erosion and exposure. Dr. hee ended her talk by providing key points for success that include identifying the center of the eye to match the center of the IOL, marking the limbal points along the circle of best fit, miosing the pupil before implantation, and identifying the entry point by checking the needle tip before penetration. EWAP Editors’ note: Dr. Chang is a consultant for Centricity Vision, Inc. Dr. Barrett has authored several IOL calculation formulas that he has licensed to several companies; he has also been a consultant for both Alcon and Zeiss. Dr. Koch is a consultant for Zeiss. Dr. Gatinel is a consultant for Physiol/BVI. Dr. Chee has interests with various companies, none relevant to her to talk.