EyeWorld India September 2021 Issue

FEATURE 8 EWAP SEPTEMBER 2021 by Chiles Aedam R. Samaniego CSCRS: Progress to Perfection A joint symposium of the APACRS, ASCRS and ESCRS A t this year’s Combined Symposium of Cataract and Refractive Societies (CSCRS), held at the 33rd APACRS–SNEC 30th Anniversary Virtual Meeting, the APACRS invited colleagues from the American Society of Cataract and Refractive Surgery (ASCRS) and the European Society of Cataract and Refractive Surgeons (ESCRS) to take a critical look at whether cataract and refractive surgery technology has advanced enough to supercede the importance of manual techniques. The symposium followed the broad structure of cataract surgery itself, discussing “low- tech” manual techniques and “high-tech” equipment and instrumentation first in creating a continuous curvilinear capsulorhexis ( ), then through nucleus dissection and removal, and ending with techniques and technologies informing refractive outcomes. Capsulorhexis Tasked with making the case for the “low tech” side of CCC creation, Filomena Ribeiro, MD, PhD, FEBO, Portugal, had to admit that current data shows that only about 10% of manual CCCs achieve an accuracy of less than ±0.25 mm of decentration; nevertheless, she said, “only a few scenarios” from European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) publications showed any benefit to creating CCCs using a femtosecond laser over manual techniques—this despite the fact that near perfect lens centration is “mandatory for maximal optical benefits with modern cataract surgery.” Beyond the data, however, Dr. Ribeiro made an appeal to doctors’ more artistic sensibilities. “The capsulorhexis is an important part of your signature that you leave in every eye,” she said. “Even decades after your surgery, a fellow doctor will be able to examine that eye and see the results of your handiwork.” On the opposite side of the CCC debate, Richard Tipperman, MD, U.S., agreed that while automated capsulorhexis has “a number of theoretical advantages compared to manual capsulotomy, absent a large multicenter study no conclusive statement can be made of its benefit.» However, recalling the history of phacoemulsificationpwhich was first developed in £9ÈÇ but only became the dominant mode of cataract surgery in the 90s after the introduction of foldable IOLs—Dr. Tipperman said that FLACS and automated capsulorhexis may not reach a significant percentage of surgical volume until the arrival of just such an enabling technology that would then leverage the benefits of “high-tech» creation. Nuclear matters For dealing with the nucleus, Takayuki Akahoshi, MD, Japan, made the case for using manual prechop, which he said he has been performing since he described the technique in 1992—nearly 30 years of practice. The phaco prechop, he said, is so safe and efficient, it has reduced his cataract surgery time to 3–4 minutes per procedure and allowed him to perform a routine 60 cases a day “without stress.” In 2020, he performed a total of 8,263 cases, all performed using phaco prechop through This article was adapted from the EyeWorld Asia-Pacific daily coverage of the 33rd APACRS–SNEC 30th Anniversary Virtual Meeting, held online from 30 to 31 July 2021.