Unhappy patients after cataract surgery: Reasons for dissatisfaction and how to help Reportage by Christina Chintanaphol and Chiles Aedam R. Samaniego Day 1 On Saturday, 11 June 2022, the APACRS returned for its first in-person annual meeting since the beginning of the COVID-19 pandemic, jointly holding its 34th annual meeting with the 2022 annual meeting of the Korean Society of Cataract and Refractive Surgeons (KSCRS). The first day featured a packed instructional scientific program centered on the Society’s signature series of MasterClasses, included a “Squid Game” of challenging cases, and culminated in the 2022 APACRS Film Festival Symposium and Awards Ceremony. A NEW DAWN: Highlights of the 34th APACRS-2022 KSCRS Joint Meeting MasterClass: Mastering Refractive Surgery Complications In the MasterClass on “Refractive Surgery Complications,” Cordelia Chan, MD, Singapore, summed up “Handling Unexpected Scenarios and the Unhappy Refractive Patient.” Intraoperative refractive surgery complications, Dr. Chan said, do not occur frequently; when they do, even the most experienced surgeons may be caught off guard. Reacting to this challenge well, she added, comes with experience. Much consideration in her talk was given to the subjective experience of the patient. While surgeons themselves should stay calm, it is important for them to help keep the patient calm and choose their words and what is conveyed to the patient very carefully. In addition to identifying risk factors and detailing management strategies including sharing cases of suction break, flap tear, and gas bubbles, Dr. Chan noted how patients who have had “complicated” refractive surgery may be psychologically impacted and dissatisfied with their visual outcome and attribute every symptom they experience to the intraoperative event—even if the complication was visually inconsequential. Thus, she said, surgeons need to spend more time with these patients postop, empathizing, comforting, and reassuring them, while treating coexisting issues such as dry eye more aggressively. In the same MasterClass, Sri Ganesh, MD, India, discussed “Dealing with the Frowning Patient after SMILE,” describe some complications they’ve found unique to SMILE and how they dealt with them. In the first case Dr. Ganesh presented, they were referred a post-SMILE patient who complained of blurred vision in both eyes that did not improve with glasses, so bad that the patient could not drive. While the topography, aberrations, and anterior segment OCT were unremarkable, retroillumination revealed an irregular interface with “crop circle” patterns in both eyes, resulting in an abnormal scatter further quantified using an HD Analyzer. Reviewing the case, Dr. Ganesh noted that the surgeon, who had only begun to perform SMILE, used an unusually high energy setting, resulting in the irregular interface. Energy optimization, he concluded, is a crucial factor for visual recovery and quality of vision. Dr. Ganesh corrected the problem using the Circle software and phototherapeutic keratectomy (PTK). In the second case, despite an apparently intact SMILE lenticule extracted, retroillumination revealed a black patch which they interpreted as a surface irregularity but turned out to be a retained lenticule fragment. They corrected using the Circle software with removal of the fragment and PTK. MasterClass: Mastering Biometry The MasterClass on “Mastering Biometry” covered the EWAP meeting reporter banner.indd 1 27/07/2022 10:22 AM
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