chart to describe age-related changes in astigmatism, Dr. Oshika took the opportunity to express support for Ukraine, especially the doctors, healthcare workers, and patients in that area. “We stand for them,” he said. In the same symposium, Graham Barrett, MB BCh, FRACO, FRACS, Australia, discussed “Mastering the Barrett Toric Calculator.” Dr. Barrett created the calculator based on a theoretical model he conceived to explain why the cornea behaves the way it does; unlike other calculators that use a population-based model, it predicts a unique posterior corneal astigmatism for each eye. The calculator recognizes that not all residual is due to the posterior cornea because the visual axis is not aligned with the optical axis of the eye; there is an angle alpha and this produces an apparent tilt. “If you don’t take account of this, you won’t get an accurate result,” he said. Dr. Barrett’s formula is a Gaussian formula—for each individual lens, it calculates the location of principal planes; the thickness of the lens and principal planes impact toric IOL prediction. At the end of his talk, Dr. Barrett was asked whether he performs a toric IOL calculation in every case. “Getting rid of astigmatism is as important as getting a great spherical outcome,” he said. “There’s no point in getting a great spherical outcome if you’re leaving residual astigmatism. That means every patient really is a candidate for toric IOL, which means I do a toric IOL prediction in every case.” He decides whether to proceed with a toric IOL depending on the results. MasterClass: Mastering IOL Fixation The MasterClass on “Mastering IOL Fixation” presented a variety of patient case surgical videos, allowing attendees to visually learn IOL fixation techniques from different complex surgeries. Even before surgery takes place, Chee Soon Phaik, MD, Singapore, emphasized the importance of the pre-surgical examination. “You need to examine the patient from the front to the back of the eye,” she said, to make sure there are no abnormalities. Additionally, the surgeon should perform an endothelial count, observe the macula, and look for viral infections before performing biometry. In an iris suture fixation video, Dr. Chee showed how to bring the intraocular lens (IOL) to the plane of the iris root by using IOL-grasping forceps. By stretching the iris away from the iris root, miosing the pupil, taking only a 1-clock hour bite of the iris as peripheral as possible, and using a Siepser sliding knot and McCanel suture, Dr. Chee is able to perform successful iris suture fixation. “It is important to ensure you can retrieve the IOL and clear vitreous safely,” reminds Dr. Chee. The next few videos shown by Seong Jae Kim, MD, PhD, South Korea, demonstrated captured optic fixation using trans-scleral sutures. By utilizing an Artificial Bag with optic Capture (ABC) technique, Dr. Kim showed the ease of performing this procedure. In this technique, the artificial bag helps the haptics position in the sulcus during IOL insertion. Additionally, optic capture occurs between two sutures: the posterior suture is located 0.5 mm in front of the anterior suture at the limbus. Finally, the posterior suture prevents dislocation of the IOL into the vitreous. Dr. Kim’s visual examples through his video showed how simple the ABC technique is, how easily accessible the technique is to anterior segment surgeons, and how stable and achievable the results are without IOL tilt and conjunctival issues. Another prominent technique in IOL fixation is the Yamane technique. As Hiroyuki Matsushima, MD, PhD, Japan, described in his presentation, he frequently utilizes a modified version of the technique for flanged fixation, in which the main incision is performed on the right side with a lower 30-G incision more than 90 degrees from the main incision. Dr. Matsushima pointed out that polyvinylidene fluoride (PVDF) haptics and ultra-thin wall needles are most suitable for flanged fixation. When making a flange, it is important that the ends of the haptics are cut 1 to 2 mm and cauterized using an ophthalmic cautery device. Dr. Matsushima advised not to touch the haptics directly using the cautery and instead use heat to make the flange. Additionally, the flange must be small enough to be buried into the sclera. Managing a decentrated IOL is possible, too, by correcting the IOL position. The surgeon should pull out and shorten the haptic. Since it is difficult to pull out the flange after it being buried into the sclera, the surgeon must expose the head of the flange using a needle and then use a capsule forceps to EWAP meeting reporter banner.indd 1 27/07/2022 10:22 AM
RkJQdWJsaXNoZXIy Njk2NTg0