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EW MEETING REPORTER 74 August 2018 Reporting from the 2018 World Ophthalmology Congress, June 16–19, Barcelona, Spain ment could be problematic if you're trying to reverse optic capture, and he would choose to abandon the original plan and do an LRI or some- thing else. You could consider an anterior chamber lens, he said. Dr. Chang chose to proceed with the toric because he already had a toric in the other eye. The worst thing that could happen is dislocation, he said. During the procedure, Dr. Chang said the haptics unfolded slowly and the case ended looking good. He put acetylcholine chloride in to bring the pupil down as quick- ly as possible. Dr. Chang emphasized that during the procedure, he was doing everything to not expand the tear, but he noted that the tear won't wrap around if you don't put a lot of pressure on it and pull vitreous up through it. With the case completed, Dr. Chang asked the audience what they would tell the patient immediately postop. Half (50%) of the respon- dents indicated that they would discuss the unexpected "difficulty" but not specifics and tell the patient that "everything is fine." Mean- while, 21% of respondents said they wouldn't mention any complica- tion, unless a problem should arise later, and 29% said they would dis- cuss the PCR but not the lack of the three-piece multifocal. Dr. Ribeiro said that you must tell the patient vitreous prolapse. More than a third said they would use CCI and split infusion. Dr. Ravindran said he would use split infusion and anterior vitrecto- my through the limbus with a new incision, and 24% of the audience agreed with him. While 29% of the audience voters said they would do pars plana plus a limbal infusion cannula, none of the panelists said they would use a pars plana approach. However, the pars plana ap- proach was actually how Dr. Chang proceeded in this case. It's hard to get through the proximal opening, he said, and the goal is to not ex- pand the rent. If you do an anterior limbal approach, you're going to bring vitreous up and expand the rent, so the pars plana approach can help eliminate this risk. Dr. Chang next questioned the audience about which IOL option they would choose. Of the respon- dents, 10% said they would choose a toric SPA IOL in the bag, 25% would choose a toric SPA IOL in the bag with reverse optic capture, 10% would choose a non-toric SPA IOL in the bag, 55% would choose a non-toric three-piece IOL in the sul- cus, and no one voted to enlarge the incision and use an AC or PC PMMA IOL in the sulcus. Dr. Crandall said since the patient is 96, you don't want to go back to the OR. He added that align- She concluded by highlighting the flanged intrascleral IOL fixa- tion with double-needle technique, published by Shin Yamane, MD, PhD, which has become extremely popular. Flanged intrascleral fixation requires appropriate vitrectomy, Dr. Arbisser said. There is no contact with uveal structures, no sutures, no conjunctival or scleral flaps, no fibrin glue, and no slippage. Also, with attention to detail, there is no tilt, iris capture, or pseudophacodo- nesis, she said. She briefly discussed the tech- nique and said that one of the most important things is to get all the angles correct. Dr. Arbisser suggested that the LUCIA lens (Carl Zeiss Med- itec, Jena, Germany) is the best lens to use with this technique. Video session encourages audience to "make the call" An interactive session featured video case presentations of cataract surgery complications. The videos were paused at specific points, with audience members voting on man- agement decisions. David Chang, MD, Los Altos, California, led the session, along with Filomena Ribeiro, MD, PhD, Lisbon, Portugal. A panel of Alan Crandall, MD, Salt Lake City, Ehud Assia, MD, Tel-Aviv, Israel, R.D. Ravindran, MD, Pondicherry, India, and David Spalton, MD, London, U.K., weighed in, as did a second panel of Luis Izquierdo Jr., MD, Lima, Peru, Burkhard Dick, MD, Bochum, Germany, Lisa Arbisser, MD, Salt Lake City, and Ahmed El-Massry, MD, PhD, Alexandria, Egypt. Dr. Chang shared a case where he used a high power toric IOL in a patient's second eye. The patient was a 96-year-old who already had a T5 toric in the right eye and presented with a cataract in the left eye with a lot of cylinder. The patient needed a T6. Dr. Chang noted that in this case he experienced temporal PC rent with subincisional I/A and vitreous coming up in the incision. He asked the audience to weigh in on what vitrectomy plan they would choose for a torn PC with View videos from the 2018 WOC: EWrePlay.org Jorge Alio, MD, PhD, discusses the use of stem cells to promote cornea stromal regeneration.

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