Eyeworld

EW MEETING REPORTER 88 EyeWorld reports from the 2018 APACRS annual meeting, July 19–21, Chiang Mai, Thailand patients. Careful examination to detect zonular instability is import- ant to plan surgery well, she said. Treating preexisting conditions that might limit a promising outcome is also important. Dr. Sujirakul highlighted IOL selection for these patients. In terms of focality, a monofocal may be preferred to a multifocal. Most papers advise to choose a monofocal to avoid light scatter, she said, as the photoreceptor may be compromised. She said that acrylic material is preferred to PMMA or silicone, and a three-piece lens is generally preferred to a one-piece. In terms of choosing a clear vs. yellow tinted color, Dr. Sujirakul said that the trend is to use more yellow, but there is no solid evidence. She also said to aim for plano or myopia. Important intraoperative considerations include minimizing phototoxicity, minimizing stress on the zonules, and making every effort to prevent capsular contraction syndrome and posterior capsular opacity. Dr. Sujirakul detailed how to minimize capsular contraction syn- drome. This includes larger ACC size (at least 5.5 mm), meticulous ACC polishing, using a three-piece IOL, possibly using a capsular tension ring, using multiple radial relaxing incisions, and good control of post- operative inflammation. Postoperative considerations include being more aggressive in inflammation control to avoid PC, capsular contraction syndrome, and IOL subluxation. Early detection of CME is important, and if there is CME, you can use topical steroids, NSAIDS, or local steroid injections. Low vision rehabilitation might be needed in some patients. Cataract surgery in uveitis Cataract surgery in uveitis was the topic of a symposium presented by the Thai Ocular Immunology and no difference in RP progression rate detected by spectral domain OCT or other function tests. She said that phototoxicity is also unlikely. There has been no worsening of vision or direct pho- totoxicity reported with the current surgical procedure. These patients may have a higher rate of zonular compromise and IOL subluxation. This can be detected in the preoperative, periop- erative, and postoperative period. Additionally, chronic inflammation and increased inflammatory cyto- kines can cause this. Patients also have a higher incidence of rapid capsular contrac- tion syndrome, and some cases are reported as early as 2 weeks postop. Higher incidence of posterior capsular opacification (PCO) may also be a concern. Dr. Sujirakul said that 40–50% of patients require a YAG capsulotomy. This occurs more frequently with PMMA and silicone IOLs compared to acrylic material. These patients may have more visually significant postop CME, which may be caused by preexisting epiretinal membrane. Dr. Sujirakul shared some of the preoperative considerations for these Cataract surgery and the retina A symposium presented by the Thai Retinal Society (TRS) featured vari- ous presentations relating to cataract surgery and the retina. Tharikarn Sujirakul, MD, Bangkok, Thailand, presented "All You Need to Know about Cataract Surgery in Retinal Dystrophy." She said that the impact of cata- racts in retinal dystrophy patients is well known, and these patients may be more sensitive to lens opacity compared to normal patients. High- er intraocular light scattering can also occur, as well as compromised photoreceptor function. Dr. Sujirakul said some of the main concerns are if the patient's vision will improve, if the cataract will quicken RP progression, and if there will be phototoxicity. Will the patient's vision im- prove? Dr. Sujirakul said it will. There is significant visual improve- ment in terms of visual acuity or subjective vision in all patients, and patients with intact central ellipsoid line have a better postoperative visual outcome. Will the cataract surgery quick- en RP progression? It won't, Dr. Sujirakul said, adding that there is September 2018 EyeWorld reports from the 2018 APACRS annual meeting Sponsored by

• Blank Page
• Blank Page (1)