Eyeworld

89 EW MEETING REPORTER Dr. Mekhasingharak said that third cranial nerve palsy with pu- pillary involvement must urgently undergo vascular imaging because of the risk of aneurysm. APACRS annual meeting kicks off with opening ceremony The APACRS annual meeting open- ing ceremony featured welcome addresses by Pannet Pangputh- ipong, MD, Bangkok Thailand, organizing chairman of the meeting, Prof. Emeritus Piyasakol Sakolsa- tayadorn, Minister of Public Health of Thailand, and Ronald Yeoh, MD, Singapore, APACRS president. During his welcome address, Dr. Yeoh stressed the value of the Barrett Online Calculator, created by Graham Barrett, MD, Perth, Austra- lia. The calculator is available online for free, and Dr. Yeoh noted that it gets around 50,000–100,000 clicks per day and has helped countless surgeons and patients. "Before I step down as the president, I want to thank Graham once more for giving this wonderful calculator to the world," he said. "Thank you for entrusting me with the presidency of APACRS, which has been the highlight of my career," Dr. Yeoh said, adding that Hiroko Bissen-Miyajima, MD, PhD, Tokyo, Japan, will be the next APACRS president. "I'm sure she will take APACRS to new and greater heights," he said. APACRS LIM Lecture The APACRS LIM Lecture was presented by Eric Donnenfeld, MD, Rockville Centre, New York, on the topic of "Refractive Surgery Comes of Age: How Good is LASIK? The Myths, Misconceptions, and Reality." In spite of LASIK's long clinical and historical presence, misconcep- tions about the risks and benefits of information on neuroimaging for ophthalmologists. During the ses- sion, Nattapong Mekhasingharak, MD, Phitsanulok, Thailand, present- ed "I See Two of You! My Cataract Keeps Bothering Me!" He shared a case of an 87-year-old woman who developed double vision for 2 weeks. Her double vision would disappear when either eye was covered. She also had hypertension that was well controlled. When evaluating a patient with a complaint of double vision, Dr. Mekhasingharak said that the first question to ask is if the diplopia is monocular or binocular. Monocular diplopia is an optical abnormality associated with uncorrected refrac- tive error, cataract, corneal surface irregularity, iris hole, or dislocated lens, he said. However, this patient's double vision would disappear when either eye was covered, so she had binoc- ular diplopia. Binocular diplopia is caused by ocular misalignment. The diagnosis for this patient was partial third cranial nerve palsy with pupillary involvement. There may be numerous causes of third nerve palsy. She underwent emer- gency MRI and MRA but did not have cataract surgery. Kittisak Unsrisong, MD, Chi- ang Mai, Thailand, noted that MRI is tricky because you have to specify what you're going to look at (the brain, the vessel, the cranial nerve, etc.). The clinical history is import- ant for this, and without it, you could miss the abnormality. Dr. Mekhasingharak said that the patient was admitted to the neurosurgical ward, but she refused to get any further intervention after discussing risks and benefits. Two months later, the patient's symp- toms improved, and 5 months later, she had no diplopia in primary position and had light limitation of upward and downward movement in the right eye. be required to achieve a sustained quiescence, she added. Next, Dr. Sittivarakul stressed preoperative steroid prophylaxis. Increase steroid dosage briefly before surgery as a prophylaxis against surgically induced inflammatory re- lapse. She also said that an immuno- modulatory agent stays unchanged prior to surgery in those who've been using it as a maintenance for uveitis. The regimen of steroid prophylaxis depends on the diag- nosis/course of patients' underlying uveitis, Dr. Sittivarakul said. Her next consideration related to the IOL. An IOL is not contrain- dicated with optimum control of inflammation preoperatively, but pediatric use may be controversial. In-the-bag placement is always preferred, Dr. Sittivarakul said, and acrylic IOLs and heparin surface modified PMMA IOLs performed better than non-heparin surface modified PMMA and silicone IOLs in study. Silicone IOLs should be avoided in patients who may require vitre- oretinal surgery in the future, and a multifocal IOL might be a poor choice in chronic uveitis. Her final point was to coun- sel patients with uveitis who are undergoing cataract surgery. They will need to know that increased medication dosage in the perioper- ative period may be required, and it is a more complicated surgery with prolonged surgical duration. Additionally, patients should beware of significant postoperative inflam- mation and delayed visual recovery. Medication adherence is important. They will need more frequent visits, and there is a chance they will have to undergo additional procedures. Neuroimaging for ophthalmologists During a symposium presented by the Thai Neuro-Ophthalmology Society (TNOS), physicians shared Inflammation Society (TOIS). During the session, Wantanee Sittivarakul, MD, Songkhla, Thailand, discussed preoperative evaluation in these cases. Cataract is a common com- plication of uveitis, she said. "It's almost never a routine surgery in uveitic eyes," Dr. Sittivarakul said. It requires a detailed preoperative assessment, is often technically com- plex intraoperatively, and there may be uncertainty of the postoperative course. She presented important points to consider preoperatively. First, establish an accurate diag- nosis of uveitis. To do this, obtain appropriate medical history and labs and define uveitis by course, lateral- ity, and anatomic location. Different diagnoses have different prognosis, and infectious uveitis must be iden- tified and treated. It's important to determine the need for cataract surgery. Indica- tions for cataract surgery include visually significant cataract in eyes with good potential for improved vision, lens induced intraocular inflammation, and poor view of the fundus for examination or posterior segment surgery. She also said to de- termine whether or not the cataract is responsible for the patient's visual loss. Dr. Sittivarakul stressed the importance of doing a complete ophthalmic evaluation. This in- cludes assessing the visual potential and coexisting ocular problems, as well as doing an assessment of other conditions that affect surgical planning. The timing of the surgery is important. Dr. Sittivarakul said preoperative inflammation control is crucial for a good outcome. Quies- cence of uveitis for a minimum of 3 months prior to surgery is import- ant. But if this is not possible, do the surgery when the inflammation is maximally suppressed and stable. Immunomodulatory therapy may September 2018 continued on page 90

• Blank Page
• Blank Page (1)