Eyeworld

EW MEETING REPORTER 92 EyeWorld reports from the 2018 APACRS annual meeting, July 19–21, Chiang Mai, Thailand September 2018 probe and move it to one side, it occludes the irrigation on one side, Dr. Donnenfeld said. It creates irriga- tion flow that pushes things through the zonules and into the posterior chamber, and he said that 25% of patients who have cataract surgery today can be found to have these chips. To avoid this, Dr. Donnenfeld offered several tips. You can keep your phaco tip open and central. You can make the incisions a little larger, so it doesn't occlude irriga- tion to the side. There are also new designs for phaco irrigation sleeves that have little elevations to prevent occlusion of flow to the side. Pannet Pangputhipong, MD, Bangkok, Thailand, shared tech- niques for minimizing discom- fort in high myopic eyes during phacoemulsification. This dis- comfort may be caused by sudden change in IOP or if the bottle height is too high. The key solution, he said, is "slow motion irrigation." The first technique Dr. Pangputhipong suggested for doing this is slow tip insertion: Use continuous irrigation; slowly insert the phaco or I/A tip; and allow the AC to inflate slowly. He also suggested pinching the irrigating line, adjusting the bottle height (lowering it to 30 cm and slowly raising it up), or using low phaco parameters. EW instead—he would consider these IOLs for glaucoma suspects, patients with ocular hypertension, and those with mild glaucoma who are stable and controlled with no signs of progression. Dr. Chakrabarti said he regularly implants toric IOLs in glaucoma pa- tients but noted that he avoids them in patients having a combined pha- co/trabeculectomy procedure due to the with-the-rule astigmatic shift that can be seen postoperatively. Dr. Chakrabarti noted the impact of the ocular surface on multifocal and toric IOLs. With the majority of glaucoma patients having some degree of ocular surface disease, the issue needs to be diag- nosed and managed before using one of these lenses. Top cataract surgery tips The final session of the APACRS annual meeting was "Achieving Nirvana," which featured presenters sharing surgical tips and maneuvers that attendees could take home and use in practice. Eric Donnenfeld, MD, Rock- ville Centre, New York, spoke about nuclear chips in the vitreous after cataract surgery and how to prevent these. Nuclear chips can sometimes be found floating in the back of the eye and can cause inflammation after surgery. How do they get into the vit- reous? When you're using a phaco to haptics, particularly when they are sticking together or sticking onto the anterior surface. Based on studies looking at different preloaded systems, Dr. Auf- farth had several conclusions. Im- plantation and unfolding behavior among hydrophobic IOLs revealed large variability. He added that haptic adhesions to the optic can be of clinical sig- nificance, especially in complicated cases. Injector force pushup systems vary among contemporary preload- ed systems, Dr. Auffarth said, and improvement of injector systems reduces the damage of the plunger/ cartridge to the IOL. Finding the Right Path: Predicting Outcomes in Cataract Surgery Cataract surgery has moved from being a rehabilitative surgery to a refractive surgery. As such, "it is my firm conviction that the same philosophy should be extended to glaucoma patients who need cata- ract surgery," said Arup Chakrabar- ti, MD, Trivandrum, India. However, there are special considerations that should be taken into account when selecting an IOL and calculating a power. Trabeculectomy can induce with-the-rule corneal astigmatism, and after successful trabeculectomy, when the IOP comes down, there can be a decrease in axial length. There can be an increase in axial length in post-trab eyes after cata- ract extraction (a myopic shift) and a decrease in axial length in post-tr- ab eyes after phaco (hyperopic shift). When it comes to premium lenses, there is little in the published literature about the role of multi- focal lenses in glaucoma patients. However, Dr. Chakrabarti pointed out, patients with moderate to ad- vanced glaucoma can have reduced contrast sensitivity and a decrease in other visual functions. These conditions could exacerbate some of the optical issues associated with multifocal lenses, such as dyspho- topsias and optical aberrations. Though he would not recommend a multifocal lens for a patient with ad- vanced glaucoma—recommending monovision with an aspheric lens View videos from the 2018 APACRS: EWrePlay.org Michael Lawless, MD, discusses the advantages and disadvantages of the SMILE technique for keratorefractive surgery. Sponsored by

• Blank Page
• Blank Page (1)