Eyeworld

EW MEETING REPORTER 80 November 2018 EyeWorld/ASCRS reports from the 2018 ESCRS Congress, September 21–26, Vienna, Austria outcomes in patients, considering the particular optical characteristics of highly ametropic eyes. Corneal refractive surgical outcomes for high myopia (–6 to –10 SE) have improved. Jodhbir Mehta, MD, Singapore, said that high myopes are at a significant risk for unwanted side effects like severe dry eye and HOA induction, but many of these patients already have preoperative issues with aberrations from glasses and contact lens wear. Specialists should be aware of associ- ated retinal pathologies, and for very high myopia, Dr. Mehta recom- mends ICL implantation. Oliver Findl, MD, Vienna, Austria, discussed intraocular sur- gery in the long eye, saying that while refractive pIOL outcomes are excellent, the key to pIOL selection should take complications into account, as explantation is a definite scenario in most cases. In long eyes, options for treatment include phakic IOLs and RLE, with which retinal detachment is a main issue, as well as the fact of inducing presbyopia in younger patients. In the ongoing MYOPRED ESCRS study, Dr. Findl is investigating the influence of poste- rior vitreous detachment on retinal detachment in lens surgery in my- opic eyes. The multicenter, interna- tional study has currently enrolled 618 patients with axial lengths in cated this is how they would have handled this case. Dr. Mennel added that you have to be careful because there could be a risk of rupture of the posterior capsule. Before closing, panelists also revealed whether they think a multifocal or toric lens would be a contraindication in this case. Dr. Bellucci said he thinks a toric is con- traindicated, and he said he may do a multifocal if it was the second eye, but not in the first. Dr. Mennel said he would not use a toric or multifo- cal lens in this case. Best solutions for high ametropia Refractive surgery specialists con- vened at a symposium for an in- formative exchange of perspectives about risky, borderline patients. Corneal refractive surgery and cataract surgery can both disrupt the eye's natural compensation for ab- errations, according to Pablo Artal, MD, Murcia, Spain, who spoke on optical and anatomical limitations. In comparing phakic IOLs (pIOLs) with LASIK, he noted that the mea- sured optical performance of pIOLs is slightly superior to LASIK but less than predicted from corneal data. Retinal images also show a slight edge in favor of pIOLs. Ablation profiles and pIOLs would improve countered a partial radial tear of the anterior capsule. He questioned the audience how they would proceed with a par- tial radial tear. While 26% said they would proceed and ignore the radial tear and 11% said they would re- move the instrument and complete the CCC, the majority (63%) said they would stay with the tip, inject OVD, and complete the CCC. However, in this case, Dr. Amon noted that he removed the instru- ment, which resulted in a total tear. Dr. Amon then asked how the audience would proceed with a total radial tear. Responses were split more evenly, with 28% indicating they would do ECCE, 20% would do supracapsular phaco, 22% would choose divide and conquer, 24% would chop, and 6% would divide oblique to the tear. Dr. Amon said he chose to divide oblique to the tear. He rotated the lens and broke the hard nucleus in an oblique position. Panelist Dr. Bellucci noted that a radial tear may be able to be left alone without extending to the posterior capsule, if you are in good control of the fluidics. When asked which IOL position and type they would choose in this scenario, 52% of audience mem- bers said they would pick a one- piece hydrophobic IOL in the bag. Meanwhile, 27% would choose a three-piece lens in the sulcus, while only 5% would choose a one-piece hydrophilic IOL in the bag. Panelist Stefan Mennel, MD, Feldkirch, Austria, indicated that he would choose to do a three-piece lens in the bag, while Dr. Bellucci said he would choose the one-piece hydrophobic IOL (being sure to open the lens slowly). He noted that the hydrophilic IOL may not be a good option in this case because a hydrophilic lens tends to open quickly, which could disturb the anatomy of this capsule. Dr. Amon indicated that he chose a hydrophobic one-piece lens with slow and gentle unfolding. Finally, to handle the capsulor- hexis, Dr. Amon said he removed OVD and rotated the haptic to 90 degrees; 61% of the audience indi- View videos from the 2018 ESCRS: EWrePlay.org Thomas Samuelson, MD, discusses the CyPass and guidance for moving forward with patients who have had the device implanted. Sponsored by

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