Eyeworld

EW MEETING REPORTER 24 December 2011 steepening of the cornea, signifi- cantly increasing near vision. Mean- while, SUPRACOR uses the same algorithm to increase depth of field. While promising, neither approach, he said, is perfect. INTRACOR results in a mild loss of best corrected distance vision, while early experience with SUPRACOR reveals some night vi- sion disturbances. Other corneal ap- proaches were examined in the symposium. Dr. Yoon talked about his experience with modified mono- vision, which, he said, compared with traditional monovision, "has the potential to improve through- focus visual acuity" through binocu- lar summation. John Chang, M.D., Hong Kong, presented his results with micro-monovision in presby- opic LASIK, an approach that aims to create a prolate cornea to in- crease the depth of field. Tae-Young Chung, M.D., South Korea, and Klaus Ditzen, M.D., Weinheim, Germany, both talked about laser blended vision, a procedure that es- sentially combines monovision with an increased depth of field, provid- ing, said Dr. Ditzen, "excellent dis- tance vision and good near vision abilities." Perhaps the most common approach today, related to the ten- dency toward cataract in the rele- vant patient population, is to replace the crystalline lens with an IOL, usually of the multifocal type. Hyo Myung Kim, M.D., South Korea, described his experience with the Acri.LISA multifocal IOL (Carl Zeiss Meditec), noting that while he has not seen a significant difference between it and other currently avail- able multifocals, it is "at least as good." In cases where patients de- velop presbyopia after cataract sur- gery and implantation of a monofocal IOL, Robert T. Ang, M.D., Philippines, has begun look- ing into the use of SUPRACOR to provide pseudoaccommodation. Initial results look promising, with most patients satisfied with the procedure. Multifocal IOLs, how- ever, are very sensitive to impreci- sions in refractive outcomes. R. Doyle Stulting, M.D., Atlanta, rec- ommended examining the patient for the following issues, in the order of his proposed algorithm: residual refractive errors, surgical complica- tions or pre-existing conditions, IOL decentration, pupil size issues, and/or posterior capsular opacifica- tion. He noted that surgical issues requiring either explantation or YAG capsulotomy should be at the bot- tom of the algorithm, since they may preclude or complicate correc- tions to potential issues listed higher in the algorithm. Most of the cur- rently available options for presby- opes, Dr. Ditzen said, are static, relying on pseudoaccommodative mechanisms. Gerd Auffarth, M.D., Heidelberg, Germany, said the third generation of accommodating lenses offers the most promise, his own ex- perience showing the NuLens (NuLens Ltd., Israel) and FluidVision lens (PowerVision Inc., Belmont, Calif.) capable of around 8-10 D of true accommodation. Advances in cataract surgery explored In a lecture that peaked the inter- est of many attendees, Tetsuro Oshika, M.D., Tokyo, thoroughly explained the transconjunctival sin- gle-plane sclerocorneal incision for cataract surgery. He believes this technique is superior to clear corneal incisions due to the high inci- dence of endophthalmitis, a serious issue that didn't become a significant problem until clear corneal incisions increased in popu- larity. For procedural pearls, Dr. Oshika said it's important not to di- rect the tip of the knife too inter- nally. Doing so will create a chevron mark, which is not desirable. One "annoying complication" of the technique, he said, is conjunctival chemosis. To prevent this, it's impor- tant to have proper configuration of two conjunctival incisions at both ends and a reduction of leakage through the incision. Some doctors choose to use a smaller knife to re- duce leakage, but Dr. Oshika has an- other way: He uses the same sized knife but stops short of cutting through to the anterior chamber. "In general, the incision is smaller and closer to the limbus," he said. In Japan, a specific knife for the proce- dure is available from Kai Industries (Gifu, Japan). Dr. Oshika expects the tool to be exported to other coun- tries in the future. The technique can also be used for glaucoma eyes. Handy methods for minimizing cataract surgery complications Physicians discussed methods for minimizing complications in cataract surgery. The process be- gins long before surgery—before a surgeon first picks up a phaco probe, in fact. Bonnie Henderson, M.D., Boston, and colleagues are working on a Cataract Mentor Training Sys- tem, a computer tutorial program that will help cataract surgery trainees prepare for surgery even be- fore they meet their first patient. The program will walk trainees through the cataract surgery proce- dure step-by-step, presenting them with situations they may en- counter and options on how to pro- ceed, honing their decision-making skills and offering discussions for every mistake and rationale for every correct decision. Video demonstrations, answers to fre- quently asked questions, opinions on cataract surgery issues, and a wide variety of related topics from some of the top experts in the field are built into the program. The pro- gram, she said, should be available to training institutions all over the world soon. The Cataract Mentor Training System offers cognitive training not meant to replace hands- on wet labs. Endophthalmitis is— according to Shinichiro Kobayakawa, M.D., Tokyo, and fre- quently reiterated by experts—the "most devastating" potential com- plication of cataract surgery. The most common causative organisms for endophthalmitis, he said, are commensals on the ocular surface; there is evidence that topical fluoro- quinolones administered 3 days be- fore surgery may be more effective than starting topical drops on the day of surgery. One issue facing the surgical team is maintaining antisep- sis throughout the procedure— aqueous levels of antibiotics admin- istered intracamerally, for in- Reporting live from the Asia-Pacific Association of Cataract & Refractive Surgeons meeting, Seoul, South Korea Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team from the 2011 APACRS meeting, Seoul, South Korea.

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