EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/422211
73 December 2014 EW MEETING REPORTER Taking the refractive perspective, Michael Knorz, MD, Mannheim, Germany, said he would combine laser cataract surgery with an EDF IOL in this patient. The patient needs excellent contrast, full stereopsis, and good near vision to fly, he said, which leaves an EDF IOL as the only choice. All surgeons want to avoid refractive surprises, but what happens when they come up? Cesar Espiritu, MD, Metro Manila, Philippines, and Damien Gatinel, MD, Paris, debated the best course of action for a 52-year-old patient who had LASIK 15 years ago to correct 10 D of myopia and who had recently undergone bilateral cataract surgery with multifocal IOLs and ended up with 2 D of hyperopia in both eyes. Assuming that the patient's post-LASIK vision was acceptable, Dr. Espiritu, who took the cataract approach, recommended an IOL exchange to an aspheric monofocal IOL centered closest to the visual axis. Dr. Gatinel, taking the refrac- tive approach, recommended relift- ing the LASIK flap and performing a hyperopic laser ablation, saying that a laser corneal procedure would be better in efficacy and predictability in this type of situation. A flap relift is easy when the initial procedure was uneventful, he said, and this option has the fewest risks in terms of safety. An update on glaucoma highlights A symposium focusing on glaucoma highlights provided an update on topics such as understanding the patient perspective, pitfalls in diagnosis, and trabeculectomy. Nitin Anand, MD, Hudders- field, U.K., discussed some of the pitfalls in the diagnosis of glaucoma, specifically referencing the Glauco- matous Optic Neuropathy Evalua- tion (GONE) Project. General ophthalmologists and trainees will both overestimate and underestimate glaucoma, he said. Underestimation tends to be due to missing typical glaucoma findings on the optic discs. Overestimation of glaucoma is more likely in large discs. Dr. Anand warned physicians to watch out for the base-rate fallacy. The base-rate fallacy happens when available statistical data is ignored in favor of specific data to make a probability judgment, he said, add- ing that physicians are particularly susceptible to the base-rate fallacy. Do a qualitative assessment rather than relying on the quanti- tative output of OCT software, Dr. Anand said. Sometimes progression of structural or functional loss is the only way to make the diagnosis. Prin Rojanapongpun, MD, Bangkok, Thailand, presented on his new and revisited thoughts on trabeculectomy. "We know that trabeculectomy is still the gold standard, but it's far from perfect," he said. The presentation explored trabeculectomy and its problems. Trabeculectomy is declining in the number of surgeries, he said. Failure and complications are two of the main problems associated with trabeculectomy. "In trabeculectomy, what we do need is filtration," Dr. Rojanapongpun said. Blebs are necessary, but they can cause problems. There are both unpreventable and preventable problems associated with bleb failure. Unpreventable problems include inherent intraocular in- flammation, genetic predisposition, previous surgery, young age, and conjunctivitis. Preventable factors include surgically induced trauma, failure to control pre- and post- operative inflammation, failure to maintain constant flow through the bleb, and failure to intervene in a timely manner. Some alternatives to trabeculectomy are MIGS or safer filtering surgery. MIGS is still under development, he said. Trabeculectomy is the standard procedure in glaucoma surgery, Dr. Rojanapongpun concluded, but failure and complications are still common. New and safer techniques and devices are available and could be beneficial. Angle surgery and oth- er novel devices will become useful as alternatives in selected cases that may minimize complication risk, he said. However, more complex phar- macological and technology features are needed to improve outcomes in filtering surgery. EW DailyNews Catch up on the Daily News from 2014 APACRS Jaipur Easy to access through our online web portal! Click here to begin viewing Over 25 Photo Pages from Bollywood, the Gala Dinner in our Monday e-edition! APACRS APACRS Jaipur 2014 View all dailies at daily.eyeworld.org.