EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/422211
EW MEETING REPORTER 66 December 2014 Reporting from the 2014 Asia-Pacific Association of Cataract & Refractive Surgeons annual meeting, Jaipur, India Microphaco, 'Bag to the Wall' MasterClass phaco techniques The Asia-Pacific Association of Cataract & Refractive Surgeons (APACRS) kicked off its 27th annual meeting by providing attendees with a "more advanced level of education" through the latest series of MasterClasses. Keiki Mehta, MD, Mumbai, India, mod- erated a MasterClass he intended would "slowly take [attendees] down not only the path of microphaco, which I hope you will adopt down the line, but also challenging cases." Dr. Mehta began the "Microphaco and Advanced Phaco Techniques in Challenging Cases" MasterClass with his talk on the "Successful Application of Biaxial/Coaxial Microphaco in Difficult Cases." Microphaco, he said, is just one of the many terms used for phacoemulsification performed through a sub-2 mm incision. While he admits there are problems asso- ciated with the procedure—among them the technical proficiency required to handle the narrow tips—Dr. Mehta said that smaller incisions have definite advantages. Aberrometric analysis he and his col- leagues conducted on their patients who underwent microphaco versus those who underwent regular phaco revealed significant changes in the latter group not seen in the former. In addition, he said, microphaco provides clear advantages over regu- lar phaco in complicated cases such as subluxated lenses, which tend to drop "once you open it up" with a regular-size incision. In the same MasterClass, Cyres Mehta, MD, Mumbai, India, demonstrated a technique he developed to manage subluxated lenses, which he called the "Bag to the Wall" technique. In cases of "ex- treme subluxation," as in patients with Marfan's syndrome, Dr. Mehta said that surgeons have several op- tions for implanting the IOL outside the bag, such as in the anterior chamber or the sulcus. However, there are "not very many options if you want to go in the bag." His "Bag to the Wall" technique provides one such solution. The keystone to the technique, he said, is to do a very small rhexis. "Once you've made a 3–4 mm curvilinear rhexis, consider it done." However, the actual "bag to the wall" component comes in the IOL implantation phase. Dr. Mehta ties the trailing end of a 10-0 prolene suture to the midpoint of the haptic of a single-piece acrylic IOL and the other end to a 1-inch straight needle. Inserting the needle through the main incision, he then passes it through the fornix, through Reporting from the 2014 APACRS annual meeting Graham Barrett, MD, president of APACRS, welcomes attendees to the 27th APACRS annual meeting. Supported by