Eyeworld

131 September 2015 EW MEETING REPORTER Reporting from the Date AAAA City, Country MD, Kuala Lumpur, Malaysia. When performing LASIK with a microker- atome, the 1% of patients who cause terror in the surgeon are those who have small eyes or interpalpebral fissures, are sensitive to light or touch, are anxious, or who exhibit intraoperative blepharospasm. These issues can be a "recipe for disaster" during the microkeratome pass, Dr. Kamal said. In these cases, Dr. Kamal advised attendees to be prepared preoperatively to switch to surface ablation to avoid disaster. Hungwon Tchah, MD, Seoul, South Korea, presented a pearl for lifting the flap during LASIK en- hancements. Lifting the flap is a delicate procedure that can cause an epithelial tear that can lead to epi- thelial ingrowth if not done proper- ly, Dr. Tchah said. The best way he has found to prevent epithelial tear is to "unzip" the flap before lifting it. He makes a small opening in the peripheral area of the flap, opens it with a Sinskey hook, and then slowly unzips the rest of the flap from the initial opening. So far, Dr. Tchah said he has seen no cases of epithelial ingrowth when using this technique. Ekktet Chansue, MD, Bang- kok, Thailand, offered a pearl for performing small incision lenticule extraction (SMILE). The number one problem for beginner SMILE sur- geons is dissecting the wrong plane, Dr. Chansue said. To make sure you dissect the right plane, after laser treatment, visualize the edge of the lenticule before you start dissection, he said. Finding the edge of the lent- icule is the most important part of the surgery, he said, and if you can't find it in 10 seconds, it isn't there. Rather than searching around for it, point the hook up and try to find it under the cap, he said. During LASIK, the flap is reflected and laid on the superior sclera, but this is difficult to do in Asian eyes, said Wing Kwong Chan, MD, Singapore, because there is not enough room on the sclera. In these eyes, the flap ends up sitting on the speculum and often dries out. His pearl was to "tuck the flap" under the upper lid in these cases. Tucking the flap helps to eliminate flap des- iccation that can occur and ensures full reflection of the flap during ablation. After replacing the flap, ir- rigate aggressively before concluding surgery, he added. Dr. Ganesh closed the refractive portion of the session with a pearl for marking and compensating for cyclotorsion when correcting a cy- lindrical error during SMILE. At the conclusion of the presen- tations, the audience voted for their favorite refractive pearl. Dr. Ganesh was the winner for the second year in a row. EW View videos from Sunday at APACRS: EWrePlay.org Florian Kretz, MD, Heidelberg, Germany, reports his experience with a bi-toric trifocal intraocular lens capable of correcting very high levels of astigmatism.

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