Eyeworld

EW MEETING REPORTER 126 Reporting from the 28th APACRS annual meeting, August 5–8, Kuala Lumpur, Malaysia care of Sanduk Ruit, MD, Kath- mandu, Nepal. His video of the case at the symposium on "Cataract Conundrums" elicited an audible gasp from the audience: Contrary to convention, Dr. Ruit implanted the IOL at the beginning of the procedure, rather than the end. Dr. Ruit explained the decision: Lacking more sophisticated instrumenta- tion, he used the lens to stabilize the capsular-zonular diaphragm before bringing the nucleus out. He was making a very particular point: In considering her specific case, Dr. Ruit thought not about what technique was good for the cataract, but what was good for the patient. Cataract surgery, he said, is a matter of thinking about and doing what is best for the patient. He was aiming to perform the surgery in a way that would leave his patient sight- ed for years to come. "I know the patient will see tomorrow and for many years," Dr. Ruit said. He was speaking on "The Role of SICS [small incision cataract surgery] in Modern Ophthalmology." Earlier at the meeting, Dr. Ruit had conducted a MasterClass on manual small incision cata- ract surgery (MSICS). During the course, he emphasized the value of the procedure particularly for addressing the massive cataract backlog at the community level. He also advocated making MSICS and similar non-phaco techniques an essential part of resident training as the procedure teaches surgeons particular skills they can use to manage complications encountered at the operating table. He repeated those points at this symposium. "More than half—that's an under- statement—of cataract surgery in the world is being performed with non-phaco surgery," he said. "There is still a role for non-phaco surgery." Dr. Ruit said that while the cataract discourse at ophthalmology meet- ings tends to focus almost exclu- sively on phacoemulsification and expensive cutting-edge technologies such as femtosecond lasers, ophthal- mic surgeons should not overlook such non-phaco techniques that are essential at the community level. This is not to dismiss phacoemulsi- fication offhand—Dr. Ruit admitted that they are also looking into ways decrease in contrast sensitivity was a major issue for these patients. To resolve this, there are new categories of IOLs for improved near performance. They include low- add diffractive, refractive rotational asymmetry, and extended depth of focus. Dr. Negishi also discussed some specific new IOLs, including the LENTIS Mplus (Oculentis, Berlin, Germany). Diffractive multifocal IOLs have captured the largest share of the IOL market, she said. "However, decreased contrast sensitivity is a major issue associated with this type of IOL." The visual and refractive outcomes were excellent and stable up to 1 year after cataract surgery with implantation of refractive segmented multifocal IOLs with and without a toric component, she said. "The refractive segmented multifocal IOL is a good option for correcting presbyopia after cataract surgery because both the visual and refractive outcomes and the contrast sensitivity were excellent after im- plantation of this IOL," Dr. Negishi concluded. Benjamin Cabrera, MD, Makati City, Philippines, presented on the topic of unhappy multifocal IOL patients. Dr. Cabrera highlighted several key points for happy patients with multifocal IOL implantation. His recommendations included considerations for the cornea, CME, the capsule, cylinder and residuals, of bringing phaco down to the community level. Phaco needs to become available at low cost while retaining good quality. He said this would require the phaco machine equivalent of a laptop—user friend- ly, with lower-cost consumables. Bringing phaco to communities would also require intensive and standardized training programs; however, these would have the potential of serving a large target group. The symposium was co-host- ed by the Chinese Cataract Society. 'Close Encounters' in presbyopia At the APACRS symposium co-host- ed by the Philippine Society of Cata- ract & Refractive Surgery, presbyopia was the major topic. Kazuno Negishi, MD, Tokyo, Ja- pan, presented on refractive and dif- fractive multifocal IOLs. Multifocal lenses have become widely accept- ed, she said. Dr. Negishi discussed a case series of 50 eyes where the multifocal IOL had been explanted. The multicenter study looked at 50 eyes of 37 patients who underwent explantation of a multifocal IOL and implantation of another IOL at 10 major medical institutions in Japan between January 2005 and December 2012. The data from this study indicated that 84% of the ex- planted IOLs were diffractive types. Additionally, it was shown that a EyeWorld Asia-Pacific celebrates its 10th anniversary at the APACRS meeting. September 2015

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