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Reporting from the 2016 World Ophthalmology Congress, February 5–9, Guadalajara, Mexico EW MEETING REPORTER 126 March 2016 treatment has become more com- mon. A 2014 survey showed that 75% of centers worldwide use OAC as a first-line therapy, Dr. Francis said. Vitreous seeding is another re- cent innovation for the treatment of retinoblastoma, Dr. Francis said. Pearls for complicated phaco cases During a session focusing on com- plicated phaco cases, presenters gave attendees their top 5 pearls for dealing with a number of issues. This was followed by a panel discus- sion on topics such as intraoperative floppy iris syndrome (IFIS)/small pupils, posterior polar cataracts, pseudoexfoliation/weak zonules, phaco with glaucoma, the rock hard lens, avoiding femtosecond laser complications, and vitreous loss and anterior vitrectomy. Abhay Vasavada, MD, Ahmed- abad, India, presented his pearls relating to posterior polar cataract management. His first pearl was to avoid rapid buildup of hydraulic pressure. With this, you don't need to perform hydrodissection, he said. The second pearl was to create a mechanical cushion effect pro- tecting the posterior capsule when performing the procedure. Conven- tional delineation is fine, he said, but Dr. Vasavada thinks inside-out delineation may be better. more than 50% die from metastases within 15 years. Previous trials that covered existing treatments showed only a 1% response rate. However, publication of treat- ment results with selumetinib in 2014 in the journal JAMA added some promise for patients with uveal melanoma. With selumetinib, progression-free survival was 16 weeks versus 7 weeks with chemo- therapy, Dr. Francis said, addressing attendees during the "WOC Day of Landmark Advancements (2014– 2016): Ocular Oncology and Pathol- ogy, Uveitis and Ocular Inflamma- tion, Pediatric Ophthalmology and Strabismus, and Neuroscience and Regenerative Medicine." That said, the overall survival rate was the same in both groups. Some side effects with selu- metinib include an acneiform rash (75%) and fatigue (50%). Thirty-sev- en percent of patients in the JAMA report required a dose reduction. Still, "it's a promising therapy, although there is no difference in overall survival," Dr. Francis said. Dr. Francis also addressed recent treatment for retinoblastoma, the most common primary eye cancer in children. The cancer had a poor sur- vival rate in the past, but now, there is about a 95% survival rate. Ophthalmic arteric chemosur- gery, also known as OAC, has led to fewer tumors in patients, and the Pearl 3 was to avoid forward bulge of the capsule-zonular dia- phragm. When you are done sculpt- ing, Dr. Vasavada said, it's important to inject OVD. His next pearl was to create a communication between the anterior and posterior compart- ments, and pearl 5 was the possible use of femto delineation for posteri- or polar cataracts. Dr. Vasavada offered a bonus pearl to preoperatively counsel the patient and family about multiple interventions and IOL fixation options. Susan MacDonald, MD, Boston, discussed pearls for deal- ing with anterior vitrectomy. First, she said, prepare your whole team. "One of the most important things you can do as a surgeon is to train your OR staff for an unexpected anterior vitrectomy," she said. It's also important that everyone knows that if a vitrectomy isn't performed properly, there may be even more complications. Dr. MacDonald rec- ommended having a vitrectomy kit (either put together or a list of what would be needed). Improving your visualization of the vitreous was the second pearl Dr. MacDonald offered. Pearl 3 was to maintain chamber pressure. "I think the best way to do this is with a bi- manual approach," she said. A pars plana approach may also be good, but that will require further educa- tion on the surgeon's part, she said. The next pearl was to cut, don't tug, and Dr. MacDonald's final pearl was that "you need to suture all of your wounds." This is especially important because these patients are at a higher risk for endophthalmitis and hypotony. New technologies in refractive imaging and corneal lasers Time-domain is the standard for OCT, but there are also other OCT options, said Naoyuki Maeda, MD, Osaka, Japan. His presentation focused on 3 other OCT options: spectral domain OCT, swept-source OCT, and full field OCT (a potential option in the future). These all have the potential for a higher resolution than time domain OCT, he said. View videos from WOC 2016: EWrePlay.org Richard Packard, MD, discusses advances in cataract surgery in the last 2 years.

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