Eyeworld

Reporting from the Asia-Pacific Academy of Ophthalmology (APAO) Congress 2016, March 24–27, Taipei, Taiwan EW MEETING REPORTER 174 Timing of phaco in relation to a trabeculectomy is also important to consider. It's well known that cata- ract surgery causes trabeculectomy failure to some degree or another, he said. But it is worth knowing that just because cataract surgery caus- es trabeculectomies to fail doesn't mean that it's necessarily a good idea to do the cataract first. The fourth point that Dr. Barton discussed was phaco plus, or phaco with MIGS procedures, which he said is interesting and timely. If the glaucoma is not severe and the IOP his presentation, with 5 key points. He first discussed IOP lowering in primary open-angle glaucoma. There is substantial evidence regarding the amount of IOP lowering in phaco, he said. Data shows that cataract surgery does lower the pressure. He also discussed phaco in an- gle-closure glaucoma. Phaco is useful in different types of angle closure, Dr. Barton said. It's useful to prevent angle closure secondary to pupil block. However, it's not as effective to prevent angle closure secondary to plateau iris. In chronic primary angle closure, it can be effective but may be insufficient in some cases. fragments are present, use the IOL scaffold technique for phacoemulsi- fication. Dr. Beiko said that a 1-piece IOL can be placed in the capsular bag if there is a linear break in the posterior capsule. He added that a 1-piece IOL can be placed in the sulcus if optic capture in the anterior capsulorhexis is possible. Finally, Dr. Beiko said that a 3-piece IOL in the sulcus is a good back-up strategy. Dr. Lam focused one of his presentations on doing an IOL exchange. He first discussed a number of common causes for an IOL exchange. The most common cause is intolerance to a multifocal IOL, he said. Wrong IOL power, IOL decentration, and IOL-induced anterior uveitis with or without glaucoma are also causes. It's best to perform an IOL exchange between 1 and 3 months after surgery, he said. Dr. Lam offered his 5 pearls for exchanging an IOL. Prevention is the best cure, he said, and most of the IOL exchange cases can be prevented. Timing is also important, and he stressed again that it's best to do the procedure within 3 months. A self-sealing sclero-corneal tunnel is a good option as well. Be prepared to address issues of zonular defect, Dr. Lam said, and be prepared to do optic capture/sulcus fixation/scleral fixation in the event of posterior capsule rupture. Editors' note: Dr. Beiko has financial interests with Abbott Medical Optics and Bausch + Lomb. The other speakers have no related financial interests. Phaco in eyes with ocular problems Another session highlighted phaco in eyes with ocular problems. There may be co-existent oc- ular surface disease and cataracts, said Namrata Sharma, MD, New Delhi, India. She detailed steps to minimize postop discomfort, including detection of OSD prior to phacoemulsification, optimizing the ocular surface, using intraoperative measurements to minimize surface damage, and using postoperative management to optimize results. Keith Barton, MD, London, highlighted phaco and glaucoma in April 2016 continued on page 176 View videos from APAO 2016: EWrePlay.org Christopher Leung, MD, discusses the applications of retinal nerve fiber layer imaging in diagnosing and managing glaucoma. View videos from APAO 2016: EWrePlay.org Caroline Chee, MD, discusses the incidence, identification, and treatment of CME after routine cataract surgery.

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