Eyeworld

169 April 2016 EW MEETING REPORTER Considerations include the age of patients, their visual needs, the de- gree of remaining capsular support, the type of IOL, the integrity of the capsular bag, iris support, and anterior chamber depth. Surgeons should also note if the patient has any comorbidities, Dr. Chang said. Editors' note: Drs. Chang and Huang have no related financial interests. Latest developments and advances Two sessions focused on some of the latest developments and ad- vancements within subspecialties in ophthalmology. Presentations highlighted gene therapy in treat- ing eye diseases, myopia treatment, presbyopia, cataract and IOL surgery, ophthalmic imaging, prevention of blindness, stem cell therapy in treating eye diseases, collagen cross- linking, corneal lamellar surgery, diabetic retinagraphy and maculopa- thy, refractive surgery, and treatment of floaters. occur, it's important to prevent further extension of the tear, as well as further prolapse of the vitreous. Dr. Huang said to be sure to clean up the remaining fragments and cortex and to secure IOL implantation. Jonathan Chang, MD, New York, highlighted the problem of IOL dislocation. Cataract surgery is very safe but has some risks, he said. Cataract surgery instrumentation has improved, and surgeons are able to operate on riskier patients. Addi- tionally, patients are living longer. IOL dislocations may still be seen over time, he said. There are a number of causes for IOL disloca- tion, with pseudoexfoliation one of the most common. Potential solutions to address these patients include using contact lenses or glass- es, implantation of an AC IOL, an iris-sutured IOL, an iris-fixated IOL, sutured sulcus fixation of the IOL, or intrascleral fixation of the IOL haptics without sutures. Surgeons should try to individ- ualize the choice and tailor it to the patient, Dr. Chang said. "There's not one perfect way," he said. Editors' note: Dr. Yeoh has financial interests with Alcon and Abbott Medical Optics. Dr. Tsai has no related financial interests. Cataract surgery in complicated cases A session highlighted cataract sur- gery in cases with capsule/zonule de- fect, dislocated or subluxated IOLs. Wei-Jen Huang, MD, Taipei, Taiwan, offered information on the value of OVD, which he said is a powerful tool in the management of challenging cataract procedures, such as capsule and zonular prob- lems. Some issues that a surgeon may encounter include white cataracts, polar cataracts, a CCC tear, a PC tear, and zonular dehiscence. There are a number of tools that can be used in the management of these situations, Dr. Huang said, includ- ing trypan blue, femto, iris hooks, a CTR, a vitrector, and OVD (either cohesive or dispersive). However, he noted that some of these tools are not readily available in Taiwan. The best policy is prevention, but if capsule/zonule problems the U.S., you can present options to the patient in combination with refractive IOLs, she said, so if they choose a premium IOL or astigma- tism correction, they will pay extra for this procedure. The question on everyone's mind, however, she said, is what is the future of the femto- second laser? One worry surgeons may have is that they will end up spending a lot of time and money without knowing if the technology will become obsolete in the future. So, should you incorporate fem- tosecond cataract surgery into your practice? There are both pros and cons, Dr. Tsai said. Pros include that it's widespread in multiple countries. A major factor in the U.S. is that the next generation is learning it. You see it in a lot of residency programs, she said. The femtosecond laser aids in complex surgery and may offer improved refractive outcomes. The cons include difficulty with access to the technology; cost, time, and the learning curve of using the new technology; cost effectiveness; and potential procedure complications. continued on page 170 View videos from APAO 2016: EWrePlay.org Nathan Congdon, MD, discusses strategies for improving outcomes and overcoming treatment barriers in a rural Chinese population with glaucoma. View videos from APAO 2016: EWrePlay.org Ronald Yeoh, MD, discusses improvements in femto cataract technology over time.

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