Eyeworld

Reporting from the BRASCRS annual meeting, June 1–4, 2016, São Paulo, Brazil EW MEETING REPORTER 80 July 2016 Jose Ignacio Barraquer Lecture The 2016 Jose Ignacio Barraquer Lecture was given by J. Bradley Randleman, MD, Atlanta, on the topic of "Fragility of Knowledge." During his lecture, he stressed how to work with knowledge that is acquired and how to treat pa- tients with that and move the field forward. "Knowledge is fragile," Dr. Randleman said. "It must be in- troduced first." Then, it must be acquired by the learner and accepted by the group. It must be challenged and validated, and knowledge must be accurate, he said. Peer-reviewed literature is flawed, but it's the best model that we have to date to get the best in- formation out there, Dr. Randleman said. It's incumbent on everyone to do good science to get your research out there, he added. Dr. Randleman discussed the importance of corneal biomechan- ics as an example of the fragility of knowledge. He spoke about the evo- lution of technologies available and studies published on this topic. Femto cataract Another session looked at the "grand debate" of femto cataract. Presenting at the session were Virgilio Centurion, MD, São Paulo, Brazil, Gustavo Ricci Malavazzi, MD, São Paulo, Brazil, Hamilton Moreira, MD, Parana, Brazil, Carlos Palomino Bautista, MD, Madrid, and Ike Ahmed, MD, Toronto. Dr. Centurion presented on the femtosecond laser, speaking about his enthusiasm with the technol- ogy and saying that he would use it in all of his cases if possible. The femtosecond laser has added a re- fractive touch to cataract surgery, he said. This is the concept: a new way to operate on cataracts to obtain better refractive results. This can be achieved by combining complemen- tary techniques. The femtosecond laser provides a good capsulotomy, incision, and nuclear fragmentation, Dr. Centurion said. Surgeons use less energy, which translates into a fast visual recovery; this is very import- ant to patients nowadays, especially KTP is minimally invasive, he said, and new study results found a de- crease in subjective glare, photopho- bia, and monocular diplopia. Indications for keratopigmen- tation include symptomatic periph- eral iridectomy, traumatic aniridia, traumatic coloboma, atrophic and fixed dilated iris, and iridocorneal endothelial syndrome. It also has cosmetic indications in a low visual potential cornea. In traditional KTP, the physician denudes the corneal epithelium with a blade or excimer laser, Dr. Pineda said. Use a 27- or 30-gauge needle at an oblique angle for application of the pigment into the corneal stro- ma, he said. Dr. Pineda then described his technique for FLAK, which includes using topical anesthesia, 2 separate corneal pockets, a circular center pocket to simulate the pupil, and a peripheral channel to simulate the iris. "With this technique, you can customize the dimensions of the treated area," he said. There are well-defined lamellar dissections; it's faster than conventional treatments, less painful, and theoretically less likely to fade, he added. "Obviously, there are some lim- itations," Dr. Pineda said. "It does require a relatively clear cornea." There are also limited tattoo pig- ment colors, and extensive kera- topigmentation can limit visualiza- tion of intraocular structures if they require monitoring, he said. Potential complications to be aware of with keratopigmentation include under pigmentation, over pigmentation, pigment migration, infection, perforation, delayed heal- ing, and uveitis. Dr. Pineda said there are still factors to investigate for the future. "We want to continue to monitor the long-term effects of these dyes," he said. The need for tattoo en- hancement in the future may also warrant further investigation. He thinks FLAK is an effective tech- nique and is an alternative method of keratopigmentation for the treat- ment of problematic PIs, corneal leucomas, or leukocoria, despite its added expense. Charles Kelman Lecture Dr. Malyugin gave the Charles Kelman Lecture and received the Charles Kelman Medal. In his lecture, Dr. Malyugin dis- cussed many innovations through- out the years and specifically discussed his experience working in Russia. One topic he spoke about in depth was the concept of the femto conveyor, which creates multiple stations for different parts of a femto procedure and a way for patients to rotate from station to station. The idea of a conveyor belt is still viable today, he said. The Malyugin ring was also discussed during the lecture. In- novation never stops, and there is always room for improvement, Dr. Malyugin said. He cited this as the reason for the new Malyugin ring 2.0, which is easier to implant and remove, is thinner, and is gentler for the tissue. Expertise should be shared in the innovation cycle, Dr. Malyugin said, and that's why it's so important to share your knowledge in the sur- gical field, as well as at meetings. Can the passion for innovation be stopped? Dr. Malyugin thinks not and that it is an inherited behavior with strong environmental influence. New technologies A session devoted to new tech- nologies covered topics including intraoperative OCT, femtosecond laser-assisted keratopigmentation (FLAK), and true accommodation vs. pseudoaccommodation. Roberto Pineda, MD, Boston, presented on FLAK. Keratopigmentation has been around for some time, he said. It is a form of anterior segment reconstruc- tion using a corneal tattooing treat- ment. It's been used for centuries, traditionally for cosmetic purposes, but now is being used for optical function. However, he noted that this procedure is not like the danger- ous conjunctival tattooing that has become popular in some places. Keratopigmentation (KTP) is now done with micronized mineral pigments and new surgical tech- niques, Dr. Pineda said. It's possible to manage moderate to severe visual dysfunctions related to iris defects.

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