Eyeworld

Reporting from the 29th APACRS annual meeting, July 27–30, 2016, Nusa Dua, Bali Sponsored by EW MEETING REPORTER 82 August 2016 Ronald Yeoh, MD, Singapore, the president of APACRS, also spoke at this time, discussing his first meeting as APACRS president and the previous years under Arthur Lim, MD, and Graham Barrett, MD, who Dr. Yeoh said are the "two people who created our society." Dr. Yeoh said he had the good fortune of being guided and mentored by these "giants in ophthalmology." Dr. Lim's driving forces that started APACRS were an obsession with research, training, and edu- cation; an obsession with quality cataract surgery; an obsession to eliminate cataract blindness; and an obsession to elevate the standards in Asia. Dr. Lim used his own wealth very constructively to further oph- thalmology and cataract surgery in Asia. He ran APACRS in his own private clinic with his own staff, self-funded, and with no secretariat. Dr. Barrett served as president of APACRS from 2000 to 2015. He undertook important initiatives, including the launch of EyeWorld Asia-Pacific, an inclusive policy for all regional cataract and refractive societies, and a full-time secretariat located in the Singapore National Eye Centre. APACRS will continue to strive to provide better and more relevant meetings, Dr. Yeoh said, as well as to strengthen the relationship with regional and international partners. APACRS LIM Lecture Oliver Findl, MD, Vienna, Austria, gave this year's APACRS LIM Lecture on "Achieving Emmetropia with Lens Surgery—Still Some Way to Go?" Dr. Findl began his lecture talking about postoperative refrac- tion. We have increased demands because of multifocal IOLs, clear lens exchange, toric IOLs, and accom- modating IOLs, as well as a growing demand from patients, he said. He then highlighted biometry and power calculations, including new technologies and intraoperative measurements. The newest develop- ment is the use of swept-source OCT for biometry. the external incision, Dr. Tan said, and the tunnel should be "uniform and complete for smooth nucleus delivery." Dr. Tan also touched on compli- cations that can occur with MSICS. A button hole in the scleral flap, for example, can result from superficial dissection. Such a complication can be managed by deepening the incision and finding a deeper plane, starting at the opposite side of the button hole. Dr. Tan cautioned against over cautery as it could cause wound shrinkage and scleral melt. To reduce postop astigmatism, Dr. Tan rec- ommended creating the wound at the steepest meridian and said the wound should only be as long as necessary. A longer wound could result in more flattening. Opening ceremony highlights history of APACRS The APACRS annual meeting official- ly opened with the Opening Cere- mony followed by the APACRS LIM Lecture. Johan Hutauruk, MD, Jakarta, Indonesia, the organizing chair- man of the meeting, kicked off the ceremony with a welcome address. On behalf of the organizing com- mittee, he expressed his pleasure in welcoming attendees to Bali, "one of the world's most beautiful islands" and the 29th APACRS meeting. This meeting was last held in Bali 12 years ago in 2004. Following Dr. Hutauruk, Nila Moeloek, MD, Jakarta, Indonesia, the Minister for Health of Indonesia and president of the Indonesian Ophthalmologists Association, spoke. More than 90% of the world's visually impaired are in develop- ing countries, she said, and it's a challenge for both governments and eyecare providers. There has been progress in the country over the last 20 years in reducing cataract-related blindness, but despite that success, the cataract blindness rate in Indonesia is still among the highest in Southeast Asia, Dr. Moeloek said. "We need to be doing even more to help those suffering from cataracts," she said. developing MSICS, said in his pre- sentation leading the MasterClass. Showing a couple of videos highlighting the technique, Dr. Ruit briefly described the process but emphasized to attendees that he and his faculty would go through the process several times so "by the time we finish our course, you'll be quite conversed with the basic principles of small incision cataract surgery." Dr. Tan got into more detail on MSICS in her presentation, focusing on wound construction. "We will soon realize that wound construction is the founda- tion of the surgery," Dr. Tan said. "When we make the wound, first of all, we want to make it self-sealing. Other things we want to consider are the size and hardness of the nu- cleus and the lens we're putting in." Before deciding to perform MSICS, Dr. Tan noted that one has to evaluate the status of the sclera, excluding patients with scleral thinning. Dr. Tan said the external inci- sion is relatively short with a long tunnel that ends in a large inter- nal incision, resulting in a trape- zoid-shaped wound. The external incision, which ranges between 5 and 8 mm in size, is important "because it stretches to allow for the delivery of the nucleus and allows you to insert the intraocular lens." A frown-shaped incision results in minimal surgically induced astig- matism, but Dr. Tan said this curved shape can be difficult for those just learning the technique. She advised those starting out with MSICS use a Blumenthal incision, which is a straight incision with two oblique cuts at the end. When it comes to the scleral tunnel, Dr. Tan said the optimal scleral flap thickness is about 0.3 mm. Too thin of a flap could result in a tear or button hole, while too thick of a flap could result in pre- mature entry. Creating an optimal scleral tunnel can be aided by mak- ing sure the scleral bed is dry, using sharp crescent blades, and stabiliz- ing the globe with toothed forceps rather than grasping the scleral flap. The internal aspect of the tunnel should be about 25% bigger than

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