Eyeworld

EW CATARACT 52 September 2016 by Ellen Stodola EyeWorld Senior Staff Writer Last but not least, the team from North America presented. Dr. Raviv showed a case of anterior capsule tear with a toric IOL. When looking at past research, he learned that anterior capsular tears rarely extended posteriorly during the ex- tracapsular era. The anterior zonules were bridging the tears, stretching, and preventing posterior capsular extensions, he said. However, in the phaco era, with pressurized cham- bers, we can see these extensions. He offered a number of measures to avoid this—all aimed to minimize trampolining of the capsule—in- cluding filling the eye with OVD before withdrawing I/A, using gentle insertion of a one-piece acrylic IOL, hydrating incisions before OVD removal, and ensuring watertight closure postoperatively. In the end, Dr. Miller won the Cataract Pentathlon event, Dr. Ahmed won the Cataract Marathon event, Dr. Ventura won the IOL Gymnastics event, and Dr. Tchah won the Freestyle Surgery event. The judges chose the second and third place teams, with the team from Europe and the Middle East taking home the bronze and the team from the Asia-Pacific taking the silver. Based on audience votes, the North American team came in first and took home gold. EW Editors' note: Dr. Raviv has financial interests with Abbott Medical Optics (Abbott Park, Illinois), Bausch + Lomb (Bridgewater, New Jersey), Glaukos (Laguna Hills, California), and Ocular Therapeutix (Bedford, Massachusetts). Dr. Malyugin has financial interests with Alcon, Carl Zeiss Meditec (Jena, Germany), and MST (Redmond, Washington). Dr. Barrett has financial interests with Alcon, Bausch + Lomb, Haag-Streit (Koniz, Switzerland), and MST. Dr. Chee has financial interests with Abbott Medical Optics and Bausch + Lomb. Dr. Velasco has no financial interests related to this article. Contact information Chee: chee.soon.phaik@singhealth.com.sg Barrett: graham.barrett@uwa.edu.au Malyugin: boris.malyugin@gmail.com Raviv: talraviv@eyecenterofny.com Velasco: ceciliovelascobarona@gmail.com Europe and the Middle East. He showed a case with the femtosecond laser. When the patient arrived, he noticed that the pupil was constrict- ed, and Dr. Malyugin decided to use a second generation Malyugin ring in a 2 mm incision to expand the pupil. The patient had previously undergone penetrating keratoplas- ty (PK). His plan was to implant a custom-made toric IOL with 12 D of cylinder, so he needed good expo- sure of the pupil and lens and want- ed to control how the IOL would be positioned in the capsular bag. Dr. Malyugin showed a second case with an initially small pupil and detailed his technique for expansion in order to be able to apply femtosecond la- ser energy to that particular patient. The third presenting team was from Latin America. Dr. Vejarano presented a case where his tech- nician unexpectedly hit his hand during surgery. Dr. Ventura showed her Ventura amputated IOL haptic technique. Dr. Velasco highlighted some problems that may occur with a white cataract. When dealing with these cases, one issue may be the Argentinian flag sign. The case spe- cifically dealt with a 5-year-old child with an intumescent cataract where the femtosecond laser was used to do the capsulorhexis. but then he put in a contact lens and noticed that it was sitting on the macula. The patient ended up needing a vitrectomy followed by a closed loop lens. Dr. Barrett offered several lessons learned from the case. Always check the case supine prior to turning up for surgery. It's also possible to convert a three-port vitrectomy into a scleral fixated IOL with 7-0 GORE-TEX (Gore, Newark, Delaware). Finally, he said that for this type of technique, some lenses are better than others, but according to Dr. Barrett, a closed loop four- point lens is ideal. Dr. Chee's case dealt with a dif- ficult intumescent lens. In order to perform the capsulotomy safely, she needed to flatten the anterior cap- sule. She first punctured with a bevel and then turned the bevel down to remove as much intumescent lens material as possible. Then, she began using a cannula from the opposite side. Once the anterior capsule was flattened, Dr. Chee could safely pro- ceed with her capsulotomy. Dr. Chee said she preferred iris hooks to capsular hooks in this case. She warned against rotating the nucleus because she said that if you rotate the nucleus, this could com- promise more zonules. Dr. Malyugin presented the freestyle case for the team from Video-based session at the 2016 ASCRS•ASOA Symposium & Congress featured a number of challenging cases D uring the 2016 Cataract Surgery Olympics session at the 2016 ASCRS•ASOA Symposium & Congress, teams of surgeons from around the world shared video case presentations with attendees. David F. Chang, MD, Los Altos, Califor- nia, and Richard Hoffman, MD, Eugene, Oregon, moderated the session. The North American team con- sisted of surgeons from the U.S. and Canada, including Kevin Miller, MD, Los Angeles, Ike Ahmed, MD, Toronto, Tal Raviv, MD, New York, and Robert Weinstock, MD, Largo, Florida. The Asia-Pacific team in- cluded Amar Agarwal, MD, Chen- nai, India, Graham Barrett, MD, Perth, Australia, Soon-Phaik Chee, MD, Singapore, and Hungwon Tchah, MD, Seoul, South Korea. Making up the team from Latin America was Arnaldo Espaillat, MD, Santo Domingo, Dominican Republic, L. Felipe Vejarano, MD, Popayán, Colombia, Cecilio Velasco, MD, Mexico City, and Bruna Ventura, MD, Recife, Brazil. Finally, the team from Europe and the Middle East included Ehud Assia, MD, Tel-Aviv, Israel, Khaled Abdel Rahman Khalifa, MD, Cairo, Egypt, Brian Little, MD, London, and Boris Malyugin, MD, Moscow. The judges were Luis Izquierdo, MD, Lima, Peru, Bonnie Henderson, MD, Boston, David Spalton, MD, London, and Ronald Yeoh, MD, Singapore. The "events" of the session were the Cataract Pentathlon, where up to five devices could be used; the Cataract Marathon, which tested en- durance; the IOL Gymnastics, which showed skill and creative maneu- vers; and Freestyle Surgery, where "anything goes." The Asia-Pacific team present- ed first. Dr. Barrett presented on a case where he initially saw no IOL Team North America takes home gold in 2016 Cataract Surgery Olympics Judges Dr. Yeoh, Dr. Izquierdo, Dr. Spalton, and Dr. Henderson pose with the winning team from North America, including Dr. Weinstock, Dr. Miller, Dr. Ahmed, and Dr. Raviv. Source: ASCRS Presentation spotlight

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