EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/76185
July 2012 EW MEETING REPORTER 57 said. Graphical user interface and real-time OCT allows surgeons to both plan the procedure and monitor it as it unfolds. All relevant steps of cataract surgery can be performed with the Victus, includ- ing capsulotomy, corneal incisions, and lens fragmentation. The session concluded with a talk by Abhay Vasavada, M.D., Ahmedabad, India, expressing his uncertainty over the technology. He acknowledged that the device has some positive applications but "will it really help my patients?" he asked. He can see how the femtosecond laser will make an average cataract surgeon good, but isn't certain the laser can make a good cataract surgeon great. "With some experience, it isn't that difficult to achieve some degree of consistency and precision and therefore predictability with whatever you do," he said. 2012 APACRS Film Festival: Another level of sophistication This year's APACRS Film Festival winners made the blend of art, entertainment, and education seem almost effortless, displaying a so- phisticated marriage of ophthalmic surgical acumen and cinematic vision. In the category of Cataract Complications/Challenging Cases, Ronald Yeoh, M.D., Singapore, took the prize for "Fibro follies," a film he produced to highlight the difficul- ties that capsular fibrosis causes and how surgeons can manage these problems. In the category of Cataract General, Suresh Pandey, M.D., Kota, India, won with "Piggyback implantation of toric and multifocal IOL: Exploring uncharted territory." In the Refrac- tive/Cornea Surgery category, Sujatha Mohan, M.D., Chennai, India, won with "LASIK lapses." Describing her film, Dr. Mohan said that although current excimer lasers, eyetracking, wavefront- and topogra- phy-guided treatments are "almost completely safe," flap creation using mechanical microkeratomes remains "a major stress" to surgeons. Her film showed complications associ- ated with mechanical microker- atomes and emphasized the need to understand the pros and cons of what she called a "seemingly innocuous cosmetic procedure." In the General Interest category, Abhay Vasavada, M.D., Ahmedabad, India, won with his film "Lights, Camera, Action." Last but not least, the Grand Prize went to Myoung Joon Kim, M.D., Seoul, South Korea, for his film "Let there be Wavefront II." Dr. Kim's film explored the interac- tions between spherical aberration and defocus and their impact on cataract and refractive surgery as well as presbyopia correction. The winners were announced at the Film Festival awards ceremony held at the Shanghai International Convention Center Auditorium. All about lenses Once they've decided to use a pha- kic IOL, surgeons often find them- selves struggling with where to put the lens. Problems exist with poste- rior segment implantable contact lenses, as well as angle-supported or iris-fixated PIOLs, according to Keiki Mehta, M.D., Mumbai, India, who spoke at the "New Implants: Lens Choice Today" symposium. "Sec- ondary development of cataracts [occurs] in an unacceptable number of patients, even in the hands of very gifted surgeons," Dr. Mehta said about implantable contact lenses. Positioning of the angle-supported lens is problematic—if it rides back, there is ovaling of the pupil. If it's too far in front, the surgeon risks peripheral corneal problems down the road. "None of these places is really where we want the lens to be," Dr. Mehta said. "The obvious answer is to use a vaulted lens so that the human lens is not at risk. A new concept of a phakic IOL sitting in the anterior chamber (AC) but taking support from the sulcus seems to be the final answer to solve those problems, but it still needs to be tested." The lens is made from a hema acrylate foldable material and has a helical or screw-shaped coil, looped structure which "gives good lift above the human lens and is still rock stable," Dr. Mehta said. The tip has a small recurved "iris stud" to prevent the tip of the IOL from re- versing itself out of the sulcus. "Through an AC IOL, the loops go to the posterior chamber through two YAG capsulotomies and sit in the sulcus," Dr. Mehta explained. The lens supports itself in the ciliary sulcus. It does not go below and touch the human lens." This helical composite sulcus-supported anterior chamber implant won't compromise the eye's delicate angle structures, he added. Researchers have up to 28 months of follow-up in 129 cases. "Optical results seem to be reason- able, but there is a small cosmetic glitter problem," Dr. Mehta said. 76.2% of the patients had vision within one line of their pre-op level, according to the study. Challenges in refractive surgery Left to right: Bi Hong Sheng, Li Yi Zhi, Abhay Vasavada, Yang Ming, Yao Ke, Ehud I. Assia, Zhao Jia Liang, He Shou Zhi, Graham Barrett, Ronald Yeoh, Y C Lee, Charity Wai, John Chang, Zhao Kan Xing, Tang Xin, Kathy Chen The KAMRA (Acufocus, Irvine, Calif.) corneal inlay is an excellent option for presbyopes, said Michael Knorz, M.D., Mannheim, Germany, during the APACRS refractive sym- posium. More than 14,000 inlays have been implanted worldwide. There are two primary ways to perform KAMRA implantation. In a minority of cases, such as in post- LASIK patients, a pocket procedure may be used. Most cases will require a Sim-LASIK procedure, though, because you'll need a target refrac- tion of about –0.75. "[Sim-LASIK] is pretty much like LASIK, but you have to use a thick flap," Dr. Knorz said. "You need to use a femtosec- ond laser. You need to use a 200- micron flap. I prefer 9 mm because most of my patients are hyperopes, but you can argue that maybe 8.5 continued on page 58