Eyeworld

Reporting from the Asia-Pacific Academy of Ophthalmology (APAO) Congress March 1–5, 2017 Singapore EW MEETING REPORTER 178 April 2017 tures. To remedy this, Dr. Pfeifer said the artificial iris was repositioned and the patients improved. A way to address this, he said, is by implant- ing the artificial iris so that it does not touch any intraocular structures. Dr. Pfeifer said this is done with the artificial iris floating on four sutures. The sutures come out of the sclera, and the artificial iris isn't touching any intraocular structure, he said. Assessing ectasia risk Cordelia Chan, MD, Singapore, talked about "Post-LASIK Ectasia Risk Assessment: Where Are We Now?" Fortunately, Dr. Chan said, post- LASIK ectasia is rare, with reported incidence ranging from 0.04 to 0.6%. But are current preop LASIK screening protocols sufficient? Screening protocols, she said, are more common with topogra- phy and tomography. However, no topography system is currently able to detect subclinical keratoconus with 100% sensitivity and specificity due to variability in the quality of examination, which is affected by eye movements, blinking, and tear film. Moreover, topographic chang- es may be undetectable or difficult to characterize in early subclinical keratoconus, and ultimately relies on subjective interpretation by the clinician. Dr. Chan described use of the SCORE analyzer software, which she incarceration. A second IOL should not be placed, Dr. Chanana said. He also suggested air tight closure of the wound and frequent topical steroids. An IOP reducing agent or hyperos- motic drugs may be indicated. He also suggested a vitreoretinal referral and careful attention to detect other complications. In conclusion, Dr. Chanana said not to over-manipulate in order to avoid further extension of the capsular tear and further compli- cations. Use an ophthalmic viscos- urgical device to prevent further anterior migration of the vitreous, he said. Dr. Chanana also said to keep your incision watertight with sutures to avoid other postoperative complications, such as hypotony or endophthalmitis. Remain calm and resist the urge to chase, he said, and refer to a retina specialist. He added that dropped IOLs during cataract surgery, in most cases, do not lead to any serious complication if it is handled correctly during the first cataract operation and re-operated in a secondary procedure using pars plana vitrectomy and removal. Vladimir Pfeifer, MD, Ljublja- na, Slovenia, discussed repair of the iris and lens. He highlighted both artificial iris and IOL implantations. Dr. Pfeifer mentioned several cases he saw of patients with cystoid macular edema and clinical in- flammation. It was found that the problems were due to contact of the artificial iris on intraocular struc- assessment of the optic nerve/ nerve fiber layer. • Plano target. Dr. Tchah, like some of the previous speakers, said astigmatism should be targeted between 0.5 to 0.75 D. He said he's found greater success in the low-add multifocal IOLs and cited studies that have found high patient satisfaction for mixing and matching IOLs. • Perfect surgery. You need the perfect surgery when using these lenses, Dr. Tchah said, advocating for femtosecond laser cataract surgery in these cases. • Postoperative complication management. When it comes to postoperative complications, Dr. Tchah said he first likes to wait and see, reassuring the patient that some of their complaints might resolve given time. If treatment is needed however, laser vision correction or IOL exchange might be needed. These patients will need more chair time to be satisfied, he said. IOL dislocation and repair strategies discussed in symposium A session highlighted cataract topics, focusing on the topic of IOL Fixation with Deficient Capsular Support. Bhuvan Chanana, MD, New Delhi, India, shared his man- agement pearls for a dislocated IOLs. Intraocular lens dislocation has been reported to occur in 0.2% to 1.8% of patients, he said. Intraocular lens dislocation could occur intraoper- atively or postoperatively. Intraop- erative dislocation may come from unnoticed posterior capsular rent, misjudging capsule support, or PCR during IOL dialing. Postoperatively, IOL dislocation may be associated with zonular dehiscence, trauma, or a spontaneous loss of zonular support. The best approach must be de- termined individually, Dr. Chanana added. The approach will be based on factors such as clinical circum- stances and coexisting complica- tions. He offered several recommen- dations for IOL dislocations. He suggested an anterior vitrectomy, though he said to avoid vitreous continued on page 180 View videos from APAO 2017: EWrePlay.org Bennie Jeng, MD, Baltimore, Maryland, discusses the changes in treatment patterns for corneal ectasia.

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