Eyeworld

89 June 2017 EW MEETING REPORTER and best corrected image quality, he said. Dr. Thompson finds wavefront analysis, the HD Analyzer (Visiom- etrics, Costa Mesa, California) and the Pentacam (Oculus, Arlington, Washington) helpful in determining candidacy for certain procedures. He considers corneal refractive procedures when the patient is not an eye rubber, they have a healthy ocular surface, quality cornea and topography, minimal higher order aberrations, and other factors. For lens-based procedures, Dr. Thomp- son said there is less risk of retinal detachment with a phakic IOL vs. a refractive lensectomy. Editors' note: Drs. Hoffman, Wang, and Thompson have financial interests related to their comments. Dr. Yeoh has no financial interests related to his comments. Pearls exchanged in rapid-fire X-Rounds The X-Men of ASCRS took to the annual X-Rounds symposium's stage with moderator Eric "Beast" Donnenfeld, MD, Rockville Cen- tre, New York, and panelists David "Wolverine" Chang, MD, Los Altos, California, Bonnie "Storm" Henderson, MD, Boston, John "Professor X" Hovanesian, MD, Laguna Hills, California, Stephen "Archangel" Lane, MD, Stillwater, Minnesota, and Stephen "Magne- to" Slade, MD, Houston. In the "What am I doing dif- ferently?" category, Dr. Chang was voted the winner by the audience for sharing his thoughts on switch- ing to intracameral moxifloxacin in light of the evidence associating intraocular vancomycin prophy- laxis with hemorrhagic occlusive retinal vasculitis (HORV). Dr. Chang highlighted recent data supporting the efficacy of moxifloxacin. He said he uses compounded moxifloxacin, but noted a preparation by Imprimis Pharmaceuticals (San Diego) and the use of Vigamox (Novartis, Basel, Switzerland). The generic version of Vigamox, Moxeza, should not be used intracamerally due to preserva- tives, Dr. Chang said. for cataract surgery in long eyes (30 mm or more). Dr. Yeoh said opti- cal biometry is essential for precise axial length measurements. When it comes to the formula, he said the SRK-T is widely used, but in very large eyes, you can get errors due to change in lens configuration from convex to meniscus as IOLs of lower and lower dioptric power are select- ed. As such, Dr. Yeoh recommend- ed the Barrett Universal II, which factors in lens shape. In terms of operative issues, it's important to minimize cham- ber shallowing. Complications could include pseudophakic retinal detachments, which can be pre- vented by maintaining the chamber and avoiding abrupt shallowing. "Before removing the I/A tip, inject viscoelastic," Dr. Yeoh said. He said you can press a cotton bud on the wound as you withdrawal. Even if an eye is indicated for a zero power IOL, Dr. Yeoh said this IOL should still be implanted in case a YAG capsulotomy is needed. YAG on an aphakic eye can result in pupil block and IOP rise. Zheng Wang, MD, Guangzhou, China, and Vance Thompson, MD, Sioux Falls, South Dakota, discussed their thoughts on refractive surgery for the –10 D myope. Dr. Wang said there are several papers that show LASIK is safe and effective for high myopes. In contrast, he said intraoc- ular procedures are riskier, the long- term safety has not been established, and follow-up is longer compared to that for laser vision correction patients. Dr. Wang noted new technolo- gies as bringing additional safety to corneal refractive surgery—small in- cision lenticule extraction (SMILE), combined LASIK and crosslinking, and combined SMILE and crosslink- ing—but said he thinks phakic IOLs do have some advantages in this cat- egory and are "probably the future for high myopes." Dr. Thompson considers –10 D a very high myope, and he'll start thinking of phakic IOLs more quick- ly in this category than in lower myopes. Choosing the best proce- dure for the patient is about pre- serving best corrected visual acuity continued on page 90

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