Eyeworld

Reporting from the 2017 ASCRS•ASOA Symposium & Congress, May 5–9, 2017, Los Angeles EW MEETING REPORTER 84 June 2017 Sponsored by Taking risks, testing the status quo essential to achieving goals No goal is insurmountable if you have a plan, take risks, work as a team and challenge the status quo. That was the message Captain Scott Kelly delivered to attendees during the ASCRS Lecture on Science, Medicine and Technology, "The sky is not the limit: Lessons from a year in space." Captain Kelly reflected on his success as a Navy pilot and then as an astronaut with NASA during his moving and inspiring talk. As an astronaut, Captain Kelly has traveled more than 143 million miles and spent more than 500 cumulative days in space—including a full year aboard the International Space Sta- tion—but confessed he started out as a simple kid who had problems doing his schoolwork. "When I was a kid, growing up, I was a really bad student," he said. "My path was not the easy path. It was the hard path." Growing up during the height of the Apollo missions, Captain Kelly said going to space was always on his mind, but he never thought he could actually do it. But he got his first lesson in working toward a goal when he was as a teenager and his mother decided to pursue a career as a police officer. An advantage of the ring is that there are a number of iris retaining points, which help cause minimal trauma to iris tissue. Dr. Malyugin spoke about winning an award at the ASCRS Film Festival in 2006 for his video on the Malyugin ring, and he mentioned its first appearance in peer-reviewed lit- erature, which showed the Malyugin ring to have advantages in intraop- erative floppy iris syndrome (IFIS). Over time, there have been improve- ments in the design of the ring, and the injector has been modified. In 2014, the Malyugin ring hit the milestone of having helped more than 1 million cataract patients all over the world. "From history, we know innova- tions come in cycles," Dr. Malyugin said. Just last year, the Malyugin ring 2.0 was released with improved elasticity, the injector and holder redesigned, and with the ability to be inserted into a small incision to allow the device to be used in a variety of clinical situations. Still, Dr. Malyugin noted that small pupils may be challenging even with the newest state of technology. Editors' note: Dr. Malyugin has finan- cial interests with MicroSurgical Tech- nology (Redmond, Washington). Binkhorst Lecture highlights small pupils in cataract surgery Boris Malyugin, MD, PhD, Moscow, Russia, delivered the 2017 Bink- horst Lecture on "Cataract Surgery in Small Pupils: Building the Bridge Over Troubled Waters." Dr. Malyugin spoke about the problem of small pupils in cataract surgery, which he said has been a challenge for surgeons for many centuries. Poor mydriasis is not purely a geometrical issue, he said. Rath- er, this is an indication of various systemic and/or local comorbidities, including but not limited to zonular pathology, blood-aqueous barrier disruption, and IOP spikes. Small pupils are usually associated with an increased complication rate, Dr. Malyugin said, like iris trauma, capsular rupture, vitreous loss, and inflammation. There are a number of surgical techniques to manage small pupils in cataract surgery. One good option is to deliver a mydriatic agent right into the anterior chamber. The direct contact of the agent with the iris tissue provides stable mydriasis, he said. This technique, however, may not work for all patients, so other strategies are needed. In some cases, it is quite chal- lenging to access the lens, and in these patients, there may not be enough pupil size to proceed with surgery, Dr. Malyugin said, adding that pupil stretching can help ex- pand and proceed with surgery. Iris hooks were historically the first device to be used in small pupils in cataract surgery, Dr. Malyugin said, noting that he prefers to use specially designed iris capsule hooks. The major drawback of an iris hook is in relation to the geometry of the pupil because it is square and not round. This causes tissue to be stressed and traumatized. Dr. Malyugin spoke about the Malyugin ring and other ring devic- es. Many people have asked where he got the idea for the Malyugin ring, and he said that in a closed sys- tem, the total energy of the system is conserved. He thinks that oph- thalmology is a closed system with ideas spiraling around. View videos from ASCRS•ASOA Los Angeles: EWrePlay.org Richard Hoffman, MD, describes the surgical challenges of operating on microphthalmic and nanophthalmic eyes.

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