Eyeworld

Reporting from the 30th APACRS Annual Meeting, June 1–3, 2017, Hangzhou, China EW MEETING REPORTER 82 July 2017 bag even after a posterior capsule tear. How often have you had to give up a premium IOL for a three-piece because of PCR? she asked. Instead of switching immediate- ly to a three-piece, first inject OVD to create space. Inject the desired premium IOL into the sulcus or anterior chamber, rotating it to the desired axis. Then, to place the IOL into the bag, gently flex each haptic near the optic/haptic junction to ease the IOL into the bag. The technique can even be used for plate haptics, although the optic will require additional support. Hadi Prakoso, MD, Jakarta, Indonesia, gave the audience's sec- ond favorite tip. In case your knife doesn't seem as sharp as it should be, Dr. Prakoso suggested putting pressure on the cornea to not create counterforce but raise the IOP slight- ly to make the cornea stiffer and more rigid, making it easier to create an incision. Guo Hai-ke, MD, Guangdong, China, gave the audience's favorite tip. In dealing with a small pupil, Dr. Guo showed how the surgeon can still make a CCC beyond the diame- ter of the pupil. He then proceeded to perform phaco through the small pupil, using his second instrument to protect the iris. Avoiding unexpected outcomes A symposium highlighted differ- ent factors to help ensure optimal optical outcomes, with topics including cataract surgery and dia- betic retinopathy, preoperative and intraoperative imaging, astigmatism management, astigmatic refractive surprise, and cataract surgery in post-keratoplasty patients. Wong Tien Yin, MD, Singapore, focused his presentation on cataract surgery and diabetic retinopathy. Diabetes is a major problem affect- ing many people around the world. Recently, he added, there has been more interest in diabetic macular edema (DME) and not just diabetic retinopathy. The history of DME is that it's a slow, chronic disease. It doesn't happen overnight, Dr. Wong said. For many years, the laser has been used as the treatment of master's skill, give away some of the secrets to their apparently arcane mastery. Gaurav Luthra, MD, Dehradun, India, kicked off with a pair of tips to manage small pupils without iris hooks or rings. First, inserting a cannula through a side port, an injection of balanced salt solution enlarges the pupil. Second, in case of floppy iris, pull out of the eye and allow the aqueous to escape. Going back in, distend the chamber with balanced salt solution. If some aqueous redirection caused the pupil to constrict, it should now expand with ease. Dr. Luthra also offered tips to manage leaky incisions. Using try- pan blue to identify leaky incisions, he demonstrated the use of suprain- cisional tunnels or small pockets made above the leaky incisions. These tunnels or pockets can be hy- drated to help seal the incisions over which they lie. Kendall Donaldson, MD, Plan- tation, Florida, demonstrated the "modified chip and flip" or "upside down chop" technique for soft cat- aracts. Often at these meetings, she said, the focus is on hard cataracts, but soft cataracts can be just as challenging. In the modified chip and flip, after the cataract is broken into two hemisections, the chopper is exchanged for a smooth, flat instru- ment such as a Koch spatula. The surgeon slips it under the nucleus and cracks upward, then essential- ly folds each piece over into the phaco handpiece. The instrument stays within the capsular bag, going under the nuclear material, and up to crack. Chee Soon Phaik, MD, Sin- gapore, shared her technique for inserting a premium IOL into the for an expedition in Nepal. The pair performed 224 cataract surgeries in 3 days; Dr. Tabin acknowledged he only performed about 2 dozen, while Dr. Ruit performed the rest. "The joy was palpable," Dr. Tabin said, adding that the results appeared as good as phaco surgery for a cost of about $25. "I told Dr. Ruit, 'I want to join you in this.'" With that the pair formed the Himalayan Cataract Project. Dr. Tabin has since focused his career on bringing quality eyecare, not just cataract surgery, to the places that need it most. Dr. Tabin said they joined forces with Alan Crandall, MD, who had been performing the highest volume of cataract surgery in Ghana, expanding access to eyecare in Ethiopia, Rwanda, South Sudan, Tibet, Myanmar, and more. "We all need to realize that blindness is preventable and treat- able for 18 million cataract patients on our planet," Dr. Tabin said. Dr. Tabin called on his fellow ophthalmologists to join him in bringing these numbers to zero. "Elimination of avoidable blindness is something we can do," he said. Spirit of APACRS embodied by "Kung Fu Masters" At its annual meetings, APACRS con- stantly strives to provide attendees with a concise yet comprehensive, always practical, and ultimately relevant educational experience, packing as much useful content as it can into 3 days. In that sense, "Wis- dom from the Kung Fu Masters" best embodies the meeting's spirit. At this symposium, experts were asked to share surgical tips any sur- geon can apply the very next time they visit the operating room, tips that, rather than showing off each

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