Eyeworld

Reporting from the XXXV Congress of the ESCRS, October 7–11, Lisbon, Portugal EW MEETING REPORTER 92 Dr. Vlasenko said CBDS type 1 presents with transparent fluid in the bag that is almost invisible at the slit lamp but visible with OCT; treatment is not generally required with this group, but patients should be followed. CBDS type 2 will feature semi-transparent or opaque fluid; puncture of the posterior capsule with the YAG laser can drain the fluid into the vitreous with good visual results afterward. CBDS type 3 is accompanied by posterior capsule opacification and a homogenous transparent or semitransparent liquid in the bag; YAG laser was used in these cases. CBDS type 4 includes a posterior capsule opacification and an opaque turbid liquid; Dr. Vlasen- ko said surgical aspiration is used in these cases to extract the liquid. What is causing CBDS? While the exact reason is not known yet, Dr. Vlasenko said they think lens epithelial cells migrating, along with products of their lysis, are getting into the retro-optical space behind the optic-haptic junction, similar to the mechanism causing posterior capsule opacification. Other papers discussed further research on in-the-bag IOL disloca- tion, material and pattern analysis of opacified IOLs, and clarity charac- teristics. EW said occurs in 7–10 years after cata- ract surgery in 1% of pseudophakic patients. There is no established consensus of the preferred method to correct this situation though. Dr. Kristianslund and coauthors com- pared IOL repositioning with scleral suturing and IOL exchange with an iris-claw. Previous research has shown the two methods have simi- lar safety and efficacy, and there was more of an IOP decrease after IOL exchange vs. repositioning. In terms of refractive results, Dr. Kristianslund said both methods had an acceptable amount of surgically induced astigmatism, though ex- change tended to have more, which was expected. Exchange, however, resulted in a higher refractive pre- dictability within 1 D (83%), and Dr. Kristianslund said a slightly higher A-constant for retropupillar fixation of the iris-claw IOL might provide better results. IOL repositioning had an average myopic shift of –0.7 D, due to a more anterior position of the IOL-capsule complex. Anna Vlasenko, MD, Moscow, Russia, described a management strategy for different stages of a rare complication called capsular bag distension syndrome (CBDS), which presents when the capsulorhexis opening is sealed by the IOL optic and a liquid substance accumulates in the bag. to inexperience and are included in the learning curve. Most also have a favorable resolution with no lasting effect on the patient's visual acuity, she added. Some postop complications are similar to LASIK (epithelial defects, dryness on the corneal surface, DLK, haze at the interface, and epithe- lial ingrowth), with SMILE's post- op complication frequency being comparable to that of LASIK, Dr. Albou-Ganem said. SMILE-specific complications include suction loss, black spots/opaque bubble layers, lenticule rupture, and cap rupture. Some of these complications can be prevented using specific techniques, but much of it resolves once one has gotten over the learning curve. Re- treatment options are also available for all under and over corrections, she said, with favorable resolution and no lasting effect on the patient's visual acuity. While most discussion regarding SMILE refers to myopic corrections, Walter Sekundo, MD, Marburg, Germany, shared some early results with SMILE and FLEx for hyperopia and hyperopia with astigmatism. Hyperopic SMILE has been shown to have similar centration to LASIK, larger optical zones, and less spher- ical aberration. Advantages it could bring to hyperopic correction in- clude elimination of fluence projec- tion errors, elimination of trunca- tion errors, and decreased incidence of epithelial ingrowth, Dr. Sekundo said. Disadvantages could include a higher degree of suction loss due to a large treatment zone and a poten- tially greater increase of intracorneal haze due to the proximity of both parallel planes. There is an ongoing multicenter CE study for SMILE to further establish its potential for hyperopic correction. Lens dislocation and opacification papers Various studies involving lens dislo- cation and opacification and their management were presented in a paper session. One paper was about late in- the-bag lens dislocation, which Olav Kristianslund, MD, Oslo, Norway, November 2017 View videos from ESCRS 2017: EWrePlay.org Filomena Ribeiro, MD, PhD, explains categories of IOL formulas.

• Blank Page
• Blank Page (1)