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EW MEETING REPORTER 158 Reporting from the Asia-Pacific Academy of Ophthalmology (APAO) Congress, February 8–11, Hong Kong MD, Dehradun, India, Lional Raj Ponniah, MD, Tirunelveli, India, and Yassine Daoud, MD, Baltimore. The Capsular Bag Team included Samaresh Srivastava, MD, Ahmed- abad, India, Soon-Phaik Chee, MD, Singapore, Rohit Om Parkash, MD, Amritsar, India, and Mun Wai Lee, MD, Perak, Malaysia. Dr. Tchah shared a case of a pa- tient who underwent multiple IOL exchanges. His 57-year-old patient first wanted MFIOL surgery, and she was highly motivated to get it. The nucleus was soft, and it was an easy surgery; he implanted a diffractive MFIOL bilaterally. However, at 1-day postop, the patient was complain- ing. Her right eye was fine, but in the left eye, she complained about scattering light, despite having good near and distance vision. The pa- tient wanted the MFIOL in her left eye removed. Dr. Tchah said the patient was a VIP, so he agreed to do an IOL exchange at 1-month postop. The second surgery went well, and he ex- changed the MFIOL for a three-piece hydrophobic IOL. However, the patient was again complaining from day 1 postop of light scatter, and she wanted to go back to a MFIOL. Eventually, Dr. Tchah was persuaded to perform a second exchange, and he exchanged the IOL to a rotationally asymmetrical refractive MFIOL. observe. He recommended choosing the easiest cases initially, avoiding aphakia, iris abnormalities, glauco- ma procedures, and eyes with poor view, even considering general anes- thesia in these early cases; recruiting an experienced "buddy" surgeon for early cases; carefully informing and educating patients of the procedure to get their consent; and seeing ini- tial cases daily for several days and carefully taking note of any "wrin- kles" encountered to learn which may affect outcomes. In terms of surgical technique, Descemet's stripping endothelial keratoplasty (DSEK) remains the most common procedure, according to Sanjay Patel, MD, Rochester, Minnesota. However, questions re- main regarding visual outcomes and rejection rates with the technique. Descemet's membrane endothelial keratoplasty (DMEK), while current- ly lacking long-term outcomes data, promises better visual outcomes and an even lower rejection rate. For now, the choice between DSEK and DMEK largely depends on ocular status, medical status, and patient preference. Data Dr. Patel cited suggests faster visual recovery and lower rejection rates with DMEK, although the differenc- es seem to "wash out" over time. Surgeons should therefore consider the long-term value of the procedure to individual patients and measure their own outcomes. One major limitation to DMEK is the relative difficulty of the tech- nique, requiring more manipulation but using a "no-touch" technique that manipulates the tissue indirect- ly. This makes it less than ideal for complicated cases. Donald Tan, MD, Singapore, described a "hybrid" technique that may allow surgeons to perform DMEK in complicated cases. The ba- sic concept is to adopt the standard DSAEK procedure, using the donor stroma as a carrier but pulling the Descemet's membrane through. Why bother with DMEK in complicated cases? Dr. Tan said that 20/20 vision is not the main goal; the major advantage of DMEK is the low rejection rate. The pull-through hybrid DMEK technique, he said, provides more consistent control, and according to outcomes recorded at his institution in Singapore, significantly lower glaucoma and rejection rates than either DSAEK or PK. Ophthalmic Premier League The Ophthalmic Premier League session featured four teams showing videos of challenging or compli- cated cases. Amar Agarwal, MD, Chennai, India, served as the chair of the session. John Chang, MD, Hong Kong, and Charles McGhee, MD, Auckland, New Zealand, served as chairmen. The two judges were Ronald Krueger, MD, Cleveland, and Hugh Taylor, MD, Melbourne, Australia. Match referees were Pichit Naripthaphan, MD, Bangkok, Thailand, and Bennie Jeng, MD, Baltimore, and umpires were Vishal Jhanji, MD, Hong Kong, and Victo- ria Wong, MD, Hong Kong. The Accommodators Team included George Beiko, MD, St. Catharines, Canada, Ronald Yeoh, MD, Singapore, Hungwon Tchah, MD, Seoul, South Korea, and Toshi- hiko Ohta, MD, Shizuoka, Japan. The Multifocal Team included Jorge Alio, MD, Alicante, Spain, Burkhard Dick, MD, Bochum, Germany, Rob- ert Ang, MD, Manila, Philippines, and Tetsuro Oshika, MD, Tsukuba, Japan. The Divide and Conquer Team included Mohan Rajan, MD, Chennai, India, Gaurav Luthra, March 2018 View videos from the 2018 APAO Congress: EWrePlay.org Ronald Yeoh, MD, shares his top five pearls for femtosecond cataract surgery. continued on page 160 Sponsored by

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