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EW MEETING REPORTER 166 Reporting from the Asia-Pacific Academy of Ophthalmology (APAO) Congress, February 8–11, Hong Kong elastics to prevent further anterior migration of vitreous; keep incisions watertight with sutures; and refer to retina specialists when necessary. He said that dropped IOLs during cataract surgery "in most cases do not lead to any serious complications if handled correctly during the first cataract surgery and reoperated in a secondary procedure using pars plana vitrectomy and removal." Mun Wai Lee, MD, Perak, Ma- laysia, described his go-to technique, developed by Shin Yamane, MD. The flanged intrascleral intraocular lens fixation with double-needle technique is a transconjunctival technique using a three-piece IOL, two 30-gauge needles to exteriorize the haptics, and cautery to create mushroom head-shaped flanges at the tips of the haptics. These flanged tips are buried in the sclera to fixate the haptics. Dr. Mun Wai Lee said Dr. Ya- mane's technique is simple but not easy. Some finer points in the per- formance of this technique include accurate marking of entry points to ensure proper IOL position and stability, creating intrascleral tunnels about 3 mm long, using a needle-op- tic push to position the trailing haptic, and pulling both haptics out simultaneously. EW glaucoma in pediatric PKP vs. adults, and uncontrolled glaucoma is a cause of graft failure and must be monitored and treated. Engineering corneas Current treatments for corneal diseases requiring tissue replacement are quite effective but are limited by problems in terms of supply and immunological rejection—hence the interest in tissue engineering, according to Mark Daniell, MD, Melbourne, Australia. At a symposium on "Contem- porary Tissue Engineering of the Cornea," Dr. Daniell detailed work developing a synthetic carrier to support transplantation of cultured corneal endothelial cells to help solve the problem of supply. The carrier is a poly(ethylene glycol)-based hydrogel film—a fully synthetic, fully biodegradable ma- terial with no risk of disease trans- mission. Based on their research, Dr. Daniell concluded that the film combined with a cultured corneal endothelial cell monolayer may be a replacement for donor tissue. Shigeru Kinoshita, MD, PhD, Kyoto, Japan, provided updates on work on culturing human corne- al endothelial cells for injection therapy for bullous keratopathy. Dr. Kinoshita and his colleagues had previously sought to use stem cell- like cells, but have shifted to using fully differentiated (mature) cultured human corneal endothelial cells, mimicking in vivo human corneal endothelial cells. So far, they have been able to produce reasonably high endothelial cell densities in limited clinical tri- als, with no cases of immunological rejection. IOL fixation techniques In-the-bag IOL implantation is fairly straightforward; unfortunately, it isn't always possible. Experts shared their preferred techniques for IOL fixation in cases where there is inad- equate capsular bag support. Shu-Yen Lee, MD, Singapore, prefers a four-point scleral fixation technique using the Alcon CZ70 BD IOL (Fort Worth, Texas). Dr. Lee makes the markings for the placement of the sclerotomies for haptic fixation 2.5 mm from the limbus, 4 mm apart. Gore-Tex sutures—which are stronger, "not as fiddly," and do not induce inflam- mation—are threaded through adja- cent eyelets to minimize iris contact. These sutures are used to fixate the haptics through the sclerotomies. Enumerating the considerations for choice of approach, Dr. Lee said the conjunctival health should be evaluated along with any comorbidi- ties, prior procedures and/or trauma, and surgeon's preference. Dr. Lee said that good vision can be achieved with sutured scleral fix- ation of the IOL, and the four-point fixation technique appears to have greater ease of surgery and better stability. IOL dislocation has numerous causes, from unnoticed posterior capsular rent (PCR), misjudged cap- sular support, and PCR during IOL dialing intraoperatively to zonular dehiscence, trauma, and sponta- neous loss of zonular support due to comorbid conditions postoperative- ly. In any case, Bhuvan Chanana, MD, New Delhi, India, said that suc- cessfully managing a dislocated IOL requires that the surgeon remain calm and resist the urge to chase the IOL. He said the surgeon should not over-manipulate to avoid further extension of the capsular tear and further complications; use visco- March 2018 View videos from the 2018 APAO Congress: EWrePlay.org Sri Ganesh, MD, describes tips to maximize SMILE outcomes. Sponsored by

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