Eyeworld

EW MEETING REPORTER 156 Reporting from the Asia-Pacific Academy of Ophthalmology (APAO) Congress, February 8–11, Hong Kong His last pearl highlighted the use of a femto pre-chopper. Soft cataracts up to 2+ NS can be difficult to grasp and crack, Dr. Yeoh said. Using a femto pre-chopper designed for FLACS can help complete the nuclear cracking. Endothelial keratoplasty in 2018 The Asia Cornea Society (ACS) held a symposium examining the state of endothelial keratoplasty in 2018. Charles McGhee, MD, Auck- land, New Zealand, kicked off with a discussion of surgical disasters and how to avoid them. Beginning with disasters, Dr. McGhee said, helps "fo- cus your mind on the successes" to be presented later in the session, but overall the ACS symposium aimed to examine the changing indica- tions for transplant in light of the increasing number of procedures, with lamellar procedures exceeding penetrating keratoplasty, and the growing variety of glides, inserters, and injectors; to discuss eye bank tissue preparation; and report new data on long-term outcomes. Based on his experience as a consultant at a tertiary center performing endothelial keratoplasty procedures since 2007, Dr. McGhee said that to avoid disasters, surgeons should do a number of courses and wet labs, and visit busy centers to device that creates grooves in four quadrants in the sclera, inserting wedge segments of a band into the scleral pockets to create tension and expand the area. Alternative- ly, scleral translocation and elastic alignment modulation (STEAM) uses an infrared laser to selectively treat three anatomical structures: the cili- ary body apex, allowing anterior and inward translocation of the ciliary body; the ora serrata, allowing re- laxation of the scleral insertion; and the scleral spur, allowing peripheral corneal relaxation, which increases asphericity and opens the trabecular meshwork. Dr. Krueger thinks that success- ful refinement of these and similar technologies may change the way presbyopia correction is viewed in the future. Plenary session and opening ceremony Before the opening ceremony, a plenary session surveying "the evolution of ophthalmology in various spheres" was held. At the session, some of the world's leading experts came together to share their thoughts on a variety of topics, in- cluding the role of ophthalmologists and tools they can use to improve eye care for all; comprehensive sur- veys of the past, present, and future of treatment for significant public eye health conditions; and brief his- tories of some of the world's leading ophthalmology institutes. Vision—encompassing its literal and figurative definitions—was the unifying theme of the talks, with particular emphasis on how vision grounded in the experience of the past, formed in the present, ensures ophthalmology's future. At the official opening cere- mony of the 2018 APAO Congress, Clement Tham, MD, Hong Kong, the Congress president, spoke first, welcoming attendees to the meet- ing. He thanked those involved in organizing the meeting, the many supporting organizations, and noted that Hong Kong has been a strong supporter of the APAO Congress for a long time, with a number of past meetings held in the city. Pearls in refractive surgery with IOLs Ronald Yeoh, MD, Singapore, discussed pearls in femtosecond la- ser-assisted cataract surgery (FLACS). Possible benefits of FLACS include better CCC and better nuclear fragmentation. Dr. Yeoh noted that FLACS may be particularly helpful in more difficult cases. He first discussed surgeon choic- es: choose your eye, choose your pa- tient, and choose your battleground. Always dilate pupils to the max- imum, Dr. Yeoh said. There may be post-laser miosis, but miosis can be prevented using NSAIDs. He next discussed docking and lasering, stressing the importance of ensuring anatomical position with the eye looking straight up at the microscope. Dr. Yeoh added that as the laser is firing, observe the CCC closely and make note of where there might be problems. His next pearl pertained to CCC management. Beware the CCC rim, watch for tags, and I/A beyond the edge of the CCC. Dr. Yeoh then discussed hy- drodissection and gas. This can be potentially dangerous, and surgeons should watch for pupil snap sign during hydrodissection. Gas forma- tion leads to increased intracapsular bag pressure/volume. March 2018 View videos from the 2018 APAO Congress: EWrePlay.org Tien-Yin Wong, MD, discusses new roles for artificial intelligence in ophthalmology and an application in retinopathy screening. continued on page 158 Sponsored by

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