Day 1 :
Keynote Forum
Randall J Olson
University of Utah John A Moran Eye Center, USA
Keynote: In vitro testing to show what actually does work to increase safety and efficiency in cataract surgery
Time : 09:35-10:10
Biography:
Randall J Olson, MD completed his BA in 1970 and his MD degree in 1973, both at the University of Utah. He completed his residency in Ophthalmology in 1977 at UCLA and then a fellowship in Cornea and External Diseases at the University of Florida and Louisiana State University School of Medicine in 1978, where he started his first faculty position. In 1979 he was recruited to the University of Utah to run a one person Division of Ophthalmology in the Department of Surgery. This has since grown to the present John A Moran Eye Center with 55 faculty members, over 500 employees and 210,000 square feet dedicated to clinical care, teaching and research. He serves as the CEO as well as the Department of Ophthalmology Chair. His key area of research is cataract surgery technology and complications. He lectures all over the world, has over 250 peer reviewed publications, and has been awarded the ASCRS Binkhorst medal in 2012 and the AAO Kelman medal in 2014.
Abstract:
While ultrasound based cataract removal through a small incision has been the standard form of cataract removal in the developed world for several decades, the technology available is constantly evolving with many claims of superiority made with little clinical evidence to back such claims. I will describe an approach that has allowed us to duplicate the removal of cataract segments with an in vitro model to finally determine what actually generates increased efficiency and suggest what may result in safety concerns at the same time. In a few short years we have published many peer reviewed articles using this technique. The published as well as our latest findings will be presented.
Keynote Forum
Iva Dekaris
University Eye Hospital ‘Svjetlost’, Croatia
Keynote: Refractive lens exchange with implantation of premium intraocular lenses
Time : 10:10-10:45
Biography:
Iva Dekaris is a Professor of Ophthalmology at Universities of Zagreb and Rijeka (Croatia), and Associate-member of the Department of Medical Sciences of the Croatian Academy of Sciences and Arts. She works as Medical Director at University Eye Hospital “Svjetlost” in Zagreb. Dr. Dekaris completed Postdoctoral Research Fellowship at Harvard Medical School and the Schepens Eye Research Institute in Boston. She was twice awarded with the highest Croatian State Reward for Achievements in Science (1999 and 2013). She is an immediate past president of the European Eye Bank Association (2010-2013).The areas of her expertise are corneal transplantation, cataract and refractive surgery. She has an overall experience of over 20,000 surgeries mainly PHACO, corneal transplantations, refractive lens exchange, phakic IOLs, amniotic membrane and stem-cell transplantations. She published 48 papers in CC Journals (citations: 393 Scopus), presented numerous invited talks all over the world, and co-authored 4 books.
Abstract:
Introduction: “Premium" intraocular lenses have advanced features beyond those found in basic mono-focal intraocular lenses (IOLs). Multifocal IOLs (m-IOLs), for example, are presbyopia-correcting lenses enabling almost spectacle-free life after conventional cataract surgery, or in case of refractive lens exchange (RLE). Currently, there is a whole spectrum of mIOLs on the market out of which bifocal IOLs correct only distance and near vision, while trifocal and extended range of vision IOLs provide also good intermediate vision. With invention of toric mIOLs, full visual correction may be obtained even in patients with pre-existing astigmatism. Our results with the implantation of different types of premium IOLs are presented.rnrnSubjects & Methods: In a period 2005-2015, at our Hospital over 3000 eyes had RLE with m-IOL implantation (Restor +4, Restor +3, Tecnis ZM900&ZMA00&ZMB00, Re-Zoom, Acry-Lisa & ATLISA 809MP, Tecnis Symfony and Trifocal ED). In last two years mostly trifocal and Symphony lenses were used, with the results presented in this study. Trifocal IOL: Ninety five patients (204 eyes) underwent bilateral trifocal IOL implantation (ATLISA tri839MP, Zeiss, Germany) after RLE. Patients were presbyopes; 95 hypermetropes and 7 myopes, aged 46 to 68 years. Twenty 20 eyes with hyperopic or myopic astigmatism received trifocal toric IOL (ATLISA tri-toric 939MP, Zeiss, Germany). Uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) at 80 cm, uncorrected near visual acuity (UNVA), uncorrected distance visual acuity under 10% contrast level, visual disturbances and subjective satisfaction were measured and compared to Bifocal group (AT LISA 809MP; 42 patients, 84 eyes). Follow up was at least 6 months, up to three years. Symfony IOL: Forty six patients (92 eyes) were followed after RLE with bilateral implantation of the Tecnis Symfony IOL. Emmetropia was targeted in dominant eye, and mild myopia of up to -0.50 D in non-dominant eye. UDVA, UIVA at 66 cm, UNVA, spectacle independence, patient satisfaction and visual disturbances were measured. Follow up was at least 3 months. Results: Trifocal IOL: All patients achieved monocular UDVA better than 0.1 log-MAR, (76.9% of eyes 0.0 log-MAR). Monocular UIVA better than 0.2 log-MAR was achieved in 96.1% of patients. All patients could read J2 and better; 72.1% of patients could read J1. UDVA at 10% contrast level was 0.0 log-MAR in 62.5% of patients. Halo and glare were reported in 9.6% and 7.3% of cases, respectively. Spherical equivalent was equal or less than 0.5 D in 97% of trifocal eyes; and within the range of +1.00 to -1.00 D of astigmatism in all trifocal toric eyes. Symfony IOL: Binocular UDVA of 0.02 log-MAR or better was achieved in 95% of patients. Mean binocular UIVA at 66 cm was 0.01 log-MAR and UNVA at patient’s preferred distance was 0.01 log-MAR (J1-J2). Night driving visual disturbances was reported in 6 out of 46 patients (13%), only 2% of patients reported halos.rnrnConclusions: Refractive lens exchange with implantation of trifocal or Symfony IOL enables good vision at all distances and almost completes spectacle independence. It is an excellent choice for younger, active presbyopes in need of good intermediate vision. Meticulous preoperative counseling is of outmost importance to choose proper mIOL for each patient.rn
- Workshop on Congenital cataract surgery
Session Introduction
Michael O’Keefe
Mater Private Hospital, Republic of Ireland
Title: Congenital cataract surgery
Biography:
Michael O’Keefe is a Consultant Ophthalmic Surgeon at the Children’s University Hospital and the Mater Misercordiae Hospital Dublin. He is the Newman Clinical Professor of Pediatric Ophthalmology at University College Dublin. His special interests include congenital cataract, ROP and Refractive Surgery. He is a book and chapter editor and has published over one hundred and fifty peer review papers. He was awarded the Claud Worth Medal for his contribution to Pediatric Ophthalmology in 2004 by the British Child Health Foundation. In 2008 he was awarded the Eustace Medal for his research and contribution to Ophthalmology.
Abstract:
We discuss indications, techniques, complications and longer term outcomes. Complications and outcomes of pediatric cataracts pose a particular difficulty with guarded visual prognosis. Surgical techniques and advanced pharmacology have improved the visual prognosis. Issues such as intraocular lenses, indications and timing are still an issue. Glaucoma is increasingly highlighted as a major complication resulting in a poor prognosis.
- Special Session on How to make money from cataracts
Session Introduction
Mark Fountain
Healthcare Business Solutions, UK
Title: How to make money from cataracts
Biography:
Mark Fountain has a PhD in Lean Transformation, MBA, MSc, BEng (Hons.) and is by background a Chartered Engineer. He is presently the CEO of Healthcare Business Solutions, the UK’s leading provider of integrated healthcare solutions for the NHS. He has run hospitals and healthcare businesses in the UK and Middle East. His previous roles include CEO, COO, VP and various Director Roles in blue chip Engineering companies, including Fujitsu and BOC.
Abstract:
Cataract Surgery is carried out successfully across the globe, but many providers and Ophthalmologists still make little money from this ‘routine’ procedure, individually and for their respective businesses. High volume surgery following strict protocol pathways, with high performing clinician-led teams can however deliver benefits for everyone. Add this to moving cataract surgery into an ambulatory environment and taking out of Secondary Care (UK NHS Hospitals) and understanding every cost to the nth degree and a recipe for success prevails. This presentation will deliver a radical and non-apologetic approach to “making money” whilst still delivering the utmost excellence of care. It doesn’t matter where you sit in the pathway, whether an Ophthalmologist, a Directorate Manager for an NHS Head and Neck Unit, a Private Hospital Manger, Private Medical Provider or a Supplier, when things are done right, surplus can be determined from Cataract Procedures and everyone wins. Benchmark targets derived from UK experience will be tabled plus a deep delve into some of the cost myths and perceptions. Actual costs will be detailed versus revenues awarded and you will be asked to you consider how much you should really earn from Cataract procedures and why it’s time for this to be more equitably shared. This presentation will change forever how you consider your approach to cataract surgery and will ‘raise the bar for everyone….”.
- Track 1: Cataracts
Track 3: Cataract Surgery
Session Introduction
Roy A Quinlan
University of Durham, UK
Title: Cataract – The dawning of a new age in its prevention and treatment
Time : 12:25-12:50
Biography:
Roy A Quinlan trained as a biochemist at the University of Kent. He joined the Franke lab in Heidelberg as an Alexander von Humboldt fellow (1981) and joined as MRC fellow in Cambridge (1985). He worked as a lecturer and senior lecturer in the School of Life Sciences, Dundee University (1988-2001). He was the Foundation Chair in Biomedical Sciences at Durham University (2001). His H-index is currently 43. He serves as lens section editor for Experimental Eye Research and is currently a scientific trustee for Fight for Sight UK.
Abstract:
Cataract is still the major cause of blindness. There are multiple mechanism(s) and it is also emerging that some cataracts are staging points rather than endpoints as revealed recently by the effects of oxysterols on age-related and congenital cataract in animal models. The eye lens is a deceptively simple tissue. The single cell layered lens epithelium is a key player in cataractogenesis and in the response to surgical intervention. Our research addresses fundamental questions such as how do cells know their relative position in a tissue? What emergent properties are important for tissue formation? We believe that at least part of the answer to these questions lies in the lens epithelium. It is here that the iconic hexagonal shape of the lens fiber cells and the consequential spatial order of the lens are established. During development this is easy to rationalize as the lens increases layer by layer onto a preformed template, but what happens when the lens regenerates? What determines the organization of the lens fiber cells in that scenario? We have built an interdisciplinary research team (John Girkin, Chris Saunter (Physics), Jun Jie Wu and Boguslaw Obara (SECS) with skills needed to study cell dynamics in the living zebrafish and in regenerating rat lenses. We have produced a mathematical model for the lens epithelium and we hope eventually to have a finite element model for lens accommodation. In this presentation, I shall use selected examples from my research portfolio on radiation-induced, congenital and age-related cataract.
F Nienke Boonstra
Radboud University Nijmegen, The Netherlands
Title: Congenital cataract as a cause of visual impairment
Time : 12:50-13:15
Biography:
F Nienke Boonstra MD PhD, started to specialize in pediatric ophthalmology in 1987. In 1991 she started to work in Bartiméus, Institute for the Visually Impaired and focused on the visual development of children with or without visual impairment and on the use of low vision aids in children. She performs research in Ophthalmogenetics in collaboration with the Department of Human Genetics, Radboud University Medical Center, Nijmegen and research in the development of the visual system in collaboration with Donders Institute for Brain, Cognition and Behavior, Department of Cognitive Neuroscience, Radboud University Nijmegen Medical Center. In this collaboration she focuses on eye movement recording, crowding and accommodation in children.
Abstract:
Congenital cataract is no longer a major cause of visual impairment in children. However, it becomes more and more important in case of complex and genetic diseases because it can help us in obtaining the genetic diagnosis in these diseases. Different forms of congenital cataract have different causes and can be related to for instance metabolic disease or developmental anomalies of the eye. In multiple impaired children other more predominating physical impairments can cause a delay in the detection of disorders of the eye such as cataract. Epidemiological characteristics of the population of visually impaired children will be presented, which reveal a decrease of congenital cataract as a cause of visual impairment in children in the Netherlands in the last 20 years. A group of 140 visually impaired children with congenital cataract that have been sent to our institute will be analyzed. Patient-characteristics, diagnosis and rehabilitation possibilities will be described. In visually impaired children accommodation is important to perceive small objects at near. In children, after cataract extraction, accommodation is not possible and bifocals are used. The use of bifocals will also be discussed.
Quah Boon Long
Singapore National Eye Centre, Singapore
Title: A 10 Year Review of Pediatric Cataract Surgery Outcomes at Singapore National Eye Centre (SNEC) and Kandang Kerbau Children’s Hospital (KKH)
Time : 13:55-14:20
Biography:
Quah Boon Long graduated from the National University of Singapore. He trained in Ophthalmology at Singapore General Hospital, Tan Tock Seng Hospital and SNEC. He underwent fellowship training in paediatric ophthalmology and strabismus at SNEC and The Hospital For Sick Children in Toronto. He is a Fellow of the Academy of Medicine, Singapore, Fellow of Royal College of Surgeons of Edinburgh, and a Council Member of Asia-Pacific Strabismus and Paediatric Ophthalmology Society. He currently heads the Paediatric Ophthalmology and Strabismus Department at SNEC. His areas of interest include pediatric cataracts, strabismus, childhood myopia and retinoblastoma.
Abstract:
This retrospective study is based on clinical audit that was performed annually on all children aged 16 years and younger who underwent cataract surgery at SNEC and KKH from year 2003 to 2014. The study population comprises 3 groups. Group 1 includes all children who underwent cataract surgery. Group 2 comprises children who were 8 years of age or older at time of surgery and who had at least 2 months of post-operative follow-up. Group 3 refers to children who had cataract surgery before 8 years of age and who then attained the age of 8 years during the study period. The visual outcome of group 3 is based on the findings when the child is at the visually mature age of 8 years. Final visual acuity results were taken when the child had attained the age of at least 8 years. A total of 192 children and 253 eyes (Group 1) underwent cataract surgery during the study period. Seventy-two children (83 eyes) were 8 years or older at time of surgery (group 2). About 75% of children achieve Snellen best-corrected vision of at least 6/18 at 8 years of age. Good visual outcome after pediatric cataract surgery is generally seen in bilateral and developmental cataracts without other structural ocular abnormality. Poor visual outcome is associated with pre-existing ocular disease eg. cornea scar, retinal detachment or post-operative complication eg. glaucoma, posterior capsule opacification and retinal detachment. Poor compliance or delay in amblyopia treatment is also associated with poorer visual outcome.
Ashraf Armia Balamoun
Al Watany Eye Hospital, Egypt
Title: Can we reach a safe land with these cases?
Time : 14:20-14:45
Biography:
Ashraf Armia Balamoun has completed his MBBCh from Cairo University of Egypt. He finished his Master degree in Ophthalmology MSc. from Cairo University of Egypt. Finally he finished his FRCS in Ophthalmology from Glasgow. He will present a poster presentation at the 2nd Asia- Australia Congress on (COPHy) at Bangkok, Thailand (Feb. 18- 21, 2016). He also will be a speaker at the Ophthalmology Society of South Africa (OSSA 2016). He is a Consultant Eye Surgeon at Al Watany Eye Hospital in Egypt and a shareholder at the same hospital. He is also a board of training program at the same hospital. He is a Consultant Eye Surgeon at the Egyptian Ministry of Health.
Abstract:
Two videos presents about challenge cases in cataract surgeries. The First one was male patient 15 years old with history of right eye blunt trauma since 7 years. He developed severe ocular inflammation following the trauma ending by formation of white patchy membrane on the iris and the anterior surface of the lens with 2 points of PAS. Complicated white cataract developed. Vision is HM GP GMF. IOP was 16 mmHg. Retina was in place by Ultrasound. Post surgery vision improved till 6/24. The second case is a male patient 22 years old with history of blunt trauma and with traumatic cataract since 2 years. He did cataract and implantation of a three pieces posterior chamber IOL and YAG laser posterior capsoulotomy was done. He came after two years asking for better vision and we found that he had a wrong calculated IOL. Surprisingly, we found that he needs a piggy bag IOL with – 16 D. We did not found this power and we thought to use an ICL as a piggy bag solution. Post surgery vision improved till 6/24.
Adekunle Olubola Hassan
Eye Foundation Hospital, Nigeria
Title: Femtolaser assisted cataract surgery versus phacoemulsification for treatment of cataract
Time : 14:45-15:10
Biography:
Adekunle Olubola Hassan graduated from the College of Medicine, University of Lagos, Nigeria in 1976. He is a Fellow of the Royal College of Surgeons, Glasgow, UK, Royal College of Ophthalmologist, UK, West African College of Surgeons. He is the pioneer leader of Modern Ophthalmological Practice including Vitreo-Retinal Surgery in Nigeria. He revolutionized Eye Health Care through Private-Public-Partnership, making quantitative and qualitative Eye care available for both the rich and less privilege. He has over 100 publications, scientific papers and research paper to his honor. He is the founder and Chief Medical Director, Eye Foundation Hospital Group, Nigeria.
Abstract:
Aim: To compare the visual outcomes between Femto-laser assisted cataract surgery (FLACS) and Phacoemulsification (Phaco) in Lagos, Nigeria. Methods: A retrospective analysis was done from the medical records of the patients who underwent FLACS and Phaco in Eye Foundation Hospital, Lagos, Nigeria between July 2015 and December 2015. The age, gender, degree of astigmatism in the third month and the best corrected visual acuity on first day, first month and third month post were noted. Statistical analysis was done using Stata 11. The results of the two procedures were compared. Results: Out of the 96 cataract surgeries performed, 50 cases were FLACS and 46 were Phaco. In our study, 58 were men and 38 were women. The age of patients ranged from 34 to 88 years; mean age was 63.26 (FLACS) and 64.5 (Phaco). Good visual outcome (6/6-6/18 pinhole) was noted in 62% of eyes operated by FLACS compared to 47.8% of eyes operated by Phaco on the first day (p=0.071), 96% of eyes operated by FLACS compared to 63% of eyes operated by Phaco in the first month (p=0.000) and 100% for FLACS and 76% for Phaco in the third month (p=0.001). Less astigmatism was induced by FLACS compared with Phaco measured at third month postoperative interval (p=0.003). Conclusion: Since the visual outcome was significantly better in FLACS compared to Phaco procedure (p=0.000), it is recommended more eye hospitals with adequate facilities for performing intraocular surgery should partner with companies making the machines to get them to avail more people of this facility.
Annavajjhala Venkatachalam
Hyderabad Eye Hospital, India
Title: Intra operative floppy iris syndrome in cataract surgery
Time : 15:10-15:35
Biography:
Annavajjhala Venkatachalam is a Senior Consultant Ophthalmic Surgeon and a Post-Graduate Teacher in Ophthalmology. He has completed his Master of Surgery in Ophthalmology from Gujarat University 30 years back and his fellowship in Cataract and Anteriour Segment Surgeries from Aravind Eye Hospital, Madurai. He is a Senior Cataract Surgeon in Hyderabad for the last 30 years having performed nearly 50,000 cataract surgeries. At present he is consultant and Chief Technical Advisor Lions Club of Hyderabad, Sadhuram Eye Hospital and Director of Hyderabad Eye Hospital.
Abstract:
Intra-operative Floppy Iris Syndrome (IFIS) is nightmare for cataract surgeons all-round the world. The Surgeon has to anticipate the complication and try to manage this unusual complication. In this paper we will be discussing the different causes that lead to Intra Operative Floppy Iris Syndrome (IFIS) like systemic usage of alpha-1 blockers, local pilocarpine eye drops etc., and intra-operative symptoms, signs and various ways of managing this complication.
Kilanglanga Ngoy Janvier
Kinshasa Hospital, DRC
Title: Determinants of late surgical uptake of congenital cataract in Kinshasa/DRC
Biography:
Dr. Kilangalanga is a medical director of and qualified Ophthalmologist with high experience in ophthalmology since 10 years. Currently He is the head of the eye department with activities mainly focused on surgery and other vision 2020 diseases control and performing about 1000 cataract procedures per year and teaching almost 10 medical doctors on cataract surgery every year. He is a senior ophthalmologist and Head of Eye Clinic, Saint Joseph Hospital, Kinshasa, DRC and Head of the Technical Division of the National Vision 2020 of DR-Congo. He completed his masters in 1997 from University of Kinshasa and he is graduated as medical doctor in 1987 from University of Kinshasa, DRC.
Abstract:
Aim: To determine barriers to the early surgical uptake for bilateral congenital cataract and regular follow- up after surgery in Kinshasa-DRC Methods: We reviewed 52 medical files of children who underwent surgery for bilateral congenital cataract in a tertiary eye health center from 2011 to 2013 and made a cross-sectional analysis of different determinants from children and their parents or tutors according to the surgery .A complete ophthalmological examination with clinical and socio-demographic evaluation was assessed using a questionnaire in order to determine possible barriers. We defined a late presentation when a child is presented for surgery later than 12 months of age. Results: The mean age at presentation was 5.4±4.8years old .The most frequent type of cataract was the obturant cataract with 82.4% for the right eye and 68.6% for the left eye. Nystagmus and strabismus were the more frequent associated ocular conditions respectively 47.1% and 43.2%.Children operated on earlier (before 1 year of age) represented 25.5% in our series. Barriers for late presentation for surgery were: lack of education of parents (79%), influence of advices from other people, inability to afford the surgery cost, lack of awareness on cataract from parents and guardians, jobless parents. Conclusion: Cultural and socio-economic factors were encountered as main determinants of late presentation of children suffering for pediatric cataract for surgery.
Victor Antunes
Ophthalmology Institute of Assisi, Italy
Title: Visual outcomes and patient satisfaction after implantation of multifocal sulcus IOL
Biography:
Victor Antunes works as a medical specialist at Ophthalmology Institute of Assisi. He had completed his graduation in medicine from the Faculty of Medicine of Ribeirão BLACK SAO PAULO UNIVERSITY. He is a graduate (Medical Residence) at the Hospital of Ribeirão Preto Clinics - USP. He is specialist in Ophthalmology by the Brazilian Council of Ophthalmology and at Medicine Federal Council. He is a member of various ophthalmological societies and associations. He has many publications in various fields of ophthalmology. He is a recipient of many awards and grants for her valuable contributions and discoveries in major area of research.
Abstract:
Purpose: To assess visual outcomes and patient satisfaction following implantation of a multifocal sulcus intraocular lens (IOL) in a single surgical procedure combining primary capsular bag lens implantation. Methods: The study included cataract patients older than 45 years of age, with hyperopia +1.50D and potential acuity measurement >20/30, undergoing Sulcoflex Supplementary multifocal IOL (Rayner IOLs) implantation in a single session combined with primary capsular bag IOL implantation. Eighty-six percent of eyes received an aspherical distance primary IOL, whereas the remaining received toric distance IOLs. All eyes received a plano multifocal Sulcoflex lens with +3.5D addition. Near and distance monocular and binocular visual acuity, refraction, and intraocular pressure (IOP) were measured 1 week and 1 , 3, 6, and 9 months after surgery. Patient satisfaction was assessed 1 month post-operation. Results: The study included 119 eyes (61 patients). 69% of eyes had pre-existing retinal pathologies. At 1-month, 81% of eyes had monocular UDVA 20/25 or better and 91% had monocular UNVA J2 or better. 96% and 93% of eyes respectively had binocular UDVA 20/25 or better and binocular UNVA J2 or better. At 3-months, 88% and 51% of eyes, respectively, had spherical and cylindrical refraction within ±0.5D. The majority of patients reported satisfaction and improvements in quality of life. Complications included post-op IOP increase (19 eyes), anterior capsule rupture due to toric IOL rotation (1 eye) and Sulcoflex explantation (4 eyes). Conclusion: Implantation of the multifocal Sulcoflex IOL improves near and distances visual acuity in cataract patients. Patients with retinal abnormalities were able to tolerate the multifocal IOL. The secondary IOL implantation is reversible and safe.
Sambasiva Rao Velagapudi
Aravinda Lasik Eye Hospital, India
Title: A retrospective case series review and comparative analysis of the outcomes of three refractive surgeries (PRK, Lasik and e- Lasik ) for low to moderate grade simple myopia in terms of efficacy, safety and economics over last 2 decades at a secondary centre in semi urban southern India
Biography:
Sambasiva Rao Velagapudi is a Member of All India Ophthalmic Society (AIOS) since 1982. Being founder & treasurer of FBS AIOS (Family benefit Scheme), he had given 52.5 million Indian rupees to 41 bereaved member families since 2004 as fraternity contribution, for which he won several accolades from all members. He received distinguished honor award from Indian Intra Ocular implant and Refractive Society of India in 2010. He attended AAO meetings, ICO, APAO, WOC and presented posters and papers. He did Fellowship in Retina Vitreous under Dr. P Namperumalsamy, at Aravind Eye Hospital -Madurai, Fellowship at Wisconsin, Madison, under Dr Suresh Chandra & at Eye and Ear Infirmiry, Chicago, USA under Dr Gholam Peyman.
Abstract:
Purpose: To retrospectively analyze the outcomes of all three refractive surgeries (PRK, LASIK, E-LASIK) for low to moderate myopia and compare visa via the results in terms of cost effectiveness, safety and efficacy. Materials & Methods: 12000 patients (n=24000 eyes) had been enrolled after they had met the standards for inclusion criteria and then randomized to three groups, the first group (n=16000) underwent E-LASEK, the second group (n=4000) underwent PRK and the third group (n=4000 eyes) underwent LASIK. PRK and LASIK were done in a conventional manner and E-LASEK was performed with a modified technique of using 20% absolute ethyl alcohol instead of standard sub-epithelial microkeratome to decrease the microkeratome related cost constraints to the patient and surgeon Results: The E-LASEK group (n=16000) and the LASIK group (n=4000) fared well with near emmetropia in spherical dioptric powers up to -8D alone or with astigmatism, while the PRK group did well in up-to dioptric powers of -6D .The significant outcome being the superior results of E-LASEK in thin corneas, recurrent erosions. Conclusion: The modified E-LASEK is efficacious, safe and cost effective alternative when compared PRK and LASIK in predisposed corneas and viable when economic burden is a major constraint in this part of the world.
Lily Karmona
Wolfson Medical center, Israel
Title: Induced de-novo astigmatism after Lasik surgery in non-astigmatic eyes: H-Lasik vs. M-Lasik
Biography:
Lily Karmona is an ophthalmologist at Wolfson Medical center, Israel and has a great experience. She does have articles publication with her name in various field of ophthalmology. She is a recipient of many awards and grants for her valuable contributions and discoveries in major area of research.
Abstract:
Purpose: To compare the surgically induced astigmatism by H-LASIK vs. M-LASIK in patients with no pre-operative refractive astigmatism. Methods: A retrospective study of patients who had H-LASIK and M-LASIK during 2005-2014 at the Care-Vision Laser Center, Tel-Aviv, Israel. We calculated the mean absolute surgically induced astigmatism and performed risk factor analysis for induced astigmatism of more than 0.5 D. Differences between H-LASIK and M-LASIK were analyzed. Results: 3877 eyes that underwent M-LASIK and 549 eyes that had H-LASIK were non-astigmatic pre-op, received a non astigmatic treatment and met the inclusion criteria. The mean age of the patients was 32.8±19.7 SD (range 17-55 years). The induced astigmatism was determined by the post-op manifest refraction astigmatism as all cases were non-astigmatic preoperatively. 6 months after surgery, hyperopic treatment induced more SIA than myopic treatment: the mean induced astigmatism was 0.49±0.48 D in the H-LASIK group and 0.36 D±0.4 in the M-LASIK group (P<0.001). In the H-LASIK group, the risk factors for induced astigmatism of >0.5 D were: younger age (47.8±9.9 years old vs. 49.8±8.2 years old; p=0.05), higher pre-operative refractive error (p=0.003) and larger treated optic zone (7 mm vs. 6 mm). In the M-LASIK group, eyes with SIA tended to have steeper corneas (43.8±1.5 D vs. 43.6 ± 1.4 D; p=0.001), higher refractive spherical equivalent (3.43±1.53 vs. 3.07±1.45 p<0.001) and smaller treatment optic zones (6 mm vs. 7 mm). Conclusion: There was a consistent trend toward more SIA in hyperopic LASIK vs. myopic LASIK, and in higher refractive error correction. In H-LASIK we found larger optic zones to induce more SIA and in M-LASIK we found smaller ones to cause it.
Theophile B Kabesha
Lubumbashi University, Democratic Republic of the Congo
Title: Cataract outcomes at Bukavu Eye Clinic
Biography:
Dr. Theophile Kabesha is an ophthalmologist currently working at Lubumbashi University. Dr. Kabeesha’s subspecialty is Retina and Vitreous. She is a member of Congolese Society of Ophthalmology and African Ophthalmology Council (AOC). She is a board certified ophthalmologist.
Abstract:
Introduction: Cataract blindness is avoidable. Surgery is the own way to cure it and restore vision if well done. Through our study we wanted to evaluate cataract surgery out comes in our eye clinic and identify the causes of bad results. Material and methods: Prospective study of 603 eyes operated for cataract in adults from January 1rst, 2012 to December 31, 2012 (12 months). The results were analyzed by the software Monitoring Cataract Surgical outcomes (MCSO). Postoperative functional data were précised and the causes of poor performance were identified. Results: 229 women (49.6%) and 304 men (50.4%) underwent cataract surgery. The average age was 62. Extra capsular cataract extraction (ECCE), and manual suture less small incision cataract Surgery (SICS) with posterior chamber implantation in 91.4%, were the main surgical techniques. Above 50.6% of our patients had good visual acuity (≥0.3) with the correction range, 31.4% had a limit visual acuity (0.1-0.2), and 18% had a poor visual acuity (<0.1). After correction, good results increased up to 64.2% (385patients), border limit visual acuity decreased up to 20.7%(125 patients) and poor results to 15.1% (91patients). The causes of poor results were mainly related to systematical use of standard intra ocular lenses (21-22D), and refractive errors in 13.6% (82 cases), bad preoperative patient selection in 11.1% (67 cases) and surgical complications in 8.6% (52cases). Discussion: These results are lower than the WHO standards, which recommend a value greater than or equal to 80% for good outcome and a value below 5% for bad outcome. Conclusion: The identification of the causes of poor performance draws attention to the use of biometry, a good preoperative selection of patients, improvement of surgical skills and the need for refractive surgery.
Vinit Mutha
Rajendra Prasad Centre for Ophthalmic Sciences, India
Title: Pseudo-exfoliation syndrome and capsulorhexis: Common mistakes
Biography:
Vinit Mutha has completed his MD in Ophthalmology from Dr. RP centre for Ophthalmic Sciences. He has presented a paper on oral drug Rebamipide use in dry eye in APAO 2016, Taipei. He has presented two videos at Young Ophthalmologist Society of India (YOSI) meet, 2015.
Abstract:
Pseudoexfoliation syndrome consists of deposition of exfoliative material on lens capsule, papillary margin, trabecular meshwork, lens zonules and endothelium which leads to poor visibility and potential complications such as phacodonesis, subluxation, posterior dislocation of lens, glaucoma and has a higher risk of posterior capsular rent during cataract surgeries. In this surgical video, 50 year old male patient with pseudo-exfoliative syndrome was undergoing capsulorhexis as a part of phacoemulsification surgery for immature senile and posterior sub-capsular cataract. There was no lens sub-luxation or phacodonesis in the preoperative period. Pseudo-exfoliative material was deposited on anterior capsule hampering visibility on coaxial illumination which was subsequently changed to retro-illumination mode with better visibility. Capsulotomy forceps were used to complete the capsulorhexis. Incorrect judgment lead to premature pulling out of forceps in the middle of capsulorhexis but there was no capsulorhexis extension. Procedure was completed without any complication and patient gained 20/40 vision on 1st postoperative day. To conclude, this video shows the importance of retroillumination, capsulorhexis forceps and good judgment while doing a capsulorhexis in pseudoexfoliation syndrome with poor visibility.
- Track 6: Risk Associated with Cataract Surgery
Track 13: Benefits, Cost and Management of Cataract and Refractive Surgery
Session Introduction
Stephen Russell
University of Iowa, USA
Title: A new complication of cataract surgery: Hemorrhagic occlusive retinal vasculitis
Biography:
Steve Russell is a Professor and Director of Vitreoretinal Service at The University of Iowa. He has been Chair of the AAO Self-Assessment Committee and co-edited Provision 5, the Academy’s self-assessment tool for practicing ophthalmologists. His research interests include the genetics of age-related macular degeneration, gene therapy for retinal diseases and automated detection of diabetic retinopathy.
Abstract:
Purpose: To review cases that represents phenotypic extremes of postoperative hemorrhagic occlusive retinal vasculitis (HORV) due to intracameral injection of vancomycin. Methods: Two cases of HORV were evaluated. Clinical evaluations included comprehensive ocular examination, testing and investigation for endogenous uveitis or non-HORV cause. Results: Case 1: A 65-year-old woman developed progressive visual loss over a 3 week period following uncomplicated cataract surgery with intracameral injection of 1 mg of vancomycin. Initially the patient was minimally symptomatic. Observed over the course of several weeks were transitory afferent pupillary defect and reductions in visual acuity, visual field, retinal hemorrhage and edema. She returned to 20/20 with minimal structural and visual sequella. Case 2: A 75-year-old male developed delayed onset, bilateral, severe sequential bilateral panuveitis and hemorrhagic occlusive vasculitis within 10 days of otherwise uncomplicated bilateral cataract surgeries with injections of 1 mg of intracameral vancomycin. Over the ensuing weeks he developed bilateral neovascular glaucoma requiring bilateral set on implants for IOP control. Conclusions: Presentation of postoperative hemorrhagic occlusive retinal vasculitis may range in severity and may require a high degree of suspicion for correct diagnosis. It is unclear whether current methods for detection (and treatment if necessary) of HORV is sufficient to assess its incidence.
Rehab Ismail
James Cook University Hospital, UK
Title: Complications associated with cataract surgery
Biography:
Rehab Ismail has completed her PhD from University of Aberdeen, UK in 2015. She is a fellow of the Royal College of Physicians and Surgeons of Glasgow since 2008 and member of the Royal College of Ophthalmologists, London, UK since 2009. She has published 6 papers in peer-reviewed journals and one book chapter and peer-reviewed 4 articles in reputed journals. She presented in several international and national conferences. Currently, she is a trainee in the National Health Service in UK.
Abstract:
While cataract surgery is one of the safest surgical procedures with high success rate, problems can arise. Complications associated with cataract surgery are relatively rare. They include intraoperative, early postoperative and late postoperative complications. Anesthesia-related complications are well encountered. Posterior capsule rupture is the most common intraoperative complication and its incidence can be used as a measure of surgical quality. Intraoperative zonular dialysis may result from vigorous manoeuvres that traumatize the zonules and cause complications further down the line. Intraoperative floppy iris syndrome (IFIS) is one of the important causes of a poorly dilated pupil during cataract surgery and could make surgery very difficult due to iris billowing and prolapse to the wound. Supra-choroidal hemorrhage can occur but is much less common with phacoemulsification and small-incision cataract surgery. Early postoperative complications includes shallow anterior chamber, which may be associated with low or high IOP. Infectious endophthalmitis is the most serious postoperative complication with very low incidence and ranges from 1- 3 in 1000 or even less. Toxic anterior segment syndrome generally presents with severe inflammation that is restricted to the anterior chamber. Late postoperative complications involve refractive surprises following surgery. A thickened posterior capsule is the most common postoperative cause of decreased vision with a prevalence of over 40% in many studies within five years of surgery. Rhegmatogenous retinal detachment, capsular block syndrome and pseudophakic bullous keratopathy (PBK) are recognized postoperative complications. Complications may result in significant vision loss, however can be reduced by training and reflective surgical practice.
Sophia Pujiastuti
Fatmawati Hospital, Indonesia
Title: How to manage complications of flap in Z-LASIK surgery
Biography:
Sophia Pujiastuti is Head of the Department of Ophthalmology in Fatmawati Hospital. She was graduated from The Christian University of Indonesia as Medical Doctor and continued her residency in Indonesia University. She finished Phacoemulsification Training and Lasik Program in India. She is also practicing in I Care Lasik Jakarta.
Abstract:
Intraoperative complications related cornel flap complications are incomplete or short or irregular flaps, free cap, flap buttonhole, anterior chamber gas bubbles, vertical gas breakthrough and corneal perforation. Incidence corneal flap complications are rare, however, between 0.3–14% of these complications occur which depends on the type of device used. There are two options management corneal flap complication for the second intervention: first: Recut and the second: surface ablation performed over the incomplete flap via either photorefractive keratectomy or laser sub-epithelial Keratomileusis
Subhash Mishra
Directorate of Health Services-Chhattisgarh, India
Title: Risk factors associated with cataract surgery: An analytical overview
Biography:
Subhash Kumar Mishra has completed Post-graduate diploma from Jabalpur University and Master’s from Ravishankar University, Raipur. He is Eye Specialist in Central Mobile Unit of Medical College, Raipur. He has received various awards and participated in state and national conferences in different capacities. He is the State Program Officer for Blindness Control in Chhattisgarh State.
Abstract:
There are many factors which affect the outcome of cataract surgery sometimes resulting into serious complications. Outcome of same surgeon with same protocol and IOL and medicines may be different due to patient factor. Similarly medicine factor, IOL factor, assistant factor, sterilization factor lead to different complications varying from visual unhappiness to loss of eye. These factors are grouped and discussed to make an eye surgeon understand and capable of dealing with them to provide a safe and effective sight restoration in cataract surgery. Some instances of mass post-operative endophthalmitis are mentioned with analysis of possible causes.
Sidi Mohammed Ezzouhairi
Glaucoma Center in Morocco
Title: Management of cataract surgery in pseudo-exfoliation syndrome
Biography:
Pseudo exfoliation (PEX) Syndrome, common age-related systemic disorder characterized by an abnormal production and deposition of fibrillogranular amyloid-like extracellular material, along with a wide distribution throughout the body, including eye. PEX is a strong risk factor for glaucoma and leading to a higher cataract surgery complications rate. Our recent study has shown the prevalence of PEX in Morocco is 7.5% and accountable for 32% of glaucoma’s cases. In this study, we have found that the management of surgery cataract complications among patients with PEX permits better results. The zonulopathy causes zonular dialysis, iridophacodonesis, lens sub-luxation, poor papillary dilatation and shallow anterior chamber. The trabeculopathy and its association with ocular high intra-ocular pressure or glaucoma, represents 32% in our study. Avoiding or minimizing cataract surgical complications, surgeons must be aware of numerous intraoperative and postoperative problems, therefore this surgery requires 1) Appropriate preoperative examination to detect PEX even discreet and to assess the subtle disorders. 2) Intra-operatively, be careful in care to ensure safe surgery. 3) Post-operatively, frequent and detailed follow-up to monitor complications. Overall, this surgery requires some experience. In cases of cataract surgery with PEX glaucoma, many factors must be taken into consideration to determine the appropriate surgical procedure. The preferred procedure of cataract extraction with PEX is phaco-emulsification. We illustrate by many images and short videos, the use of phacoemulsification technics and specialized alternative or adjunctive devices, which allow surgeons to achieve similar results than cataract surgery without PEX.
Abstract:
Eyes with (XFS) Pseudoexfoliation frequently have glaucoma and several other characteristics that impact surgery such as poor pupillary dilatation, zonular weakness, shallow anterior chamber etc., therefore it is not surprising that the prevalence of intra-operative complications is significantly higher than in routine cataract surgery. Cataract surgery in XFS presents challenges that require careful preoperative planning and intra-operative care to ensure successful and safe surgery. The use of specialized adjunctive devices such as highly cohesive visco-elastics, pupillary expansion devices and capsular tension devices has increased the margin of safety in these potentially complex cataract surgeries. Inadequate response to topical mydriatic is almost a rule and the use of Non steroidal anti inflammatory agent few days before surgery helps. Use of intracamaral epinephrine before injecting viscoe elastic might also augment pupillary dilatation. However other maneovers like bimanual stretching, iris hooks or pupil expanding rings may be required to have a pupillary size for adequate size capsulorhexis. Suspicion of zonular weakness as a rule means readiness to confront it. Marked lens subluxation signs like phacodonesis, lens subluxation and iridodonesis have to be looked for preoperatively. Presence of gap between the iris border and the lens, evidence of decentration of the lens nucleus, changes in the contour of peripheral lens etc shouls alert the surgeon to a possibility of zonular weakness To perforate the anterior capsule at the beginning of the capsulorhexis a sharp instrument should be used since zonular weakness results in less anterior capsular tension and reduced resistance which makes the initial puncture more difficult. If necessary counterpressure could be additionally exerted using a needle or chopper. The capsulorhexis size may be restricted to an under optimal size due to inadequate pupil in case pupil expanders are not used, leading to higher possibility of capsular contraction syndrome. The use of CTR (Capsular Tension Ring) has greatly reduced the intra and post operative complications such as zonular dehiscence, vitreous loss and capsular contraction. When capsular contraction syndrome is treated with relaxing YAG laser relaxing capsulotomies early, the result is gratifying. In glaucomatous patients combined cataract and glaucoma surgery decreases the incidence of an acute postoperative rise in IOP and may improve long-term control. XPS eyes show more inflammation as compared to normal eyes and the surgeon should be aware of this fact post operatively. Long term follow up is required, for glaucoma screening and follow up and stability of the bag.