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An Enriching Experience Dealing with Small Pupils World Ophthalmology News World Ophthalmology Congress 2012 | 16 – 20 February | Abu Dhabi Tackling ROP Therapies for AMD Tears and Bubbles The KIDROP-experience shows that Noumerous new medical therapies for Femtosecond laser flap complications tele-ophthalmology is a cost effective wet age-related macular degeneration are very rare and often linked to the possibility to spread ROP-screening are under investigation. This is one of surgical technique. Usually they can programmes into the ural areas of the most rapidly evolving fields in oph- be handled without consequences for India. ( Page 3 thalmology. ( Page 8 the patient. ( Page 11 An Enriching Experience The World Ophthalmology Congress 2012 in Abu Dhabi: Outstanding Speakers, Ultra-Modern Exhibition Centre, Traditional Hospitality ABU DHABI [jp] – For the first time the heritage, Abu Dhabi promises to be an World Ophthalmology Congress (WOC) ideal setting for scientific communi- will be hosted in the Middle East and cation and innovation.” Africa Region. See, Hear and Taste the Culture he destination is definitely new The local organizers as well as repre- to most of the participants of sentatives of the Abu Dhabi Tourism T ophthalmic congresses: Abu Authority also recognize the congress Dhabi, the capital of the United Arab as an opportunity to present the Emirates (UAE) will be the heart of the capital of the United Arab Emirates ophthalmic world from 16 to 20 and the wider emirate to a worldwide February 2012. Never before such a audience. Members of the Middle East prestigious international medical Africa Council of Ophthalmology meeting has taken place in the Middle (MEACO) strive to ensure that all WOC East and Africa Region. visitors experience a stimulation envi- ronment. Prince Abdulaziz Ahmed Another World-Class Congress Abdulaziz Al Saud, chairman of the Dr. Abdulaziz AlRajhi, this year’s ADNEC MEACO board, promises culturally congress president, is confident, that The heart of the ophthalmic world from 16 to 20 February: The Abu Dhabi National Exhibition Center rich social events: “You will see, hear the WOC 2012 “will prove to be an and taste the unique Arabian culture.” enriching experience to all the parti- E. Spivey, president of the Interna- areas. More than 45 sessions will be topic. Leading ophthalmologists cipants and delegates”. High quality tional Council of Ophthalmology is organized by the International Council around the world will coordinate, Luxury and Style scientific content from more than sure: “You can expect another world- of Ophthalmology members and par- moderate oder chair the sessions. A great opportunity to do so will be 2000 internationally recognized class congress, matching those in Ber- ticipating societies. Symposia, case the cultural night on 17 February at speakers, a rapidly evolving city with lin, Hong Kong and Sao Paulo.” studies, debates, panel discussions, Ideal Setting the Abu Dhabi Emirates Palace: an ultra modern exhibition centre Chairman of the scientific pro- video sessions and interactive lectures Wiedemann encourages the Luxury and style, infused with tradi- and the unique Arab culture: These gramme is Prof. Dr. Peter Wiedemann will give every congress attendee the colleagues from all over the world to tional values of hospitality and respect are the elements that will contribute who coordinates a programme that possibility to gain insight into the attend the WOC 2012: “A modern city will be the source of a memorable to a high standard congress. Dr. Bruce will cover 35 subspecialty and topic latest developments in their respecitve combined with a rich cultural experience. W Dealing with Small Pupils Mechanical Stretch, Iris Hooks, Malyugin Ring SUNDERLAND – The definition of a small losin use, or it may simply be a small of 1 minim of 2.5% phenylephrine ensure that your incisions in the pupil depends on the degree of ex- pupil. (Bausch & Lomb) added to 1-2 mL of cornea to place the hooks are very perience of the surgeon, and also on the Always check to see if there are BSS injected into the AC can give peripheral (there should be bleeding at degree of surgical difficulty expected to posterior synechiae and carefully added dilatation, and certainly dimi- each incision) and horizontal (figure be encountered. break these (including at mid-stroma nishes or prevents re-constriction and 2). This ensures that you are pulling if patient has been on long term also prevents iris prolapse. the pupil margin peripherally rather n experienced surgeon may miotic). In all cases consider reducing your than upwards. be happy to operate with a Simple mechanical pupil stretch fluidics parameters. A high aspiration Some hooks come in packs of 5 – A 3-4 mm pupil in a straight- with 2 instruments can be effective in flow rate increases the risk that you the 5th one is meant as a ‘spare’ in forward case, but may be unhappy many cases (figure 1). It is important will aspirate the pupil margin in small case you drop one. However, you can with a 4.5 mm pupil if dealing with a to stretch by taking the instruments pupil cases. A high vacuum then also plan to use 5. When using 4 make rock hard cataract. The problems almost into the angle. One problem is makes it much more likely that you a ‘diamond’ pattern rather than a caused by a small pupil are not con- David Allen that the pupil may then re-constrict or will damage the iris tissue if you do ‘square’ – in other words one hook fined to difficulties removing the wave in the breeze because of multiple catch it, and this can cause problems should be placed under the incision so nucleus without damaging the iris Small pupils may be due to poste- sphincter rupture. for the surgery and problems for the that you get maximum retraction margin. A smaller pupil allows less rior synechiae from previous inflam- Experience with IFIS from tamsu- patient afterwards. where you are entering the eye with light to enter the eye, and so the red mation or previous miotic use (rare losin use has shown the value of intra- For some cases it is desirable to the phaco tip (figure 3). Try to space reflex may be poorer with smaller now but was common in the past). The cameral alpha agonists either at the mechanically dilate and then in some the incisions/hooks as symmetrically pupils and the threshold for use of a condition may in other cases be due to outset or during surgery. We favour way to fix the pupil. We initially as possible. capsule staining dye is therefore some other concurrent disease/medi- phenylephrine diluted in BSS (others learned from vitreo-retinal surgeons lowered. cation e.g. pseudoexfoliation, tamsu- advocate epinephrine). The contents to use iris hooks. If you use iris hooks continued on page 2 ( 2 | WOC 2012 WORLD OPHTHALMOLOGY NEWS | 2012 ( continued from page 1 use than hooks – although it is not without its difficulties. In all cases More recently a very simple but where the pupil has been stretched Current Status of Phakic IOL ingenious device from Russia consider using additional anti-inflam- (Malyugin ring) has become very matory medication post operatively to Doubts are Justified – but New Lenses Arouse Expectations popular. Personally I find this easier to reduce the chances of uveitis/fibrin. FRANKFURT – Endothelial cell loss or in the development of different PIOLs, The weak point of iris-fixated PIOL is Further Notes on the iatrogenic cataract discourage many are still appropriate when modern the endothelial cell loss. Studies show Particular Problems of IFIS surgeons from using phakic lenses. New, PIOL are used? The answer is yes. And mean rates of up to a maximum of At the turn of the year 2004/05 we modern PIOL may offer new solutions to no. Doubts are justified, but the nega- 14.05% after 5 years.4 Outliers, how- became aware of a ‘new’ phenomenon their questions. tive experiences with former implants ever, also need to be taken into con- – the intra-operative floppy iris syn- are not 100% applicable to today’s sideration. drome (IFIS). While the exact mecha- rials comparing corneal refrac- lenses. The history of anterior chamber nism underlying this problem is still tive surgery with phakic The most dreaded complication of angle-supported PIOL is mainly a histo- uncertain, we do know that it is rela- T intraocular lenses (PIOL) reveal posterior chamber PIOL is iatrogenic ry of failures. Even though visual results tively common. The biggest risk factor the superiority of the latter in terms of cataract, induced by contact between have been very good, severe endothelial for IFIS is the current or previous use quality of vision, while other para- the PIOL and the natural lens due to cell losses, pupil ovalizations, synechia Figure 1: Use of two instruments to stretch of the drug tamsulosin. 1-2% of the meters like stability, safety and effi- insufficient vaulting and/or modified and inflammations have led to the with- a small pupil. Note, stretch out almost into cataract surgery population is in this aqueous humour fluidics. Schmi- drawal of almost every implant.3,4 The the AC angle. category. Although some surgeons dinger et al5 show a nearly linear and latest development in this field is the have been concerned about patients continuous decrease in the distance of Cachet PIOL (Alcon, figure 3), a single- taking other α1a blocking agents, the the ICL V4 (STAAR) and the natural piece, foldable soft acrylic IOL. Visual risk of experiencing IFIS in patients lens in 84 patients. From 466±218 µm results are very good, as published with tamsulosin is 40 times that in directly after surgery the distance three-year FDA trial data by Knorz et al7 patients using other blockers.
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