There once was a small group of people comprised of mavericks, eccentrics and the ambitious who were determined to stamp their mark on the world. They had few resources to call their own and had to rely on their own grit, brainpower and ingenuity, but thanks to hard work they found their place and created something truly “funk-tacoulour.” Based in Southeast Asia, this small band works day-in and day-out, and has become well known for its distinctive brand and ethos.
I’m not talking about the Media MICE team however, I’m talking about the nation-state of Singapore, truly one of the world’s great success stories. Once a relatively small British colony best known for its strategic location and naval base, upon independence Singapore leapt from colonial backwater to one of the world’s great glittering metropolises. With one of the highest standards of living in the world and a roaring economy, it’s small wonder the city-state has become a major destination for medical events and conferences.
So while nobody could be there due to ongoing COVID-19 the 33rd Asia-Pacific Association of Cataract and Refractive Surgeons and Singapore National Eye Centre 30th Anniversary virtual meeting (APACRS-SNEC 2021), went ahead on a virtual platform (as we’ve become accustomed to). Beginning on Friday, July 30, and forcing your correspondent from his bed at a rather unreasonable hour due to his living in Central Europe, the conference began with several highlights of various aspects of the ophthalmology industry. These were then followed by two company highlight events, one being ZEISS’s Driving Outcome & Satisfaction in Cataract and Refractive Surgery, and the second was Santen’s lovely reference to 19th century English literature, Sense and Sensibility of Levofloxacin 1.5%: Reducing Risk of Endophthalmitis After Cataract Surgery.
Whoopsie daisies galore in glaucoma
As the day went on the Media MICE squad did its usual perusing of the various symposiums and sessions on offer, and one that caught our eye was SNEC Instruction Course: How (and When) Not to Do MIGS – A Journey Through Complications. Your writer has a particular penchant for sessions about when things go wrong, and this examination of minimally invasive glaucoma surgery (MIGS), as well as comparing this technique to trabeculectomy procedures. The standout segment of this symposium was Not So Minimally Invasive – MIGS Gone Horribly Wrong, given by Dr. Ike K. Ahmed, assistant professor and director of the Glaucoma and Advanced Anterior Surgical Fellowship, University of Toronto, Canada.
Dr. Ahmed’s presentation did exactly what it said would do and offered some fantastic case study examples of when MIGS go horribly wrong. In one example, he highlighted a 74-year-old diabetic and obese patient with primary open-angle glaucoma (POAG) as well as cataracts, who while undergoing surgery experienced a large build-up of blood in the Schlemm’s canal. Dr. Ahmed presented footage of this taking place, and reported that the attending surgeon had to “abandon ship,” a decision he agreed with. He then recommended that a reverse Trendelenburg procedure should be considered in these cases.
Now, hopefully you won’t grudge us for a shameless segway into our third and latest magazine COOKIE, as it’s awesome and its focus on optometry is truly unique. The SNEC Symposium: Preparing for the New Wave in Optometry offered some valuable insight into what the future holds for optometry, as well as aspects of ophthalmology, and the lessons learned therein are based on SNEC’s first-hand experience. The session covered everything from the specifics of private practice to ocular surface disease in cataract and refractive surgery.
It was this last segment that really got our interest, and was ably presented by Dr. Jean Chai, a visiting consultant at SNEC’s corneal service wing. She reported on hyperosmolarity and how poor management of the tear film can cause changes to keratometry readings, higher-order aberrations, and failed topography and intraocular lens (IOL) calculations. As cataract and refractive surgery can cause dry eye, Dr. Chai recommends high-quality preoperative slit-lamp examinations to monitor eyelid blink and closure, as well as checking the Meibomian glands for evidence of dysfunction.
Does cataract surgery give you nightmares?
Posters galore were on offer on Day 1 of the APACRS-SNEC conference and there were certainly clear favorites among the Media MICE staff. A Rare Case of Secondary Angle Closure Glaucoma due to Air Bubble Entrapment following Uncomplicated Phacoemulsification really got our noggins a-scratching as this really was one of those “WTH” moments (and if you don’t know what that means, go ask one of your kids). Pediatric Cataract’s Delayed Presentation and its Surgical Difficulties: A Case Report also got us hooked, as the condition studied in the poster is obviously very unusual among children.
But for the writer of this article, there was one real stand-out poster — that was Posterior Polar Cataract Surgery – No More a Nightmare, submitted by Drs. Meghali Bhattacharjee and Aniruddha Mahindrakar from India. Their research focused on what they described as “the most dreaded form of cataract,” and studied 18 eyes with posterior polar cataract who underwent phacoemulsification. The Vasavada and Raj technique of inside-out hydrodelineation was applied, where a trench is first sculpted, and a right-angled cannula is used to direct the fluid perpendicular to the lens fibers.
Of 18, 17 eyes were treated using this technique successfully, with the one aberrant eye experiencing a small posterior capsular rent, which they say was managed well. The doctors concluded that more gentle maneuvering to avoid chamber collapse or overinflation; low parameters; avoidance of hydrodissection; nucleus rotation; posterior capsule polishing; and excessive, intraocular lens manipulation during surgery should not be performed with the same techniques as standard cataract surgery. Finally, pointing to the study’s success, they recommended the use of the Vasavada and Raj technique.
While we can’t sip gin and tonics at Raffles or watch the sunset from the Marina Bay Sands complex, we can look forward to tomorrow’s sessions. Make sure you follow the Media MICE team on our social media to stay on top of the latest APACRS events and visit our CEO Matt Young’s LinkedIn page for the top insights around. Till tomorrow!
Editor’s Note: The 33rd Asia-Pacific Association of Cataract and Refractive Surgeons and Singapore National Eye Centre 30th Anniversary virtual meeting (APACRS-SNEC 2021) was held from July 30 to 31. Reporting for this story took place during the event.
