ESCRS Winter Day 3: Ophthalmology is Not Yet Lost

Did you know that the Polish national anthem “Mazurek Dąbrowskiego” — which means Dąbrowski’s Mazurka but is more commonly referred to as “Poland is Not Yet Lost” refers to a country other than Poland, as well as a foreign leader? Indeed the song is positively francophile as it refers to Napoleon Bonaparte, the both celebrated and controversial Frenchman. This harkens back to Bonaparte’s support for Polish statehood during his eponymous wars.

“We’ll cross the Vistula, we’ll cross the Warta, we shall be Polish. Bonaparte has given us the example of how we should prevail,” goes the verse. The chorus extols the following: “March, march, Dąbrowski, from Italy to Poland. Under your command, we shall rejoin the nation.”

How fittingly European. Welcome to the third and last day of the European Society of Cataract and Refractive Surgeons (ESCRS) Winter Meeting. The last three days have shone a spotlight on some of the very best of European ophthalmology, and while we would all rather be hobnobbing over Polish pierogi and Napoleon cakes in Krakow, the Media MICE team has thoroughly enjoyed the whole online experience.

We Should Have Eaten Before Writing This

So, with this perfectly polished Polish pursuit of positive ophthalmology in mind, we would be remiss if we missed the Polish Society Symposium: Cataract Surgery in the 21st Century. One of the last livestreams of the conference, the symposium offered the viewer great insight into some of the standouts of Polish ophthalmology and cataract treatment. A particular highlight of the webinar was EDOF IOL in Cataract Surgery by Dr. Wojciech Lubiński from the Pomeranian Medical University in Szczecin, Poland.

Dr.  Lubiński’s presentation covered extended depth of focus (EDOF) intraocular lenses (IOLs), a newer concept that Dr. Lubinski said has several notable advantages. These include the elimination of overlapping near and far images as seen in multifocal IOLs, improvement of visual acuity, and “maintenance of very good distance visual acuity.” He reported no postoperative complications in a one-year follow up study, no cases of posterior capsule calcification, and no reported need for laser capsulotomy.

What’s Your Favorite Word for “Hospital?”

The main event of the day was Main Symposium: Cataract Surgery in Special Conditions (the clue’s in the name), a cracking contemplation of cataract conundrums. We particularly enjoyed watching Ocular Surface Disease. Given by Dr. Sophie Maedel from Hanusch Krankenhaus (which means hospital and is our favorite German word) in Vienna, the presentation offered oodles of information on ocular surface disease (OSD) and postoperative risk factors.

Dr. Maedel reported that preoperative risks for OSD include diabetes mellitus, thyroid disease and autoimmune disease, but also includes use of antidepressants and beta blockers, plus contact lens wear and smoking. She also warned that during the postoperative phase, clinicians should be vigilant for environmental factors (like season and climate) during OSD treatment, as it is a risk factor, along with the use of nonsteroidal anti-inflammatory drugs and preservatives. If OSD does appear at the postoperative stage, Dr. Maedel recommended the use of sodium hyaluronate, diquafosol, rebamipide and cyclosporine.

Hold Those Hands if You Can

To get to the postoperative stage of treatment outlined by Dr. Maedel requires the patient to be cooperative, but what happens if they are not? That was the subject of Dr. Zaid Shalchi from the London Eye Institute who presented Patients Who Don’t Cooperate during the same main symposium. Dr. Shalchi’s research was not focused on patients who simply refuse to engage with clinicians, but rather offered some valuable and practical advice for ophthalmologists treating those who have dementia, or have difficulty breathing, among other profiles.

For dementia patients, Dr. Shalchi recommended investing extra time at the preoperative stage to provide increased reassurance, ensuring hand-to-hand contact if possible, and making use of general anesthetic in severe cases. He also recommends giving consideration to bed placement, especially for patients who are obese or who have heart failure,  as this will help them breathe and improve their overall experience. The doctor also recommends that surgery be avoided entirely if the patient’s systolic blood pressure is over 200 and if their hemoglobin A1C is too high. Dr. Shalchi went on to state that this should be offered as part of a “carrot and stick” approach to encourage the patient to engage with their clinician better.

We Could All Use a Beacon of Hope

Now it would be remiss  if we did not cover some of the fantastic papers, so we decided to leave the very best for last. Corneal Opacities and Cataract Surgery: This is How to Do It! was one of our favorites — a case report on phacoemulsification and chronic corneal stromeal opacities by Dr. Agni Mokka from the General Hospital of Xanthi. The case was of a 77-year-old male patient who presented with bilateral multiple central and peripheral extensive corneal stromal opacities.

The patient was treated with phacoemulsification  involving the insertion of four mechanical expansion iris hooks, followed by cortical matter aspiration and IOL implantation. No complications were reported; researchers recommended to watch for preoperative comorbidities like optic atrophy, advanced glaucoma and macular scars, among others. Dr. Mokka concluded: “With careful surgical planning and utilization of surgical adjuncts, complications can be avoided. Even one quadrant of clear field is a beacon of hope for patients.” Kudos!

And that was that:  day 3 of ESCRS Winter Meeting.  We are sorry to see it go as it was bursting like a delicious pierogi, full of ophthalmological information, symposia and papers. Remember to visit the on-demand section of the ESCRS Winter Meeting virtual lobby to catch up on any content you may have missed during the conference. We will be  at the next event to continue our in-depth coverage of all things ophthalmology, but until then, here’s to 2021 — and remember, “ophthalmology is not yet lost!”

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