The opening ceremony of the 36th Annual Meeting of the Asia-Pacific Association of Cataract and Refractive Surgeons (APACRS 2024) was an unforgettable kickoff to a highly anticipated congress. The grand ballroom of the Century City International Convention Center in Chengdu, China was filled with esteemed ophthalmologists, researchers and industry leaders from across the globe–the atmosphere was charged with excitement and anticipation.
The ceremony commenced with warm welcomes from distinguished figures such as Organizing Chairman of the 36th APACRS-24th CSCRS Joint Meeting Dr. Chan Wing Kwong (Singapore) and Vice President & Secretary-General of the Chinese Medical Association (CMA) Dr. Wang Jian (China), followed by an opening address by APACRS President Prof. Yao Ke (China).
A significant highlight of the event was the prestigious award presentation, which included accolades such as the APACRS Certified Educators (A.C.E) recognition bestowed upon Dr. Patrick Versace (Australia), Prof. Wang Yan (China) and Dr. Xu Wen (China). Additionally, the APACRS Gold Medal Award was conferred upon Prof. Bi Hongsheng (China). However, the pinnacle of the evening was undoubtedly the bestowal of the esteemed APACRS LIM Lecture Award to Dr. Shin Yamane (Japan), a recognition of his remarkable contributions to the development of cataract and refractive surgery.
APACRS LIM Lecture: Tales of the flanging technique
Dr. Yamane took the stage with humility and passion, captivating the audience with his expertise and dedication to the field of ophthalmology. He shared insights into his groundbreaking work, particularly his pioneering contributions to the Yamane technique for sutureless intraocular lens (IOL) fixation which was widely used in the ophthalmic world today.
Dr. Yamane commenced by recounting the inception of the Yamane technique. This technique, lauded for its simplicity and efficacy, stemmed from a desire to avoid scleral flaps, he recalled.
Central to achieving sutureless fixation is ensuring hermetic wound closure, necessitating minimal incision size. To achieve this, Dr. Yamane adopted the needle-guide technique for IOL fixation.
He then showcased a video illustrating the first-generation Yamane technique, employing a 27-gauge needle for guided intrascleral IOL implantation with lamellar scleral dissection. Subsequently, he refined the technique with the double-needle method to enhance precision, stability and ease of sutureless IOL fixation.
Dr. Yamane also outlined essential steps for mastering the Yamane technique:
- Bend the needles at a 45-degree angle two-thirds from the tip
- Ensure an ideal grasping point of the haptics at 2 to 3 mm. Rotate to find the optimal direction.
- Mark the position of the main wounds for IOL insertion, ensuring a separation of over 70 degrees from the left scleral tunnel.
- Make a sclerotomy 2.3-2.5 mm from the limbus. Do not penetrate the needle perpendicularly into the sclera.
- Insert the IOL into the eye. Grasp about 3 mm on the haptics and align the haptics with the needle before insertion.
- Upon insertion, the first needle can be released before proceeding with the second needle.
- Externalize the haptics. Pull both the haptics to balance the IOL.
- Dry the haptics before making flange and fixate the flange securely inside the scleral. Leaving the flange at the conjunctiva carries a risk of haptic erosion.
“If the flange is too large to be pushed back into the scleral tunnel, you should enlarge the entry site with a needle or knife,” he suggested.
Next, Dr. Yamane highlighted the evolution of flange size over the years, shrinking from 1.0 mm to 0.2 mm. Additionally, he acknowledged various modifications by fellow ophthalmologists, such as the development of the trailing-haptic-first technique by Dr. Kim DB, and the adoption of the flanged IOL fixation via 27-gauge trocars.
To address challenges in controlling IOL tilt during needle insertion, Dr. Yamane developed a specialized tool—the needle stabilizer. An experimental study on 10 artificial eyes involving 5 surgeons (2 experts and 3 residents) demonstrated its efficacy in reducing IOL tilt. “The IOL tilt was examined with anterior segment optical coherence tomography (OCT). We found that the instrument is effective in reducing IOL tilt, especially for novice surgeons,” he explained.
Drawing from his experience, he noted that haptic compression can also contribute to IOL tilt. Hence, for cases with small corneas, Dr. Yamane suggested adjusting the haptics by cutting them before creating the flange to reduce this occurrence.
Subsequently, Dr. Yamane shared about flanging techniques. “Other flanging techniques based on the Yamane technique include the Canabrava technique and the Asia anchor double flanged technique. Additionally, the Yamane technique can be employed for sutureless artificial iris fixation as well as the repair of iridodialysis,” he shared.
In conclusion, Dr. Yamane emphasized the significance of education, advocating for wet labs as invaluable platforms for acquiring surgical skills. “I believe education is crucial for acquiring and developing new surgical techniques. It’s essential to learn from the past; this is how the flanging technique was developed. The technique doesn’t originate solely from my idea but from the ideas and experiences of many surgeons,”he stated.
His message to fellow surgeons was clear: “Please learn from the past and innovate new surgical techniques.”
All in all, throughout the ceremony, attendees had the opportunity to reconnect with colleagues, forge new collaborations and explore the latest advancements showcased in the exhibition hall. The opening ceremony served as a fitting prelude to the congress, igniting a sense of camaraderie and excitement that would permeate every aspect of the event in the days to come. With a packed schedule of scientific sessions, symposia and workshops ahead, the stage was set for an enriching and transformative congress experience.
Editor’s Note: Reporting for this event took place during the 36th Annual Meeting of the Asia-Pacific Association of Cataract and Refractive Surgeons (APACRS 2024), held from May 30 to June 1, 2024 in Chengdu, China. The 36th APACRS annual meeting is jointly organized with the 24th CSCRS (Chinese Society of Cataract & Refractive Surgery) annual meeting.
