Get H.I.P. (High Impact Pearls) – Refractive, part of a suite of similarly themed symposia taking place at the ASCRS Annual Meeting, offered pearls in rapid-fire video cases on the topic of refractive surgery. The session was broken into three categories with several video presentations in each category.
Source: ASCRS
Below is a recap of the audience-voted winners from each category.
Preventing and Handling Surgical Complications
Tushya Om Parkash, MD, presented on the “ridge sign” as a confirmatory sign to identify the anterior and posterior plane in small incision lenticule extraction (SMILE). He showed a case of moderate myopia treated with SMILE. The anterior plane pocket is created on one side and the posterior pocket created on the other. The ridge sign is used to confirm creation of these two pockets.
William Wiley, MD, one of the panelists in the session, said any clue like this is helpful to prevent them from getting lost in the wrong plane during the SMILE procedure. Later during the discussion, Dr. Om Parkash said if you see the ridge sign, you can be 100% sure that you’ve created the right pockets and that you will see it in all cases if the pockets were created correctly.
Diagnosing and Managing Postoperative Complications
Priya Narang, MD, showed the pinhole pupilloplasty technique for managing higher order aberrations.
She showed a case of an RK patient who, at the time they were ready for cataract surgery, had 10 D of astigmatism. Using the single-pass, four-throw pupilloplasty technique, taking care to center the pupil on the Purkinje images, Dr. Narang said there can be a massive improvement in the patient’s visual acuity and photopic symptoms.
Dagny Zhu, MD, on the panel, asked about this technique in comparison to the IC-8 Apthera pinhole IOL (Bausch + Lomb). Dr. Narang said she doesn’t have access to that IOL and noted that one of the benefits of pinhole pupilloplasty is that it can be customized for the patient. “Not one pupil size fits all,” she said. Dr. Narang further said preoperatively that patients are given different pinhole sizes to see through and select the one that gives them the most benefit. We try to customize to that size for the patient in the procedure, she said.
Rahul Tonk, MD, said during discussion that a lot of irregular astigmatism patients have bilateral problems. He asked whether Dr. Narang used pinhole pupilloplasty bilaterally. She said it depends on the patient. She said she usually recommends it for one eye but that patients might ask for it in their second.
New Surgical Instruments/Devices
Sri Ganesh, MD, showed what Dr. Wiley called a “slick” technique in his presentation: lenticuloschisis in KLEx. Dr. Ganesh called lenticuloschisis a unique method for lenticule extraction.
The laser part of the procedure proceeds normally but when it comes to lenticule extraction, instead of dissection, Dr. Ganesh showed how microforceps are used to grasp and peel the lenticle from the stromal bed. This technique requires optimized laser energy settings (settings that are not yet available in the U.S.) and a minimum peripheral lenticule thickness.
The technique involves opening the jaw of the forceps so they’re on either side of the lenticule, pull it down to the center, and remove the lenticule through the incision.
His video case was performed with the VisuMax 800 laser (Zeiss), but he did perform this lenticule removal technique with the prior VisuMax 500. With traditional dissection of the anterior and posterior plane, you’re pushing to the periphery, which causes stretching of Bowman’s. Lenticuloschisis is more centripetal. “It’s so fast and easy,” he said. “I almost always do this technique.”
Financial disclosures
Ganesh: Biotech Vision Care, Hoya, Teleon, Zeimer, Zeiss
Narang: None
Om Parkash: None
Tonk: Alcon, Bausch + Lomb, Johnson & Johnson
Wiley: Alcon, Bausch + Lomb, BVI, Johnson & Johnson, RxSight, STAAR Surgical, Zeiss
Zhu: AbbVie, Alcon, Bausch + Lomb, Beyeonics, Johnson & Johnson, Lenstec, Ocuphire, Santen, STAAR Surgical
