37th APACRS Annual Meeting Final Program

FILM FESTIVAL

FF2-07 Temporal Approach Phacoemulsification Cataract Surgery With Intraoperative Floppy Iris Syndrome (IFIS)

Jophy CHERRY India

In this video, a temporal approach phacoemulsification was performed in a challenging case of Intraoperative Floppy Iris Syndrome (IFIS) on an elderly lady with immature cataract on oral anti-psychotic medication. Despite significant iris prolapse throughout the surgery, controlled phacoemulsification with gentle manipulation, meticulous iris repositioning and careful cortex removal enabled successful IOL implantation with anterior chamber stability. This emphasizes the importance of meticulous surgical planning, gentle manipulation, and minimal anterior chamber fluctuations to

overcome complications and achieve optimal visual outcome in IFIS cases. FF2-08 Turning Challenges Into Triumphs: The journey of a post trauma eye to victory

Annu JOON India

A 55-year-old female presented with 6 clock hour iridodialysis, >180 degree lens subluxation, uveal tissue prolapse, and hypotony following blunt trauma to the eye. The complexity of managing this case was significant, given the involvement of multiple ocular structures requiring surgical intervention. The patient underwent a sequence of surgeries, with a guarded prognosis. This video highlights tackling the subluxated lens by ICCE with a temporal scleral tunnel, iridodialysis repair, and scleral patch grafting for a large scleral dehiscence. A sequential surgery of secondary IOL fixation by Yamane's technique and single pass four throw pupilloplasty rehabilitated the patient to 20/40 vision. Both the surgeon and the patient emerged victorious in this case, despite the numerous challenges posed by the multiple compromised ocular structures, emphasing the need for timely and meticulous approach to trauma. FF2-09 Ring of Precision - It’s All About Timing: Key decisions for CTR implantation in phacoemulsification for coloboma-associated cataracts Asheesh BAJAJ India Phacoemulsification in colobomatous eyes can be challenging due to smaller corneas, limited working space, harder density of the nuclei and above all weak zonular support. Although Capsular Tension Ring (CTR) can be a saviour for preserving the capsular bag and safe implantation of the Intraocular Lens, but the timing of its insertion is critical for achieving optimal outcomes. This video highlights the importance of CTR implantation at different stages of phacoemulsification in diverse case scenarios of cataract associated with coloboma. Key learnings from the video are: CTR insertion must follow the principle of "AS LATE AS YOU CAN BUT AS EARLY AS YOU MUST". Initiation of CTR implantation is opposite to the area of zonular weakness Bimanual technique ensures in the bag CTR implantation. FF2-10 Tjokro's Pass and Switch (PAS) Technique: A novel technique for iris-claw lens implantation Several studies mentioned that retropupillary iris-claw lens implantation is safer, faster and easier procedure than prepupillary implantation. However, retropupillary iris-claw implantation is not without complications. The most common complications are pupil ovalization and haptic disenclavation. By using the standard technique, we often encounter some difficulties, especially in the second haptic enclavation. Based on these findings, I propose a new modified technique for retropupillary iris-claw lens implantation: the Pass and Switch technique. This technique promises better lens centration, precise enclavation to produce a round pupil, reduced risk of deenclavation, and faster procedure duration. In addition, more stable intraoperative intraocular pressure in patients with vitrectomized eyes compared to the standard technique. FF2-11 Pearls for Management of Morgagnian Cataract Shalini KUMARI India Phacoemulsification for Morgagnian Cataract is one of most risky surgery. The milky fluid, coming out while making a capsulorhexis, obscures the vision. The liquification of cortical matter leads to loss of support to anterior capsular flap. Key is to make a small rhexis & extend it into an adequate sized one with vannus scissor and rhexis forcep. As cortex surrounding hard nucleus is liquified, doing a normal Stop & Chop or 4- Quadrant Nucleotomy is tough. The best technique is to do Direct Chop in supra-capsular zone which puts minimum stress on already weak zonules & posterior capsule. Burst mode should be put on in phaco-settings to emulsify & aspirate hard nucleus. Insertion of IOL has to be gentle. Dreaded complications of Nucleus Drop, Posterior Capsular Rent & Zonular dialysis need to be avoided. Ludwig MELINO TJOKROVONCO Indonesia

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