A pot pourri of hot topics

Experts pick out the Best of the “Best” at the 37th Congress of the ESCRS

Cheryl Guttman Krader

Posted: Friday, December 6, 2019

ESCRS Chairpersons Oliver Findl MD and Boris Malyugin MD, PhD, highlighted some of the most interesting videos, posters, free papers, and symposia presentations from the 37th Congress of the ESCRS in Paris. Together with panelists comprised of key opinion leaders, they offered their personal perspectives about the ideas and findings contained in the selections.

Video highlights
Two videos presented by Ehud Assia MD in his Binkhorst Lecture were reviewed. One of the videos demonstrated a portable operating theatre that can be erected at remote sites in underdeveloped countries. The structure keeps the patient’s head and surgical staff in a clean environment, separated from the outside world. A second video presented the adjustable flange technique, which is Dr Assia’s modification of the flanged IOL fixation technique for managing a dislocated IOL.
Descemet membrane endothelial keratoplasty (DMEK) was the topic for two videos. They included “The DMEK Kite”, which showed a technique for improving surgeon control over graft orientation, unrolling and positioning. “In vitro evaluation of the feasibility of slit-lamp Nd:YAG laser descemetorhexis” described experiments testing different Nd:YAG settings for scoring Descemet’s membrane at the beginning of the surgery.
Cataract surgery was the focus for several of the videos discussed during the session. They included “Make the turn without the burn: a critical analysis of CTR insertion and a novel injector system to reduce CTR complications”. This video described predictable cardinal movements of the capsular tension ring (CTR) that indicate uncomplicated insertion, reviewed the advantages of a suture-guided CTR insertion technique, and presented a suture-guided CTR platform that is in development as a preloaded delivery system.
The video “Creation and evaluation of complication models using slit side view cataract surgery” reported on use of the slit side view technique to gain understanding of anterior chamber dynamics as the foundation for conducting safe surgery.
A video titled “Winnie the Pooh gets stuck in a hole, how do his friends get him out of there?” provided tips for managing the situation where the IOL gets stuck in the incision during insertion.
The video “Posture perfect: ergonomics for the ophthalmic surgeon” provided advice for enhancing comfort and efficiency in the operating room. It highlighted the ergonomics of an ideal surgeon’s chair and simple exercises for safeguarding health.

Best presentations
Presentations that were chosen as “the best of the best” included several cataract surgery free papers and posters. Among them was “Cataract surgery for late in-the-bag IOL dislocation: long-term visual outcome in a randomised clinical trial – lens repositioning vs lens exchange”. The study found that the ab externo scleral suture loop technique for repositioning and IOL removal followed by replacement with an iris-claw IOL were associated with similar visual acuity and safety outcomes after two years.
“Novel technique of intrascleral IOL fixation with intraoperative adjustment of refraction” showed how cutting the haptics to change haptic length during flanged IOL fixation altered refraction.
The paper “Comparative efficacy of Barrett True-K IOL power calculation with and without measured posterior corneal astigmatism” found that in patients with a history of refractive surgery and no available history, particularly previous myopic eyes, use of direct posterior corneal astigmatism measurements and the Barrett True-K formula provided greater accuracy than other available formulas.
A free paper and a poster presenting findings from studies of two presbyopia-correcting IOLs that will be coming to market were also highlighted because of the interest these new technologies will hold for surgeons. “Clinical outcomes of a new extended-vision intraocular lens in the United Kingdom” reported on the AcrySof IQ Vivity Extended Vision IOL. “Visual outcomes and defocus curve profile of a next-generation diffractive presbyopia-correcting intraocular lens” summarised study data on the TECNIS Synergy IOL.
The paper “Inducing a trifold conformation in Descemet’s membrane endothelial keratoplasty using small paired radial incisions” was also selected as a “best of the best”. The author demonstrated how creating paired radial incisions in the DMEK graft encouraged a wide triple scroll conformation that is favorable for unfolding and worked better using younger donor tissue (age ≤65 years).
Another DMEK paper presented “Risk factors associated with high endothelial cell density decrease after DMEK”. It concluded that to reduce the risk of high endothelial cell loss, DMEK surgeons should avoid graft detachments, do continuous postop screening to ensure early detection of potential complications, and consider surgical intervention before eyes with Fuchs’ endothelial corneal dystrophy reach an advanced stage.
Two presentations from the main symposium “Surgeons Under Stress” were also considered the “Best of the Best”. They included the talk “Understanding Stress”, given by internist Michaela Bayerle-Eder MD 
that presented the physiological and medical consequences of stress and featured videos of surgeons discussing how they deal with stress. The presentation “Relaxing the surgeon: Stress control for your next surgery”, given by Stig A Severinsen PhD, also included some simple strategies for dealing with stress.