World class surgery

In addition to the papers presented, there were poster exhibitions on refractive and cataract surgical techniques, developments and outcomes, and a large trade fair. There were also several live surgeries, with a video link from a nearby operating theatre, where both simple and technically complex cataract operations were demonstrated.
These included combined cataract and vitrectomy, implantation of an accommodative intraocular lens (IOL), and C&C Vision's CrystaLens. Several refractive surgical procedures were also performed, including Lasik in a post-penetrating keratoplasty patient and customised hyperopic Lasik treatment.
The trade fair provided a wealth of opportunity to experience the latest in wavefront analysers, and IOL products.
Volk was demonstrating its new digital 1.0X lens for use in fundus photography, which claims to reduce glare and improve resolution. It was also promoting its new 360-degree gonio lens.
The video presentations included many thought-provoking topics. Dr Howard Gimbel (Loma Linda University, California) presented his view on the risks posed by the laser plume in excimer laser.
The presence of live viruses, and large oligopeptides within the plume, and extracted from the operating theatre fan filters, indicated the need for patients and clinical staff to be protected from this potential health hazard.
Dr Roger Steinert (Harvard Medical School, USA) reviewed the origin of the Zernike polynomial and how it represented the optical wavefront. He then linked this to relate higher-order aberrations to real-world phenomena.

Fast procedure
Dr Takayuki Akahoshi (Mitsui Memorial Hospital, Tokyo) commenced by demonstrating what he claimed to be the fastest phacoemulsification with IOL implantation in the world, taking only 89 seconds to complete the entire procedure.
He then proceeded to explain his development of a new technique of ultra-low energy phacoemulsification.
Nick Mammalis (University of Utah) gave a review of current small-incision IOLs. He said the new Thinoptix, an ultra-thin Fresnel-based IOL design, could be rolled into a column only 2mm in diameter to facilitate insertion through a small corneal incision. He also described the Smart IOL, which was injected as a solid rod at room temperature, but at body temperature it unfolded to become a 9.5mm biconvex IOL, which completely filled the capsular bag. This led to the theoretical possibility of accommodation and reduced posterior capsular opacification.
Dr Hiroko Bissen-Miyajima (Suidobashi Hospital, Japan) demonstrated the real time IOP changes during keratome suctioning in Lasik. It was recorded that the IOP can reach up to 120-130mmHg for the duration of the keratome suction, which was usually only about 10 seconds so theoretically would not cause any problems in normal individuals, but could pose a hazard in patients with previous optic nerve head damage.
Graham Barrett (Lions Eye Institute, Perth, Australia) delivered the Ridley Medal Lecture on hydrogel IOLs past, present and future. He explained the development of the hydrophilic lens, and his hopes for its future.
Dr Maurizio Luraschi (Hospital of Rovereto, Italy) presented a comparison of a multifocal IOL (AMO Array) and an accommodative IOL (Humanoptics 1CU) in bilateral cataract surgery. He found that both lenses were safe and effective at providing near and distance vision postoperatively, but that the AMO Array had a better visual outcome and higher satisfaction, with improvement in distance and near VA simultaneously.

yellow IOL
Khium Tjia (Isala Clinics, Netherlands) reported on his clinical experience of the new Acrysof Natural lens. This yellow IOL was designed to reduce the blue light hazard to the macula. He implanted a clear IOL in one eye, and a yellow IOL in the fellow eye, and evaluated whether the patients perceived any colour or brightness difference. He concluded that patients rarely saw any difference between the yellow and clear implants, and no clinically-significant complaints were found.
Professor Marie-Jos