Phaco Refractive Decoded 2016

Soosan Jacob

Posted: Tuesday, October 4, 2016

Conducted by the Eye Foundation, Coimbatore from 1-2nd October, the conference has seen a gathering of some of the finest names in Indian Ophthalmology. It covered basic and advanced cataract and refractive surgery. Harshul Tak from Jaipur explained the two step technique of capsulorhexis for intumescent cataracts where an initial small central rhexis is followed by depressurizing the cataract and finally by enlarging the rhexis. He also stressed on the importance of having microinstruments for performing various steps. Soosan Jacob spoke on her technique of glued capsular hooks for achieving sutureless trans-scleral fixation of the capsular bag in subluxated cataracts. She explained how this can avoid difficult steps such as passing long and thin needles across the AC and help make a difficult surgery easy as well as avoid long term suture related complications. Dr. Mahipal Sachdev discussed the advantages of femtosecond cataract surgery for intumescent cataracts – completing the rhexis in a completely closed chamber and thus avoiding the Argentinian flag sign. Though the femtosecond laser may sometimes not cut through a fibrotic capsule, he explained that it may still create a postage stamp pattern which can then be used as a guide to create the rhexis manually through. Dr. Amar Agarwal explained small pupil management using the I-ring and tips on safe and effective use. He also discussed the advantages of the glued IOL technique in eyes with deficient capsular support.


Dr. Keiki Mehta discussed safe horizontal chopping without needing to go under the rhexis with the chopper by tipping up one pole of the nucleus followed by supracapsular horizontal chop. Dr. Rajendra Prasad spoke on his terminal chop for hard cataracts that utilizes mechanical dispersive forces and naturally occurring cleavage planes to achieve nuclear fragmentation in even rock brown cataracts. Dr. Athiya Agarwal spoke on iris prosthesis for iris defects and the glued aniridia IOL. She also explained the advantages that these techniques have over other forms of secondary IOL fixation. Advantages and limitations of SMILE surgery were covered by Dr. Chitra Ramamurthy while wave front optimized treatment was discussed by Dr. Sujatha Mohan. Dr. Vardhaman Kankariya discussed how to choose the ideal refractive procedure in different patients; These were accompanied by complication management. Live surgery sessions covered glued IOL, toric ICL and toric IOL using image guidance, FLACS, SMILE, FemtoLASIK and pterygium surgery.

Soosan Jacob also discussed her techniques of PrEsbyopic Allogenic Refractive Lenticule (PEARL) which has recently received a lot of attention in the Presbyopic inlays field and explained the use of a SMILE lenticule for the correction of presbyopia. She also discussed the advantages of PDEK vs DMEK and her technique of air pump assisted PDEK. Dr. Rohit Shetty discussed the diagnostic and prognostic uses of tear and corneal epithelial studies and also explained how acute inflammation may be more in SMILE versus LASIK which gives SMILE a stronger wound healing response, thereby resulting in lesser disruption of corneal biomechanics. The Ophthalmic Premier League was the highlight of the sessions with all the team members vying with each other to show their best and worst cases and how they managed these cases. The “Toric Tycoons” lead by Dr. Mohan Rajan walked away with the trophy for best team.




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