Beyond the Basics: International Master’s Tips for Accelerating Phaco Proficiency

Pannet PangputhipongThailand Speaker Phacoemulsification: Challenging and Interesting CasesPhacoemulsification in complex cases is always challenging. Situations such as hard nucleus, intumescent cataract, posterior polar cataract, loose zonule, or small pupil require special surgical techniques to overcome the difficulties. In some patients, multiple complexities may occur simultaneously, making the procedure extremely challenging—sometimes described as a surgeon’s nightmare. This presentation will highlight selected interesting cases and demonstrate strategies to manage them safely, guiding surgeons on how to navigate through these “war zone” scenarios with confidence.Challenges in Soft Nucleus: Don’t Drown in Shallow WaterPhacoemulsification in soft nuclei can be challenging if inappropriate techniques are used. The soft nature of the nucleus makes nuclear disassembly difficult. Chopping and rotation are not easily performed because the chopper tends to cut through the nuclear mass when cracking or rotational force is applied, without achieving satisfactory results. The phaco tip also cannot hold the nucleus firmly enough during chopping or pulling. “Stab Test” using a 27g. hydrodissection canular to determine the hardness of the nucleus before performing hydrodissection is essential, in order to choose the most appropriate phaco technique. Special techniques such as Hydro Subluxation + Aspiration, Hydro Subluxation + Flip & Chop, Half Bowl + Rim Aspiration, and Chip & Flip (I. Howard Fine) will be discussed, including phacodynamics for soft nuclei. When proper techniques are applied, surgery can be performed safely and effectively.

Matteo PiovellaItaly Speaker Refractive cataract surgery to correct and eliminate presbyopia to achieve better vision in patients undergoing cataract surgerySynopsis Refractive cataract surgery is now replacing standard high-volume, low-cost cataract surgery with monofocal IOL implantation. The possibility is to correct refractive defects, myopia, hyperopia and astigmatism and overcome presbyopia limitations. It is necessary to change the preoperative patient procedures and manage Meibomian gland dysfunction in cataract patients. Normally three treatments should be applied: BlephEx (Alcon) to eliminate Demodex blepharitis Biofilm and to open glands duct LipiFlow (J&J) to get postoperative refractive emmetropia. In this course, we will review state-of-the-art knowledge on refractive cataract surgery in pursuing highly satisfactory uncorrected distance, intermediate and near vision. Routine dry eye management will be discussed. Advanced biometry, multiple shots and new procedures will be explained and demonstrated .The new technical model for the adoption of refractive cataract surgery: biometry evaporative dry eye pupil-dependent trifocal IOLsSynopsis PRESENTATION will certify as postoperative precise IOL power detection is based on quality of tear film to provide cornea smooth surface.Improvements . Multiple biometry exams are needed until refractive IOLs power stabilization Objective The MAPRY/clear oil protocol is based on consecutive session with three phisical treatments. First treatment applied is Blephex(LLC) to remove Demodex, Biofilm and to unclog excretory channels of the meibomian glands Second Treatment,LipiFlow (J&J),replaces occlusions of the MG warming the material responsible of MGD improving a solid sttatification into the liquid state easier to remove. ILux (Alcon)expels deeply from the meibomian glands the substances responsible for their obstruction. The MAPRY protocol is based on one session per month at least for 5 months, depending the grade and penetration ofhronic eyelids inflammation

FAM Han BorSingapore Speaker Astigmatism with TK more Accurate for Toric Calculation?This presentation explores the impact of Total Keratometry (TK) on the calculation of toric intraocular lenses (IOLs), focusing on the role of posterior corneal astigmatism (PCA) in refractive outcomes. Drawing on large datasets and recent studies, it highlights that PCA is a significant factor in toric IOL planning, with traditional keratometry often leading to over-correction of with-the-rule (WTR) and under-correction of against-the-rule (ATR) astigmatism. The presentation reviews evidence showing that using measured PCA values, rather than predicted ones, improves the accuracy of postoperative astigmatism prediction, especially when the steep axis of PCA is non-vertical. Comparative analysis of various toric IOL formulas demonstrates that EVO formulas with measured PCA yield the smallest centroid errors and highest percentage of eyes within 0.50D of predicted astigmatism, particularly in cases with non-vertical PCA. The findings underscore the importance of incorporating TK and measured PCA into toric IOL calculations to optimise refractive outcomes for cataract patients.