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Review of Annual Meeting 2007 FORTHCOMING MEETINGS
UKISCRS 2008
UKISCRS Satellite Meeting 2008Avoiding Risk, ImprovingOutcomes in Cataract Surgery
Liverpool ArenaMonday 19th May 2008 12.30pm to 5.15pm
UKISCRS Annual Meeting 2008The Dome, Brighton
Thursday 13th & Friday 14th
November 2008
Deadline for poster abstracts
Friday 4th July 2008
Details from:
PO Box 598
Stockton on Tees
TS20 1WY
United Kingdom
Tel: 01642 651208
Fax: 01642 651208
Email: [email protected]
Web: www.ukiscrs.org.uk
UKISCRS SATELLITE MEETING
PROVISIONAL PROGRAMME
12.30 – 14.00 Registration with sandwich lunch
14.00 – 15.30 Avoiding Risk
Chaired by Charles Claoué
14.00 – 14.20 Identifying high risk cases – Rob Johnston
14.20 – 14.40 Risk of retinal detachment after cataract surgery – Steve Tuft
14.40 – 14.55 Cataract surgery in advanced glaucoma – Peter Phelan
14.55 – 15.10 Performing the perfect rhexis – Brian Little
15.10 – 15.25 Endothelial protection/ visco elastics – Martin Leyland
15.25 – 15.30 Discussion
15.30 – 16.00 tea and coffee and cakes
16.00 - 17.15 Improving Outcome
Chaired by David Spalton
16.00 – 16.20 Improving biometry – Prof. Haigis
16.20 – 16.40 Pentacam and advances in topography – Paul Ursell
16.40 – 17.00 Piggyback lenses to correct residual refractive error– Michael Amon
17.00 – 17.15 Discussion
RegistrationThe fee of £90 for members (£150 for non-members) and £50 for traineemember ophthalmologists (£95 for trainee non-members) includes lunchand refreshments. Cheques should be payable to UKISCRS and sent to theaddress below. For an application form or for further information or to payby credit card, please contact:
UKISCRS, PO BOX 598, Stockton on Tees, TS20 1WYTel or Fax: 01642 651208; email: [email protected]
Avoiding Risk, Improving Outcomes in Cataract SurgeryConveners: Charles Claoué & David SpaltonMonday 19th May 2008, 12.30 pm to 5.15 pm, The Arena, Liverpool
Following our decision to move from Chester,this year’s annual meeting was held at TheQueen’s Suite in The International Centre inHarrogate on 27th & 28th September 2007.
New Techniques in Corneal Transplantation
Ewan Craig started with a history of a corneal transplantation, theadvantages and disadvantages of penetrating corneal grafts and gave a verygood argument for only doing what is necessary. He included thesurprising statistic that the first deep lamellar keratoplasty was performedin 1956 but cautioned that this new technique has its own surgicalcomplications.
Martin Leyland told us he is using DLK for about a third of all his surgicalkerartoconus cases. He pointed out that penetrating corneal grafts forkeratoconus have a 90% ten-year survival, so this new technique wouldhave to do very well to compare favourably. He reported a 5% conversionrate and that it was less likely to get excellent visual acuity with a DLK andthat it was better to have a penetrating corneal graft than a DLK that wasnot deep enough. He reported that a higher failure rate in the early casescould perhaps relate to a learning curve.
Bruce Allen gave an interesting discussion of the forces that hold the thinendothelial layer to the host cornea in DSEC and that excess manipulationof this thin layer can lead to a 60% failure rate. What was a surprise wasthat sometimes the interface haze can take 9 months or so to clear.
Mike Tappin spoke about novel approaches in DLK. He showed how tostrip a Descemets membrane and demonstrated an interesting frying pan-shaped cannula. It was interesting to see an 8mm stepped corneoscleralsection making a comeback for this technique.
Sheraz Daya presented on the use of Femtosecond lasers in cornealgrafting. In theory such a laser should be able to cut an extremelyaccurate and smooth interface and it does, but in practice there is amarked drop in endothelial cell count. Femtosecond laser however can beused for penetrating corneal graft interface cuts and it is possible toprogramme dramatic interlocking shapes leading to much better woundsecurity.
Anterior segment trauma
“Primary Management” was presented by David O’Brart. He reminded usthat between 2-3% cases of anterior segment trauma lead toendophthalmitis. This was a presentation with a lot of common sense andincluded the delightful quote “If you don’t know what you are doing, atleast try to do it neatly!”
Our President David Spalton demonstrated the management of iris traumaincluding a beautiful video of an iridodialysis repair. He also demonstratedthe use of Morcher interlocking occlusive rings with a reminder of howfragile and expensive they are. He gave us some practical tips on whichsutures to use for iris repair.
Injuries to the lens and zonule was covered by Som Prasad which includedan impressive video of iris hooks used to hold a capsulorhexsis. Forzonular injuries he suggested that a 14mm capsule tension ring should beused for all but the very smallest eyes and reminded us that after insertion
Nathanial Knox-Cartwright from London beingawarded the £750 Bausch & Lomb prize for the bestrefractive surgery paper
Hamid Porooshani from Oxford being awardedthe £500 Alcon prize for the best poster
David Spokes from Leeds being awardedthe £750 spectrum prize for the bestcataract surgery paper
Romesh Angunawela from London beingawarded the £1000 UKISCRS prize and FoundersMedal for the best overall paper.
this, such as the Tecnis lens, assumed an average increase in sphericalaberration. After insertion of Tecnis lenses, 89% of eyes had a reduction ininduced spherical astigmatism, but 11% have a worse sphericalastigmatism. He suggested that it would be better to have IOLs withvarying asphericity, but in the absence of this, a standard Tecnis lens couldbe restricted to those with high positive spherical aberration.The final speaker was Julian Stevens. He spoke on complex re treatments.In a wide ranging talk he felt that therapeutic wavefront guided treatmentwas important but that it was equally important to analyse the underlyingissue and to use this as one of multiple tools to benefit the patient.
The final session of the day was “You The Jury” chaired for the first time byJustice Brian Little. There were robust arguments for and against sphericalaberration free lenses, bilateral restore versus mix-and-match lenses,surface oblation for forme frust keratoconus and both for and againstFemtosecond flaps.
On the Friday morning there was an excellent free paper session, whichwas well worth the early start. The prizewinners were:
Alcon £500 prize for the best poster was awarded to Hamid Porooshanifrom Oxford for his poster entitled:“Drug delivery from HydrophilicAcrylic Intra Ocular Lenses”
Spectrum £750 prize for the best cataract surgery paper, awarded toDavid Spokes from Leeds for his paper entitled:“Biocompatibility ofhydrophilic acrylic intraocular lens: three-year photographic follow-up”.
Bausch & Lomb £750 prize for the best refractive surgery paper,awarded to Nathanial Knox-Cartwright from London for his paperentitled:“Human corneal strain: the immediate biomechanicalconsequences of LASIK and modifying effect of wound healing”
UKISCRS £1000 prize for the best overall paper, awarded to RomeshAngunawela from London, for his paper entitled:“fish-tail’ allows stressfree capsular tension ring insertion”
of a CTR, tangential movement of the IA probe is required to thread outresidual cortex. He demonstrated the use of capsule tension segments thatcan be multiple and suggested that whenever possible the capsule tensionsupport should be inserted before further lens surgery.
John Salmon finished the symposium with a presentation about traumaticglaucoma. He suggested early washout of the hyphema in cases of raisedintraocular pressure where there was no improvement in 48 hours with apressure of over 50mm/Hg. If this fails to control the intraocular pressurea trabeculectomy maybe required. He described the importance ofassessing angle recession, any amount of which would lead to a 6-9%chance of glaucoma within ten years although this was much morecommon with more than three quadrants involved. He reported that 60-90% of blunt injuries lead to angle recession and stressed the importanceof comparing the angle to the normal fellow eye. He also mentioned thatangle recession was an independent risk factor for failure of atrabectulectomy but the trabeculectomy with MMC had a success ratesimilar to other secondary glaucomas.
After lunch Ray Applegate gave a superb Pierce Medal lecture on wavefrontsensing, wave front guided corrections and vision. In a superblyconstructed talk he explained first, second and third order aberrations,explaining that higher order aberrations were third order aberrations andabove. He then described how such aberrations are analysed using aHartman-Shack sensor, describing its lens array, the pattern expected from aperfect optical system, and shows the variation from that perfect result andits subsequent processing. Then using a seaside analogy showed howwavefront correction could be designed. This superb talk was very wellreceived.
Wave front aberrations in ophthalmology
Milind Pandé told us that with conventional laser treatment there was anincrease in higher order aberrations and that with wavefront guided laser,higher order aberrations should be reduced. Currently wavefront guidedtreatment does not reduce higher order aberrations from pre-operativelevels, but does reduce induced higher order aberrations.Roberto Bellucci spoke about wavefront and the management of cataractpatients. He reported that with old style intraocular lenses, there wasgenerally an increase in spherical aberration. Lenses designed to minimise
Peter Barry gave the Choyce Medal lecture,“Endophthalmitis After CataractSurgery”. The important points were the benefit of an intra cameralinjection of Cefuroxime at the end of cataract surgery, which reduced therate of endophthalmitis five fold. However there were other messages. Thefollowing were found to be associated with an increase in the risk ofendophthalmitis, clear corneal incisions (especially temporal), the use ofsilicone IOLs, intraoperative complications. Interestingly the highest oddsratio was for the clear corneal incision and its position.
Surgically induced inflammations and infections
Henry Marsh gave a talk about CJD and prions. He stressed the importanceof physical cleaning of instruments with washing being the most importantmethod of prion removal. Autoclaving is less effective but if a set ofinstruments is used on a contaminated individual and then subsequently onnormal individuals, the first three patients who have been exposed to thatinstrument pack would be the ones who were warned that they were atrisk of developing CJD.
David Spalton described toxic anterior chamber syndrome. This is an acuteinflammation usually occurring in multiple patients from one list. It isthought to be due to a polysaccharide from the cell wall of gram-negativebacteria. This toxin survives autoclaving and can be present in otherwisesterile solutions that can be used to rinse sterile equipment.
Tim Cole talked about the legal aspects and infrastructure of sterileservices. He explained that Little Sisters autoclaves were withdrawnbecause sterilisation of instruments with lumens could not be guaranteed.He described new developments in laser etching of surgical instruments toaid traceability. He gave us an interesting rule of thumb that the stock ofsurgical instruments should be one day’s use plus 50%.
There followed the ever-popular video symposium of problem cases incataract and refractive surgery. Unfortunately the chairman could notattend but an interesting variety of presentations were delivered.
All in all this was an extremely enjoyable annual meeting, one of the best Ican remember. For various reasons it will not be possible for the annualmeeting to remain in Harrogate but an even better venue has been found.Watch this space!
David Smerdon
Middlesbrough
Royal College of Ophthalmologists and UKISCRS announceJoint Ventures in Refractive Surgery Training
HST Course in Refractive Surgery aimed at Specialist Registrars and Consultants
wanting to learn more about refractive surgery
Topics include; imaging techniques, corneal-based procedures, intraocular lens procedures (phakic and aphakic).Wet-labs will provide familiarisation with microkeratomes, incisional techniques, intracorneal implants and theimplantation and enclavation of phakic IOLs.For more information, please contact Clive Peckar at the Warrington Ophthalmic MicrosurgicalTeaching Unit, Warrington Hospital - Tel: 01925 662188
Certificate in Laser Refractive Surgery
The Royal College of Ophthalmologists has introduced an assessment in laser refractive surgery, which leads to acertificate of competence to practice, subject to satisfactory yearly appraisals and continuing professionaldevelopmentFor further details contact the Royal College of Ophthalmologists - Telephone: 020 7935 0702 orwww.rcophth.ac.uk/exams/laser-refractive-surgery for an application pack
Revision Course for the College’s forthcoming Refractive Surgery Assessment Exam
The Society plans to hold this course in the future and for more information contact Clive Peckar as above.
PresidentDavid Spalton
SecretaryDavid Smerdon
TreasurerTayo Akingbehin
DirectorsStephen HaworthEmanuel RosenClive Peckar
Immediate Past PresidentPaul Rosen
COUNCILLarry BenjaminJohn BrazierCharles ClaouéVinod KumarBrian LittleSimon LongstaffDavid O’BrartMilind PandéSom PrasadMiles TuttonPaul Ursell
CO-OPTED MEMBERSTony Benedict-SmithSheraz Daya
PRESIDENT ELECTPaul Chell
CORRESPONDENCEPlease route all correspondenceand queries to:
PO Box 598Stockton on TeesTS20 1WYTel: 01642 651208Fax: 01642 651208Email: [email protected]
UKISCRS OFFICERS2008
2008 No.1
Call for abstracts for postersUKISCRS Annual Meeting 2008The Dome, BrightonThursday 13th & Friday 14th November 2008
The deadline for receipt of abstracts is Friday 4th July 2008.The best abstract submissions will be invited to presenta rapid-fire free paper. In addition, all successfulpresenters must display a poster.
There is a £500 prize for the best poster displayed. Inaddition, current junior members of the Society have thechance of competing for one of three prizes in the free papersession (£1000 and two at £750).The presenter of thewinning oral free paper will also receive the Founders Medal.The abstract should be submitted on the appropriate formavailable from www.ukiscrs.org.uk or [email protected] on the correct form via email only.
PRESIDENT’S LETTER
Changing Address?
Please make sure that you inform UKISCRS (not ESCRS) ifyou change your mailing address. Either write c/o: PO Box598, Stockton on Tees,TS20 1WY or send an email to:[email protected]
New Look for UKISCRS Website
The Council is pleased to announce that the UKISCRSwebsite will be getting a makeover over the coming months.We will be offering more features including on-lineregistration and feedback for meetings. Please keepchecking the website for updates.
Treasurer’s ReportI am pleased to report that the Society’s finances remainhealthy. Many members are paying their annualsubscription by direct debit and if you would like toregister for the direct debit scheme, please contactUKISCRS at the usual address. The Society can now takecredit and debit card payments for membershipsubscriptions and meeting registration fees. For securityreasons, we are taking credit and debit card payments bytelephone only.
I am delighted to announce that the Society has notincreased the membership fees for 2008. Benefits ofUKISCRS membership include a free subscription to theJournal of Cataract & Refractive Surgery, FREE membershipof ESCRS, online access to the JCRS, reduced fees to attendESCRS and UKISCRS meetings, and for trainees, the chanceof winning a substantial prize (£1000 or £750) bypresenting in the free paper session at the Society’s AnnualMeeting. Don’t forget also that the UKISCRS is on theInland Revenue’s approved professional body list, whichmeans that your membership fee is tax deductible.
Please do encourage your colleagues and junior staff to jointhe Society!
Tayo Akingbehin
Honorary Treasurer
For November 2008 our AnnualMeeting moves from the austereEdwardian elegance of Harrogate tothe rather more sensual Georgiandecadence of Brighton where wehave arranged the two-day meetingfor Thursday and Friday, 12th and13th of November at the BrightonDome. This beautiful building wasoriginally the stables and ridingschool of the Prince Regent’sadjacent Brighton Pavilion, surelyone of the most bizarre andspectacular and under ratedbuildings in the country and thescene of his lavish social excess,sadly UKISCRS funds don’t allow torepeat this! The move will separateour meeting from the proximity ofthe ESCRS and allow us to developa bipolar ‘north - south’ alternateyear structure for our annualmeeting making it easier forsurgeons from all over the UK toattend.
Apart from spectacular architecturethe venue has excellent dedicatedconference facilities for twoauditoria, allowing parallel sessions,excellent exhibition space and awide variety of hotelaccommodation. The backbone ofthe program is in place and willconcentrate on the major practicalissues at present of themanagement of astigmatism,multifocal IOLs, the newdevelopments in the managementof ectasia and keratoconus andmicro incision cataract surgery.Jose Guell, the pioneering cornealand refractive surgeon fromBarcelona, will give the RaynerLecture. In addition we areorganizing a parallel day onrefractive surgery in the secondlecture and symposia will be onControversies in LVC, latesttechnologies, Minimising Risks andEthics in Refractive Surgery and asession on Audit and Quality ofVision. We hope to have some highscience on adaptive optics forrefractive surgery, and an AlliedProfessionals Day, which was such asuccess last year. All in all it is ameeting that you cannot afford to
miss if you want to keep abreast ofthe advances in our speciality, somake a note of the date for yourdiary now.
The Satellite Meeting in Maypromises to be another greatmeeting and the programme andregistration details are to be foundin the newsletter. I am sure thatthis will be an extremely popularmeeting, so book now to avoiddisappointment.
I recently wrote to the MDU to askthem to look at whether theirincreased premium for refractivesurgery was still justified in thelight of the College’s programme ofaccreditation for refractive surgery,better guidelines for the parametersof laser refractive surgery and theincreasing fusion of cataract andrefractive surgery to a singleprocedure as well as phakicintraocular lenses. Members willbe interested to see the reply fromChristine Tomkins (Deputy ChiefExecutive and Professional ServicesDirector of the MDU) who startedoff her professional career someyears ago in ophthalmology.
“MDU subscriptions are keptunder constant review and arebased upon external actuarialadvice. We take a prudentapproach when assessing riskand the increased subscriptionrate for members undertakingrefractive surgery reflects the
actuarially assessed frequencyand size of claims generated bymembers undertaking thiswork,
We define refractive surgery asany surgery carried out wherethe prime aim is to correct arefractive error not caused by apathological process. Whilstrecent developments mightmean that, in due course wemight see fewer complicationsarising from refractive surgery,we have seen a rise in claimsfrequency in relation to electiverefractive surgery in the past.
The nature of clinicalnegligence claims means thatthere can he a significant delaybetween treatment andnotification of claims and afurther delay before settlement.This means that any change inclaims experience, consequentupon changes in clinicalpractice, may take some lime tobe evident actuarially. We will,however, keep the matter underclose review. If it becomes clearthat the risk associated withrefractive surgery is changing,this will be taken into accountwhen future subscription ratesare calculated.”
I wish you all a happy andsuccessful New YearDavid Spalton
President
New Council Members
The following members have been elected to UKISCRSCouncil for 2008: John Brazier (London),Vinod Kumar(Cardiff) and Miles Tutton (Chester).
“Private Medical Insurance aims todictate quality in cataract surgery”
Letter to:Manager of Network ExemptionsAXA PPP
Dear Ms Power
I recently had a patient due to come into the Fitzwilliam Hospital,Peterborough on the 6th December for right cataract extraction.A week before surgery, the patient was telephoned by yourcompany and told that she would not be eligible for treatment atthis hospital because it was “not a centre of excellence”. Thepatient has detailed the conversation in writing in an email.
You might have issues with the costs of surgery at theFitzwilliam. If that is the case your company should have madethat clear to the patient. By stating that the hospital is “not acentre of excellence” you are implying to the patient that the careprovided by the hospital and its surgeons is below par. How doyou think this affects our reputation?
Damage to our reputation will lead to reduced referrals and lossof income. I wonder if your company’s activity constitutesslander. What is your justification for declaring that theophthalmic clinical care provided by the Fitzwilliam Hospital isbelow par?
Timothy Rimmer PhD FRCS (Ed) FRCOphth
Consultant Ophthalmic Surgeon
Peterborough Hospitals NHS Trust
David Spalton, President and Judy Pearce presenting Ray Applegate withthe Pearce Medal at the 2007 Annual Meeting in Harrogate
If anything like this has happened to you pleasecontact Richard Packard, Chair of the AOO [email protected]
