Program Overview

Bioptics procedure refers to a double surgical technique approaching the two main refractive planes, cornea and lens, to perfectly correct an extreme refractive error.
It may involve a laser vision correction on the cornea combined with an implantation of phakic IOL or combined with a pseudophakic IOL. Why, when and how to perform Bioptics procedure will be taught clearly in this course.

Corneal perforation is always challenging even for advanced ophthalmologists, either autoimmune or trauma, infectious or not infectious, small or large and its exact location. Through this lecture, you will find out how to make a decision from its cause to define the treatment. Will a bandage lens close the wound, or additional glue is needed. or maybe suture is a one way solution? Follow this course, and you will find out how to make a decision for your corneal perforations patients

Brown cataract usually very hard, leathery and tough, and always become a big challenge for a phaco surgeon and sometime change to be a nightmare in the operating theatre. A long discussion and debate had been done on which approach are the best method to tackle this hard cataract. Stop and Chop, Direct Chop (either horizontal or vertical) and Pre-Chop had been proposed as the safest way. In this occasion, expert will show implementation of those technique and its advantage or disadvantage in dealing with brown cataract.

Traumatic cataract needs a special attention in the way a surgeon should do the surgery. Why it is so special? Because there were various types of cataract caused by trauma. It might be seemed as common cataract, or combined with capsule rupture, zonular dehiscence (with or without vitreous prolapse to anterior chamber), or combined with corneal perforation due to sharp object. Each condition requires different judgement and approach that will be described here.

Modern refractive surgery, including lasik and cataract surgery is now very sophisticated, thanks to advances in technology and medical science. The success rate of the surgery is very high, with a high degree of accuracy and predictability in controlling postoperative refractive errors. The level of patient satisfaction with this operation is also quite high, thanks to the much shorter recovery and visual rehabilitation period compared to past surgical procedures such as manual ecce, radial keratotomy, etc.

However, it is not uncommon after undergoing refractive surgery procedures that some patients feel dissatisfied with their vision. Some felt that their visual acuity was not optimal, or there was no difference with the condition before surgery. There are also those who complained that their eyesight got worse after surgery even though the operation went well without complications.

In this course session, several conditions will be discussed from the perspective of a retinal specialist that can affect the final outcome of refractive surgery by experts from the InaVRS group. Posterior segment condition such as diabetic retinopathy, vitreo-retina interface disorders, AMD, peripheral retinal degeneration are some of the common causes that affecting the visual outcome post refractive surgery. Pre op examination thoroughly including the posterior segment sometimes is not that easy due to significance opacity of the lens. Knowing the health condition of the retina before performing refractive surgery is very important to be able to assess the prognosis comprehensively, which is certainly the right of a patient to know and we as surgeons are obliged to convey this, good or bad. And it should not be forgotten, it is necessary to also mention the risk of complications that may arise from these procedures. In this session, there will be interactive discussions between experts, as well as with the participants. I wish you an enjoyable meeting.

In this 2 hours didactic course, join a series of discussions as they explore and explain the most cornea cases and their latest treatment. Several diagnostic tools, latest surgical technique and options with basic mechanism of action for cornea medication. From recurrent simple cases like epithelial defect to perforated corneal ulcers.

As with all types of surgery, refractive surgery procedures are associated with a risk of complications. While these risks are very low, they can vary widely from one patient to another based on preoperative characteristics, the type of refractive surgery and postoperative management.

One of the rarer, but more serious, complications of corneal refractive procedures is corneal ectasia or keratectasia, haze, flap problem, suction lost and bullous keratopathy. This enhanced approach also allows the surgeon to augment the efficiency of the procedure, selecting the most appropriate surgical method for optimising the chance of success and preventing complications.

Medication, as important as the surgery itself are essential aspect on gaining great results in the field of Ophthalmology. Development of new and updated drugs grows almost as synchronized as the development of new and updated surgical techniques. Understanding various routes, mechanism of action and drug preparation, if used correctly will definitely increase the rate of treatment success. With this course, we would like to share expert views on the latest and updates on medication use in and around Cataract, Corneal and Refractive surgery.

In this course we explain more about myopia treatment. The surgical treatment of myopia is growing rapidly. the most popular are vision laser correction and Refractive Lens Exchange. But in certain cases it requires other surgical treatment such as Phakic IOL in cases of myopia in young people, IntraCollamellar Lens (ICL), Lasik Extra in cases of myopia with keratoconus and Piggyback IOL in cases of post-op cataract refractive surprise. The indication of the surgery and the surgical techniques will be discussed in this didactic course.

Once a patient decides to have cataract surgery, the patient and surgeon should discuss plans for the surgery, such as the anesthesia that will be used.
Commonly, cataract surgery is performed with topical anaesthesia. This is accomplished by instilling a very strong numbing medication into the eye.
Sometimes, medication is injected around the eye socket to numb the eye and paralyze eye and eyelid movement. It called Retrobulbar or Peribulbar anaesthesia. This injection carried their own risk.
With modern local anaesthesia drugs and skilled medical persons, it will give a very safe and good result to the patient and comfortable surgery for the Ophthalmologist.

Refractive surgery has become the most rapidly developing field in ophthalmology. Several modern refractive procedures have become available over the last 10 years including laser vision correction and a few others. Laser refractive surgical procedures are currently used to address refractive errors. No single procedure works best for everyone; each one has its own set of advantages and disadvantages.

Careful patient selection is the key for optimum visual outcomes. Treatment algorithms have been refined over the years, improving accuracy. Laser technology and delivery platforms are under continuous improvement, leading to increasingly precise results. This session will be discussed several laser surgery procedures which fit for our patients who don’t want to use glasses.

In refractive surgery, we strive to obtain excellent visual outcomes and patient satisfaction which is also critically important. In order to achieve both great visual outcomes and high satisfaction levels, refractive surgeons must perform a thorough evaluation and anticipate the possibility of new symptoms after the procedure.

Therefore, in this didactic course we would like to emphasize the importance of tear film, from preoperative screening to management of dry eye after refractive surgery, the influence of corneal topography, and the value of refractive cataract workup to be a successful surgeon.

Pterygium is highly associated with environmental factors, and recurrence rates can be unacceptably high and cannot be successfully predicted. New techniques and Conjunctival autograft preparations and several approach options in order to reduce pterygium recurrence rates and surgical complications will be discussed in this course.

Cornea and lens are the two main refractive components to focusing the bundl of light into the macula to develops the shadow of image; however, the real mechanism it’s not as simply as describing the optical’ physic, it’s an interplay of the delicate and fragile bio-mechanism forces, and a progressive impact of ageing process.

Corneal refractive power could be modify through simple intervention such as incission and/or sutures (surface contour principle), and volume-thickness modification principle. Whereby, nowadays, the lens refractive power are manage either by toric and/or multi-focals intra ocular lens.

This session would like to disclosure the surface contour principles of corneal intervention toward to corneal refractive power and the premium intra-ocular lens.

Our cataract patients’ expectations have steadily increased as our surgical technique and IOL technology has advanced over the years. Today we recognize patients could see the 20/20 line but their vision fluctuated in different lighting conditions.

What was the explanation for the unsatisfactory post-op vision? A lot of it is attributed to something called photic phenomenon due to spherical aberration. Spherical aberration (SA) distorts and degrades the visual image. Other things also contributed to patients complaints including mild posterior capsule opacification, fix dilated pupil or macular problems like cystoid macular edema. As an ophthalmogist, we have to give a great deal of attention on the smallest detail during the entire process of cataract surgery from pre-operative, surgery and post-operative management. This increased attention-to-detail will help us to achieve better outcomes and resulted in more highly satisfied patients.

As all surgeons are aware, however, cataract surgery is not always this simple. If the surgeon knows of pre-existing challenges pre-op, proper planning can alleviate surprises during the procedure. When the surgeon is unprepared, however, the challenge is intensified.

The Expert surgeons will speak about their most challenging cataract cases, and what pearls they could offer all surgeons who might face a similar situation to have optimum visual outcomes after surgery.

Anatomically and functionally, the crystalline lens by nature is a flexible and vulnerable tissue. The flexibility of the lens is related to the contraction of the 360o degree meticulous fibers, zonula Zinnii which attached to the ciliary body.

There are many conditions, such as ageing process, inflammation, hereditary or inborn defect, and injury or iatrogenic which may damaging this important fiber structures, which may lead to an unstable position of either the natural crystalline lens or the in the bag Intra Ocular Lens.

The unstable position will subsequently deteriorating the patient’s visual aquity or starting another progressive complication. This session will be focusing on how to manage such a problems in various situation and surgical techniques.

This course will deal with issues pertaining to phacoemulsification in the presence of some anterior to posterior segment pathologies. Topics covered are brief overview of common specific cataract cases requiring special attention/handling (cataract In pediatric cases, cataract with glaucoma, cataract in high myopia, in floppy iris and cataract post silicon oil removal). How are these eye different from routine, intraoperative risk involved, preoperative assessment and surgical planning, intraoperative management of distorted anatomy (such as small pupil, shallow anterior chamber, extremely long axial length, nuclear brunescence, etc). At the end of the course the attendees will become familiar with current strategies in management of eyes with cataract and co existing anterior and/or posterior pathologies.

Cataract surgery is the bread and butter intervention in Ophthalmology; especially in the high blindness rate country like Indonesia. Thus, mastering cataract surgical competency is a must; the first aim is to be a safe surgeon which could freeing from blindness and low vision patients to reached back their productivity.

The next cataract surgical competency is to be an expert in optimizing the visual acuity of the patients to their optimal visual capacity. Those surgical competency could not be reached; unless, you’ll learn from mistakes which could be happened in any time by any one.

This session is a potpoury of during and after cataract surgery disaster, both anterior and posterior segment and their specific solutions from each sub-specialty expert.

Every cataract surgery case is different. While most are done without any complications, other times complication cannot be avoided. Cataract surgeons need to be prepared for managing complication that may happen during surgery. An early complication, such as failure to make a complete CCC, will make phacoemulsification procedure harder and further complications may arise. Meanwhile, during lens extraction, surgeon might have to deal with vitreous prolapse and it needs immediate management to avoid further damage. Even so, sometimes after a successful cataract surgery, the patient may suffer with late onset complications, such as IOL drop or IOL dislocation. This course will enable you to learn from experienced cataract surgeons on how to best manage these complications.

Performing phacoemulsification needs a clear visibility of surgical area, that are not only possible due to a good operating microscope but also a clear cornea, to see the cataract and surgical procedure perfectly throughout the whole surgery. If corneal transparency becomes a problem due to a scar or edema, phaco procedure becomes a big challenge with several potential risks. Some tricks will be shown on overcoming such situation that makes the surgery still possible to be done safely.
Another condition that may make phaco surgery difficult are cases with undilated pupil due to some causes such as post uveitis, PXF, IFIS, diabetes and history of long term used of miotic agent. In such condition, some efforts may be done to expand the pupil diameter, with or without aid of devices as iris hooks, malyugin ring etc. Those efforts will be described step by step to facilitate the phacoemulsification held smoothly.
Some postoperative situations may force us to explant the intra ocular lens, for example subluxated IOL, calcified IOL, heavily glistening IOL, postop refractive surprise or even unhappy patient (with multifocal IOL). In these cases, we may or may not be able to take out the IOL solely without harming the capsular bag. Which cases could still be put a new IOL in the bag or in the sulcus will be guided clearly in this didactic course.
After an IOL explant or any other condition that left patient in aphakic without capsular bag, a secondary IOL implantation may need to do to improve his/her vision. One option that more physiological is IOL implantation in posterior chamber with scleral fixation. Fixating IOL by tying its haptics to the sclera with suture were proven facing some effects that may impair their vision due to IOL tilting, or decentration, or even worse subluxation due to suture degradation after years. A brilliant technique to fixate the IOL sutureless on the sclera introduced by Yamane will be demonstrated in detail by our expert.

Cataract surgery is now become a cataract refractive surgery with the availability of advanced technology IOLs like multifocal and toric IOLs to correct any refractive errors. Although the recent IOL formulas are getting better to predict the correct IOL power, further challenges are encountered in the process of IOL calculations when cataract surgery is to be performed on eyes with a history of refractive surgery, eyes with corneal ectasia, such as keratoconus, silicone filled eye and post keratoplasty also prove difficult for the surgeon in attempting to calculate accurate IOL power values using traditional methods. This didactic course will address how to improve IOL power calculation when dealing with eye with special cases.

Introduced as the least invasive among Cataract surgery procedures, phacoemulsification is expected to be safe . Different from other surgical procedures on the eye, most of the time phacoemulsification is performed under Retro-illumination which is expected to be stable throughout the surgery.

We open this DC with guidelines for settings of the operating microscope to obtain ergonomic perfect visualization with an evenly distributed retro-illumination and adequate depth perception. Settings may differ for each surgeon and specific for certain operating microscope brands.

Phacoemulsification is performed in a closed and watertight chamber. A precisely fashioned corneal incision to match the diameter of the instruments that are going into the eye is needed to maintain this chamber stability .

A properly fashioned incision will ensure a watertight-self sealing wound at the end of surgery.

The use of Ocular Viscoelastic Devices which were originally created to maintain a perfect voluminous chamber, has now been developed into a device to protect the endothelium and other delicate intraocular tissues. Each OVD variety has its own specific role during the process of phacoemulisification.

An ideal Continuous Curvilinear Capsulorhexis (CCC) is mandatory for the cataract surgery and for the Intraocular Placement. Several factors contributing to a centrally placed CCC are presented in the fourth session.

Ultrasound power, intraocular pressure/bottle height, vacuum and flow settings of the phacoemulsification machine will be presented in the last session of this DC, the phaco-dynamics for a safe and efficient surgery is mandatory to obtain an ideal visual outcomes after cataract surgery.

The aim of this DC is to teach surgeons to perfom safe harmless cataract surgery by means of the Phacoemulsification technique.

Barrett Formulae is considered as one of the most accurate intraocular lens (IOL) power calculation formulas. There is a need to conduct this didactic course on how to use the online calculator available free from the APACRS website. There are several topics to be discussed in this didactic course, including Barrett Universal II, Barrett Toric, Barrett True-K and Barrett Total Keratometry. Delegates will need to bring their own notebook to follow the instructors.

This comprehensive course will provide you with the in-depth knowledge needed to perform cataract surgery using various phacoemulsification techniques. Courses cover a variety of phaco techniques: divide and conquer, stop and chop, direct chop and pre chop. The speakers who are experts in the field of cataract phacoemulsification surgery will guide you to perform various phacoemulsification techniques step by step so that you understand well all the phacoemulsification techniques and can manage any complications during phacoemulsification surgery that may arise. So that you can do it safely and produce a good visual outcome after surgery.

On this didactic course, we will learn more about how it is important to perform slit lamp examination prior to (especially) cataract or corneal surgery. Considering that both clarity and normal structure is important even before posterior surgical procedure, careful anterior segment evaluation is mandatory for anterior segment surgical procedure. Nevertheless, anterior segment examination using slit lamp biomicroscope is inestimably precious on our ophthalmology daily practice. Knowing how to perform and what to look for might be the art of anterior segment examination. By completing this course, we were expected to be able to gain many valuable information with effective clinical procedure.

Opthalmology is the frontier in medical speciality which using subjective and objective scoring in many physical and biological interactiona aspect, and functional capacity; thus, it subsequently have an impact to the evolutional and yet, revolutional development of science and meticulous, digital diagnostic and micro-surgical technology.

This development is coined as the “predicted and computed surgery paradigm” which is derived from standard outcome, rather than the common mainstream way of thinking, the standard input and/or procedures. Such a paradigm can only become a reality, by many great inventio which aiming high, which are not just to cure or rehabilitate the avoidable blindness; but to optimize the visual acuity beyond their natural level through the refinement of microscopic digital cataract, lens and corneal refractive surgery.

This session will be highlighted those inventions which empowering and raising the bar of our profession.