Instructional Courses

Course 1: Intrascleral IOL fixation

Friday 2 October, 17.00 - 18.00 CEST | Room 4

Leader: O. Findl AUSTRIA

Faculty: G. Scharioth GERMANY, M. Kronschläger AUSTRIA

Course Description

Course will present instructions for IOL fixation using novel techniques: intrascleral canals, flanged haptics and sutures. Videos will illustrate the positioning of IOLs and the surgical pearls and pitfalls. Results and management of complications will be presented.

Course Objectives

Attendees will learn new techniques of IOL fixation in eyes without capsular support. The advances and difficulties of these techniques will be discussed critically.

Course Schedule

O. Findl Introduction and concepts: 5 minutes
G. Scharioth Intrascleral canals: 15 minutes
O. Findl Flanged haptics: 15 minutes
M. Kronschläger Flanging basics: 10 minutes
Complications / difficulties: All 15 minutes

Course 2: Therapeutic Corneal Refractive Surgery: Achieving Excellent Outcomes in Complications After LASIK or PRK

Friday 2 October, 18.15 - 19.45 CEST | Room 4

Leader: Dan Reinstein UK

Faculty: G. Carp UK, T. Archer UK

Course Description

Refractive complications of corneal surgery after previous corneal procedures (LASIK, PRK, RK, DALK, PK etc.) will be discussed. Patient complaints and diagnostic testing must lead to a specific diagnosis in order to best choose the therapeutic course of action (Wavefront-guided, Topography-guided, Trans-epithelial PTK or others). Subjective and objective tests will be discussed in the context of obtaining a diagnosis in the various types of complication (small optical zone, decentration, irregular astigmatism, irregularly irregular surfaces etc.).

Course Objectives

The attendee will attain a sound understanding of the diagnostic approach and optimal therapeutic actions possible in complicated corneal refractive cases.

Course Schedule

D. Reinstein Diagnostic technology and techniques for complicated cases after refractive surgery
G. Carp Treatment options for small optical zone / high spherical aberration (induced night vision glare and halos)
G. Carp Treatment options for decentration
T. Archer Treatment planning and population outcomes of topography-guided custom ablation
D. Reinstein Treatment options for irregularly irregular astigmatism
T. Archer Population outcomes of trans-epithelial PTK in irregularly irregular astigmatism
D. Reinstein Stromal topography-guided treatment and conclusions

Course 3: Tips and Tricks for Refractive Lens Exchange in Challenging Patients

Saturday 3 October, 09.00 – 10.30 CEST | Room 4

Leader: M. Nanavaty UK

Faculty: T. Kohnen GERMANY , P. Rosen UK, S. Srinivasan UK, J. Stevens UK, M. Pande UK

Course Description

This course will give very useful tips and trick for successful refractive lens exchange in challenging patients. The challenges discussed in this course will be at each step of the surgery from patient selection, assessment, preparation for surgery, anesthesia, intraoperative issues, management of intra and postoperative complications and handling expectations.

Course Objectives

The attendees will learn useful tips and tricks for successful counselling and selection of patients with refractive lens exchange, pre and intraoperative assessments, management of intraoperative challenges, managing patients expectations, managing postoperative complications and expectations. The cases will include refractive lens exchange in anxious patients & demanding patients and patients with dry eyes, previous retinal issues, corneal pathology, intraoperative complications & it's management, managing postoperative expectation, Excimer laser enhancements, intraocular lens exchange scenarios, etc.

Course Schedule

Each of the following speakers will present cases covering the above mentioned topics:
T. Kohnen (10 minutes) Discussion: 5 minutes,
J. Stevens (10 minutes) Discussion 5 minutes
P. Rosen (10 minutes) Discussion: 5 minutes
M. Pande (10 minutes) Discussion: 5 minutes
S. Srinivasan (10 minutes) Discussion: 5 minutes
M. Nanavaty (10 minutes) Discussion: 5 minutes

Course 4: Current state of CXL: Controversies and Recommendations

Saturday 3 October, 11.00 – 12.30 CEST | Room 4

Leader: F. Hafezi SWITZERLAND

Faculty: C. Mazzotta ITALY , R. Shetty INDIA, R. Vinciguerra ITALY, B. Randleman USA, T. Seiler SWITZERLAND

Course Description

This course will discuss the latest controversies and trends in CXL and will give clear clinical recommendations on the use of CXL for a number of indications, including ectasia, refractive laser surgery, and corneal infection.

Presentation 1: will give an overview about factors modulating CXL efficacy (i.e. oxygen) and how understanding these factors helps understanding the varying success rates of the clinical protocols.

Presentation 2: discusses epi-on and accelerated protocols and shows indications, results and pitfalls of these protocols.

Presentation 3: shines a light on the cell biology of CXL. Which proteins and enzymes are differentially regulated during and after CXL and how can we use this information to make CXL even better?

Presentation 4: explains new diagnostic approaches to measure the corneal biomechanical response in the living human eye. Techniques discussed include dynamic high-speed Scheimpflug imaging and Brillouin microscopy.

Presentation 5: is on PACK-CXL for the treatment of corneal infiltrates and ulcers. It will summarize the current state of clinical application, new experimental findings, and recent improvements of the technique.

Presentation 6: update on the current state of customized CXL, the use of CXL as a primary refractive surgery and new data on endothelial damage UV threshold levels.

Course Objectives

The objective of the course is to make the clinician familiar with the indications and contraindications of CXL. The course will provide a comprehensive overview on the current state of CXL, its principles, the technique, clinical indications and recommendations. 1) To update the clinician with the latest modifications of the treatment protocol, 2) To enable the clinician to choose the ideal treatment parameters for each indication, 3) To demonstrate future trends in the use of CXL and 4) to give clear and concise guidelines for treatment.

Course Schedule

F. Hafezi Essential modulators driving CXL success
C. Mazzotta Epi-on and accelerated CXL protocols
R. Shetty Biological responses in CXL
R. Vinciguerra Measuring in-vivo corneal biomechanics changes after CXL
B. Randleman PACK-CXL for infectious keratitis
T. Seiler Customized cross-linking and CXL as refractive procedure

Course 5: The Transition from Cataract Surgery to Refractive Cataract Surgery

Saturday 3 October, 14.15 – 15.45 CEST | Room 4

Leader: R. Morris UK

Faculty: P. Rosen UK , A. Shortt UK, R. Packard UK, M. Wevill UK, A. Hamid UK

Course Description

Many highly competent cataract surgeons wish to transition to refractive cataract surgery / refractive lens exchange / presbyopia correction. These patients have very different characteristics and requirements to those with age related cataract where the refractive outcome or the correction of presbyopia is not the principal requirement of the patient. This course discusses the changes required for the clinical assessment, investigation and counselling. We will describe the lens technologies and how they can be matched to the patient's requirements. The management of the complications and the strategies to deal with the unhappy patients are discussed with reference to actual clinical problems.

Course Objectives

For the competent cataract surgeon to understand the differences and learn how to transition to refractive cataract surgery and presbyopia correction. To be able to interpret the relevant investigations. To learn how to manage the patients and any complications.

Course Schedule

Cataract vs the refractive cataract surgery - what’s the difference
Patient characteristics, investigations and their interpretation
Counselling consent and medicolegal issues
Surgical options and lens technologies
Managing the complications: creating the happy from the unhappy patient
Case presentations

Course 6: Techniques and Devices for Surgical Reconstruction of Traumatic and Developmental Iris Defects

Saturday 3 October, 16.15 – 17.45 CEST | Room 4

Leader: S. Srinivasan UK

Faculty: K. Miller USA , M. Snyder USA, S. Masket USA

Course Description

Iris reconstruction is required in cases of partial defects or total aniridia. This course will review all the currently available artificial iris implants in Europe and North America, techniques and practical tips on implantation. Topics will include (1) Preoperative assessment and surgical planning for iris defects (2) systematic approach to iris reconstruction, (3) review of currently available iris reconstruction implants (in USA and Europe), (4) indications, (5) surgical techniques of each type (demonstrated with videos), and (5) complications and management. Surgical videos will be used extensively to demonstrate the techniques of each modality and the management of complications.

Course Objectives

After the course, the attendee will have gained a greater insight into the assessment, indications and surgical strategies available for reconstructing the iris together with management of complications in iris reconstruction.

Course Schedule

I. Approaches to iris reconstruction

a. How to assess patients with iris defects

b. When to use artificial iris implants

II. Review of currently available iris reconstruction implants

a. Historical models and approaches

b. Currently available Implants

i. Morcher

ii. Ophtec

iii. Dr. Schmidt

c. Implants Materials, Design and Models

i. Morcher – Aniridia /partial aniridia rings and implants

1. Aniridia rings

2. Aniridia implants (Models: 67, 68, 94)

3. Partial aniridia implants (Models 67, 94)

4. Partial aniridia rings (Models 96E, 96F)

ii. Ophtec – Iris Prosthetic systems (Standard and Custom designed)

1. Aniridia lens 1 (Model 310) for scleral fixation

2. Aniridia lens 2 (Model 311) for scleral/sulcus fixation

iii. Dr. Schmidt Custom Iris

III. Indications for the use of artificial iris implants

a. Patient selection

i. Pros and cons of each implants

ii. How to select an implant based on iris defect

b. Assessment of intraocular anatomy

Course 7: Therapeutic Refractive Surgery... Live! Grand Rounds on Complex Cases

Sunday 4 October, 09.00 – 10.30 CEST | Room 4

Leader: D. Reinstein UK

Faculty: J. Alio SPAIN, S. Mosquera GERMANY, A. Stojanovic NORWAY, J. Tan SINGAPORE, P. Vinciguerra ITALY

Course Description

Different aspects of therapeutic refractive surgery are covered in our didactic ESCRS instructional course. This course will serve as a grand rounds style interactive teaching course to complement the didactic course. We would usually include presentation of cases by attendees to engage with the expert panel and discuss the diagnosis and possible treatment plan. Given the virtual nature of the congress this year, different cases will be presented by each of the faculty, which will then be discussed by the rest of the expert panel. These cases will demonstrate that the majority of complications can be treated with the currently available technology. The panel will provide insight into the application and interpretation of the different diagnostics technologies currently available as well as describing the treatment planning process for complex therapeutic refractive surgery cases.

Course Objectives

The attendee will experience the discussion of complicated therapeutic refractive surgery cases by an expert panel and see in action the decision-making processes required for diagnosis and treatment planning.

Course Schedule

D. Reinstein Introduction to therapeutic refractive surgery, 10 minutes
J. Alio Therapeutic case 1, 15 minutes
P. Vinciguerra Therapeutic case 2, 15 minutes
A. Stojanovic Therapeutic case 3, 15 minutes
S. Arba Mosquera Therapeutic case 4, 15 minutes
J. Tan Therapeutic case 5, 15 minutes

Course 8: Astigmatism Management with Toric IOL

Sunday 4 October, 14.15 – 15.45 CEST | Room 4

Leader: J. Bovet SWITZERLAND

Faculty: F. Soler-Fernandez SPAIN, W. Hill USA, E. Assia ISRAEL, P. Stodulka CZECH REPUBLIC


Course Description

This course will review the state of the art for different toric IOL, calculation, IOL selection, surgical techniques to adjust the lens at the right degree, management of intra & postoperative complications, discussion to introduce the new multifocal toric IOL.

Course Objectives

Attendees will learn the theory of astigmatism and how to manage a toric IOL Attendees will be able to use, to adjust toric IOL & to use the different calculator for adjusting their lens.

Course Schedule

J. Bovet To understand the astigmatism and to adjust the toric lens, 15 min
W. Hill The pre-operative measurement of corneal astigmatism, 15 min
E. Assia Optimizing Toric IOLs, 15 min
P. Stodulka Torics IPCLs, 15 min
F. L. Soler-Fernandez, how to precisely position your toric lens, 15 min

Course 9: Strategies and Techniques for IOL Exchange

Sunday 4 October, 16.15 – 17.45 CEST | Room 4

Leader: M.J. Tassignon BELGIUM

Faculty: G. Auffarth GERMANY, V. Pfeifer SLOVENIA, S. Masket USA

Course Description

The number of procedures for IOL exchanges increases steadily each year. The reasons for IOL exchange are diverse: IOL opacification, IOL dislocation, IOL decentration, bad quality of image perceived by the patient after monofocal or premium IOL implantation, unexpected refractive outcome, damaged IOLs. This course will focus on different techniques of IOL exchange based on the indication, the IOL type, the integrity of the capsule bag and the refractive outcome.

Course Objectives

The aim of this course is: (a) to show the indications and surgical techniques for IOL exchange in Europe (M.J. Tassignon-G Auffarth-V Pfeifer) and in USA (Samuel Masket) (b) to show (video based), by all faculty members, different instruments that can be used for the purpose of IOLexplantation. Emphasis will be put on keeping the integrity of the capsular bag and zonules where possible, and how to increase the succes rate for capsule preservation by using the capsule peeling technique. 'c) Indications for the femtosecond laser to re-size the anterior capsulorhexis in case of capsule phymosis (S Masket). (c) to show different techniques of secondary IOL implantation after IOL exchange (scleral fixation, iris fixation, capsular support, sulcular support and different suturing techniques).

Course Schedule

Overview of IOL exchange indications and techniques (all faculty members)
Explantation techniques (all faculty members)
Secondary implantation techniques (all faculty members)
Helpful medical devices (all faculty members)
Capsular peeling (M.J. Tassignon- S Masket)
The faculty will promote an interactive Q&A with the audience