Eyeworld

JUL 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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July 2012 DUOVISC® Viscoelastic System is designed to give two viscoelastic materials with different physico- chemical properties that can be used differently and/or sequentially to perform specific tasks during a cataract procedure. DUOVISC® of VISCOAT® Viscoelastic System consists PROVISC® Ophthalmic Viscosurgical Device and Ophthalmic Viscosurgical Device. CAUTION: Federal law restricts this device to sale by or on the order of a physician. VISCOAT® OVD (Sodium Chondroitin Sulfate – Sodium Hyaluronate) Ophthalmic Viscosurgical Device INDICATIONS: VISCOAT® OVD is indicated for use as an ophthalmic surgical aid in anterior segment procedures including cataract extraction and intraocular lens (IOL) implantation. Viscoat maintains a deep anterior chamber during anterior segment surgeries, enhances visualization during the surgical procedure, and protects the corneal endothelium and other ocular tissues. The viscoelasticity of the solution maintains the normal position of the vitreous face and prevents formation of a flat chamber during surgery. WARNINGS: Failure to follow assembly instructions or use of an alternate cannula may result in cannula detachment and potential patient injury. PRECAUTIONS: Precautions are limited to those normally associated with the surgical procedure being performed. Although sodium hyaluronate and sodium chondroitin sulfate are highly purified biological polymers, the physician should be aware of the potential allergic risks inherent in the use of any biological material. ADVERSE REACTIONS: VISCOAT® OVD has been extremely well tolerated in human and animal studies. A transient rise in intraocular pressure in the early postoperative period may be expected due to the presence of sodium hyaluronate, which has been shown to effect such a rise. It is therefore recommended that Viscoat be removed from the anterior chamber by thorough irrigation and/or aspiration at the end of surgery to minimize postoperative IOP increases. Do not overfill anterior chamber. ATTENTION: Reference the Physician Labeling/Directions for Use for a complete listing of indications, warnings and precautions. PROVISC® OVD (Sodium Hyaluronate) Ophthalmic Viscosurgical Device INDICATIONS: ProVisc® OVD is indicated for use as an ophthalmic surgical aid in the anterior segment during cataract extraction and intraocular lens (IOL) implantation. Ophthalmic viscoelastics serve to maintain a deep anterior chamber during anterior segment surgery allowing reduced trauma to the corneal endothelium and surrounding ocular tissues. They help push back the vitreous face and prevent formation of a flat chamber during surgery. PRECAUTIONS: Postoperative increases in intraocular pressure have been reported with sodium hyaluronate products. The IOP should be carefully monitored and appropriate therapy instituted if significant increases should occur. It is recommended that PROVISC® OVD be removed by irrigation and/or aspiration at the close of surgery. Do not overfill anterior chamber. Although sodium hyaluronate is a highly purified biological polymer, the physician should be aware of the potential allergic risks inherent in the use of any biological material; care should be used in patients with hypersensitivity to any components in this material. Cannula assembly instructions should be followed to prevent patient injury. ADVERSE REACTIONS: Postoperative inflammatory reactions such as hypopyon and iritis have been reported with the use of ophthalmic viscoelastics, as well as incidents of corneal edema, corneal decompensation, and a transient rise in intraocular pressure. ATTENTION: Reference the Physician Labeling/Directions for Use for a complete listing of indications, warnings and precautions. A new technique for safe, atraumatic removal of intraocular foreign bodies Jeffrey Olson, M.D., Douglas Mackenzie, M.D. Developed by Drs. Olson and Mackenzie at the University of Colorado, the Lens Wrangler Device is a new surgical tool for difficult intraocular procedures. Using suction, the handheld instrument can be used to grasp and manipulate objects such as dislocated IOLs, sub- luxed crystalline lenses, or intraocu- lar foreign bodies. Often these items are too large or irregularly shaped to be held with conventional forceps. Corneal crosslinking for infectious keratitis Lawrence R. Tenkman, M.D., Francis W. Price Jr., M.D., Marianne O. Price, Ph.D., Amilia Schrier, M.D. This prospective pilot study, conducted at two centers, evaluated the use of riboflavin/ultraviolet-A (corneal crosslinking) for treatment of infectious keratitis in conjunction with topical anti-microbial therapy. Forty patients were enrolled; bacteria species were identified in 24 eyes, fungal in 7, protozoa in 2, viral in 1, and no identification was made in 6. Patients were between 14 and 86 years old, and the maximum infiltrate diameter ranged from 1-12 mm. Seven eyes had a previous keratoplasty, and 30 (75%) were al- ready being treated with antibiotics when referred. The results suggested that photo-activated riboflavin was promising for adjunct treatment of infectious keratitis, and it appeared to be most effective when the infec- tion was limited to the anterior por- tion of the cornea. The success rate IOL continued from page 19 Trokel SL, Srinivasan R, Braren B. Excimer laser surgery of the cornea. Am J Ophthalmol. 1983;96(6):710-5. Wang L, Hill WE, Koch DD. Evaluation of in- traocular lens power prediction methods using the American Society of Cataract & Refractive Surgery Post-Keratorefractive Intraocular Lens Power Calculator. J Cataract Refract Surg. 2010;36:1466-73. Editors' note: Dr. Butler is affiliated with the Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver. Dr. Henderson is affiliated with Ophthalmic Consultants of Boston, Waltham, Mass., and Harvard Medical School, Boston. They have no financial interests related to this article. Contact information Butler: butler.ande@gmail.com Henderson: bahenderson@eyeboston.com was higher for bacterial infections than fungal infections. Conjunctival rotational flap combined with fibrin glue and MMC for primary pterygium surgery: Long-term follow-up David Zadok, M.D., Sigal Zmujack- Yehiam, M.D., Oren G. Benyamini, Yakov Goldich, M.D., Isaac Avni, M.D., Orly Wussuki Lior The purpose of the study was to assess the safety and efficacy of intraoperative MMC as adjunctive treatment for primary pterygium surgery using rotational conjunctival flap with fibrin glue. We invited for examination all subjects who under- went surgery for primary pterygium using a rotational conjunctival flap with fibrin glue between 2004-2009. Follow-up period was at least 12 months. We compared the outcome in eyes that had been treated with intraoperative MMC 0.02% for 2 minutes with those in whom MMC had not been used. The main out- come measures were recurrence and complication rates in each study group. Included in this study were 77 eyes of 67 patients. Forty-three eyes had been treated with MMC, and 34 had surgery without MMC. Duration since the surgery ranged from 12-65 months. The total recur- rence rate using fibrin glue was 5.2% (4/77), with intraoperative MMC 4.6% (2/43) and without intraopera- tive MMC 5.9% (2/34) (P=0.81). Of the four eyes with recurrence, two eyes were re-operated with no fur- ther recurrence or complication. No other serious complications were re- ported. In one patient, the flap de- tached requiring a second surgery to reposition the flap. We found no sig- nificant difference in the recurrence rate or complications whether or not intraoperative MMC was applied when using a rotational conjuncti- val flap and fibrin glue in primary pterygium surgery. Residents and Fellows Best Paper of Session Corneal wavefront aberrations and pseudoaccommodation with aspheric monofocal IOLs Rory A. Myer, M.D., Marc A. Michelson, M.D. Pseudoaccommodation describes functional near vision in an emmotropic or distance-corrected pseudophakic eye. We studied asso- ciations between corneal wavefront aberrations and pseudoaccommoda- tion in patients who had cataract surgery with implantation of an aspheric IOL (SN60WF, Alcon, Fort Worth, Texas). Using data from corneal topography (Humphrey Atlas, Carl Zeiss Meditec, Dublin, Calif.), we compared the mean wavefront values of 25 patients with near vision ≥J3 (pseudoaccommoda- tors/PA) and 30 patients with near vision ≤J5 (presbyopes/PR). For the 6 mm optical zone, significant mean differences included vertical coma (PA 0.299 µm, PR 0.172 µm), root mean square (RMS) of coma (PA 0.275 µm, PR 0.188 µm), and distance of coma (absolute value of the difference between the two coma terms) (PA 0.403 µm, PR 0.203 µm). For the 3 mm optical zone, significant mean differences included vertical coma (PA 0.049 µm, PR 0.027 µm) and distance of coma (PA 0.065 µm, PR 0.039 µm). Our study suggests that pseudoac- commodation with aspheric IOLs is associated with coma-like corneal wavefront aberrations. EW ASCRS Best papers of session © 2011 Novartis 11/11 © 2011 Novartis 11/11 VIS11628JAD-PI VIS11628JAD-PI

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