EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78708
66 EW MEETING REPORTER June 2012 Reporting live from the 2012 ASCRS•ASOA Symposium & Congress, Chicago Highlights from coverage of the 2012 ASCRS•ASOA Symposium Friday, April 20 Real-world advice for difficult cases focus of Glaucoma Day Angle-closure glaucoma patients with elevated intraocular pressure and glaucomatous optic neuropathy should get a laser iridotomy, recom- mended Thomas D. Patrianakos, M.D., Chicago, during ASCRS Glaucoma Day 2012. The jury is still out, however, on which primary angle-closure suspect patients would benefit from the treatment. Patient medication compliance remains a significant barrier in glaucoma therapy, said Douglas J. Rhee, M.D., Boston. "The best tool you have is doctor-patient communication," he said. "Whatever chair time you can give will maximize impact." During chair time, it is critical to emphasize medication won't improve vision. Dr. Rhee also recom- mended providing written instruc- tions and coupling dosing with a daily activity to help patients remember their drops. Despite the potential of MIGS devices, Kuldev Singh, M.D., Palo Alto, Calif., believes glaucoma surgeons will still be doing trabeculectomy in 5 years. When choosing between performing a trabeculectomy and a tube shunt surgery, surgeons have to look at a variety of factors including IOP goal and conjunctiva scarring. If a patient does have scarring, Dr. Singh recommended tube shunts. "Trab is generally the first proce- dure in my high-risk glaucoma patients," he said. "Always keep in mind what you're going to do if the procedure you're doing at the pres- ent time fails. None of these surger- ies last forever." Tube shunt surgery is not with- Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team from the 2012 ASCRS•ASOA Symposium & Congress, Chicago. Meeting Reporter sponsored by Alcon. out complications, though, as Celso Tello, M.D., New York, pointed out in his talk. Many of these difficul- ties—such as conjunctival erosion, strabismus, and implant extrusion— ASCRS president Edward J. Holland, M.D. (left), welcomes incoming president David F. Chang, M.D. (right) Source: Convention Photo by Jeff Orlando can be avoided by improving surgical technique. "Tubes can be inserted in the anterior chamber, the sulcus, or the pars plana," he said. "If it is a pseudophakic patient I prefer to put the tube in the sulcus. I like to inject viscoelastic into the sulcus to elevate the iris and to push the iris and the capsule posteriorly. You can also inject an air bubble." Marlene R. Moster, M.D., Philadelphia, gave pearls for avoid- ing and tackling early post-op tra- beculectomy issues. Too much flow through the flap will give an unex- pected hypotony. "Controlling flow is the key to success," she said. "Put extra sutures in and remove them early and often to [achieve] the best pressure and flow desirable for your patient and for a potentially excellent result." Editors' note: The doctors mentioned have no financial interests related to their comments. Cornea Day starts out strong The morning sessions of Cornea Day (co-sponsored by the Cornea Society and ASCRS) began with Graham D. Barrett, F.R.A.C.O., Perth, Australia, declaring incision security during phaco "depends largely on the con- struction and the size of the incision and is unlikely to be dramatically improved by femtosecond technol- ogy." Prof. Barrett added the tech- nology "may not be ready for prime time." Conversely, Robert J. Cionni, M.D., Salt Lake City, said his group found the technology to be "supe- rior in effective lens position pre- dictability," and in his practice, "63% of our patients are now opting for astigmatic correction" with the femtosecond cataract laser. For the more advanced corneal surgeon, Michael Snyder, M.D., Cincinnati, discussed his techniques for iridoprosthesis (none of the iris devices are approved for use in the U.S.); three manufacturers in Europe make the devices (Ophtec, Groningen, the Netherlands; Morcher, Stuttgart, Germany; and HumanOptics, Erlangen, Germany). "Damaged irises can be success- fully repaired, and when significant amounts of iris are missing, implants can be very helpful," he said. The second morning session featured a he said/she said format, with topics ranging from penetrat- ing keratoplasty versus deep anterior lamellar keratoplasty to Descemet's