EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78708
June 2012 proval process and medical device reform, are slated to be included. The goal is to sign into law an omnibus bill before the August recess, according to a press release from ASCRS. "I'm not proposing that we change the high standards of safety and effectiveness in the U.S.," Rep. Paulsen said. "This is not about get- ting rid of the FDA or watering down our standards. We must streamline and modernize the FDA so this industry remains strong." Achieving the best refractive outcomes in cataract surgery In a joint symposium sponsored by ASCRS and the Japanese Society of Cataract and Refractive Surgery, Richard J. Mackool, M.D., New York, said marking the cornea cor- rectly is a key component to success- ful surgery, and a new corneal marker made of titanium "will leave less abrasions than the ones we're currently using." He also advocates using penetrating limbal relaxing incisions (PLRIs) because they will not result in corneal changes. "PLRIs are a simple, safe, and ef- ficient way to reduce astigmatism," he said. Naoyuki Maeda, M.D., Osaka, Japan, said astigmatism analysis "is not easy." To minimize the variables, he said axial measurements may be most important. Using combination aberrometry and topography can re- sult in a small change in the cornea and improvement of astigmatism when using lower level toric lenses (specifically the T3-T5, Alcon, Fort Worth, Texas). Stephen S. Lane, M.D., Stillwa- ter, Minn., is a strong advocate for using aberrometry pre- and intraop- eratively. "Get it right, right on the table, the first time," he said, noting he uses the ORA (WaveTec, Aliso Viejo, Calif.). "It will capture your outcomes and give you customized and personalized results." Eric D. Donnenfeld, M.D., Long Island, N.Y., said one advan- tage of the femtosecond technology is its ability to create customizable flaps. "The ability to control astig- matism is really in our hands now," he said, and surgeons can opt to cor- rect the refractive error pre-op or in- traoperatively (or even post-op). Douglas D. Koch, M.D., Hous- ton, said calculating IOL powers in the post-refractive eye "has always been difficult." Both LASIK and pho- torefractive keratectomy change the ratio of the amount of corneal curve, and corneal power is used to deter- mine effective lens position. Surgeons can eliminate the erbium laser phacoemulsification errors by using the double-K or Holladay II IOL calculators, he said. Editors' note: Dr. Donnenfeld has financial interests with Abbott Medical Optics (Santa Ana, Calif.), Alcon, and WaveTec. Dr. Koch has financial inter- ests with Ziemer (Alton, Ill.). Dr. Lane has financial interests with SMI (Germany) and WaveTec. Dr. Mackool has financial interests with Alcon. Dr. Maeda has financial interests with Top- con Medical Systems (Oakland, N.J.). Monday, April 23 Say goodbye to PKP for endothelial issues A revolution is among us—in corneal transplantation. That's ac- cording to Deepinder K. Dhaliwal, M.D., Pittsburgh, who enthusiasti- cally supports procedures like deep anterior lamellar keratoplasty (DALK) over penetrating kerato- plasty (PKP). "We do not need to do PKP for endothelial stromal disease or ecta- sia," she said at a symposium titled "Controversies in Keratoconus, Cataract, and Custom Ablation." Rather, there are many benefits of DALK, which include the long- term viability of endothelium and less graft failure. "There's no chance for blinding endothelial rejection [with DALK]," Dr. Dhaliwal said. "There's also less steroid exposure, hence a decreased risk of cataract and glaucoma." Sutures can be removed earlier with DALK, she said. Visual rehabili- tation is faster. "You can do a PKP later if vision is suboptimal," Dr. Dhaliwal noted. Dr. Dhaliwal also noted the in- traoperative benefits of DALK with Abbott Medical Optics presents High Definition Live Surgery at the Art Institute of Chicago Source: Convention Photo by Jeff Orlando an interesting story of a 370-pound patient with advanced keratoconus undergoing the procedure under general anesthesia. During the procedure, the anes- thesia wore off as the patient began thrashing about. "We were quite concerned," Dr. Dhaliwal said. "We feared an explo- sive corneal hemorrhage." Instead, Descemet's membrane was strong enough to withstand the forces, she said. Had the patient been undergoing PKP instead, the scenario would have been quite dif- ferent and visually devastating, she said. The DALK technique is more technically challenging than PKP, admittedly, she said. There's also the potential for interface scarring with DALK. Visual acuity results are com- parable for both techniques, Dr. Dhaliwal said. "But DALK is my procedure of choice when the endothelium is normal," Dr. Dhaliwal said. "New devices and technologies are making it even easier to perform." Editors' note: Dr. Dhaliwal has no financial interests related to her comments. Tuesday, April 24 The glaucoma- cornea conundrum We continue to feel the repercus- sions of the "baby boom" of the post-war years. As that population EW MEETING REPORTER 69 ages, the number of patients with glaucoma increases exponentially, said David A. Goldman, M.D., Palm Beach Gardens, Fla. Dr. Goldman focused on the consequences of treatment, saying that doctors need to be cognizant of the side effects of glaucoma drops on the anterior segment, especially the cornea. For instance, the prostaglandin analogue latanaprost has been asso- ciated with anterior uveitis, with discontinuation of the inflammation occurring with discontinuation of the drops. The drops have also been associated with the occurrence of cystoid macular edema 1-11 months after initiation of therapy. Meanwhile, carbonic anhydrase inhibitors have been associated with endothelial dysfunction 3-20 weeks after initiation of therapy. Preservatives, particularly benza- lkonium hydrochloride (BAK), have long been known to have cytotoxic effects on corneal epithelium; fur- thermore, while the use of any drops causes tear dysfunction, parameters such as tear breakup time are re- duced to a greater degree from base- line by drops containing BAK. Doctors must be mindful of the differences between each class and should change medicine class when necessary to optimize treatment while reducing complications. Continuing the theme of "The Conundrum of Glaucoma and the continued on page 70