Eyeworld

EW MEETING REPORTER 72 August 2018 Reporting from the 2018 World Ophthalmology Congress, June 16–19, Barcelona, Spain A human trial using this tech- nique is underway. Currently, five patients with moderate to severe dry eye disease have been recruited, treated in one eye, and followed out to 3 months. Fluorescein staining was reduced in all treated eyes within the first week, with the most prominent results after 2 months, Dr. Bar said. Three out of five pa- tients reported a reduction in eye lu- bricant use by at least half, and one patient taking cyclosporine for dry eye said the drug no longer stung upon application in the treated eye. Relief of symptoms was reported within 3–4 weeks. Recruitment for another 25 patients in this trial is ongoing. Joobin Hooshmand, MD, South Launceston, Tasmania, de- scribed Zepto (Mynosys, Fremont, California), a device that is inserted through a 2.2 mm incision and ap- plies brief pulses of energy to create a capsulotomy. In a prospective case study of 100 eyes, Dr. Hooshmand said 70 complete capsulotomies were created, 27 were incomplete (17 had focal attachment, 10 broad attach- ment), four capsule tears occurred, and treatment failed in three eyes. While animal and cadaver studies have shown perfectly rolled edges of the capsulotomy on scanning elec- tron microscopy, Dr. Hooshmand said they saw some irregularly rolled edges and other defects on their ex vivo human specimens. This, he in significantly decreasing visual analogue scale measurements, im- proving hyperemia (50% of treated eyes), improving corneal staining as measured by the Oxford scale by at least 2 degrees, and significantly increasing tear breakup time (TBUT). The lower dosage also improved TBUT and conjunctival hyperemia. TBUT improvement of the two doses was not significantly different when compared to placebo, but Dr. Bleau speculated this could be due to the small sample size of the study (20 patients in each treatment arm and in the placebo group). A Phase 3 clinical, double- masked study with 300 patients with moderate to severe dry eye is ongoing, using a 1.125% Tivanisiran dose. Asaf Bar, MD, Tel-Aviv, Israel, discussed transcranial neurostim- ulation—a type of treatment that has been used for other indications, such as depression and Parkinson's disease—as a potential noninvasive treatment for dry eye. The therapy, a pulsed magnetic stimulation that is performed once, takes 11 min- utes, has no contact with the eye, and results in a tingling sensation as reported by patients, Dr. Bar said. The treatment was first tested in an animal model, which showed less corneal staining and improved AC fluorescein concentration in the treated eye compared to the non-treated eye. of multiple sources for astigmatism measurement and at least two or three different devices to get the best overall picture. Dr. Weikert takes extra time with corneal marking to ensure the utmost precision. Finally, astigmatism correction and nomogram adjustment of small incision lenticule extraction (SMILE) for myopic eyes was addressed by Wang Yan, MD, Tianjin, China, who said the procedure showed acceptable outcomes in eyes with myopic astigmatism. A controversy centering on subjective versus objec- tive alignment exists due to the fact that SMILE is associated with a lack of eye tracking, uses surgeon-depen- dent centration, and has not been proven to benefit astigmatism cor- rection. Increasing the nomogram for astigmatism is important, she said. Factors influencing outcomes are the original cylinder value, angle kappa, cyclotorsion adjustment, bio- mechanical properties, the direction of the incision, and overall the need for further investigation. Updates on late-breaking news Attendees of a free paper session caught up on some of the news in the world of ophthalmic research. Several studies focused on differ- ent possible treatments for dry eye disease. Anne-Marie Bleau, PhD, Madrid, Spain, described a new class of RNA interferon (RNAi) drugs that could use a natural pathway to block several of the symptoms associated with dry eye. RNAi drugs, Dr. Bleau explained, act upstream of tradition- al medications, are long-lasting, very specific, and have few side effects. Tivanisiran (Sylentis, Madrid, Spain) inhibits the transient receptor potential cation channel subfam- ily V member 1 protein synthesis, which Dr. Bleau explained is an "important mediator of ocular pain signal." She said it is thought that topical Tivanisiran could reduce ocular pain and proinflammato- ry mediators and could modulate production of mucin protein to improve tear quality. Phase 1 studies showed systemic and ocular toler- ance in healthy volunteers. Two Phase 2 studies compared different doses (0.75% and 1.125%) with pla- cebo. Overall, 1.125% was effective View videos from the 2018 WOC: EWrePlay.org Kathryn Colby, MD, PhD, discusses do's and don'ts for keratoprosthesis.

• Cover