Eyeworld

73 August 2018 EW MEETING REPORTER Lisa Arbisser, MD, Salt Lake City, highlighted three key papers during her presentation. The first she discussed was the extensive study from the Aravind Eye Hospital on "Endophthalmitis reduction with intracameral moxifloxacin prophy- laxis: analysis of 600,000 surgeries." The purpose of this study was to compare the rate of postop endoph- thalmitis before and after initiation of intracameral (IC) moxifloxacin prophylaxis. This was a retrospective clinical registry of 617,453 cases over a 29-month time, about half before and half after initiation of IC moxifloxacin. Dr. Arbisser discussed the meth- od: 0.1 ml moxifloxacin 0.5% was instilled into the anterior chamber at the conclusion of cataract surgery. Topical ofloxacin was used pre- and postop for all patients, and data was collected prior to and after begin- ning intervention. The study was started in August 2014 in 10 Aravind centers for both charity and paying patients, and endophthalmitis rates were evaluated for all cohorts. Results found that there were no adverse events, no TASS, and no corneal decompensation. Both groups had comparable rates of complications. The overall rate of endophthalmitis after initiating IC moxifloxacin declined from 0.071% to 0.020%, Dr. Arbisser said. There was a three-fold reduction in the MSICS patients and a six-fold reduc- tion in the phaco patients. Overall, there was a 3.5-fold decrease in endophthalmitis. Next, Dr. Arbisser discussed a systematic review and meta-analy- sis of "Intraocular lens dislocation in pseudoexfoliation" (conducted by Pedro Vazquez-Ferreiro and colleagues). This pooled analysis yielded an odds ratio of 6.02 for IOL disloca- tion in patients with pseudoexfo- liation, and high odds ratios were detected for both early and late dislocation. There were no signif- icant associations detected when the results were stratified by year, incision size, or use of hooks or retractors. Only 14 studies met the strict criteria of the analysis. prospects offered by MIGS. Com- paring landmark trials revealed that the iStent (Glaukos, San Clemente, California), CyPass (Alcon, Fort Worth, Texas), and Hydrus (Ivantis, Irvine, California) all showed >20% IOP reduction over phaco, fulfill- ing the primary study goals, with iStent achieving a reduction of 53%, CyPass 77%, and Hydrus 77% at 24 months. MIGS with medications after prior failed trabeculectomy achieved the IOP goal of 12–13 mm Hg with few secondary interven- tions. Dr. Craven said that quality of life studies with the Hydrus showed visual acuity recovery to be on par with phaco, and comparison of quality of life outcomes between MIGS and trabeculectomy were simi- lar. He noted that IOP tended to stay down when more than one iStent was used. Looking to the future, he sees all three devices on-label for mild to moderate open angel glauco- ma, but thinks that larger studies are needed on their standalone efficacy and other indications. Finally, achievements in cornea and the external eye began with a discussion on a new herpes zoster vaccination. George Florakis, MD, New York, explained that there is an increasing rate of varicella zoster virus worldwide and that herpes zoster ophthalmicus arises in up to 76% of these individuals. A new recombinant, adjuvanted zoster vac- cine has shown 97% efficacy for rash prevention and 91% for post-her- petic neuralgia. Dr. Florakis also described a novel approach to treat endothelial dysfunction known as Descemet's stripping only (DSO) for the treatment of Fuchs' endothelial dystrophy that has the advantages over DMEK of no rejection, donor infection/expense, rebubbles, refrac- tive shift, or chronic steroids. Second Landmark Achievements session highlights IOL complications, surgical retina, and more The second Landmark Achievements reviewed some of the most import- ant achievements in managing IOL complications, choroidal diseases, surgical retina, and clinical trials and management of uveitis from 2016–2018. the prospect of replacement cells, for instance for retinitis pigmentosa. CRISP/CAS9 may have the potential to correct genetic defects in vivo and AAV gene therapy was seen to improve vision in TRDs. Finally, a new treatment with vitamin B3 may help glaucoma patients. Achievements in ocular oncol- ogy were presented that are mak- ing definitive strides in addressing treatments and saving lives. Carol Shields, MD, Philadelphia, shared developments in the treatment of conjunctival tumors, retinoblasto- ma, lymphoma, choroid melanoma, and in tumor biomarkers. She said that the three "biggies" are ocular surface squamous neoplasia (14%), melanoma (12%), and lymphoma (7%). Ocular surface squamous cell carcinomas are generally large, recurrent, bilateral, and very inva- sive, and have both surgical and non-surgical treatment options. Non-surgical options include MMC, 5-FU, and interferon. Dr. Shields said that retinoblastomas hardly lead to enucleation anymore thanks to today's standard of intra-arterial chemotherapy, reducing deaths from retinoblastoma in the U.S. to 12%. Finally, a new agent (AU-011) is in trial in the U.S. for the treatment of choroidal melanoma, which once injected and light-activated, causes the targeted necrosis of tumor cells. E. Randy Craven, MD, Bal- timore, spoke about the exciting noted, could have been due to in- consistent distribution of energy or the OVD used might have interfered with suction of the device. Passing this information onto Mynosys, Dr. Hooshmand said several changes were made to Zepto and a new study of 52 eyes resulted in a 96% rate of complete capsulotomy. While Dr. Hooshmand said Zepto shows promise as an innovative device, he thinks it requires more investigation in terms of safety and noted cost as being a barrier over manual capsulo- tomy creation. Progress that will change the future The World Ophthalmology Congress Day of Landmark Achievements re- viewed the most important achieve- ments in ocular genetics, ocular oncology and pathology, MIGS, and cornea and external eye disease from 2016–2018. David Mackey, MD, Perth, Australia, spoke on ocular genetics, highlighting the most cited papers from the past 2 years. Studies point toward a new understanding in the genetic mechanism of AMD (with a common gene being identi- fied in most AMD patients), glauco- ma (three new genes identified for POAG and five identified for PACG), myopia, cataract, diabetic retinop- athy, and inherited retinal diseases. Dr. Mackey showed how stem cells provide disease in a dish model and View videos from the 2018 WOC: EWrePlay.org Boris Malyugin, MD, PhD, discusses the use of the femtosecond laser to create a capsulotomy in cases of severe zonular dialysis. continued on page 74

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