Eyeworld

UPDATE 17 "Situations that may merit consider- ation of CyPass Micro-Stent position adjustment or removal include, but are not limited to: intermittent or persistent contact between the CyPass Micro-Stent and the corneal endothelium; significant decrease in endothelial cell density that ap- pears related to CyPass Micro-Stent positioning or stability; iris-cornea touch; persistent hypotony; per- sistent uncontrolled uveitis; recur- rent or persistent hyphema with IOP elevation above target pressure; or any anatomic or functional clinical sequelae of the anterior or posterior segment that may cause a threat to vision." Eyes with 0 or 1 ring of the CyPass device visible in the an- terior chamber by gonioscopy: Without clear evidence of corneal decompensation, the consensus was that no action other than clinical monitoring is recommended. Eyes with 2 or 3 rings of the CyPass device visible in the anterior chamber by gonioscopy: In these eyes, there is a greater risk of corneal ECL. However, not all eyes in this category will experience clinically meaningful ECL. Without clinically significant evidence of corneal decompensation, no action other than monitoring is indicated. More frequent corneal evaluation could be considered. Considerations for device revision If corneal decompensation develops and >1 ring of the device is visible, the surgeon may consider CyPass repositioning, removal, or proximal end trimming. It was the consensus of the group that implant reposi- tioning, i.e., deeper implantation, would be most safe if performed within 7–10 days of implantation. Beyond this time period, there was concern expressed by the group that fibrosis around and/or through the filtration holes of the device may create a higher risk of complications with device repositioning. Due to the potential for fibrosis around and possibly investing the device, device removal was not favored by the group. Trimming of the proxi- mal end is likely to be the preferred procedure if the patient and physi- cian desire intervention. Technical descriptions of the procedures are described in the CyPass Micro-Stent IFU. A detailed overview of the re- sults from the 5-year follow-up study of the CyPass Micro-Stent is avail- able at www.alcon.com/CyPass. EW Disclaimer: This consensus statement is provided by ASCRS for informational and educational purposes only and is intended to offer practitioners recom- mended monitoring and treatment op- tions for cataract patients who received the CyPass implant. Practitioners should use their personal and profes- sional judgment in interpreting these recommendations and applying them to the particular circumstances of each affected cataract patient. This docu- ment is not intended to provide medical advice, create a standard of care, or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtain- ing the same results. Adherence to these recommendations will not ensure successful treatment in every situation. The information in this statement is provided "as is," and ASCRS makes no warranties as to its accuracy or completeness. This consensus statement may need to be updated as future stud- ies on the effect of the CyPass implant are conducted. In the journal Transepithelial photorefractive keratectomy: review study Soheil Adib-Moghaddam, MD, Saeed Soleyman-Jahi, MD, Ali Sanjari Moghaddam, MD, Niloofar Hoorshad, MD, Ghazale Tefagh, MD, Ali Haydar, MD, Marjan Razi- Khoshroshahi, MD, Samuel Arba Mosquera, PhD The use of transepithelial photorefractive keratectomy (transPRK) was initially introduced with the aim of forestalling issues with conventional PRK and LASIK. However, transPRK, which is usually followed by PRK in the two-step platform, when compared to conventional PRK was not seen to be superior in terms of safety or efficacy. Better comparative safety results were found, however, using the single-step transPRK epithelial and stromal ablation, using an Amaris laser (Schwind eye-tech-solutions, Kleinostheim, Germany). New improvements to the Amaris laser have included reverse single-step transPRK and use of smart pulse technology to offer a smoother stromal bed counter after ablation. A modified nomogram was also used in a refined single-step platform for determination of ablation parameters, which in hyperopia resulted in better comparative results. Investigators think that more substantial evidence could be gleaned with use of comparative trials comparing these new methods with other modern laser-assist- ed approaches. Influence of the vitreolenticular interface in pediatric cataract surgery Jan Van Looveren, MD, Arnout Vael, MD, Nick Ideler, MD, Hedwig Sillen, MD, Danny Mathysen, PhD, Marie-José Tassignon, MD In this prospective case series, investigators set out to examine the impact that the condition of the Berger space as well as abnormal growth of the vitreolentic- ular interface can have on complications during primary posterior continuous curvilinear capsulorhexis in pediatric cataract cases. Of the 64 pediatric cataract cases included here, 35 abnormalities were found in the Berger space. In cases with persistent fetal vasculature as well as those with posterior cataract, inves- tigators found that there was most likely to be anterior vitreolenticular inter- face abnormalities, with significantly more occurring when there was posterior capsule plaque and a unilateral cataract. During such pediatric cases, breaks in the anterior hyaloid membrane occurred in 58.6% of cases, with unintended vit- rectomy arising in 13.8% due to the fact that the primary continuous curvilinear capsulorhexis was more surgically demanding. In all but one of these pediatric cases, investigators found that it was possible to use bag-in-the-lens IOL implan- tation. Investigators concluded that during pediatric cataract surgeries, especially those involving a PCP in a unilateral cataract, they often encountered primary vitreolenticular interface abnormalities. They stressed that the primary posterior continuous curvilinear procedure may ultimately be complicated by the presence of anterior vitreolenticular interface abnormalities, which may at times result in an unintended anterior vitrectomy. A phase 3, prospective, randomized, open label, parallel-design, multicenter study to evaluate the safety of IBI-10090 for inflammation associated with cataract surgery Eric Donnenfeld, MD, Kerry Solomon, MD, Cynthia Matossian, MD This prospective randomized multicenter trial of 194 patients compared the impact of anterior chamber intracameral dexamethasone suspension IBI-10090 for treating inflammation after cataract surgery with use of prednisolone acetate 1% drops. Patients were either given a 5 microliter intracameral injection of IBI-10090 or told to take one drop of prednisolone four times a day for 3 weeks following the procedure. Investigators found that 96.8% of the 130 patients who received the IBI-10090 completed the trial, as did 94.5% of those receiving the prednisolone acetate. There were no serious adverse events related to the treat- ment, although there were two serious unrelated occurrences reported. There was no significant difference in the decrease in endothelial cell density found when the treatment groups were compared. Systemic adverse events were slightly more common in the prednisolone patients, occurring at a rate of 10.9% versus 7.9% of those receiving the IBI-10090. Investigators determined that at the postop- erative 8-day mark, 51.6% of those who had received IBI-10090 had attained anterior chamber cell clearing compared with 50.9% of those in the prednisolone group. By the 90-day mark, 98% of all eyes had attained such clearing. When asked whether not having to use eye drops was convenient, 68.7% of those given the intracameral IBI-10090 strongly agreed that this was an asset, as did 39.2% of those who took the prednisolone drops, who acknowledged they would have preferred the dropless approach. Investigators concluded that while there was similar safety and efficacy with the two approach, the IBI-10090 was ulti- mately favored. EW October 2018 For the online version, complete with hyperlinks and supporting figures, go to ascrs.org/CyPass_Statement.

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