Eyeworld

EW MEETING REPORTER 124 EyeWorld reports from the 2018 Combined Ophthalmic Symposium (COS), August 24–26, Austin, Texas countries, you may find yourself outside your wheelhouse. Many locations don't have subspecialty access, and telemedicine could be a good option. M. Bowes Hamill, MD, Hous- ton, focused his presentation on iris cysts, highlighting iris stromal cysts caused by implantation of limbal stem cells into the stroma, which can be seen after trauma or after surgery. These cysts are frequently large, thin walled, and filled with repli- cating epithelial cells, Dr. Hamill said, calling this type of cyst "a time bomb." The location and size of these cysts make it difficult to excise and remove surgically, and there is risk of epithelial ingrowth with cyst rupture. When treating the cyst, the goals, Dr. Hamill said, are to remove or debulk the cyst and to prevent the escape of epithelial cells from the cystic space. He described a modified tech- nique using intralesional ethanol injection for cyst drainage. His method involved entering through the conjunctiva, inserting the needle into the cystic space, aspirating the cyst and collapsing it, and using an- other syringe to inject alcohol. EW Editors' note: Dr. Raju and Dr. Hamill have no financial interests related to their comments. atopathy, recurrent erosions, bullous keratopathy, exposure keratopa- thy), chemical or thermal injuries, Stevens-Johnson syndrome/ocular cicatricial pemphigoid, infectious keratitis/corneal ulcers and perfora- tion, ocular surface disease and dry eye, and ocular surface reconstruc- tion, he said. Dr. Weikert noted that physi- cians should pay attention to the coding when using amniotic mem- brane. Editors' note: Dr. Yeu has financial interests with a number of ophthalmic companies. Dr. Weikert has no finan- cial interests related to his comments. Challenges, tricks, and musings The final session of the meeting featured presentations on a variety of topics. One topic highlighted by Leela Raju, MD, New York, was outreach and opportunities to get involved. Affordability and accessi- bility are the goals, she said, adding that much of her outreach work has been focused on children. She mentioned the value of preventative ophthalmology, including school screenings. Dr. Raju stressed that it's important to remember to work within the limits of that location, not just when doing surgery but also making sure the patient will be able to receive the follow-up necessary. When doing outreach work in other For these cases, Dr. Kim advo- cated for using the miLOOP device (Iantech, Reno, Nevada). When doing cataract surgery in patients with Fuchs' endothelial dystrophy, Dr. Kim suggested several surgical strategies: dispersive visco- elastic, surgical maneuvers, phaco power modulation, efficient I/A, IOL considerations, and FLACS/other devices. He stressed the use of disper- sive viscoelastic and phaco power modulation. He noted that ultra- sound power modulation can offer increased efficiency of torsional ul- trasound, greatly reduced repulsion, decreased turbulence, enhanced fol- lowability, less risk of thermal burns, and less endothelial trauma. Lastly, Dr. Kim highlighted re- tained lens fragments in cataract sur- gery, and he said it might be best to viscodissect the fragment, bringing it up to the wound and burping the fragment out. Dr. Kim said if you go in with an I/A tip, it could flush the fragment out and sometimes into the iris, and you might not be able to find it. Editors' note: Dr. Kim has no financial interests related to his comments. Ocular surface management Elizabeth Yeu, MD, Norfolk, Virgin- ia, gave an update on management of the ocular surface and discussed current options and those in the pipeline. She first noted that it's less common to have purely aqueous de- ficiency; meibomian gland dysfunc- tion is involved in greater than 80% of dry eye disease. There are targeted strategies based on disease severity and etiology, and she said to treat both signs and symptoms. Dr. Yeu highlighted options such as lubricants, nutrition, anti- inflammatory agents, and amniotic membrane. She briefly touched on lid margin disease management and some new investigational approach- es in artificial tears, neurostimula- tion, and anti-inflammatories. Mitchell Weikert, MD, Hous- ton, discussed the different types of amniotic membrane and ap- plications. You can use amniotic membrane for non-healing corneal epithelial defects (neurotrophic ker- October 2018 View videos from COS 2018: EWrePlay.org Alan Crandall, MD, makes the case for small incision cataract surgery in developing countries.

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