Eyeworld

EW MEETING REPORTER 72 November 2018 EyeWorld/ASCRS reports from the ASCRS Young Eye Surgeons Advanced Cataract Training, September 15–16, San Francisco EyeWorld/ASCRS reports from the ASCRS Young Eye Surgeons Advanced Cataract Training, September 15–16, San Francisco The posterior capsulotomy considerations depend on the age of the patient. If the patient is able to sit for a YAG, there is no need for a posterior capsulotomy, she said. Dr. Farid noted that clear cor- neal wounds in pediatric eyes don't seal very well with standard stromal hydration, and you may want to consider if suture closure is feasible in your patient. She said that a scler- al tunnel wound may be considered if you're dealing with a toddler or if there is concern for eye rubbing. She also mentioned that all IOL options are considered off-label for the pediatric population. If you're deciding to use an IOL, which could be a good option if the patient is older than 2 years old, it's important to discuss with a pediatric ophthal- mologist. She added that toric or multifocal/extended depth of focus lenses could be a good option in the adaptable pediatric population. Also during the session, Thom- as Oetting, MD, Iowa City, Iowa, shared his "5 tips for hyperopes." He first noted that the formula is critical. He said that a small pupil is common, and there may be risk of iris prolapse. Because of this, there is less room for a ring, so Dr. Oetting prefers iris hooks in these cases. He said to beware of laser pe- ripheral iridotomy (LPI), to protect the endothelium, and to break the nucleus into small pieces. Editors' note: Drs. Lin and Oetting have no financial interests related to their presentations. Dr. Farid has financial interests with a number of ophthalmic companies. Innovations in glaucoma surgery During a Saturday afternoon session focused on glaucoma surgery, Blake Williamson, MD, Baton Rouge, Louisiana, shared his nine pearls for intraoperative gonioscopy. With MIGS, the key is visualization, he said, and you can't treat what you can't see. First, he highlighted office- based gonioscopy, saying that Editors' note: Dr. Fram has financial interests with Shire. Managing the complex cataract patient A video/case-based session on Sun- day morning focused on managing the complex cataract patient. Dr. Lin shared a case dealing with iris prolapse. She first highlighted some of the risk factors for iris prolapse: pressure gradient present (too much posterior pressure), wound issues (too short, pushing on posterior lip), IFIS, the pupil not well dilated, and excessive iris manipulation. In dealing with iris prolapse, Dr. Lin said that the first rule is to always decompress the anterior chamber. If iris prolapse is mild, place viscoelastic to push it into the anterior chamber, she said. Gently reposit with a cannula (via wound or sweep across from paracentesis) and tap on the wound. Dr. Lin then shared a situation where iris prolapse complications occurred in a routine cataract case. Dr. Lin's 85-year-old patient had a lot of posterior pressure. She began with hydrodissection and saw big gradient coming out. But instead of compressing the anterior chamber, Dr. Lin tried to sweep the iris back, which caused a large iridodialysis. Dr. Lin was losing the iris/pupil margin. She put in iris hooks to try to help stabilize and get the iris back in. Eventually, Dr. Lin was able to get the wound sealed and sweep the iris back in, and her patient ended up happy and the iridodialysis set- tled down. Dr. Farid discussed manage- ment of pediatric cataracts. These require special considerations, she said, relating to the capsulorhexis, posterior capsulotomy and anterior vitrectomy, wound closure, and IOL options. When considering the capsulor- hexis, Dr. Farid said that the anterior capsule is thicker and elastic in the pediatric population. She suggested physicians "shear instead of tear," and start smaller, and you can en- large after IOL placement. Editors' note: Dr. Lin has no financial interests related to her presentation. Dry eye breakfast A breakfast session sponsored by Shire (Lexington, Massachusetts) delved into dry eye. Dr. Fram led a presentation and discussion, high- lighting dry eye and Xiidra (lifite- grast, Shire). When addressing dry eye with patients, you have to realize there's a huge amount of the population who doesn't know they have dry eye, she said, adding that dry eye can present in different ways. Dr. Fram said that when she was training, the way to treat dry eye was to prescribe an artificial tear. However, she noted that inflam- mation is a key component of dry eye disease, and it can cause ocular surface and tissue damage. Inflam- mation is a continuous cycle that will exacerbate dry eye until it is in- terrupted, she said. To treat dry eye, Dr. Fram said to consider treating the inflammation. She also mentioned several common risk factors that can lead to dry eye: topical and systemic medications, contact lens wear, non-surgical procedures, ophthal- mic surgery, comorbid conditions, and digital device use. Symptoms of dry eye disease are variable and can interrupt daily activities. Dr. Fram went on to discuss Xiidra to treat dry eye. She partic- ularly noted data from five clinical trials with more than 2,400 patients with Xiidra: four 12-week trials and one where patients were followed for a year. In three out of the four 12-week studies, Xiidra showed improvement in inferior corneal staining at 12 weeks. She added that in all four of the 12-week studies, Xi- idra showed relief from eye dryness at 6 and 12 weeks. There are some possible adverse reactions, Dr. Fram noted, which could include instil- lation site irritation, dysgeusia, and reduced visual acuity. The majority of adverse reactions were considered mild to moderate in the 1-year safe- ty study, Dr. Fram said.

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