Eyeworld

EW MEETING REPORTER 76 EyeWorld/ASCRS reports from the 2018 ESCRS Congress, September 21–26, Vienna, Austria tic screening and patient selection become more refined. Ridley Medal Lecture Rudy Nuijts, MD, PhD, Maastricht, the Netherlands, presented the Rid- ley Medal Lecture on "Facts First!" He highlighted the shift to "evi- dence-based medicine." He discussed evidence relating to several topics in ophthalmology: toric IOLs, the PREMED study, endo- thelial cell loss and phakic IOLs, and endothelial keratoplasty. Dr. Nuijts shared studies on how toric IOLs perform in relation to monofocals, marking with toric IOLs, and cost effectiveness. He also detailed results from the PREMED study, which looked at preferred preventive treatment of macular edema in non-diabetic and diabetic cataract patients. Dr. Nuijts shared results from a study looking at endothelial cell loss with iris-fixated phakic IOLs. He described a prospective, clinical co- hort study to evaluate the long-term change in ECD in a total of 507 eyes of 289 patients receiving the Artisan myopia and Artisan toric iris-fixated phakic IOL (Ophtec, Groningen, the Netherlands). Dr. Nuijts noted that the patient cohort was unique in this study because the same protocol and same specular microscope were Theo Seiler, MD, PhD, Zurich, Switzerland, argued that the best corneal refractive outcome is after PRK (surface ablation). In comparing LASIK and surface ablation, he noted that with surface ablation, you can save tissue. But he did add that rehabilitation/visual recovery with surface ablation takes longer. The ranges of treatment are similar for both procedures, he said. Eric Donnenfeld, MD, Rock- ville Centre, New York, argued that the best outcome is after LASIK. He shared a number of studies looking at outcomes with the two proce- dures. While Dr. Donnenfeld admit- ted that the visual outcomes may be similar following LASIK and PRK, he noted the potential for corneal haze following PRK. He also highlighted the comparison of safety with LASIK and PRK, and he said that the "one differentiating factor" was the risk for infection. He noted that in a study of more than 300,000 eyes, the risk of infection was five times greater with PRK than with LASIK. PRK has a higher risk of corneal ulceration and scarring, he added. Dr. Donnenfeld concluded by saying that LASIK is the safest, most successful, and most studied elec- tive procedure in the world. LASIK results have continually improved as technology and surgical techniques advance and preoperative diagnos- Her next step was to biopsy the conjunctiva, which confirmed the OSSN and PAM diagnosis. Dr. Karp stressed that OSSN can often hide in other diseases, and the high-reso- lution OCT aided her in this case to identify it. She added that OSSN can be treated medically or surgically. Finessing the application of crosslinking The ESCRS/EuCornea symposium on corneal crosslinking invited re- nowned speakers to update delegates on some of the newest, most influ- ential crosslinking studies. Theo Seiler, MD, PhD, Zurich, Switzer- land, clarified the technical aspects of the procedure. Shorter operation times are achieved by increasing the irradiance from 3mW/cm 2 up to 15mW/cm 2 without any loss of efficacy, and the application of ri- boflavin in HPMC solution shortens imbibition time from 30 to 10 min- utes. Oxygen flow over the cornea creates strong superficial crosslink- ing, however, good data is lacking. Switching UV light on and off does not increase efficacy, he said. In the long term, custom crosslinking will produce a greater response than standard crosslink- ing, said Cynthia Roberts, PhD, Columbus, Ohio. She said that the primary corneal alteration is focally biomechanical, and the future will lead to the ability to predict curva- ture changes that result in visual improvements for patients, based on initial biomechanical measurements. In a presentation on topogra- phy-guided crosslinking, Francois Malecaze, MD, Toulouse, France, showed evidence of its safety and efficacy in the treatment of progres- sive keratoconus. It is currently the most adapted solution for custom- ized treatments. Improvements are expected with transepithelial ribofla- vin solution and oxygen saturation. Controversies in cataract and refractive surgery The JCRS symposium explored con- troversies in cataract and refractive surgery. Topics included intraoper- ative OCT for the anterior segment, cataract surgery and corneal trans- plantation, and corneal refractive surgery. November 2018 continued on page 78 View videos from the 2018 ESCRS: EWrePlay.org Renato Ambrosio, MD, PhD, discusses methods of screening for ectasia using biomechanics and imaging. Sponsored by

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