EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/104833
44 EW FEATURE February 2011 Retinal pharmacotherapy for the anterior segment surgeon January 2013 Pharmacological continued from page 43 just adjacent to the fovea or surrounding it like an island," Dr. Kaiser said. In such a case, the practitioner may fear that the cataract surgery will cause sight-threating progression. However, he said that the data here also remains inconclusive. "There are just as many papers that say [cataract surgery] causes progression as those that say it doesn't," he said. In this situation, Dr. Kaiser emphasized the importance of proper informed consent, in conjunction with discussing with the patient the benefits of cataract surgery. In such cases currently, pharmacology is not an issue beyond continuing Age-Related Eye Disease Study (AREDS) multivitamin supplementation. "At this point we don't have any treatment for dry AMD outside of the AREDS multivitamin regimen," Dr. Kaiser said. It is impor- tant to remember that there is no known therapy to slow expansion of geographic atrophy. Unearthing the edema layer In contrast, proper pharmacologic treatment for diabetic patients to control blood vessel leakage remains essential, Dr. Boyer said. He pointed out that a number of studies indicate that the cornea will swell simply from having cataract surgery, even for standard patients. This, he thinks, indicates that there's probably a small amount of increase in edema, even in cases where it doesn't become clinically significant or require treatment. However, in diabetic patients the increase in edema can be profound. "The addition of cataract surgery and the mild inflammation and hypotony that occur can cause a marked worsening in the diabetic macular edema," Dr. Boyer said. "This is a time when you have to give your injections or whatever treatment you're offering them and dry them out as completely as possible." Dr. Boyer advised practitioners to use an anti-VEGF agent or a steroid like 1 mm of triamcinolone to make sure that the inflammation doesn't increase. While neither the anti-VEGF nor triamcinolone will slow wound healing, the latter can cause pressure elevations, Dr. Boyer warned. He also recommended get- ting nonsteroidals and steroidals on board for a couple of weeks pre-op and then post-op using these for an extended period of time because diabetic patients are at much greater risk of developing or having worsening edema after cataract surgery. Likewise, Dr. Kaiser strongly advocates use of nonsteroidal medication pre- and post-op to stave off edema. "I like nonsteroidals for all patients, but in diabetics I almost consider it mandatory," he said. Overall, in performing phacoemulsification in this special population, Dr. Kaiser urged cataract surgeons to consult their retinal friends if they have any questions. "It's a partnership," he said. "If you have a diabetic patient considering cataract surgery and you're concerned about the outcome, the quicker you get [the patient] to us, the better." EW Editors' note: Dr. Boyer has financial interests with Alcon (Fort Worth, Texas), Allergan (Irvine, Calif.), Genentech (San Francisco), and Regeneron (Tarrytown, N.Y.). Dr. Kaiser has financial interests with Alcon, Bausch + Lomb (Rochester, N.Y.), Bayer (Leverkusen, Germany), Genentech, Novartis (Basel, Switzerland), and Regeneron. Contact information Boyer: 213-483-8810, vitdoc@aol.com Kaiser: 216-444-2020, pkkaiser@aol.com "Expanding the Realm of the Possible" "T he pursuit of education in the cornea subspecialty remains a most important mission of the Society," said Donald Tan, M.D., Singapore, president of the Asia Cornea Society (ACS). To this end, the organizing committee of the ACS meeting in Manila put together a "stimulating scientific program delivered by over 70 eminent international and regional corneal opinion leaders" around the theme of "Expanding the Realm of the Possible." At the opening ceremony of the 3rd Biennial Scientific Meeting of the Society, the ACS presented a number of awards: The Asia Cornea Foundation Medal, a medal lecture and the Society's most prestigious award "presented to a corneal specialist in recognition of an outstanding lifetime contribution to the field of cornea," was given to Richard Abbott, M.D., Mill Valley, Calif. The Association of Eye Banks of Asia (AEBA) Award, presented to "an ophthalmologist or non-ophthalmologist who has made a substantial impact and contribution to the development of eye banking," was given to Gullapalli N. Rao, M.D., Hyderabad, India. The first Saiichi Mishima Award, recognizing "the most outstanding contributions and achievements in scientific research in the field by a clinician or basic scientist in Asia," was given to Teruo Nishida, M.D., Yamaguchi, Japan. Finally, Congress president and chair of the organizing committee, Ma. Dominga Padilla, M.D., Manila, was nominated to deliver the Asia Cornea Foundation Lecture (Asia), a lecture "honoring an eminent Asian corneal clinician for his/her work in the field of cornea." The Asia Cornea Society 3rd Biennial Scientific Meeting ran from Nov. 28-29, 2012, in Manila.