Eyeworld

95 EW MEETING REPORTER tears. The first amniotic membrane dissolved quickly, and an amniotic membrane was reinserted 3 days later. The patient ended up needing a tarsorrhaphy, Dr. McDonald said, and 8 days later, there was complete healing. Four months and 1 week after first presenting, the patient returned to 20/20 uncorrected on no medications. One problem with this case, Dr. McDonald said, is that the girl was able to order the lenses online with- out consulting a doctor. She stressed the importance of reporting sites that sell these types of unapproved lenses to the FDA. Editors' note: The speakers have financial interests with a number of ophthalmic companies. Surgical cornea panel The second panel featured modera- tors Sumit "Sam" Garg, MD, Irvine, California, and Elizabeth Yeu, MD, Norfolk, Virginia, with panelists Zaina Al-Mohtaseb, MD, Houston, Brandon Ayres, MD, Philadelphia, John Berdahl, MD, Sioux Falls, South Dakota, Alan Faulkner, MD, Honolulu, Sumitra Khandelwal, MD, Houston, and Sonia Yoo, MD, Miami. Dr. Khandelwal shared a case of OSD conjunctivochalasis. This is an under-represented diagnosis, she said, and patients often present with epiphora, dry eye, and other symptoms where nothing seems to work. Panelists agreed that this is something they see quite a bit. Dr. Faulkner said that many of his patients with this problem pres- ent purely with tearing, and many note that the problem is worse in down-gaze reading. Conjunctivochalasis is a grow- ing condition, Dr. Khandelwal said, and, it's seen more in scleral lens wearers. She noted several approaches for management: focal cauteri- zation, diffuse cauterization, and surgical excision. EW Editors' note: The panelists have finan- cial interests with a number of ophthal- mic companies. a cost aspect, she said. Monovision can go through the patient's insur- ance, and it's cheaper than some of the premium options. It could also be an option if the patient has a his- tory of enjoying monovision; if the patient is highly motivated and not willing to accept dysphotopsias; and if the patient does not require a high degree of depth perception. Some of the benefits of mono- vision are it maintains quality of vision; it's easy to simulate with contact lenses; you can avoid unpre- dictable dysphotopsias; it provides a high degree of spectacle indepen- dence; studies support a high level of patient satisfaction; you may avoid loss of contrast sensitivity; monovision is less dependent on the ocular surface compared to multifo- cals; and it's inexpensive. There are some limitations, in- cluding potential loss of stereopsis, each eye is dedicated to a different focal point, and some patients may not adapt. Dr. Donaldson shared her "3 keys to successful monovision": 1. Choose your patients wisely. 2. Set accurate expectations before surgery. 3. Do a trial before surgery. Editors' note: Dr. Donaldson has finan- cial interests with a number of ophthal- mic companies. The SALT trial Jeffrey Goldberg, MD, Palo Alto, California, presented on the Steroids After Laser Trabeculoplasty (SALT) trial. The purpose of the study was to determine whether short-term use of steroids or NSAIDs affects the efficacy of selective laser trabecu- loplasty (SLT). The study was a double-masked, randomized, placebo-controlled clin- ical trial conducted at the Bascom Palmer Eye Institute and the Uni- versity of Pittsburgh Medical Center Eye Center (and analyzed by the University of California, San Diego and Stanford University). The pri- mary outcome was IOP lowering of each group versus placebo at 6 and 12 weeks, with secondary outcomes of anterior chamber reaction and ocular discomfort. Participants were double masked and randomized to three groups: ke- torolac 0.5%, prednisolone 1%, and saline tears. All groups were asked to use their drop four times daily for 5 days, where the first day was the day of SLT. Dr. Goldberg said all patients were pretreated with one drop of apraclonidine immediately before the laser treatment, and 180 to 360 degrees of the angle was treated with SLT using 50 to 100 non-overlap- ping applications, with a spot size of 400 µm (centered on the trabecular meshwork) and pulse duration of 3 ns. The initial energy used was 0.8 mJ, and the energy was titrated to champagne bubble formation. The study ended up including 96 eyes of 85 patients and there was no difference in baseline IOP among the three groups. Dr. Goldberg said that at 6 weeks, there was a trend toward better IOP lowering in the non-ste- roidal and steroid groups compared to the saline tears group. This trend became statistically significant at 12 weeks. For the secondary outcomes, there was no inflammation past 1 hour, with no difference between groups. Dr. Goldberg noted that the study had some limitations, includ- ing a small sample size and a short follow-up period. There need to be repeated studies to generate confi- dence in the results. In summary, he said that the trial showed that both NSAIDs and steroids resulted in improved IOP lowering compared to placebo. He noted that this can potentially be applied to practice now. Editors' note: Dr. Goldberg has finan- cial interests with a number of ophthal- mic companies. Medical cornea panel A panel focusing on medical cornea included moderators Preeya Gupta, MD, Durham, North Carolina, and Francis Mah, MD, La Jolla, Califor- nia, with panelists Kendall Don- aldson, MD, Plantation, Florida, Marguerite McDonald, MD, Lyn- brook, New York, Lisa Nijm, MD, Warrenville, Illinois, Priyanka Sood, MD, Atlanta, William Trattler, MD, Miami, and Helen Wu, MD, Boston. Dr. Sood shared a case of a 68-year-old man who presented with blurry vision since his cataract surgery at an outside hospital. He denied any pain, flashes, floaters, or veils of vision loss. On exam, Dr. Sood discovered a central detach- ment of Descemet's membrane. Interestingly, within a month of this patient presenting, she had another patient with the same prob- lem. A 71-year-old female patient presented with clouding vision, and she also denied flashes, floaters, or veils of vision loss. The patient's exam also showed central Descem- et's detachment. In both cases, Dr. Sood said there didn't seem to be any corneal edema. Anterior segment OCT can help show the height of detachment. The ultimate goal in these sit- uations is reattachment. If you can get reattachment, you'll decrease the risk of pigment clumps and signifi- cant visual disturbances, she said. However, both of Dr. Sood's pa- tients had pigment clumps already, so she didn't think that reattach- ment would help. In both cases, she ended up doing descemetorhexis of that small area. In the long term, the patients did well. Dr. McDonald presented a case of a 13-year-old girl who had taken her mother's credit card and ordered blue tinted contact lenses from the internet. The lenses were not FDA approved, and the girl had no fitting session with an optometrist or ophthalmologist. The patient wore the lenses for a few hours on two consecutive days and developed pain and loss of visual acuity. She was managed for 2 days before being referred to Dr. McDonald for poor response to topical lubrication and antibiotics. The patient had severe photo- phobia and was in agonizing pain. She also had non-healing epithelial defects. Dr. McDonald noted that the left eye healed, but the right eye would not, so she put an amniotic membrane in and initiated serum March 2019

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