EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/115557
March 2013 He always uses this in persistent epithelial defects, including ulceration, acute chemical burns, high-risk penetrating and lamellar keratoplasty, and fornix reconstructive procedures; he never uses amniotic membrane in pterygia or bleb leaks where the tube is exposed, unless the eye is neurotrophic. "The bottom line is that while amnion has been a paradigm shift in ocular surface repair and rehabilitation, my belief is that the best substitute for conjunctiva is conjunctiva, because it is instantly available and readily prepared and infinitely more affordable," Dr. Kenyon said. "In the future, I see an increasing proliferation of both ocular and extraocular applications of amnion, as well as exploitation of its active ingredients." Editors' note: Dr. Kenyon has financial interests with Keera, the manufacturer of an amniotic membrane product. Topical antiviral for HSV In the past, when cornea specialists wanted to treat herpes simplex virus type 1 (HSV-1) epithelial keratitis topically, they had to use trifluorothymidine (TFT, Viroptic, Pfizer, New York), which needs to be refrigerated and dosed nine times daily. Topical acyclovir, the standard of care in other parts of the world, isn't available in the U.S. Today, oral antivirals such as acyclovir, valacyclovir, or famciclovir have been mostly replaced by a relatively new topical antiviral, ganciclovir 0.15% gel (Zirgan, Bausch + Lomb, Rochester, N.Y.), according to Marguerite B. McDonald, M.D., Long Island, N.Y. Ganciclovir inhibits HSV-1 and HSV-2, as well as Epstein-Barr virus, herpes zoster, cytomegalovirus, and HHV-6. Researchers also believe that it may be useful against adenovirus. "It is dosed one drop in the affected eye five times a day, which is basically every three hours while the patient is awake until the cornea heals, then three times a day for the next week," Dr. McDonald said, adding that there are no contraindications for the gel. "No refrigeration is required." Editors' note: Dr. McDonald has financial interests with Bausch + Lomb. Not so gentle? Though many physicians advise dry eye patients to scrub their lids with baby shampoo, Henry D. "Hank" Perry, M.D., Mineola, N.Y., says he's a little more cautious. Dr. Perry gave Hawaiian Eye attendees an update on dry eye diagnosis and treatments, including artificial tears and punctual plugs. "Lid hygiene is extremely important in treating these patients; warmth is especially important in helping meibomian gland secretions," Dr. Perry said. However, "I've always wondered why people use baby shampoo, since most of our patients have meibomian gland disease, which involves too much detergent in our tear film. The free fatty acids and inflammation lead to saponification or soap formation, so why in the world do we add shampoo to a problem that has too much to begin with?" Dr. Perry advocates tea tree oil shampoo on patients with MGD. Editors' note: Dr. Perry has no financial interests related to his talk. Friday, January 25 The final day of Hawaiian Eye 2013 focused on refractive surgery, with presentations on technical pearls, updates on research, and the latest and greatest on tools in vision correction. Scraping and replacement of the flap alone may be inadequate to treat epithelial ingrowth after LASIK, so surgeons may turn to other methods, such as suturing of the flap, tissue adhesive or amniotic membrane adhesive to manage it, reported Helen K. Wu, M.D., Boston, in the day's first presentation. "As we know, the incidence of epithelial ingrowth after primary LASIK is very low, but it is markedly increased after LASIK retreatments, particularly several years later," she said. "The potential danger with these patients is they don't have symptoms until it's too late and when the epithelium is advancing toward the visual axis." YAG treatment of areas of ingrowth also can be used in recalcitrant cases, but "prevention may be the best cure," Dr. Wu cautioned. "YAG energy should be delivered to the corneal flap interface beginning in the center of the opacity," she said. The least amount of energy required should be used (0.6 ml) to create the cavitation bubbles. EW MEETING REPORTER 161 Several treatments may be required. According to Dr. Wu, epithelial ingrowth can be prevented by using surface ablation rather than LASIK for patients who have anterior basement membrane dystrophy (ABMD). "Consider surface ablation with mitomycin-C for an enhancement procedure as an alternative to lifting flaps years after LASIK," she said. continued on page 162 San Francisco Dining - Quick guide Boulevard Aziza 1 Mission St. 415-543-6084 www.boulevardrestaurant.com Cuisine: French/American 5800 Geary Blvd. 415-752-2222 www.aziza-sf.com Cuisine: Moroccan Kiss Seafood DOSA on Fillmore 1700 Laguna St. 415-474-2866 www.kissseafood.com Cuisine: Japanese 1700 Fillmore St. 415-441-3672 www.dosasf.com Cuisine: Indian Acquerello Chowder's at Pier 39 1722 Sacramento St. 415-567-5432 www.acquerello.com Cuisine: Italian Pier 39, 2 Beach St. 415-705-5500 www.chowderspier39.com Cuisine: American