JUN 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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June 2013 December 2011 May 2013 EW NEWS & OPINION 9 ASCRS update 2014 ASCRS Winter Update by Vanessa Caceres EyeWorld Contributing Writer In the journal … June 2013 Phacoemulsification after DMEK Fayyaz U. Musa, FRCOphth, Javier Cabrerizo, MD, Ruth Quilendrino, MD, Isabel Dapena, MD, Lisanne Ham, PhD, Gerrit R.J. Melles, MD After a patient has undergone Descemet's membrane endothelial keratoplasty (DMEK) for conditions such as Fuchs' endothelial dystrophy or bullous keratopathy, how do things bode for phacoemulsification? Results from a comparative case series of 106 consecutive phakic DMEK eyes showed there is little need for added concern. In the series, five of the DMEK eyes later needed to undergo phacoemulsification. This took place a mean of 9.5 months after the initial DMEK surgery and was uneventful, with the Descemet's graft remaining in place in all cases. All eyes here attained 20/30 or better corrected distance visual acuity at the six- and 12-month marks. After phacoemulsification, also at the six- and 12-month marks, endothelial cell density dipped to a mean of 1158 mm2 from a mean of 1535 mm2 prior to cataract surgery. All of the corneas stayed clear, and there were no significant changed in pachymetry noted here. Investigators concluded that there is little risk of graft detachment for those who undergo phacoemulsification after DMEK. Predictable refractive outcomes, usually showing improvement, after phacoemulsification in these patients were seen, with a decrease in endothelial cell density that was considered acceptable. IOP measured by a new tonometer-pachymeter after LASEK Kyung Eun Han, MD, Hye Sun Kim, MD, Na Rae Kim, MD, Ikhyun Jun, MD, Eung Kweon Kim, MD, Tae-im Kim, MD Investigators here took intraocular pressure (IOP) measurements with a new tonometer-pachymeter device (Tonopachy, Nidek) and compared these measurements, garnered before and after myopic LASEK, to those taken with standard Goldmann applanation tonometry (GAT), dynamic contour tonometry (DCT), and noncontact tonometry (NCT). Preoperatively, measurements made by the new Tonopachy device correlated with all of the others. Postoperatively, investigators found that there continued to be a correlation between measurements taken by three of the tonometers, but not with the DCT device. However, postoperatively the corrected IOP values of the DCT and tonometer-pachymeter formula 3 did not change. Investigators also found that using GAT and NCT, the percentage change in IOP measurements correlated with the percentage change in central corneal thickness and corneal curvature and change in diopters, but not with those of the new tonometer-pachymeter or the DCT. The conclusion reached was that after LASEK the corrected IOP using the tonometer-pachymeter formula 3 was similar, as was that attained using the DCT. Review/update: Refraction after vitrectomy and phacovitrectomy Hassan Hamoudi, MD, Morten La Cour, MD It may be par for the course in those who have undergone vitrectomy and phacovitrectomy—a myopic shift in refraction. In this review, investigators honed in on studies involving phakic and pseudophakic eyes that had undergone vitrectomy and phacovitrectomy for macular hole or epiretinal membrane. They determined that cataracts will usually develop in phakic eyes that undergo macular hole or epiretinal membrane surgery. Investigators, therefore, considered it important to look at the sequence of surgeries here. They reviewed whether performing combined phacovitrectomy, performing vitrectomy first followed by cataract surgery, or removing the cataract first followed by vitrectomy might have an impact on the myopic shift. They concluded that no matter the sequence, most studies showed a myopic shift in eyes undergoing these procedures. Meeting to provide personal interaction and cutting-edge education C atch up on ophthalmic education in a gorgeous location during the dead of winter at the 2014 ASCRS Winter Update, to be held Feb. 13-17 in Fajardo, Puerto Rico. The meeting will take place at El Conquistador, a Waldorf-Astoria property. The El Conquistador is located where the Caribbean and Atlantic meet, and there are panoramic views throughout the resort. The resort features 23 restaurants, lounges, and cafes. Onsite activities include a water park, private island, an Arthur Mills golf course, spa, beach and horseback riding, and shops. El Conquistador is located near El Yunque National Forest and the La Laguna Grande Bioluminescent Bay. The location offers a respite from the winter cold—the average temperature is 84 degrees F during the day and 69 degrees F at night. Clinical sessions will feature a range of topics to help expand your anterior segment knowledge and revitalize your practice. In addition to the clinical sessions, there will be an ASOA practice management track. "The ASCRS Winter Update meeting is truly a unique educational experience," said ASCRS Winter Update co-chair Edward J. Holland, MD, Cincinnati. "There is a world-class faculty presenting in an informal setting. In addition, the meeting attendees have the opportunity to converse with the faculty through the unique interactive format that has become a hallmark of this meeting." Fellow co-chair Roger F. Steinert, MD, Irvine, Calif., agreed that the Winter Update's smaller size is always a highlight. "This meeting is structured to address the hot topics in anterior segment surgery in a more intimate setting that encourages a lot of faculty and attendee interaction," he said. "The venue and timing also encourage family to come and enjoy a spectacular warm setting in the dead of winter." Fellow co-chair Stephen S. Lane MD, Stillwater, Minn., believes this will be the best ASCRS Winter Update thus far. "Set in a beautiful family-friendly Caribbean location, the facility offers many amenities and is easy to get to. Learn in a casual setting from some of the best-known faculty in the world who will use largely video-based media to illustrate points. Audience participation is encouraged, and audience and faculty interaction is a large part of the curriculum. Whether you are looking for an educational tune-up or to discover the latest in technology and techniques, the Winter Update should not be missed." For more information on the 2014 ASCRS Winter Update and to register, go to winterupdate.org. EW Femtosecond continued from page 3 Return on investment According to the respondents, 59% of the single-surgeon centers (13/22) and 95% of the multi-surgeon centers (41/43) are surpassing the breakeven point of 19 cases a month. On average, those centers are performing 57 cases a month with the laser, with most performing somewhere between 19 and 60 cases (although 17 centers perform between 61 and 100 cases a month with the laser). Most centers purchased the femtosecond laser, with only 7% leasing the equipment. A good number of respondents (83%) have a positive outlook on the return on investment or believe the volume has already surpassed the breakeven point. Although a smaller percentage, 3% of respondents said the laser has already paid for itself. Lastly, on a scale of 0 (very unlikely) to 10 (very likely), 42% said they were very likely (a score of 9 or 10) to recommend their peers get involved with the technology. According to Mr. Mahdavi, this annual survey is helping demystify the economics around acquiring the laser for a surgical practice. The data, coming directly from users, are very powerful at providing an accurate picture of the real world adoption of this technology, he said. Sponsors of the survey were Alcon (Fort Worth, Texas), Bausch + Lomb (Rochester, N.Y.), OptiMedica (Sunnyvale, Calif.), and LENSAR (Orlando, Fla.). EW Contact information Mahdavi: shareef@sm2strategic.com

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