SEP 2013

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

Issue link: https://digital.eyeworld.org/i/176967

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Page 88 of 98

September 2013 Pearls continued from page 84 said. "After UVB exposure, mitomycin soaking has the most potent suppressive effect on post-PRK haze formation." However, because of the toxicity of mitomycin-C, alternatives should be explored, he said. He proposed the possibility of bevacizumab (Avastin, Genentech, South San Francisco) and rapamycin (Rapamune, Pfizer, New York) in corneal wound healing, which he and colleagues have been investigating. He said these drugs might be safe alternatives to mitomycin-C during refractive surgery to prevent postoperative corneal haze by "affecting the keratocyte number." The next step is a clinical trial of bevacizumab, Prof. Tchah said. Focus on the posterior capsule Roger Steinert, MD, U.S., discussed "The PCO-Multifocal IOL Connection" and said he wanted to explore the issue of posterior capsular opacification (PCO) with multifocal IOLs and some optical realities that multifocal IOLs can present. Dr. Steinert explained the way a person will see with a multifocal IOL. With a multifocal, you will see the combination of the sharp focused image with the out-of-focus image. There will be some blurring of the edge but an element of a sharp edge. "If you add those two things together, you have an understanding of why contrast sensitivity must be impaired with a multifocal lens," he said. Sometimes with PCO and a multifocal IOL, physicians automatically think to do an IOL exchange; sometimes physicians look at the posterior capsule and assume the problem is there. "It's very easy to start doing a YAG capsulotomy on these patients hoping to make them better," he said. However, he said that an IOL exchange should be the last option. He offered tips for how to assess PCO clinically. "The way that most physicians get deceived by the posterior capsule is the lack of understanding of the difference between back scattering and forward scattering," he said. He said you can get a view of retina detail with a direct ophthalmoscope. However, his preferred way is to "look at the red reflex with the posterior capsule in focus." If the capsule is causing optical disruption, the red reflex will be disrupted, he said. To look for evidence of this, you need to have the capsule in focus with the oblique slit beam but rotate that around to see the red reflex, Dr. Steinert said. From left: N. Venkatesh Prajna, MD, Chia Li Pang, Christopher Rapuano, MD, Michael W. Belin, MD, Donald Tan, MD, Elmer Tu, MD, Gail Reggio, and W. Barry Lee, MD, came together to discuss the first Cornea Day outside the U.S., which was held prior to the APACRS meeting.

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