OCT 2013

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

Issue link: https://digital.eyeworld.org/i/194331

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Page 116 of 134

114 EW MEETING REPORTER October 2013 continued from page 113 of experience using the technology, including six years of doing the procedure for 272 patients, 480 eyes. A majority of the eyes remained stable. "We had progression in only two patients," Dr. Tamayo said. "We are speaking about a real progress in the treatment of keratoconus, something that if you are a cornea surgeon you should have in your Sh ar pe n yo ur LEADERSHIP Sharpen your LEADERSHIP sk il ls and strengthen your skills and s t re ng t he n your NETWORK NETWORK with OWL!! O h OWL ? ! Ophthalmic Women Leaders leadership l advancement l community JOIN Ophthalmic Women Leaders (OWL) for powerful programming and more events than ever before. Connect with women leaders across ophthalmology in a unique collegial environment. OWL membership includes: Ȉ Ȉ Ȉ Ȉ Ǥ Ǥ ǯ Ƥ for the professional development and advancement of women. "Being part of OWL has given me immense opportunity for pportunity for networking, being mentored and more. I cannot recommend OWL more to someone who is new to the industry, or looking to make industry, y deeper roots. The experiences are invaluable." Allison Potter, Manager of Professional Relations, Potter, M r Professional Pascale Communications armamentarium. Results also confirm stabilization in cases of RK." At the end of follow-up only one eye lost two lines of best corrected visual acuity, but that was due to a corneal ulcer, he added. Dr. Tamayo said he changed to accelerated crosslinking two years ago, and since then none of his patients have experienced haze. The recovery time is shorter, too, he said. Contraindications include low endothelial cell count, scars in the visual axis, high expectations and curvatures greater than 60 D, unless the procedure is combined with Keraflex, Dr. Tamayo said. Dr. Tamayo said he has solid proof that crosslinking halts the progression of keratoconus, but he was quick to point out that he wasn't making any claims about improved vision. "I'm not saying we have a refractive treatment with crosslinking," he said. "If we follow the protocol, the worse scenario would be no effect. We are not making permanent damage to the eye. Crosslinking is not a refractive treatment, so you have to know this and tell this to your patients." Another option for treating keratoconus, Dr. Tamayo said, is surface ablation paired with crosslinking, a procedure he called "safe and effective." Other possible uses for crosslinking include degenerative myopia, melting of the cornea, as a coadyuvant in the treatment of corneal ulcers, to broaden the role of treatments with the excimer laser, and as a coadyuvant in other procedures such as surface excimer laser ablation, intrastromal rings or intraocular lenses, he concluded. PK vs. DALK DALK has yet to overtake PK as a main corneal transplant procedure, though keratoconus benefits tremendously from the procedure, said Shigeto Shimmura, MD, Japan, during the cornea session. DALK also is indicated for most stromal diseases, he said. Many surgeons have stressed that DALK is technically difficult, but it's getting easier thanks to newer techniques using air or viscoelastic before removing the stroma, Dr. Shimmura said. "There is no excuse not to try the technique, " he said. "You can generally produce a very smooth surface." There are some complications, however. Keratoconic eyes have very deep anterior chambers—too much air causes the membrane to rupture. "Deflate the anterior chamber— remove all the air—before doing the stromal dissection," Dr. Shimmura suggested.

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