NOV 2013

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

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November 2013 EW MEETING REPORTER 61 ESCRS Congress Current, future corneal endothelium techniques Key parameters in keratoplasty include vision and other aspects that are important for clinicians to be aware of, said Dr. van Rij in the EuCornea Medal Lecture. "It's all about quality of vision and how long does the graft survive," he said. "What's the endothelial density, and when we use corticosteroids, we will find secondary glaucoma, which is a big problem." In his lecture "The cornea: how many endothelial cells are necessary?" Dr. van Rij also discussed endothelial dysfunction and ways of treating it. He said that until recently, the majority of his keratoplasty procedures were for endothelial dysfunction, which remains the standard of care in those cases. "Most of us are doing endothelial keratoplasty. But in the future, we will prevent disease progression and maybe delay the need for surgery," he said. Future ways of preventing disease could be gene therapy and ROCK inhibitor eye drops, he said. For now, different types of treatments can assist with different cases, Dr. van Rij said. "It depends on the population you have," he said. "Traditional grafts in our hands mean trouble, ruptured corneas, ulcers, microsis, Acanthamoeba, that you cannot treat in other ways and you sometimes have to do penetrating keratoplasty, some mushrooms and some DALKs; it depends on the amount of keratoconus that you have," he said. Traditional penetrating grafts can result in ectasia and irregular astigmatism. In addition, sutures are required, and the trauma involved can lead to a weaker eye with more problems, Dr. van Rij said. He outlined other techniques, including DALK and the big bubble technique, both of which have many positive features. For instance, the big bubble technique at 9 mm offers long graft survival and no endothelial rejection. It also leads to a good visual outcome. However, it has a significant learning curve, he said. Dr. van Rij also touched on the question as to whether the femtosecond laser will improve keratoplasty results. He said a randomized prospective study is still needed to determine that answer. Cornea specialists highlight hot topics In the EuCornea symposium "What do I do differently this year than last year?" top experts in the field shared their experiences and knowledge on hot topics including corneal techniques of choice and corneal collagen crosslinking. Friedrich Kruse, MD, Erlangen, Germany, presented the talk "I switched from DSAEK to DMEK." He said there has been a great deal of debate about which technique to use, but he has made his choice. "What has been changing in our practice is that we have been moving entirely to DMEK from DSAEK," he said. He posed the question of "why should we move from DSAEK to DMEK" because DSAEK is a straightforward procedure to perform, while DMEK has been linked to technical issues. "The major reason why we think it's better to perform DMEK instead of DSAEK is because it renders better visual acuity. Why is this? You only need a very small cut to deliver the small graft, only 2.5 mm in contrast to DSAEK, which is a larger cut, so you have a problem of astigmatism. You don't need any sutures in DMEK. Your equipment basically costs nothing—you just need a razor blade and two forceps and maybe a trefoil." François Malecaze, MD, Toulouse Cedex, France, presented "I moved to last evolutions of transepithelial crosslinking." While conventional crosslinking, or epi-off, has been shown to be highly effective, it also comes with complications and risks, he said. Those can include pain, temporary lose of visual acuity, and stromal haze. He outlined several options in performing transepithelial crosslinking, or epi-on, and how those options work, along with study results and pros and cons of the procedure. Glaucoma Day addresses surgical, medical issues This year's ESCRS Glaucoma Day, with the scientific program organized by the EGS, featured topics ranging from challenging the concept of IOP as a vital glaucoma risk factor to medical treatment to surgical treatment. Leading experts in the field from Europe and around the world discussed the latest in glaucoma issues, including in diagnosis, treatment, and the burden of care. Burden of care serious issue in glaucoma The direct and indirect costs of glaucoma on society impacts people and countries globally, said Augusto Azuara-Blanco, MD, Belfast, U.K. Dr. Blanco presented "The burden of glaucoma on patients and society: direct and indirect costs" at the EGS/ESCRS Glaucoma Day. "The take-home message is that visual loss is very expensive to society," he said. In the U.K., it costs more than £500 million a year to care for glaucoma patients. In the U.S., the cost is nearly $3 billion. Dr. AzuaraBlanco discussed how indirect costs could be just as important, not only for medical reasons, but also in impacting family and friends. People who are blind from glaucoma need assistance doing simple tasks, including reading mail, putting in eye drops, and going to ophthalmology appointments. That can lead to a burden on family and others who help care for blind patients, he said. Watch the EyeWorld Video Reporter at www.EWrePlay.org

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