Eyeworld

EW MEETING REPORTER 96 February 2011 ner, can be combined with collagen crosslinking for excellent results, Dr. Raizman said. He showed a video of the procedure using the Keraflex KXL (Avedro, Waltham, Mass.). "The application of energy actually takes less than a second," he said. Mi- crowave energy is applied to the sur- face of a pre-cooled cornea, which results in a toroid of collagen shrink- age in the superficial cornea. "There is also flattening of the central cornea, which will be particularly ef- fective for keratoconus," Dr. Raiz- man said. He said the procedures have been done in Europe and Asia, with the 6-month follow-up having good initial results. "There are a lot of interesting applications for this technology," he said. "Things are evolving, and I think there is truly a revolution in our management of keratoconus. I think we're going to see a decreasing reliance on pene- trating keratoplasty." Editors' note: Dr. Perry doesn't have any financial interests to report. Dr. Price doesn't have any financial inter- ests to report in association with his talk. Dr. Raizman has a financial inter- est with Avedro. The final day of Hawaiian Eye 2011, Friday, January 21, focused on refractive surgery, with sur- geons and experts offering tips on the many ways the procedure is done in clinical practice. Stephen D. Klyce, Ph.D., Mount Sinai School of Medicine, New York, offered refractive surgeons a few pearls on effective patient screening for forme fruste keratoconus using topography and pachymetry. "It's very important to identify and screen these patients before (refrac- tive) surgery because ectasia can and does develop," he said. Reduced pre- op corneal thickness is one of the risk factors for ectasia after refractive surgery, Dr. Klyce said, citing a 2003 study published in Ophthalmology. Ultrasound pachymeters are consid- ered the gold standard of care for measuring corneal thickness, but slit-based devices are gaining popu- larity because they also give pachymetry readings over the entire surface of the cornea. Corneas thin- ner than 510 microns have a higher risk for the development of ectasia, Dr. Klyce said. Pellucid marginal degeneration puts patients at a higher risk of de- veloping ectasia than keratoconus, Dr. Klyce said. Topography will show a claw or C-shaped figure and skewed radial axes, as well as against-the-rule corneal astigmatism on one cornea and with-the-rule on the other. "That's an abnormality," Dr. Klyce said. "Both corneas should be topographically similar." Restasis (cyclosporine, Allergan) is not useful in routine refractive surgery, according to David J. Tanzer, M.D., San Diego. Dr. Tanzer started a study to determine whether cyclosporine improves visual out- comes, quality of vision, and symp- toms following PRK or LASIK in routine use. "We are endeavoring to enroll 100 patients to have PRK and another 100 to have LASIK," Dr. Tanzer said. Fifty patients in each will be treated with cyclosporine and the other 50 will not. In interim results, the patients who are enrolled in the study showed better best cor- rected and uncorrected vision post- op without the aid of the drug in both procedures. Low contrast acu- ity also was better without cy- closporine, especially in the PRK group. Dry eye symptoms appeared worse with cyclosporine, as did over- all vision. "Results are trending to- ward concluding that cyclosporine is not useful in routine refractive sur- gery—both PRK and LASIK." Editors' note: Dr. Klyce has financial interests with AMO, AcuFocus, ForSight Vision3 (Menlo Park, Calif.), LensAR, NIDEK (Fremont, Calif.), and Ocularis Pharma (North Riverside, Ill.). Dr. Tanzer had no financial interests to report. Reporting live from the 2011 Hawaiian Eye Meeting, Maui, Hawaii by Jena Passut Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team continued from P. 94

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