Eyeworld

EW MEETING REPORTER 114 March 2011 D espite powerful winter storms in the northeast U.S., attendees flocked in record num- bers to the 4th ASCRS Winter Update Meeting in Palm Beach, Fla., which offered im- portant clinical information from experts in an intimate atmosphere. The interactive morning session began Friday, January. 28, with seven complicated cataract cases pre- sented by moderator David F. Chang, M.D., clinical pro- fessor of ophthalmology, University of California, San Francisco. An expert panel discussed op- tions available to surgeons when dealing with cataract and uveitis, a bag-IOL dislocation, weak zonules, polar cataracts, vitreous loss, rock- hard cataracts, and unhappy multi- focal IOL patients. In one case, Dr. Chang used a Malyugin ring (MicroSurgical Tech- nology, Redmond, Wash.) to dilate and expand the small pupil of a 37- year-old woman with a significant case of uveitis, rather than an iris re- tractor or other ring. "One of the things that I think is nice about (the Malyugin ring) is you don't stretch the pupil way be- yond the diameter that you need," Dr. Chang said. "I particularly like this for tiny, fibrotic pupils and a fragile iris." Vincent P. de Luise, M.D., assis- tant clinical professor of ophthal- mology, Yale University School of Medicine, New Haven, Conn., said the Malyugin ring does less damage to the iris and is a better choice for cosmetic reasons because patients get a rounder iris. "One of the problems with the Malyugin ring is removing it and re- moving it safely without tearing the iris," he said. "That needs to be con- sidered carefully." To quiet the eye pre-op, besides using topical steroids, most of the audience members said they would add oral plus periocular or intraocu- lar injections. "Strive for zero inflammation. You need an absolutely quiet eye, as few cells and flare as possible, ideally no cells and flare," Dr. de Luise said. "I would have started pre-opera- tively with immunomodulation." The panelists discussed which type of IOL they would use in this case—hydrophobic or hydrophilic acrylic, silicone, collamer, or poly- methylmethacrylate (PMMA). Dr. Chang said silicone could be used, as well as either acrylic. "The answer is you can use all of these modern-day materials," he said. Dr. de Luise said it's crucial to make sure the IOL is fully in the bag. "There's no doubt that chafing of the haptics against the back of the iris will cause increased inflamma- tion," he said. To prevent posterior synechiae, it's important not to leave the implant in the sulcus, the panel said. "The plastic needs to be in the bag," Dr. de Luise said. "In these eyes, inflammation can be chronic and cause systoid macular edema, which may be harder to treat in the uveitic eye than in the non- uveitic eye." Editors' note: Drs. Chang and de Luise have no related financial interests. Tools for imaging the anterior segment In a lunchtime workshop, experts gave overviews of devices for ante- rior segment imaging and diagnostic testing. R. Doyle Stulting, M.D., Ph.D., Woolfson Eye Institute, At- lanta, uses anterior chamber optical coherence tomography for mapping opacities and evaluating pathology, detecting keratoconus, detecting and evaluating LASIK flaps, and calculat- ing IOL power, as well as for anterior chamber biometry and post-op eval- uation of patients. Gary J. Foster, M.D., Fort Collins, Colo., gave attendees an overview of Scheimpflug imaging with the Pentacam (Oculus, Lynnwood, Wash.) and GALILEI Dual Scheimpflug Analyzer (Ziemer Ophthalmic Systems AG, Port, Switzerland), a technology he uses as a screener for all of his refractive pa- tients. "I don't like to operate without knowing what the posterior surface is doing," Dr. Foster said. Confocal microscopy is working to replace the specular microscope, according to Jonathan B. Rubenstein, M.D., vice chairman of ophthalmology, Rush University Medical Center, Chicago. The devices are especially good for detecting microbial keratitis, Acanthamoeba, and fungi, he said. "Acanthamoeba is a very tricky diagnosis, and this has been a Reporting live from ASCRS Winter Update, Palm Beach, Fla. by Jena Passut and Faith A. Hayden Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team.

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