Eyeworld

April 2011 Reporting live from APAO 2011, Sydney, Australia Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team. EW MEETING REPORTER 64 As APAO Sydney 2011 continued March 23, members of the Tear Film and Ocular Surface Society reported on the results of the recently concluded International Workshop on Meibomian Gland Dysfunction. Meanwhile, experts talked about changes currently being made to improve the "gold standard" procedure in glaucoma surgery. MGD, international Published literature reports an "ex- cess of meibomian gland dysfunc- tion [MGD]" in the Asia-Pacific region compared with the rest of the world, said Eric Papas, M.D., of the Tear Film and Ocular Surface Society (TFOS). Some studies suggest that up to 60% of Asian populations suffer from MGD. However, he added, the lack of standardization of defini- tions, classification, and methods for clinical assessment of conditions as- sociated with MGD makes the impli- cations of this data unclear. Last year, the TFOS conducted an international workshop to estab- lish just such a set of standards. Be- ginning in late 2008, TFOS began a thorough evaluation of available evi- dence from around the world to consolidate what is known about meibomian gland structure and function, and elucidate how they re- late to the disease. TFOS defines MGD as a func- tional abnormality of the meibo- mian gland, said Jennifer Craig, M.D. It differentiates MGD from meibomian gland disease, which is the term for the broader range of meibomian gland disorders that in- cludes MGD. Today, we have a fairly clear pic- ture of the meibomian gland's anatomy and histology, but much about its function remains a mys- tery. TFOS's Thomas Miller, M.D., finds the subject fascinating. For in- stance, it's known that meibomian glands synthesize extremely long chain fatty acids, consisting of more than 30 carbons. But we have no idea how the chains are produced or where these glands get the carbon to make them. The full report from the TFOS International Workshop on Meibo- mian Gland Dysfunction will be published later this year. Editors' note: None of the doctors men- tioned reported any financial interests related to the TFOS workshop. The old and the new The theory behind trabeculectomy seems sound, and yet the procedure rarely results in an unqualified suc- cess, with adequate reductions in in- traocular pressure rarely achieved without long-term complications. Surgeons are constantly looking for ways to improve the procedure and for new ways to improve outcomes in glaucoma. This was the theme of the Asia Oceanic Glaucoma Society's cospon- sored symposium, "Something old and something new (Trabeculec- tomy improvements and new surgi- cal techniques)." Two approaches currently being explored involve the addition of im- plants to the trabeculectomy proce- dure. The EX-PRESS Glaucoma Filtra- tion Device (Alcon) is designed to improve outflow control. The only difference between EX-PRESS device implantation and standard tra- beculectomy, said Kaweh Mansouri, M.D., Jules Gonin Eye Hospital, Lausanne, Switzerland, is that sur- geons need to pay closer attention to surgical landmarks. So far, said Dr. Mansouri, results with the device have been as good as standard trabeculectomy in terms of IOP lowering, but with improved safety. The second implant is the Ologen implant (Aeon Astron Cor- poration, Leiden, the Netherlands), a collagen matrix implant intended to guide the random and diffuse growth of tissue inside the bleb. In one small-scale, prospective, non- randomized study, Shamira Perera, M.D., and colleagues, Singapore Na- tional Eye Centre, haven't found any significant advantage to using the biodegradable implant. For now, he said, what they can conclude is that the implant is safe to use in pa- tients undergoing glaucoma surgery. Editors' note: None of the doctors de- clared any financial interests related to their comments. APAO Sydney 2011 continued March 24, with highlights that included the Nakajima and Holmes named lectures, and a special symposium held by the Macular Degeneration Foundation. The 2011 Nakajima Award The Nakajima Award is given to in- dividuals 40 years old and younger who do "outstanding international work in ophthalmology." The award was established to encourage younger ophthalmologists in the re- gion to play an active role in devel- oping ophthalmology. The award is a named lecture, and this year the honor of delivering the Nakajima Lecture was given to Yasui Yanagi, M.D., assistant professor, University of Tokyo School of Medicine. Drugs for retinal conditions are usually injected intravitreally, said Dr. Yanagi. Unfortunately, these in- jections, when used repeatedly, can lead to ocular inflammation, retinal injury, and even endophthalmitis. One solution is to inject the drug intravenously. However, any drug introduced intravenously must avoid recognition by the body's reticuloendothelial system (RES) as well as glomerular filtration and ex- cretion in order to reach the target tissue within the eye. To get the drug into the eye

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