Eyeworld

EW MEETING REPORTER November 2011 55 Friday, September 16 Two subspecialty days preceding the 29th annual congress of the Euro- pean Society of Cataract & Refractive Surgeons (ESCRS) in Vienna, Austria, gave attendees a chance to hear from key glaucoma and cornea thought leaders. Glaucoma Day Anton Hommer, M.D., Vienna, opened the Glaucoma Day session titled "Lasers and New Devices" by giving his take on ALT (argon laser trabeculoplasty) vs. SLT (selective laser trabeculoplasty). ALT, the older of the two procedures, is more well- known and is better used in pig- mented trabecular meshwork, but there is no need to know gonioscopy in SLT, which also has a shorter learning curve and involves less tis- sue destruction, Dr. Hommer said. Disadvantages of ALT are local side effects, including IOP spikes, inflam- mation, and discomfort. "The com- plications are significantly lower in SLT, but you can have some IOP spikes as well," Dr. Hommer said, adding that the laser is newer but is still unable to be used on the retina. "It is not something that has no risk at all. Of course, we would like to have more data." Stephen Kaminski, M.D., Baden, Austria, ad- vised the audience about when to consider refractive surgery in glau- coma suspects. Considering that most patients who opt for elective refractive surgery are young, Dr. Kaminski said, "It's impossible to predict who in a group of refractive patients will develop glaucoma later in life." Surgeons should establish a pre-op IOP and take a meticulous medical history from all refractive patients, he advised. Dr. Kaminski touted the benefits of a new non- contact tonometer that was intro- duced at the ESCRS meeting. The Corvis ST (Oculus, Lynnwood, Wash.), which is awaiting 501K ap- proval in the U.S., allows surgeons to see the reaction of the cornea after an air puff is administered, all while a high-speed Scheimpflug camera records the movements of the cornea. "This gives you an idea of the corneal biomechanics, " he said. "If you have these results pre- operatively, it might be easier to de- tect higher IOPs afterward." EU Cornea Congress Gene therapy could be applied to precut corneas and Descemet's strip- ping automated endothelial kerato- plasty (DSEK)/Descemet's membrane endothelial keratoplasty (DMEK) procedures and decrease the number of graft failures after corneal transplantation, according to T.A. Fuchsluger, M.D., Germany, who spoke during the first day of the 2- day EUCornea Congress. "Gene ther- apy of allogeneic epithelial grafts for ocular surface reconstruction might increase currently poor prognoses, such as in bilateral limbal stem cell deficiencies," he said. "Better under- standing of the relevance of apopto- sis in allograft failure can open new treatment strategies other than gene transfer." Peter R. Laibson, M.D., Philadelphia, discussed a new topical antiviral medication, ganciclovir gel (Zirgan, Bausch + Lomb, Rochester, N.Y.), during his EUCornea Medal Lecture titled "Herpes Simplex Keratitis: A 50-Year Retrospective." Previous drugs were causing tox- icity when treating the disease. "We haven't solved the problem of recur- rent herpes," Dr. Laibson said. "It's not so much the epithelial disease we have to worry about today; it's the stromal disease." Michael Belin, M.D., Tucson, Ariz., said ophthal- mologists have been using two-di- mensional imaging to analyze the cornea for more than 20 years and stressed that it's time to move on to newer technology. "I am surprised by the reluctance of ophthalmology to let go of outdated technology," he said. Relying on surface analysis means physicians will miss most early disease, he said. "Corneal Complications After Refractive Surgery" was one of two morning sessions that kicked off the second day of the EUCornea Con- gress. Moderator Béatrice Cochener, M.D., Brest, France, presented new tools and biomarkers for tear osmo- larity during her keynote lecture ti- tled "Dry Eye: Not to Misjudge." The TearLab Osmolarity Test (Tear Lab Corp., San Diego, Calif.) is expensive because of its gold tip, but it's highly useful, Dr. Cochener said. The RPS InflammaDry Detector (Rapid Pathogen Screening, Sarasota, Fla.), which is not commercially available in the United States, is an in-office test that detects elevated levels of matrix metalloproteinase-9 (MMP-9) in tear fluid. "MMP-9 is a non-specific marker of inflammation that systematically increases in dry eyes," Dr. Cochener said. The Optical Quality Analysis System test (OQAS, Visiometrics, Terrassa, Spain) is a double pass, non-invasive opti- cal assessment of tear film quality. The LipiView OSI (TearScience, Morrisville, N.C.) is an interferome- ter that can quantify lipid layer thickness and works with the Lipi- Flow Thermal Pulsation System for the treatment of meibomian gland dysfunction with thermal pulsation applied directly to a patient's eyelid. Has the femtosecond solved our problem? In his EUCornea Congress talk, Joseph Colin, M.D., Bordeaux, France, explored the idea that fem- tosecond lasers may help solve inter- face complications in refractive surgery. "Corneal flaps created with the femtosecond laser have been shown to be more predictable in depth and have a more desirable pla- nar morphology," Dr. Colin said. The femtosecond flaps "can be cus- tomized according to depth, profile, morphology, and side-cut configura- tion." Benefits of femtosecond flap creation include a reported 25% de- crease of low contrast visual acuity loss. Most studies also indicated that the femto flap induces "fewer in- duced higher order aberrations" compared to mechanical microker- atomes, Dr. Colin noted. He added that another benefit may be that flap thickness and diameter are inde- pendent of keratometry and pachymetry. Saturday, September 17 The 29th annual congress of the Eu- ropean Society of Cataract & Refrac- tive Surgeons (ESCRS) opened in Vienna, Austria, highlighting a four- Reporting live from the 2011 European Society of Cataract & Refractive Surgeons Congress, Vienna, Austria Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team from the 2011 ESCRS meeting, Vienna. Meeting Reporter is sponsored by Abbott Medical Optics, Santa Ana, Calif. continued on page 56

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