Eyeworld

EW MEETING REPORTER 25 stance, drop very quickly, requiring re-administration every 15 min- utes. The future, he said, includes drug delivery systems that will help maintain the necessary antibiotic levels. October 16, 2011 The Presidents' Symposium was unique in that the presidents of all the societies involved rarely get the chance to come together in one meeting. "It is gratifying to see all the presidents come together for this session as it reflects the growing rele- vance of our meeting and the meet- ing's importance in the calendar year," Dr. Barrett said. Boris Malyugin, M.D., Moscow, kicked off the symposium with a talk on "Cataract Surgery Tech- niques in Small Pupils." Despite the obvious challenges posed by small pupils, Dr. Malyugin said that any experienced surgeon can "absolutely" perform successful cataract surgery in such cases. Creat- ing a small capsulorhexis following the outline of the pupil and holding the instruments at the center of the anterior chamber without going under the iris, any surgeon, he said, can complete the surgery while maintaining reasonably low infusion and aspiration settings. Even in the face of such chal- lenges, modern cataract surgery is generally thought of as nearly per- fect, but is it really? Philippe Sourdille, M.D., repre- senting Jose Güell, M.D., president, ESCRS, said that clinically speaking, the answer is probably yes. However, he said, using a laser flare meter, fluorescein angiography, and OCT post-op reveals iatrogenic changes to the blood-aqueous barrier that indi- cate otherwise. These tests, said Dr. Sourdille, reveal changes in the blood-aqueous barrier that typically resolve after a few months, but may on the other hand lead to the development of complications like cystoid macular edema. Dr. Bissen-Miyajima suggested that ophthalmologists may be able to move beyond traditional patient indications for multifocal IOLs. Dr. Bissen-Miyajima pointed to her own successful cases, a glaucoma patient, a small pupil case, a patient with high myopia, and a 97-year-old pa- tient who insisted on being given multifocals, to prove that these types of cases shouldn't immediately be ruled out. Ke Yao, M.D., president, Chi- nese Cataract Society, concluded in his talk that coaxial micro-incision cataract surgery (MICS) is an innova- tive way to perform cataract surgery because there is a smaller incision. "The ongoing coaxial micro-in- cision phacotrabeculectomy can re- duce tissue damage and the chances of surgically induced astigmatism and offers enhanced post-operative visual rehabilitation," he said. The simple operation also means mini- mized injury and a watertight inci- sion, he said. The final lecture given during the Presidents' Symposium was from Dr. Barrett with his talk on "Perfect IOL Power Prediction." Dr. Barrett admitted to struggling with the issue of refractive predictability due to several hurdles such as formulae in- accuracy, extreme myopia, and pa- tients who have had previous radial keratotomy or LASIK. Three cate- gories of patients exist: those with a full clinical history, those with no clinical data, and patients with a partial history, where the change in refractive status before and after LASIK is known. To deal with LASIK patients, Dr. Barrett has developed his own method to more accurately predict lens power, which he's dubbed the "True-K Formula." This allows physi- cians to calculate the true K value from the measured K post-LASIK and the change in refraction produced by the refractive procedure. It also provides a double K solution in that the formula derives a modified for- mula constant for use with different lens calculation formulae, he said. December 2011 B+L launches enVista, discusses Victus, Lotemax D uring a symposium held at APACRS, attendees heard three very specific reasons why it's an exciting time to be a refractive surgeon: enVista, Victus, and Lotemax (Bausch + Lomb, B+L, Rochester, N.Y.). The enVista is the first-ever hydrophobic acrylic intraocular lens proven to be glistening free, said Dylan Chan, M.D., a Hong Kong-based ophthalmologist. In order to permit the label claim of no glistenings, the FDA asked for data on 100 patients followed for 6 months. U.S. investigator Edward Holland, M.D., performed the independent examination that demon- strated the IOL material to be glistening free in an FDA-reviewed clinical trial. The enVista avoids glistenings through pre-hydration and packaging in 0.9% saline. It has 4% water content and in saline is in equilibrium with its environment, which means there is no water movement in or out of the IOL. Peter Heiner, M.D., Vision Eye Institute, Australia, shared his early experiences with the lens, as well as the injector system. Two injectors are approved for use with the enVista IOL—a 2.2-mm and a 2.6-mm injector from Medicel (Wolfhalden, Switzerland). The lens is currently undergoing FDA review in the U.S. and is already available in Australia and New Zealand. It was recently launched in South Korea and has been released in Europe. Soon-Phaik Chee, F.R.C.Ophth., Singapore National Eye Centre, dis- cussed her experience with the Victus Femtosecond Laser Platform, a first- of-its-kind technology that's capable of performing cataract, refractive, and therapeutic procedures on one platform. Prof. Chee noted how im- pressed she was with the docking system and how quickly the laser made the capsulorhexis and a four-section cut. The laser is not currently approved for use in the U.S. Prof. Chee pointed out that although a skilled surgeon can create manually what looks to be a round capsulorhexis, the manual capsu- lorhexis cannot stand up to the femtosecond-created capsulorhexis when compared side-by-side. To prove this, she gave an overview of a study con- ducted by K. P. Reddy, M.D., in Hyderabad, India. He evaluated patients with a 5.5 mm capsulorhexis. Thirty-one had a manual capsulorhexis and 31 had their capsulorhexis performed with the Victus. "This study showed that the Victus platform is able to produce a cap- sulorhexis that has a precise diameter, better accuracy, and predictability for centration, as compared with a manual tear," she said. In his lecture, "Management of ocular inflammatory response," Sunil Shah, M.D., Birmingham, England, discussed the need for another topical steroid, specifically Lotemax (loteprednol etabonate ophthalmic suspension). Some of the concerns about ophthalmic steroids are an elevation in IOP, cataract formation, infection aggravation, and a delay in healing. Lotemax is potent but limits IOP elevation and doesn't cause cataracts, Dr. Shah said. "It's a very simple change in the chemical structure where we have an ester group there instead of a ketone group. That makes this drug the only one that has an ester group at the C-20 position. All the other steroids that we are able to use are ketone derivatives."

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