Eyeworld

EW MEETING REPORTER 60 May 2014 Over time, she said, "other indi- cations came" for corneal crosslink- ing: Corneal crosslinking has now been investigated as a potential alternative treatment for conditions such as corneal edema and infec- tious keratitis. Studies have shown that corneal crosslinking can provide immediate improvement in corneal edema, but with limited long-term efficacy. This effect is seen in both diffuse and focal edema. Meanwhile, in the treatment of infectious keratitis, in vitro and ani- mal models have shown that corneal crosslinking may have very minimal antibacterial activity against Staphy- lococcus aureus. No activity has been observed against filamentous fungi or Candida. In the setting of Acanthamoeba keratitis, in vitro studies with corneal crosslinking have shown no activity against the amoeba. However, look- ing at the literature reporting in vivo cases, Dr. Hofling-Lima said that a randomized controlled trial appears necessary to tell whether corneal crosslinking has activity against Acanthamoeba. In any case, she said, rather than using corneal crosslinking to treat the infection, it should be considered in this setting only for arresting the development of corneal melt. In the treatment of uveitis, Rubens Belfort Jr., MD, Brazil, in his talk on "New surgical procedures in uveitis," said "sometimes the new is the old revisited." Steroids, he said, are a mainstay of treatment for uveitis that have been around since 1953. But while steroids might be old news, perhaps the most significant recent develop- ment in uveitis therapy is in terms of their delivery: If injection is considered a surgical procedure, then intravitreal injections are the most important new surgical proce- dure for uveitis, said Dr. Belfort. A second, even newer method of delivery, intravitreal implants including Retisert (fluocinolone intravitreal implant, Bausch + Lomb, Bridgewater, N.J.) and Ozurdex (dexamethasone intravitreal implant, Allergan, Irvine, Calif.), is also promising. In addition to steroids, these systems may be used to deliver other agents, including antibiotics, methotrexate, anti-VEGF agents, and biologics. Dr. Hofling-Lima chaired the symposium together with Marcus M. Marcet, MD, Hong Kong, who discussed the "Posterior approach to blepharoptosis repair." Also at the session were William Culbertson, MD, U.S., with "Small incision intrastromal lenticular extraction – SMILE"; Michel Eid Farah, MD, Brazil, with "Update in 25 gauge chromovitrectomy"; William Mieler, MD, U.S., with "Controver- sies in the management of open-globe injuries involving the posterior segment"; and Joel S. Schuman, MD, U.S., with "Schlemm's canal surgery – new tools, new approaches." DSAEK vs. DMEK Techniques and outcomes of Descemet's stripping automated en- dothelial keratoplasty (DSAEK) and Descemet's membrane endothelial keratoplasty (DMEK) were outlined by a group of cornea experts at the "Endothelial Transplantation: Tech- niques and Outcome" symposium. "There is still a strong debate about which procedure is better and which situation is better," said Jose Guell, MD, Spain. "With the avail- able literature, we know that there are some advantages from DMEK compared with DSAEK." The session was chaired by Akira Kobayashi, MD, Japan, Ali Al Rajhi, MD, Saudi Arabia, and Mark Terry, MD, U.S. Dr. Kobayashi presented "Devel- opment of new devices for DMEK"; Andrew Huang, MD, presented "Use of viscoelastic agents for endothelial keratoplasty"; Dr. Rajhi presented "DSAEK in congenital hereditary endothelial dystrophy (CHED)"; Sonia Yoo, MD, presented "Enhancing vision after DSAEK"; Dr. Terry presented "How to decide who gets DSAEK and who gets DMEK"; Donald Tan, MD, Singapore, presented "An inserter for ultra thin DSAEK and DMEK"; Dr. Guell presented "DMEK: Improving adher- ence with SF-6 gas bubbles"; Efdal Yoeruek, MD, Germany, was set to present "Novel maneuver facilitating Descemet's membrane unfolding in the anterior chamber" but was un- able to attend so Dr. Terry presented for him instead. Dr. Terry showed his own video of Dr. Yoeruek's technique and said that this new technique was a "revolution" for him that eliminated a steeper learning curve. Dr. Yoo presented results of cases including subepithelial fibro- sis, interface haze, and managing astigmatism after surgery. She said special scenarios can be encountered in practice and it is helpful to know how to deal with different cases to achieve best out- comes. In his own presentation, Dr. Terry discussed results in his practice of cases that had ultra-thin DSAEK in one eye and DMEK in the other eye with no comorbidities to affect vision. He and his colleagues' results in this subset of cases was interest- ing to note, he said. "We found that the mean corrected visual acuity at 6 months in DMEK was 20/24 and in DSAEK was a little worse, at 20/33. The 20/20 or better vision group was the one that was of most interest," he said. "[With DMEK], 50% of those at 6 months were 20/20 or better, and DSAEK was only 11%. With a little survey that we did, we found that 70% of patients preferred the vision in the DMEK eye over the DSAEK eye." However, "12% didn't think there was a difference, but there was 13% of patients that preferred the DSAEK eye over the DMEK eye, so it's not 100% on anything in medi- cine or this controversy of ultra-thin [DSAEK] vs. DMEK." Cataract course explores challenging topics The "Spotlight on Cataract Surgery" session featured a number of topics on challenges that cataract surgeons face. Topics broached in this instruc- tion course were management of mature cataracts, brunescent or black cataracts, and posterior polar cataracts. Susan MacDonald, MD, U.S., focused her presentation on the Reporting live from the 2014 World Ophthalmology Congress, Tokyo Supported by Carl Zeiss Meditec AG

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