EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/387844
139 October 2014 EW MEETING REPORTER complication rate, and decreases patient dependence on medications. However, he noted that by combin- ing MICS and MIGS, potential issues double. Potential challenges of com- bining the 2 revolve around patient selection, appropriate procedure selection, considerations for surgery site and incision placement, issues involved with both cataract surgery and glaucoma surgery, adjustment of IOL calculation and nomograms, refractive predictability, and choice of medications and an appropriate postoperative regimen. MICS + MIGS is a new trend in the combined treatment of cataracts and glaucoma, Dr. Malyugin said. While there is a learning curve, the techniques are safe and easy to master. In some cases, statistically significant IOP reduction versus phaco alone can be achieved. The combination of the procedures could aid in the reduction of med- ication used by patients; however, long-term data is still needed and healing remains a challenge in long-term outcomes. Hot topics in corneal refractive surgery debated in ISRS Symposium The ISRS Symposium discussed "Three Big Debates and Controver- sies in Corneal Refractive Surgery." Following the welcome and intro- duction, the 3 main topics were epi-on versus epi-off in corneal collagen crosslinking; centration of refractive procedures like IOLs, corneal ablations, and corneal inlays; and therapeutic refractive surgery. Doyle Stulting, MD, PhD, Atlanta, Ga., U.S., discussed the science behind epi-off crosslinking and spoke about why epi-on cross- linking is not as effective. A healthy epithelium is a barrier to riboflavin penetration, he said, and absorption enhancers are not comparable to epi-off treatment and do not stiffen the cornea as epi-off treatment does. Epi-on crosslinking does not have the short- or long-term effect of traditional epi-off crosslinking, Dr. Stulting said. The increased efficacy of epi-off crosslinking may justify the small increased risk compared to epi-on. Meanwhile, Parag Majmudar, MD, Hoffman Estates, Ill., U.S., discussed clinical results with epi-on. There is no question that we want epi-on to work, he said, and there is increasing evidence that this type of crosslinking is viable. However, the questions to ask are: Can enough riboflavin penetrate? Does the epithelium act as a barrier, and if so, how can that be overcome? Dr. Majmudar said that epi-on will definitely be more prominent in the future, but more work needs to be done on this technique. In his rebuttal, he argued that as the crosslinking procedure evolves, younger patients will be looking for a safe, effective, comfortable procedure that minimizes time away from work/school and reduces sight-threatening complications. EW