EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/511377
85 May 2015 EW MEETING REPORTER potentially serious complication after LASIK are surgical optical zones and IOP, said Maria Jose Cosentino, MD, Buenos Aires, Argentina. Dr. Cosentino's analysis of emerging research on post-LASIK corneal ectasia was given during the Combined Symposium of Cataract & Refractive Societies. Reported rates have ranged from 0.02% to 0.06% for post-LASIK corneal ectasia, which manifests as stromal thinning, anterior and pos- terior corneal steepening, myopia, irregular astigmatism, and decreased distance UCVA and BCVA. Among the inducing factors related to post-LASIK corneal ectasia are corneal thickness of less than 500 microns and a residual stro- mal bed of less than 300 microns. However, there is no consensus on reliable residual stromal bed thick- ness for corneal ectasia develop- ment. Research results indicate that thin pachymetry is not an isolated risk factor for ectasia in eyes with normal topography. One factor for corneal ectasia is weakened residual stromal beds due to the loss of a large amount of stromal tissue because of high myo- pia correction. This weakening may stem from the creation of a thicker- than-planned flap or from preop myopia higher than 8 diopters. On the impact of optical zones, Dr. Cosentino said its diameter modifies corneal ectasia, with the maximum risk occurring at 5 mm. Additionally, intraocular pressure changes are directly proportional to corneal ectasia. Dr. Consentino addressed con- cerns that mitomycin-C might have a role in development of corneal ectasia by noting that she uses it in every LASIK case and has not seen any difference in the rates of corneal ectasia between those patients and her corneal ablation patients. Editors' note: Dr. Cosentino has no related financial interests. harness the wealth of healthcare data stuck in paper records. In the United States, physicians face challenges with the Food and Drug Administration (FDA) not knowing how to accelerate new technologies and challenges with payers not knowing how to reimburse or cover costs. The good news is that physi- cians can leverage existing tech- nology to overcome some of those challenges and can help shift our system from a reactive system to a proactive one, Dr. Kraft said. When Apple debuted the iPod in 2001, the technology for digital music already existed, but Apple's genius was in bundling those tech- nologies into the right package, he said. The same idea can be applied to healthcare to provide better, pre- ventive, personalized, proactive care. "The future is already here, it's just not evenly distributed," he said. Editors' note: Dr. Kraft has no financial interests related to his comments. Considering cataract surgery for glaucoma patients As more glaucoma surgeons consider cataract surgery as a treatment op- tion for their patients to lower IOP, they also must think about which patients will benefit most from the procedure. Presenters at the sympo- sium "Controversies in Cataract and Glaucoma," sponsored by the ASCRS Glaucoma Clinical Committee, focused on this topic. To start things off, Thomas Samuelson, MD, Minneapolis, said that cataract surgery is a viable primary procedure for primary open angle glaucoma (POAG). He shared data on the IOP-lowering potential of phacoemulsification for other glaucoma types but raised the question of whether the lens plays a causal role in adult onset phakic POAG. "When the system is dys- functional, taking out the cataract appears to help," he said. Another consideration is the role of cataract surgery for primary angle closure glaucoma (PACG), said George Tanaka, MD, San Francisco. Although the benefit of the procedure in an acute setting is shown, the choice is murkier in patients without cataracts, he said. The best approach likely depends on whether the patient is a primary angle closure suspect or has PACG. Cataract surgery without a laser peripheral iridotomy is reasonable for a primary angle closure suspect; for PACG, cataract surgery instead of or in combination with a trabe- culectomy are solid choices, he said. Glaucoma surgeons also are awaiting the results of the EAGLE trial, which focuses on early lens extraction for the treatment of PACG. With all eyes in ophthalmolo- gy on femtosecond laser refractive cataract surgery, Eric Donnenfeld, MD, Rockville Centre, N.Y., shared possible benefits of the newer tec - nology for glaucoma patients. This can include improved architecture for incisions, more tightly sealed wounds, less endothelial trauma, and faster visual recovery. There is also less ultrasound energy used, as much as an 86% reduction per recent studies, Dr. Donnenfeld said. Although femtosecond laser technology has great advantages for glaucoma patients with mature lenses or zonule weakness, surgeons must also consider the effect of a mild to moderate IOP elevation for 1 to 2 minutes, Dr. Donnenfeld added. Surgeons want to know if there is an ideal IOL to use in their glauco- ma patients with cataracts, although the better question may actually be which IOLs to avoid, said Alan S. Crandall, MD, Salt Lake City. "There is no perfect lens," he said. In patients with pseudoexfolia- tion syndrome or trauma, Dr. Cran- dall recommends a spherical rather than aspheric lens. He also advised the use of a lens that the surgeon is comfortable with and that can be used in a zonule-friendly way. However, he cautions against the use of a multifocal IOL due to contrast sensitivity issues and the lack of long-term data. Editors' note: Dr. Donnenfeld has financial interests with Abbott Me - ical Optics, Alcon, Bausch + Lomb, and other ophthalmic companies. Drs. Crandall and Samuelson have financial interests with Alcon, AqueSys, Glaukos, and other ophthalmic companies. Dr. Tanaka has financial interests with Alcon and Allergan. What factors drive post-LASIK corneal ectasia? Corneal pachymetry and abnormal corneal topographies are closely re- lated to the development of corneal ectasia complications post-LASIK, research has shown. Other variables that surgeons should carefully consider when trying to avoid the infrequent but continued on page 86 View videos from Sunday at 2015 ASCRS•ASOA: EWrePlay.org Isabel Dapena, MD, Rotterdam, the Netherlands, discusses innovations in DMEK surgery.