EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/569879
113 EW REFRACTIVE SURGERY September 2015 Compared to other refractive correction procedures, the Visian ICL may be a better option for pa- tients with myopia above 7.0 D be- cause of the better quality of vision, elimination of the risk of ectasia and flap complications, refractive stabil- ity, and preservation of the crystal- line lens and accommodation. "For moderate myopia (between 5.0 and 7.0 D) I personally prefer the Visian ICL because of better predict- ability, less night vision complaints, and less postoperative chair time," Dr. El Danasoury said. "In many cases with low myopia (between 1.0 and 4.0 D) I still prefer the Visian ICL if the topography and/or tomog- raphy show any degree of suspicion or in cases of borderline corneal thickness. With the ICL there is no risk of surprises that we sometimes see with laser correction." Although there are some areas warranting refinement (i.e., ICL siz- ing), the current available methods, according to Dr. El Danasoury, are good enough for about 95% of the cases. Further, in the rare cases with oversizing or undersizing, the ICL can be easily exchanged for a smaller or larger lens. "Modern phakic IOLs gained a solid place in refractive surgery over the last 3 decades; the main debate that was ongoing for the last 10–15 years—which phakic IOL is better?—is now resolved, and most of the phakic IOL surgeons agree that posterior chamber IOLs are the closest to ideal because of their long-term safety, stability inside the eye, ability to correct astigmatism, better cosmesis, and higher patient satisfaction," he said. EW Editors' note: Dr. Hersh has financial interests with Avedro. Drs. Machat and Durrie have financial interests with AcuFocus. Dr. El Danasoury has finan- cial interests with STAAR Surgical. Contact information El Danasoury: malaa@magrabi.com.sa Durrie: ddurrie@durrievision.com Hersh: phersh@vision-institute.com Machat: jeff.machat@crystalclearvision.com additive procedure so it can be par- tially reversed and the lens can be easily exchanged if needed." Similar to laser vision correc- tion, the procedure is done in an outpatient setting. "In experienced hands the whole procedure takes less than 3 minutes, which minimizes the risk of infection," Dr. El Danasoury said. INDICATIONS AND USAGE ZYLET® (loteprednol etabonate 0.5% and tobramycin 0.3% ophthalmic suspension) is a topical anti-infective and corticosteroid combination for steroid-responsive infl ammatory ocular conditions for which a corticosteroid is indicated and where superfi cial bacterial ocular infection or a risk of bacterial ocular infection exists. Ocular steroids are indicated in infl ammatory conditions of the palpebral and bulbar conjunctiva, cornea and anterior segment of the globe such as allergic conjunctivitis, acne rosacea, superfi cial punctate keratitis, herpes zoster keratitis, iritis, cyclitis, and where the inherent risk of steroid use in certain infective conjunctivitides is accepted to obtain a diminution in edema and infl ammation. They are also indicated in chronic anterior uveitis and corneal injury from chemical, radiation or thermal burns, or penetration of foreign bodies. The use of a combination drug with an anti-infective component is indicated where the risk of superfi cial ocular infection is high or where there is an expectation that potentially dangerous numbers of bacteria will be present in the eye. The particular anti-infective drug in this product (tobramycin) is active against the following common bacterial eye pathogens: Staphylococci, including S. aureus and S. epidermidis (coagulase-positive and coagulase- negative), including penicillin-resistant strains. Streptococci, including some of the Group A-beta-hemolytic species, some nonhemolytic species, and some Streptococcus pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Enterobacter aerogenes, Proteus mirabilis, Morganella morganii, most Proteus vulgaris strains, Haemophilus infl uenzae, and H. aegyptius, Moraxella lacunata, Acinetobacter calcoaceticus and some Neisseria species. IMPORTANT SAFETY INFORMATION • ZYLET® is contraindicated in most viral diseases of the cornea and conjunctiva including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, and varicella, and also in mycobacterial infection of the eye and fungal diseases of ocular structures. IMPORTANT SAFETY INFORMATION (continued) • Prolonged use of corticosteroids may result in glaucoma with damage to the optic nerve, defects in visual acuity and fi elds of vision. Steroids should be used with caution in the presence of glaucoma. If this product is used for 10 days or longer, intraocular pressure should be monitored. • Use of corticosteroids may result in posterior subcapsular cataract formation. • The use of steroids after cataract surgery may delay healing and increase the incidence of bleb formation. In those diseases causing thinning of the cornea or sclera, perforations have been known to occur with the use of topical steroids. The initial prescription and renewal of the medication order should be made by a physician only after examination of the patient with the aid of magnifi cation such as a slit lamp biomicroscopy and, where appropriate, fl uorescein staining. • Prolonged use of corticosteroids may suppress the host response and thus increase the hazard of secondary ocular infections. In acute purulent conditions, steroids may mask infection or enhance existing infections. If signs and symptoms fail to improve after 2 days, the patient should be re-evaluated. • Employment of corticosteroid medication in the treatment of patients with a history of herpes simplex requires great caution. Use of ocular steroids may prolong the course and exacerbate the severity of many viral infections of the eye (including herpes simplex). • Fungal infections of the cornea are particularly prone to develop coincidentally with long-term local steroid application. Fungus invasion must be considered in any persistent corneal ulceration where a steroid has been used or is in use. • Most common adverse reactions reported in patients were injection and superfi cial punctate keratitis, increased intraocular pressure, burning and stinging upon instillation. Please see Brief Summary of Prescribing Information for ZYLET® on adjacent page. ®/™ are trademarks of Bausch & Lomb Incorporated or its affi liates. © 2015 Bausch & Lomb Incorporated. All rights reserved. Printed in USA. US/ZYL/15/0013 Ophthalmologists will forever push the envelope to achieve a smaller surgical footprint. That's why LASIK isn't the endgame of refractive surgery, but rather the beginning of the beginning.