Eyeworld

13 EW NEWS & OPINION Headline byline goes here plus fade September 2015 P residential candidate, oph- thalmologist, and senator Rand Paul, MD, joined the ASCRS Foundation and the University of Utah's John A. Moran Eye Center on a week-long surgical mission in Haiti beginning on August 17. Moran Eye Center physicians have been working in Haiti since 2012. The collaborative team performed 200 sight-restoring surgeries while working with local clinicians to improve care in an iso- lated region of the Caribbean island. "There is a high rate of prevent- able blindness in Haiti but also a real opportunity to improve eyecare," said Randall J. Olson, MD, CEO of the John A. Moran Eye Center, and chair of the Department of Ophthal- mology and Visual Sciences. "This is the second ASCRS Foundation/ Moran Eye Center mission that Sen. Paul has joined, and we are thrilled that he is helping us to bring further awareness to this epidemic." A nation in need Haiti has a high rate of blindness, largely due to the strong tropical sun and lack of available healthcare. The team worked in a region that has approximately 800,000 citi- zens, but only 5 ophthalmologists, making it difficult for those in need to get even basic treatment. Part of the mission was to provide advanced surgical training to physicians at a local clinic, which employs 4 of the region's 5 ophthalmologists. "It has been a joy to work with the Haitian staff and physicians. They are incredibly dedicated to their patients and to improving eyecare in Haiti," said glaucoma specialist Craig Chaya, MD, assis- tant professor of ophthalmology and visual sciences at the Moran Eye Center. The clinic's model uses fees from paying patients (who pay for their care on a sliding scale depending on income) to subsidize charitable care for patients in dire need, and about 30% of surgeries are performed free. However, the clinic is understaffed, and there is a major backlog of very low-income patients who would benefit from surgery. Two hundred of these patients with cataracts had their sight restored for free. In the journal . . . Schlemm's canal scaffold for intraocular pressure reduction in patients with open-angle glaucoma having cataract surgery: Two-year results from a prospective multicenter study Manfred Tetz, MD, PhD, Norbert Pfeiffer, MD, PhD, Gabor Scharioth, MD, Clemens Vass, MD, Marina Ramirez, MD, Swaantje Peters-Grisanti, MD, Katrin Lorenz, MD, Thomas W. Samuelson, MD In this prospective multicenter registry study, investigators evaluated how pa- tients with open-angle glaucoma fared with a Hydrus Microstent (Ivantis, Irvine, Calif.) in place. Investigators implanted the microstent into Schlemm's canal in 1 eye of patients during cataract surgery. While preoperatively the mean IOP was 21.3 mm Hg, at the 6-month postoperative mark it was 16.2 mm Hg, at 12 months it was 17 mm Hg, and at 24 months it was 16 mm Hg. Also, while preop- eratively the mean number of glaucoma medications was 2.1, with implantation of the microstent, at the 6-month mark 88% of patients required no medication. This remained true for 85% at 12 months and 70% at 24 months. Investigators concluded that there were clinically and statistically significant reductions in patients' IOP and in pressure-lowering medications needed when the microstent was implanted during surgery. At the 24-month mark these benefits remained. Combined intrastromal astigmatic keratotomy and laser in situ keratomileusis flap followed by photoablation to correct post-penetrating keratoplasty ametropia and high astigmatism: One year follow-up Riad B. Shalash, MD, Malak I. Elshazly, MD, Marwa M. Salama, MD For this prospective case series, investigators considered how a new technique for correcting post-penetrating keratoplasty astigmatism and ametropia fared. This technique involved linking intrastromal astigmatic keratotomy (AK) with the use of the excimer laser under a LASIK flap to correct these conditions. Included here were 20 high astigmatism and ametropia patients who underwent the treatment. With this technique intrastromal AK was performed and a LASIK flap was cut with an M2 microkeratome. Excimer laser photoablation was performed 2 to 3 months later. At the 1 year follow-up investigators found that the mean uncor- rected distance visual acuity had improved from 1.07 logMAR to 0.23 logMAR. Likewise, corrected distance visual acuity went from 0.79 logMAR to just 0.12. There was an improvement in mean refractive spherical equivalent, which went from –5.04 D to –1.47 D, and in mean cylinder, which dropped from –5.39 D to –1.05 D. With the technique, microperforations occurred in 35% of cases and epithelial ingrowth in 15%. Investigators concluded that for the correction of high astigmatism and ametropia this technique can help. However, they stressed that practitioners should keep in mind that there is an occurrence of epithelial ingrowth, which requires intervention. Incidence of cystoid macular edema following secondary posterior chamber intraocular lens implantation Linda M. Meyer, MD, Sebastian Philipp, MD, Marie T. Fischer, MD, Peter Distelmaier, MD, Patrick Paquet, MD, Natascha E. Graf, MD, Christos Haritoglou, MD, Carl-Ludwig Schönfeld, MD The aim in this retrospective case series was to hone in on the incidence and any risk factors for cystoid macular edema after posterior chamber intraocular lens (PC IOL) fixation. Eyes with secondary PC IOL implantation were placed in 1 of 2 groups. The 28 eyes in group 1 had implantation because of preexisting aphakia. Meanwhile, after a failed primary PC IOL the 14 eyes in group 2 had reimplantation or refixation of the lens. Investigators found that of the 7 eyes that developed CME, 5 were in group 1 and 2 were in group 2. They determined that a significant risk factor here was corrected distance visual acuity (CDVA) after surgery, with 0.35 logMAR serving as a meaningful cutoff. Also, a trend toward patient age as a risk factor was seen, with the age 83.9 viewed as meaningful. The conclusion reached was that although there is inherent risk of CME from secondary PC IOL fixation, this can be performed with good results. However, practitioners should keep in mind that in cases of advanced age and those involving poor CDVA, CME may be more likely to occur. September 2015 Sen. Paul joins ASCRS Foundation on surgical mission in Haiti by Abbie B. Elliott ASCRS•ASOA Manager of Communications ASCRS update continued on page 14 Dr. Chang and Sen. Paul traveled to Haiti for a week-long surgical mission. Source: ASCRS Foundation and Moran Eye Center

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