Eyeworld

139 October 2015 EW MEETING REPORTER Congress of the ESCRS Theo Seiler, MD, PhD, Zu- rich, Switzerland, spoke about the complications of crosslinking, breaking his presentation down into 2 sections of safety and efficacy followed by special complications. Dr. Seiler discussed a number of papers demonstrating a variety of complication rates. In a study of greater than 100 patients at 1 year postop, he found a 3% complication rate. Meanwhile, in studies with follow-up ranging from 4 to 6 years, complication rates varied in differ- ent countries and different centers. One study showed a 0% complica- tion rate, while another had a 13.7% complication rate, which Dr. Seiler said is likely the highest complica- tion rate shown in literature. "When talking about complications, we also think of failures," he said. This means that even after doing the crosslinking, the keratoconus con- tinues to progress. Dr. Seiler's results have shown a 3% failure rate, while other studies showed a 2.8% failure rate in France with 1-year follow-up and a 0% failure rate in England at 4 years postop. It's also important to think about special complications, Dr. Seiler said. These can include stromal haze, sterile infiltrates, stro- mal scars, delayed epithelial healing, late onset scars, and multiple sterile infiltrates. In conclusion, Dr. Seiler said that 5–10 year data from cross- linking demonstrates a complication rate ranging from 0 to 13%, a failure rate of 0 to 3%, and rare incidence of scars and infiltrates. During the re-epithelization time, the cornea is the most vulnerable, he said. It's also important to remember that cross- linking induces structural changes in the cornea that may go on for many years. It's not a "switch on and switch off" procedure, he said. EuCornea Medal Lecture John K.G. Dart, MD, London, presented the EuCornea Medal Lecture, which focused on cicatris- ing conjunctivitis. It should really be called "scarring" conjunctivitis, he said. This is a devastating dis- ease that was described in a recent editorial as "an evil curse," he said. Morbidity is due to the chronic discomfort and blindness. Addition- ally, diagnosis is difficult. "Everyone knows the management is quite complex, and despite the best we can do, the outcomes are not great," he said. Mucous membrane pemphi- goid (MMP) is the most common of the immunobullous disorders with eye involvement, Dr. Dart said. This involves the scarring of different mucosal sites. Scarring is a major problem in the eye, and that's the hallmark of the disease in the eye, he said. Making the diagnosis of a patient with MMP can be either easy or very difficult. It's easy when the conjunctival scarring occurs with MMP at other sites. However, it's dif- ficult when conjunctiva scarring is the only presenting sign. Clinicians need to differentiate from other causes of cicatrising conjunctivitis, like AKC, drug-induced scarring, neoplasia and rosacea, Dr. Dart said. There are investigations that can be done for cicatrising conjunctivitis, including routine histopathology and tests for MMP. When trying to control inflammation in these cases, topical therapy is largely ineffective, and systemic treatment has become the standard of care for the condition. However, scarring still progresses in 50% of cases with inflammation control. Dr. Dart high- lighted some potential new treat- ments being studied to help these patients. In summary, he said that cicatrising conjunctivitis remains a major therapeutic challenge. MMP is the most common cause in most developed countries. Surface disease management with immunosuppres- sive therapy improves outcomes in most, but scarring progresses in 50% of patients. There are still major problems in diagnosis and therapies for inflammation and scarring. Can imaging methods enhance clinical decision-making? Sophisticated imaging techniques such as OCT and retinal tomogra- phy give ophthalmologists more information about the structure of the optic nerve head and retinal nerve fiber layer than ever before, but can physicians actually use this information to make better clinical decisions? Ted Garway-Heath, MD, London, addressed this question during Glaucoma Day's opening session. In his presentation, "The growing role of imaging in the management of glaucoma," Dr. Garway-Heath asked: With all of the new technology, can we make better diagnostic decisions? And can we predict which eyes will lose vision to glaucoma? Examining the available literature, Dr. Garway-Heath showed that new technologies can quantify changes to the optic nerve head and provide at least as good evidence of glaucoma progression as looking at monoscopic photographs. Imaging techniques are a useful adjunct for clinicians when making diagnostic decisions, he said, and can be useful for determining which patients are at high risk of visual field loss. The challenge, however, is that clinicians need to make sense of all the data that is now available, Dr. Garway-Heath said—imaging can help make a diagnosis, but it cannot make the diagnosis for you. Clini- cians need to be aware of sources of error in imaging methods and take into account other clinical data, such as patient age, IOP, and family history, he said, before making a diagnosis. Managing the progressing glaucoma patient: Can we do any better? Disease progression in glaucoma is a lot like speculation, said Anton Hommer, MD, Vienna, Austria, in his presentation, "Risk factors for progression: Room for better man- agement?" Glaucoma progression is rarely linear and often hard to continued on page 140 View videos from Friday at ESCRS 2015: EWrePlay.org John Kanellopoulos, MD, reports 1-month results of his study on patient-reported outcomes with myopic femtosecond laser-assisted LASIK.

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