Eyeworld

117 EW CORNEA October 2015 Best in cornea Purpose: To evaluate pterygium excision performed by the Anduze bare scleral approach with 0.02% mitomycin-C (MMC) injected into the subconjunctival space, and quantify risks and benefits. Methods: Patients underwent prima- ry pterygium surgery with injection of less than 0.01 mL of 0.02% MMC into the subconjunctival space at the completion of the excision. Results: Ongoing study, results of 112 eyes (112 patients) presented, results will be updated. Three- month and one-year postoperative follow-up demonstrated a 0.018% (2/112) recurrence rate. There were no vision threatening complications to report, and adverse effects were mild 0.098% (11/112). The postop- erative complications were easily resolved with topical therapy with the most common complication being pyogenic granuloma. Conclusion: The results of this clinical review demonstrate that the Anduze bare scleral approach is an effective surgical technique for pterygium excision. Injection with 0.1 mL of MMC directly into the subconjunctival space provides superior results with minimal risk to the patient. Dr. Jeng: Although conjunctival autograft is frequently considered the gold standard method of performing pterygium excision, many other surgical techniques exist, and some techniques involve the use of adjunctive med- ications. In this paper, the authors presented their patients who under- went primary pterygia excision with 0.02% mitomycin-C, without the use of cautery, sutures, or glue. Although their recurrence rate is low, as is their compli- cation rate, more extended follow-up is necessary for study of this technique. In addition, although there were no cases of scleral melting in this series, there have been reports of this complication after use of mitomycin-C, and as such, caution should be exhibited when inter- preting the results of this study. Corneal CXL: Epi-on versus pocket technique Christoph Kranemann, MD, Alberto J. Aguayo Bonniard, MD Purpose: To compare the efficacy and safety of epi-on corneal cross- linking with crosslinking using a corneal pocket. Methods: Patients with progressive keratoconus or pellucid marginal degeneration were randomized to either technique and followed for a minimum of 18 months. The study was unmasked. A total of 24 patients were randomized—14 to epi-on and 10 to pocket crosslinking. Sequential topographies and wavefronts were taken preoperatively and postop- eratively q 3 monthly. Anterior and posterior topographies were obtained and a pachymetry map taken. Accelerated crosslinking was conducted and corneal pockets were created at 110-micron depth with a femtosecond corneal laser. Any surgical and postoperative complica- tions were recorded. Results: All patients with epi-on treatments improved topographical- ly and refractively within 24 hours. The pocket patients only improved after a minimum of 6 weeks. All refractive and topographic gains regressed in the epi-on group by the 18-month mark. The pocket group improved up to the 12-month mark and remained stable at 18 months. Mean topography improved from 53.4+/–2.1 D in the epi-on group to 51.5+/–1.9 vs. 52.9+/–1.85 D in the pocket group to 51.8+/–2.2 at 3 months NS. At 18 months the mean topography had regressed to 53.6+/–2.5 in the epi-on group vs. 50.8 +/–2 in the pocket group P 0.03. There were no complications in either group. Conclusion: Epi-on corneal cross- linking appears to have a faster recovery but a limited long-term ef- fect in the treatment protocol used. Pocket crosslinking appeared to be more effective in the medium term. Dr. Jeng: Corneal collagen crosslinking (CXL) has continued to gain popu- larity as an effective modality to halt the progression of corneal ectasia. However, there is debate about whether using an epithelium-on protocol versus epithelium-off protocol is better. In this paper, the authors described the use of CXL using a technique called corneal pocket crosslinking. In this procedure, a femtosecond laser was used to create a lamellar pocket where riboflavin can be injected. This procedure allows better delivery of the drug to the corneal stroma without the disadvantages of scraping the corneal epithelium. When compared to transepithelial CXL, the corneal pocket technique demonstrated more sustained effect at 18 months. Be- cause this was a small study, more data is warranted, but this does seem to be a promising new technique that harnesses the advantages of both epithelium-on and epithelium-off CXL. EW Editors' note: Dr. Jeng is professor and chair, Department of Ophthalmolo- gy and Visual Sciences, University of Maryland School of Medicine, Balti- more. He has no financial interests related to this article. Contact information Jeng: bjeng@som.umaryland.edu View Dr. Jeng's presentation at Clinical.EWrePlay.org.

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