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107 EW INTERNATIONAL March 2016 Contact information Mah: Mah.Francis@scrippshealth.org White: andrew.white@sydney.edu.au worsened again to 2/60, and central corneal thickness was 677. Famciclovir and dexamethasone improved her condition. Primary issue was not glaucoma "All 5 cases of unilateral glaucoma were found to be secondary to HSV/ CMV infection and treated effective- ly with anti-viral medications," Dr. White said. "Although the confocal microscopy results were not always diagnostic, it was suspected that a few patients may have had iridocor- neal endothelial (ICE) syndrome. ICE syndrome is characterized by iris destruction, secondary glaucoma and corneal decompensation. ICE syndrome frequently masquerades as glaucoma; in a study, glaucoma secondary to ICE syndrome was fre- quently attributed to another cause in 68% of patients. ICE syndrome is often secondary to chronic viral infection." Dr. White recommended that HSV/CMV infection be suspected in all cases of unilateral glaucoma. "Instigating early glaucoma surgery as soon as IOP is normalized may be the only way to prevent irreversible glaucomatous changes secondary to extended periods of uncontrolled elevated IOP," Dr. White said. "Also, potentially sup- plementing these patients with an- ti-viral treatment may be effective in helping control the disease process." Other herpes-related eye diseases Francis Mah, MD, director of corneal and external disease and co-director of refractive surgery, Scripps Clinic, La Jolla, Calif., said viruses at the core of certain unilat- eral glaucoma-related issues might make sense. "We see it in cornea," Dr. Mah said. "Patients can get unilateral uveitis. They can also get endothe- lialitis and trabeculitis, where the herpes virus is specifically affecting endothelial cells of the trabecular meshwork, reducing outflow, and increasing the pressure in eyes." If patients have uveitis with elevated pressure, "you always think about herpes," he said. Typically, uveitis causes a decrease in IOP due to a mild shutdown of the ciliary body and it's ability to produce aqueous. Herpes is one of the rare causes of uveitis that includes an increase in IOP, he said. EW Editors' note: The physicians have no financial interests related to their comments. THE PRESBYOPIA SOLUTION THEY'VE BEEN WAITING FOR. The KAMRA inlay provides a full range of vision and long-term performance, while leaving the natural lens in place. Indications for Use: The KAMRA inlay is indicated for intrastromal corneal implantation to improve near vision by extending the depth of focus in the non-dominant eye of phakic, presbyopic patients between the ages of 45 and 60 years old who have cycloplegic refractive spherical equivalent of +0.50 D to -0.75 D with less than or equal to 0.75 D of refractive cylinder, who do not require glasses or contact lenses for clear distance vision, and who require near correction of +1.00 D to +2.50 D of reading add. KAMRA; the KAMRA logo; Across the page. Across the room. Across the years; and The Presbyopia Solution are trademarks of AcuFocus, Inc. ©2016 AcuFocus, Inc. MKU-157 Rev F Mean near acuity improved about 3 lines to 20/25 at 1 month and was maintained over the 5 year follow-up. The US pivotal clinical study data reported an average gain of about 3 lines of near visual acuity.** *Dexl AK et al. Long-term outcomes after monocular corneal inlay implantation for the surgical compensation of presbyopia. J Cataract Refract Surg. 2015 Mar;41 (3):566-75. **PMA data on file at AcuFocus, Inc. 20/200 20/125 20/80 20/50 20/32 20/20 20/12.5 0 10 20 30 40 50 60 SNELLEN ACUITY MONTH UNCORRECTED NEAR VISUAL ACUITY (INLAY EYE ONLY)* INLAY EYE J2 Across the page. Across the room. Across the years. Visit us at ASCRS Booth #545 ®

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