Eyeworld

Reporting from the 2016 World Ophthalmology Congress, February 5–9, Guadalajara, Mexico EW MEETING REPORTER 128 March 2016 Dr. Höfling-Lima encouraged attendees to review the ophthalmic journals for images of Acanthamoeba infection, so it will become easier to identify it in patients. In later disease, ring infiltrates, ulcerations, and corneal edema are more common. Signs of severe disease can include abscesses, glau- coma, and corneal melt. There also may be scleritis that is unrelated to Acanthamoeba. Although topical corticoste- roid treatment is controversial, if a patient has been treated for Acan- thamoeba for 2 weeks and still has persistent inflammation, it is OK to prescribe them, she said. Fungal keratitis comes with its own set of diagnosis and treatment challenges, according to Guillermo Amescua, MD, Miami. While 5% to 20% of microbial keratitis cases can be fungal, at Bascom Palmer Eye In- stitute, it can be closer to 35%. The rate of fungal keratitis will vary geo- graphically, Dr. Amescua explained. Risk factors associated with fungal keratitis include trauma, agricultural work, previous surgery, contact lens use, and herpes simplex keratitis. In terms of helping to diagnose fungal keratitis, "there's nothing better than a good scraping," Dr. Amescua said. Polymerase chain reaction and confocal microscopy are also helpful. the value of the small incision lenticule extraction (SMILE) proce- dure that many surgeons are gaining experience with (although more in- ternationally than in the U.S. at this time). SMILE uses the femtosecond laser to create a small incision into the anterior stroma and a dissection in two planes to create a lenticule, which is then removed, he said. Potential advantages of this new procedure are fewer nerves affected, faster recovery of corneal sensation, and a potential biomechanical ad- vantage. The extracted lenticule may also be "extracted," Dr. Majmudar said, either with reimplantation for ectasia or return to myopia when presbyopic or for endokeratophakia. "Femtosecond lasers have allowed us to have a renaissance or rebirth of LASIK," he said. There is widespread use due to a better safety profile and the ability to create a customized and optimized LASIK experience. Gaining efficacy by using the femtosecond laser and intracorneal ring segments David Touboul, MD, Bordeaux, France, discussed "Femtosecond and Intracorneal Ring Segment for a Gain in Efficacy." Performing the ring proce- dure with manual dissectors was sometimes difficult, he said. There were often inaccuracies in terms of centering, positioning, and depth, but the complication rate of ring implantation dramatically decreased with the use of the femtosecond laser, Dr. Touboul added. The fem- tosecond laser is the perfect tool to perform customized pre-cut pat- terns, he said. However, this technology still has its limitations. There could be tissue opacities, interface discontinu- ities, or corneal viscoelastic anisotro- pia. Other limitations that Dr. Touboul mentioned were that the femtosecond laser needs a reference plane, involving a window of appla- nation or imaging system, and it has very precise settings depending on the preoperative data and specific software. You need to be sure that many parameters are optimized for ring insertion, he said, like preop data, software settings, and surgery. In the future, Dr. Touboul said that intraoperative aberrometry sys- tems could be useful to compensate for comatic aberrations and astigma- tism. He said that the femtosecond laser provides the opportunity to get rings accurately planed and inserted for a gain of efficacy. Ring insertion is still a "handmade" procedure, he said, and is very dependent on surgeon experience. There could be more predictable outcomes in the future with more research. Pearls for anterior segment disease From Acanthamoeba keratitis and fungal keratitis to ocular rosacea and ocular surface tumors, the session "A Contemporary Review of Diagnosis and Treatment of Anterior Segment Diseases: Things You Don't Want to Miss" covered a cornucopia of ante- rior segment disease topics. Signs of Acanthamoeba keratitis include photophobia, tearing, pain, and, in the early stage, perineural infiltrates, said Ana Luisa Höfling- Lima, MD, São Paulo, Brazil. Confocal microscopy can be a helpful way to view perineural in- filtrates, she shared. "It's important to see [perineural infiltrates] once so you never miss them again," she said. View videos from WOC 2016: EWrePlay.org Marie-Jose Tassignon, MD, discusses the bag-in-the-lens procedure with a toric IOL.

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