Eyeworld

Reporting from the 2016 ESCRS Congress, September 10–14, Copenhagen, Denmark EW MEETING REPORTER 146 October 2016 Dr. Wielders stressed that a lot of research has been done recent- ly on this topic, but the general conclusions found in the systematic review remain unchanged. Researchers found that in all study groups, topical NSAIDs were more effective than steroids to pre- vent CME and a combination was also effective, she said. If the patient does develop CME, Dr. Wielders said it's import- ant to know that most patients are asymptomatic. Long-standing CME may cause retinal damage and sus- tained visual impairment. Physicians should think about secondary and tertiary prevention, she added. Growing applications for OCT technology If one thing is clear from the clinical research symposium focused on op- tical coherence tomography (OCT), it's that the uses of the technology are widespread and varied with more coming down the pike. Leopold Schmetterer, PhD, Vienna, Austria, discussed how high-definition OCT can be used on the cornea to create reflection maps of the lipid layer in the tear film, evaluate meibomian glands, and vi- sualize epithelial defects, corneal pa- thologies, some of the corneal nerve structure, and Schlemm's canal and collector channels. "One of the problems with dry eye and dry eye disease is the total costs involved with patients who de- velop macular edema after cataract surgery. She advised starting primary prevention directly after cataract surgery. However, there is some debate over the standard of care for this. Some prefer using corticoste- roids, while some prefer NSAIDs, and still others prefer a combination of steroids and NSAIDs. Dr. Wielders discussed a study that was a systematic review looking at patients undergoing uncompli- cated cataract surgery. The study included both non-diabetic and diabetic patients who had no pre- operative CME and no predisposing factors. The odds for developing CME were determined within a 3-month period postoperatively. A literature search was conduct- ed, and all treatments were classified into predefined treatment groups. A subgroup analysis was also per- formed, Dr. Wielders said, looking at patients with diabetes, without diabetes, and a mixed group. In the non-diabetic group, it was found that NSAIDs and a combi- nation of NSAIDS and steroids were more effective than corticosteroids. Meanwhile, in the diabetic group, a combination therapy was more effective than steroids alone in reducing risk of developing CME. The mixed population showed that NSAIDs were more effective in reducing the risk of CME. than 90 degrees of tissue loss. If the iris tissue defect is more significant or if there is aniridia, Dr. Malyugin said different strategies are used including iris print contact lenses, corneal tattooing, and artificial iris diaphragms. In the case of intraocular foreign body, Kristian Klemp, MD, Co- penhagen, Denmark, said patients might present with few symptoms with the eye looking quiet and a normal IOP. Upon presentation, a rigid eye shield should be placed and the foreign body should be left in the eye until the patient is seen by a specialist. A compressing eye patch should never be used. Following, biomicroscopy should be used to assess the en- trance wound, and a CT scan can reveal the extent and location of the foreign body. Once the possibility of a magnetic foreign body has been ruled out, an MRI can be ordered to identify an organic foreign body. Surgical removal will depend on its position, but Dr. Klemp advised surgeons make a sclerotomy large enough to actually remove the piece from the eye. Cataract and macular disease Cataract and macular disease was one of the topics of a clinical re- search symposium. Laura Wielders, MD, Maastricht, Netherlands, dis- cussed "Treatment and prevention of post lens surgery macular ede- ma," highlighting prevention and treatment of cystoid macular edema (CME) after cataract surgery. Cataract surgery is one of the most frequently performed surgi- cal procedures in many European countries and around the world, she said. The number of cataract surger- ies performed yearly has increased recently, and the World Health Organization (WHO) expects around 33 million cataract surgeries to be performed yearly in just a few years. Though it is performed fre- quently, there are still some prob- lems that can occur after routine sur- gery, and one such problem is CME, Dr. Wielders said. The incidence of significant macular edema is low, but in diabetic patients, incidence is much higher. There are additional View videos from ESCRS 2016: EWrePlay.org Emilio Pedrotti, MD, discusses how in vivo confocal microscopy can identify keratocyte changes during accelerated crosslinking.

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