Eyeworld

EW MEETING REPORTER 80 November 2016 Reporting from the American Academy of Ophthalmology (AAO) meeting, October 15–18, Chicago Reporting from the American Academy of Ophthalmology (AAO) meeting Refractive keynote lecture covers science of corneal haze Steven Wilson, MD, Cleveland, led the International Society of Refrac- tive Surgery's annual meeting ahead of the AAO annual meeting with a presentation on the science behind corneal wound healing and what is causing haze. "The key point of this lecture is the epithelial basement mem- brane regulates all corneal scarring and transparency," Dr. Wilson said during his keynote lecture. "Wheth- er it heals with transparency or haze depends on whether the epithelial basement membrane regenerates normally." Defective epithelial basement membrane (EBM) regeneration seems to occur after higher diopters of PRK correction compared to lower diopters of correction. It can also occur at the edge of the LASIK flap, thin LASIK flaps, and in microbial keratitis. Dr. Wilson took attendees through research that explains what is happening at the cellular level. In cases with no detectable EBM, Dr. Wilson described how my- ofibroblast cells, which are opaque, develop from bone marrow and keratocyte precursors and persist. EBM regeneration can fail when the stromal surface is rough and/or when there are insufficient kerato- cytes on the anterior surface because these cells are responsible for creat- ing the EBM components. At higher diopters of correction in PRK, there are lower levels of the EBM-building components, Dr. Wilson showed. If those keratocytes are not there then you don't get regeneration of the basement membrane, and TGFß can penetrate at higher levels and drive the development of myofibroblasts. However, even severe haze can clear, Dr. Wilson said, explaining that areas where the EBM has finally regenerated can coalesce over time and transparency can be restored. Dr. Wilson also spoke on tran- sient corneal haze, breakthrough haze, and the mechanism of mito- mycin-C. "I hope you've learned a little bit more about what causes haze. Remember, you've got to get that basement membrane regenerated to prevent haze from occurring," Dr. Wilson said, adding that he thinks it could lead to new agents that could help regenerate the basement membrane. Editors' note: Dr. Wilson has no finan- cial interests related to his comments. Individualized approach needed for vitreomacular traction Vitreomacular traction requires a tailored treatment approach that de- pends on the patient's overall health status, the risk and benefits of each treatment, the cost of treatment, and other factors, said Harry Flynn Jr., MD, Miami. Dr. Flynn gave the Charles L. Schepens MD Lecture during the Retina Subspecialty Day programming. Dr. Flynn outlined four pos- sible treatments for vitreomacular traction and discussed when each choice may be appropriate, per what published research has found. The treatment choices include a pars plana vitrectomy (PPV), pneumatic vitreolysis, enzymatic vitreolysis, and observation. A PPV appears to be the most appropriate choice in eyes with an epiretinal membrane and broader adhesions, Dr. Flynn said. Pneumatic vitreolysis is suited for focal adhesions and when there is a need for nonsurgical options. Enzymatic vitreolysis, including the use of ocriplasmin (Jetrea, ThromboGenics, Iselin, New Jersey) as well as other agents, is best for focal adhesions and when there are no epiretinal membranes. Surgeons must consider the higher cost of this treatment choice as well as its transient side effects, Dr. Flynn said. Observation, which Dr. Flynn said is usually his favored treatment strate- gy, is ideal in eyes with better visual acuity or when a patient requests no interventions. Editors' note: Dr. Flynn has no finan- cial interests related to his comments. Sponsored by

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