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102 EW MEETING REPORTER February 2012 Meeting Reporter continued from page 101 Reporting live from the 2012 Hawaiian Eye meeting surface crosslinking for suspicious cases prior to LASIK has shown promise, but Dr. Seiler said the pro- cedure has significant side effects, including prolongated DLK, delayed visual recovery, and an adherence ef- fect. That might be troublesome when a surgeon needs to lift the flap for enhancements, he said."The flap was so adherent to the wound that we could not lift it anymore," he said of one case at 3 months post- op. "Obviously there's a strong heal- ing connection." EW Lens (ICL, STAAR Surgical Co., Mon- rovia, Calif.) on the steep axis has yielded excellent results in spherical patients. "People have been so pleased with their quality of vision that they haven't wanted to have anything else done." Dr. Barnes pointed to a small study in which 98 astigmatic patients were implanted with the ICL. A 33-mm incision was created on axis in 69 male and 29 fe- male patients. "It does cause some flattening, and in this case, we want that," Dr. Barnes said, adding that he wasn't comfortable adding pe- ripheral corneal relaxing incisions to the procedure in soldiers' eyes. Dr. Barnes said 98% of the patients in the small study either retained vi- sion or gained a line of vision with the procedure. "Visual acuity was better than I expected with the un- corrected astigmatism," he said. "Honestly, I would prefer to have a toric ICL, but not enough to say let's just hold off on surgery. I'm not making people wait." PRK enhancements limit epi ingrowth Watch videos from Hawaiian Eye on your smartphone or iPad using your QR code reader. (Scanner available for free at your app store.) Or view the video at http://www.eyenewstv.com/hawaiimr Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team from the 2012 Hawaiian Eye meeting, Maui. "Regression after LASIK is tradition- ally treated with a flap-lift enhance- ment; however, there is the risk of epithelial ingrowth, and in a certain population, PRK can be a safer op- tion," said Vance M. Thompson, M.D., associate professor of ophthal- mology, University of South Dakota School of Medicine, Sioux Falls, and director of refractive surgery, Sanford Health, Sioux Falls. Dr. Vance pointed to a 2005 study that demon- strated that 34.2% of patients had epithelial ingrowth after a flap-lift enhancement, even though other studies have shown the flap-lift to be effective, with 90% of patients re- taining 20/50 or better uncorrected visual acuity post-op for up to a year.Dr. Vance reported on a retro- spective review of 68 patients who had a custom PRK enhancement after LASIK for regression. All of those patients reached 20/40 or bet- ter uncorrected visual acuity, Dr. Thompson said. Cataract formation is a concern, suggesting it is under- recognized pre-op or accelerated by post-op steroid regimen. Crosslinking 'may stop melting' It has been established that crosslinking stops the biomechanical progression of keratoconus and ecta- sia, said Theo Seiler, M.D., Ph.D., professor and chairman, department of ophthalmology, University of Zurich, Switzerland."It also makes the collagen more resistant to enzy- matic digestion, which is present in all melting disorders of the cornea," he said. "In those cases, we can stop the melting because crosslinking makes the structure of the collagen different."Dr. Seiler pointed to one case of a 24-year-old patient with Morbus Terrien in which surgeons used crosslinking to stop the corneal thinning process, but found that a reversal of the melting took place. "What is not widely known is that crosslinking makes the collagen more resistant to degradation. It's a biochemical effect," he said. Rapid Editors' note: Mr. Corcoran has finan- cial interests with Corcoran Consulting Group. Dr. Dewey has financial inter- ests with MicroSurgical Technology (MST, Redmond, Wash.) and Abbott Medical Optics (AMO, Santa Ana, Calif.). Dr. Hovanesian has financial interests with IOP Ophthalmics. Dr. Huang has financial interests with Carl Zeiss Meditec (Dublin, Calif.) and Op- tovue (Fremont, Calif.). Dr. John has fi- nancial interests with Bausch + Lomb (Rochester, N.Y.), iScience (Menlo Park, Calif.), Alcon (Fort Worth, Texas), Al- lergan (Irvine, Calif.), and ISTA Phar- maceuticals (Irvine, Calif.). Dr. Katz has financial interests with Glaukos. Dr. Packer has financial interests with AMO, Bausch + Lomb, LensAR (Winter Park, Fla.), and Wavetec (Aliso Viejo, Calif.). Mr. Pinto has financial interests with Compulink (Westlake Village, Calif.). Dr. Rajpal has financial inter- ests with Avedro (Waltham, Mass.). Mr. Reider has financial interests with Alcon, Bausch + Lomb, LensAR, Wavetec, and Lenstec (St. Petersburg, Fla.). Dr. Samuelson has financial in- terests with Glaukos and Ivantis (Irvine, Calif.). Dr. Singh has financial interests with Alcon, Bausch + Lomb, iScience, and Ivantis. Dr. Thompson has financial interests with AMO, Acu- Focus, and Alcon. Dr. Vukich has fi- nancial interests with AMO and OptiMedica (Santa Clara, Calif.). Dr. Weikert has financial interests with Alcon, Ziemer (Port, Switzerland), and AMO.