EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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14 EW NEWS & OPINION August 2012 ASCRS Best papers of session At the ASCRS•ASOA Symposium & Congress, the Best Paper of Session is selected by the moderator and panel for each free paper symposium. In the next several issues of EyeWorld, the medical editors will be highlighting some of these best papers by inviting the authors to submit a brief summary or abstract. —David F. Chang, M.D., chief medical editor Survey study comparing satisfac- tion with LASIK and contact lenses for vision correction Francis W. Price Jr., M.D., Marianne O. Price, Ph.D. This ongoing multicenter survey study is designed to assess patient satisfaction with two popular vision correction methods, LASIK and con- tact lenses, annually for 4 years. So far 19 centers have enrolled over 1,200 participants, 650 in the LASIK arm and 559 in the contact lens arm. When initially surveyed, 943 participants wore contact lenses, most for longer than 5 years, and 92% of the contact lens wearers in- dicated that they would recommend contact lens wear to friends and family. However, 8% reported that they had experienced an ocular in- fection, over half reported some feel- ings of dry eyes during the course of the previous week, and 15% re- ported having moderate to severe vision-related difficulty with driving at night. This ongoing study is ex- pected to establish a new benchmark by comparing LASIK with a popular vision correction alternative rather than with a hypothetical em- metropic eye. Randomized controlled trial com- paring nepafenac, ketorolac, and placebo in preventing macular edema after uneventful cataract extraction David R.P. Almeida, M.D., Zainab Khan, B.Sc., Lin Xing, B.Sc., Shahrukh N. Bakar, B.Sc., Karim Rahim, M.Sc., Todd Urton, M.D., Sherif R. El-Defrawy, M.D. The perioperative role of topical non-steroidal anti-inflammatory drugs (NSAIDs) in cataract surgery is unclear and their effect on health- related quality of life (HRQOL) unknown. We investigated the pro- phylactic effect of ketorolac and nepafenac versus placebo on post-op macular edema after routine cataract extraction. Additionally, we evalu- ated the tolerability and HRQOL of these topical NSAIDs in the context of routine phacoemulsification cataract surgery. At 1 month after surgery, analy- sis of means of differences revealed no statistical significance between ketorolac, nepafenac, and placebo. Topical NSAIDs were well tolerated with no negative effects on HRQOL. We conclude that in low-risk pa- tients with uncomplicated cataract surgery, prophylactic use of topical ketorolac or nepafenac seems to offer no benefit in preventing ocular coherence tomography changes in- dicative of macular edema after sur- gery. Transepithelial riboflavin/UVA corneal CXL: Effects on epithe- lium, keratocytes, and collagen fibers in human corneas Rita Mencucci, M.D., Mirca Marini, Iacopo Paladini, M.D., Eleonora Favuzza, Erica Sarchielli, Ugo Menchini, Gabriella Vannelli Purpose: To evaluate the effects of transepithelial corneal crosslinking (TE CXL) on epithelium and stroma in human corneas. Methods: Fifteen corneal but- tons were examined. Ten were from patients with keratoconus submitted to penetrating keratoplasty (PKP). Five of them were treated with TE CXL 2 hours before PKP, five of them were treated with TE CXL 3 months before PKP. Five normal corneal buttons from healthy donors were used as controls. All samples were prepared for the detection of keratocyte apoptosis by TUNEL and Caspase 3 assay. Immunohistochem- ical analysis (β Catenin, Connexin 43, CD34, collagen I) of epithelium and stroma was performed. Results and conclusions: In 2 hour after TE CXL corneas, β Catenin, Connexin 43 analysis showed an abnormal epithelial posi- tivity, and there were well-defined apoptotic phenomena both in epithelial cells and keratocytes. Conversely, TE CXL specimens treated 3 months before showed a normal structured epithelium and an almost physiological arrange- ment of collagen fibers, while a well defined apoptotic process on kerato- cytes is still present in the anterior part of the stroma (about 120 µm). Further studies will be necessary to prove the real biomechanical effect of this more superficial form of CXL. Anterior capsule healing patterns following femtosecond laser- assisted cataract surgery William W. Culbertson, M.D., Neil Friedman, M.D., Jonathan H. Talamo, M.D., Dan Andersen, Georg Schuele Since the advent of the continuous curvilinear capsulorhexis (CCC), the ultimate anterior-posterior position of IOLs placed within the capsular bag has been at the mercy of the inconsistencies in the original diam- eter, shape, and centration of the capsulorhexis as well as the unpre- dictability of fibrosis of the capsular opening over time. Previous studies have demonstrated that the fem- tosecond (FS) laser can provide en- hanced dimensional and positional precision in the creation of the ante- rior capsulotomy, providing hope that the achieved effective lens position (ELP) would be more pre- dictable and stable, thereby resulting in better refractive outcomes follow- ing cataract surgery. We embarked on this study to determine if FS laser-created anterior capsulotomies showed different fibrosis and healing patterns over time from manually created capsulorhexes. We compared fellow eyes under- going cataract surgery in 24 patients whose anterior capsulotomies were performed with the Catalys FS laser (OptiMedica, Santa Clara, Calif.) in one eye and in the fellow eye by using the traditional manual CCC technique. As expected, the diame- ter and roundness of the Catalys FS laser-created capsulotomies were considerably more precise and predictable as compared to the manually performed capsulorhexes. In both cases the capsules con- tracted over time, deviating further from the intended diameter at the time of surgery. However, the diame- ter of the apertures created with the laser deviated about 100 um with a tight standard deviation, whereas the apertures created manually devi- ated well over half a millimeter with a large standard deviation. With 1.00 defining perfect roundness, the excised capsule disc had a roundness factor of 0.987+0.01 for laser cases compared to 0.903+0.05 for manual cases. On average, between 1 week and 1 month, roundness changed 0.02 in laser cases with tight stan- dard deviations as compared to manual cases with an average change of 0.05 with a larger stan- dard deviation. So the advantage seen by the laser group at time of surgery was maintained over time. Photographs of the relative amount of fibrosis of the anterior capsule at 1 week and 1 month were reviewed by masked examiners. In- terestingly, no statistical difference was found between the manual and FS laser groups at these two time intervals compared to baseline. This finding suggests that the profound difference in the change in round- ness and diameter over the 1-month period is not the effect of any differ- ence in the amount of fibrosis of the capsule. Although this study reveals a propensity for a manual capsu- lorhexis to exhibit a greater amount of change in diameter and round- ness over time than Catalys FS laser anterior capsulotomies, this differ- ence does not appear to be the result of any difference between these two groups in the amount of progressive fibrosis of the capsule over time. Thus, there is no obvious explana- tion for these observations. One possible cause could be some direct strengthening effect of the FS laser photodisruption on the lasered edge of the capsule such as an annealing effect that conveys better strength and stability to the capsule edge. The clinical value of these potential advantages remains to be confirmed. EW