Eyeworld

145 EW MEETING REPORTER gram negative infections in Indian cases. Intracameral moxifloxacin thus provides a more promising alterna- tive. Dr. Shreyas Ramamurthy described the results of a study examining the efficacy of intracam- eral moxifloxacin endophthalmitis prophylaxis at Aravind Eye Hospital, Madurai, India. Cases were divided into three groups: SICS without prophylaxis, SICS with prophylaxis, and phaco with no prophylaxis. The study revealed a fourfold statisti- cally significant reduction in the incidence of endophthalmitis with intracameral moxifloxacin—0.02% in the SICS with prophylaxis group against 0.08 in the SICS and 0.07 in the phaco without prophylaxis groups. Significantly, this reduction was achieved despite the risk factors going against the result: the larger incision of SICS, the lower socioeco- nomic status of patients undergoing the procedure, and the fact that 40% were performed by surgeons in training. In the face of this data, the barriers to adoption remain the lack of approval from the U.S. Food and Drug Administration and subse- quent lack of commercially avail- able preparations of antibiotic for prophylaxis. EW generally agreed upon, but how do you use it? Dr. Shreyas Ramamurthy cited evidence that a drop of iodine was not significantly different from using no iodine, while irrigating the conjunctival sac significantly reduced the risk of infection. In terms of perioperative antibi- otics, Dr. Shreyas Ramamurthy said that topical antibiotics are widely used and are likely to remain so; however, with intracameral antibi- otic injections achieving far higher minimum inhibitory concentrations (MICs), the use of topical antibiotics is becoming questionable. Nevertheless, the use of intraca- meral antibiotic injections is itself famously contentious. Revisiting the ESCRS landmark study on endophthalmitis pro- phylaxis, Dr. Shreyas Ramamurthy noted that topical antibiotics did not appear to have a significant role, while intracameral antibiotics decreased endophthalmitis five- to sevenfold. However, many question these results due to the inordinately high rate of endophthalmitis in the control group—0.35%, higher than average globally. Geographic differences appear to play a role as well. The ESCRS study used intracameral cefuroxime, an antibiotic that makes no differ- ence in endophthalmitis incidence in the Indian scenario. This could be explained by a high percentage of Development of a Child: Role of School Eye Health." There is enough evidence, Dr. Buttan said, that visual stimuli im- pact all areas of child development. Visual impairment impacts a child's health and perspective, limiting vision-related activity, triggering potentially harmful coping strategies such as deliberately avoiding social interaction, impacting the child psychologically and socially. Children who struggle to see, Dr. Buttan said, struggle to learn: 80% of what young children learn is processed through sight. Providing spectacles, Dr. Buttan said, has a statistically significant impact on academic performance equivalent to adding approximately half a semester of additional learn- ing. Clearly, vision correction is life changing. National Symposium focuses on infection "We don't grow when things are easy; we grow when we face chal- lenges," said Dandapani Ramamur- thy, MD, Coimbatore, India. "En- dophthalmitis is such a challenge for ophthalmologists." Dr. Dandapani Ramamurthy spoke at a National Symposium that focused on the various aspects of endophthalmitis in ophthalmic sur- gical practice, from techniques and practices in the operating theater to the use of intracameral antibiotic prophylaxis. Antibiotic prophylaxis remains a contentious issue, but Shreyas Ra- mamurthy, MD, Coimbatore, India, endeavored to examine the evidence to provide a definitive answer. Reviewing the history of the controversy, Dr. Shreyas Rama- murthy said that the incidence of endophthalmitis had always been low, with published rates ranging from 0.03 to 0.2%, with a steady decline through the years as steril- ization practices improved. Howev- er, around 2003, with the increasing preference for clear corneal incisions over scleral incisions, there was a sudden spike to 0.29%. The use of povidone iodine prior to surgery is the one method powering the cadre with ophthal- mic knowledge and skills, they also strengthened the COPs' computer skills and spoken English, and in- cluded life skills education. The resulting workforce did comprehensive examination and counseling from eye camps to hos- pital, and could operate as a satellite hospital workforce. Assessing the program's impact from January to December 2015, during which 65 COPs underwent 6 months of training, various quality parameters improved, postoperative infection decreased, patient satisfac- tion improved, costs were reduced— quality and accessibility overall were improved. The COPs, consisting of female rural school graduates, recalled for Dr. Mathur an African proverb: "If you educate a man, you educate an individual; if you educate a woman, you educate the nation." Praveen Vashist, MD, New Delhi, India, proposed tapping another existing resource in India: the accredited social health activists (ASHAs). ASHAs, Dr. Vashist said, are primary care workers not specific to eyecare, but can act as bridge between paramedical ophthalmic assistants and communities. The ASHAs can provide general awareness of diseases, educate and empower communities by removing myths and misconceptions, and facilitate referrals and follow up. The Vision Delhi program, Dr. Vashist said, provides a model for urban eye healthcare. After taking requisite permissions, primary eye- care clinics were established in 11 centers, starting small with once-a- week clinics in every center. Ser- vices included free eye checks, free medicines, refraction services and spectacle prescriptions, retinopathy screening of known diabetics, and free cataract surgery. Vision correction "life changing" The Vision 2020 initiative and ef- forts to eliminate visual impairment take on stark urgency amid the con- text provided by Sandeep Buttan, MD, New Delhi, India, speaking on the "Impact of Visual Health on the March 2017 View videos from AIOS 2017 EWrePlay.org Inder Paul Singh, MD, Kenosha, Wis., discusses updates on YAG vitreolysis technology.

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