Eyeworld

Reporting from the 2017 ASCRS•ASOA Symposium & Congress, May 5–9, 2017, Los Angeles EW MEETING REPORTER 88 June 2017 Sponsored by tomic malformations (coloboma, for example) are present. Nanophthalmos needs to be distinguished preoperatively due to the complications that could occur, which need to be prepared for or treated ahead of time. A preoperative assessment with ultrasound biomicroscopy is helpful, Dr. Hoffman said. Accurate axial length measurement is critical, "be- cause even a small error can lead to a larger refractive error," Dr. Hoffman said. Modern IOL calcu- lators (Hill-RBF, Barrett II, Olsen, Hoffer Q, Holladay II, and Haigis) were advised, as well as piggyback IOLs for eyes needing more than 40 D of correction. As for surgical approach, Dr. Hoffman said topical and intracam- eral anesthesia should be used rather than a block, which could increase posterior pressure and vortex vein occlusion. If the IOP is more than 24 mm Hg, Dr. Hoffman advised 20% mannitol. It's also important to avoid hypotony, use a dispersive viscoelastic, and he finds microinci- sion forceps helpful for the cap- sulorhexis. If an anterior chamber doesn't exist, a limited pars plana vitrectomy can be performed, but Dr. Hoffman cautioned against it in nanophthalmos eyes as they may be too short. Ronald Yeoh, MD, Singapore, representing APACRS, gave his pearls finest things about MIGS is it gives us hope for the future that one day we will solve glaucoma," Dr. Brown concluded. Editors' note: Dr. Brown has finan- cial interests with Allergan (Dublin, Ireland), Rhein Medical (St. Petersburg, Florida), and Glaukos. East Meets West symposium presents differing viewpoints How physicians from the East ap- proach certain situations can be different from their counterparts in the West, and learning from each other was the point of the "East Meets West" symposium cospon- sored by ASCRS and APACRS. Richard Hoffman, MD, Eugene, Oregon, representing ASCRS, was up first, discussing his practical solutions for cataract surgery in short eyes (less than 20 mm in axial length). The clinical spectrum of the small eye is divided into four groups —simple microphthalmos, complex microphthalmos, nanophthalmos, and relative anterior microphthal- mos—Dr. Hoffman said. Simple microphthalmos constitutes 83% of hyperopes and is without com- plications related to the condition unless surgically induced. Complex microphthalmos is similar to simple in terms of short axial length and normal anterior chamber, but ana- idea to two companies and was ultimately rejected. This device laid the groundwork for the MicroOptx Brown Glaucoma Implant (Maple Grove, Minnesota), which is begin- ning FDA trials. In 1995, Dr. Brown and his wife developed a technique for a 360-de- gree trabeculotomy in congenital glaucoma patients. This was the precursor for gonioscopy-assisted transluminal trabeculotomy (GATT). Next, Dr. Brown developed a T-tube, a trabecular bypass device to improve outflow in both direc- tions into scleral collector channels. This device called EyePass—similar in mechanism to iStent (Glaukos, San Clemente, California)—was eventually abandoned after several FDA trials when its sponsor ran into financial trouble. Why did iStent succeed while EyePass did not? Dr. Brown called it the Columbus effect. "The first per- son often misunderstands the real market and misses the opportunity," he said. While EyePass was looking at refractory glaucoma, hoping to replace trabeculectomy, went surgi- cally from the outside in, and was not combined with cataract, iStent targeted mild to moderate glaucoma, sought to reduce medications, went ab interno, and was combined with cataract surgery. With iStent, other recently approved MIGS devices, and those in the pipeline, are we there yet, is glaucoma now a surgical disease? While it's certainly moving in that direction, Dr. Brown said cur- rent MIGS rely on passive pressure to lower pressure. While this is safe, he thinks we need active flow, a pump. "Nature's pump is cilia, and they're everywhere and they're amazing," he said, going on to de- scribe research on the development of pseudo-cilia, powered by mag- nets, that could someday be lined up in rows and used as a pump in conjunction with MIGS. "If this is like our other prod- ucts, it will be a product in 10 to 15 years by someone else," Dr. Brown quipped. "We need more innovation, and MIGS has been great, but one of the View videos from ASCRS•ASOA Los Angeles: EWrePlay.org Reay Brown, MD, discusses the foundation of MIGS, accomplishments for which he was chosen to give the 2017 ASCRS Innovator's Lecture.

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