EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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108 EW MEETING REPORTER October 2012 Reporting live from ESCRS 2012 Milan, Italy XXX Congress continued from page 107 currently in Phase III trials and not available for commercial use yet, Prof. Cursiefen said, and there are still unsolved issues with the regi- men, including dosing, duration, and timing of anti-lymphangiogenic therapies. "Avastin gives reliable regression in immature vessels," Prof. Cursiefen said, pointing out that the use is off- label. "It does not seem to have an effect on resting nerves, but on re- generating ones." Anti-VEGF on the ocular surface Stephen S. Lane, M.D., speaks at an ESCRS symposium Source: EyeWorld The ESCRS Congress officially kicked off Sunday. Corneal vascularization In the first joint session with EU- Cornea, Dalia Said, M.D., Cairo, gave an overview of different types of vessels in neovascularization. "Specific infections have specific patterns of vascularization," she said. The vessels tend to follow planes—incisional planes along the healed scar lines of lacerations, graft- host junction or arcuate incisions and lamellar planes from deep lamellar keratoplasty and endothe- lial transplants. Dr. Said and colleagues studied 165 cases of neovascularization and found that nearly half of them were caused by infections. Broken, loose, and tight sutures also cause neovascularization along the suture track. Not all corneal vascularizations are the same. They have diverse causes and manifestations, said Dr. Said. Management of a CVA classifica- Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team from ESCRS 2012, Milan, Italy tion system is needed, she said. Practitioners have two goals— preventing corneal vascularization and preventing remnants of it, said Per Fagerholm, M.D., Linkoping, Sweden. Complications of neovascular- ization include remnants of fibrovas- cular tissue, lipoid degeneration, and ghost vessels, which result in re- duced visual acuity. "Ghost vessels remain and are very resistant," Prof. Fagerholm said. Panelists continued with a dis- cussion on the medical and surgical management of corneal neovascular- ization. Corneal vascularization is the No. 1 factor for graft rejection, and there is good empirical evidence that controlling vascularization helps promote graft survival, the experts agreed. Antiangiogenic treatment op- tions differ depending on the type— either mature pericyte-covered vessels or immature outgrowing ves- sels, said Claus Cursiefen, M.D., Cologne, Germany. Fine-needle cautery combined with subconjunctival and topical Avastin (bevacizumab, Genentech, San Francisco) can be used on ma- ture vessels prior to transplantation. Steroids, anti-VEGF, and anti- sense oligonucleotides against IRS-1 (GS-101 eye drops) strategies can be used as primary prevention during keratitis and tertiary prevention after transplantation. The eye drops are also may have effects on corneal ep- ithelial and stromal healing, he added. Foremost, Prof. Cursiefen said, is treating the underlying disease be- fore adding anti-VEGF therapy. "You have to continue this treatment as long as the underlying issue is there," he said. Cataract surgery and macular disease Surgeons at the ESCRS/EURetina Symposium, which focused on cataract surgery and macular disease, discussed whether phacoemulsifica- tion accelerates conversion to wet AMD and whether prophylactic anti-VEGF therapy should be admin- istered in high-risk dry and wet AMD patients at the time of cataract surgery. One of the most common ques- tions Sebastian Wolf, M.D., Bern, Switzerland, receives is whether cataract surgery is safe for someone with AMD. Patients often worry that having the surgery will worsen their disease, he said. "There is no clear evidence that cataract surgery promotes AMD pro- gression," he said. "And there is no proof for increasing disease activity in the presence of wet AMD either." Anti-VEGF therapy also has not been proven to have a prophylactic effect on either dry or wet AMD. If signs and symptoms are sug- gestive of choroidal neovasculariza- tion, clinicians should perform an SD-OCT and fluorescein angiogra- phy before cataract surgery. Wet