Eyeworld

EW REFRACTIVE 100 October 2017 by Rich Daly EyeWorld Contributing Writer and reduced corneal thickness," Dr. Canedo said. "This illustrated the importance of IOP assessment after refractive surgery." Another insight of the poster, which was described as "ground- breaking" when it was awarded first place in the keratorefractive category of posters at the 2017 ASCRS•ASOA Symposium & Congress, was the need to measure patients with a vari- ety of glaucoma detection tools. "[Physicians must be aware and] assess proper IOP because Gold- mann applanation may be lower and underestimated after LASIK," Dr. Canedo said. "We saw with the Corvis ST and the Ocular Response Analyzer, IOP was much higher." Dr. Canedo said every surgeon must be aware of the importance of measuring IOP after refractive sur- gery—not just glaucoma patients "It's important for all patients and all ages because we don't always know the patient as he or she might have been referred to us," Dr. Cane- do said. "For instance, we didn't know if this patient had pigmentary glaucoma or pigment dispersion syndrome in the past. It's not just older patients who have glaucoma or secondary glaucoma." Dr. Canedo said a possible asso- ciation between pigment dispersion syndrome and ectatic corneal disease deserves further study. EW Editors' note: Dr. Canedo has no finan- cial interests related to this study. Contact information Canedo: alccanedo@gmail.com A case study presented as an award-winning poster at the 2017 ASCRS•ASOA Symposium & Congress encourages postop glaucoma exams for all LASIK patients A 31-year-old man was referred to the clinic of Ana Laura Caiado Cane- do, MD, Rio de Janeiro, Brazil, and colleagues due to progressive myopic regression and visual impairment after LASIK in both eyes. The patient had uncorrected distance visual acuity of 20/60 OD and 20/80 OS with no previous ocular disease or family history of glaucoma. But the funduscopic exam showed a linear cup/disc ratio of 0.3 in OD and 0.7 in OS, while pigment dispersion syndrome was detected by slit lamp biomicroscopy with Krukenberg's spindle in both eyes. Also detected was Fleischer ring and mild corneal edema in the OS eye. The glaucoma results included 18 mm Hg detected in both eyes with Goldmann applanation to- nometry, 49.1 mm Hg OD and 44.4 mm Hg OS IOPcc was found by the Ocular Response Analyzer (Reichert, Depew, New York), and 52.5 mm Hg OD and 61.5 mm Hg OS was found by the Corvis ST (Oculus, Arlington, Washington). Additionally, ectasia was con- firmed in both eyes by Pentacam HR corneal tomography (Oculus), although it was more advanced in the left eye. There was mild tomo- graphic evidence of ectasia OD. Treatment Dr. Canedo and colleagues treat- ed the patient with a topical fixed combination of timolol and topical carbonic anhydrase inhibitor. One day after treatment began IOP was reduced to 11 mm Hg in both eyes with much greater deformation amplitude observed with the Corvis ST. They also observed the impact of high IOP on the Corvis ST deforma- tion measurement. "With the high IOP it appeared there was almost no deformation," Dr. Canedo said. "When we reduced the high IOP we saw much greater deformation 1 day after a fixed com- bination." Post-treatment they witnessed moderate flattening and regulariza- tion of the cornea, as shown by a comparison of pre- and post-treat- ment Scheimpflug images, and improvement in UCDA to 20/30 OD and 20/40 OS. "We saw the improvement of visual acuity, moderate flattening Poster underscores importance of post-LASIK IOP exams to take and can be a strong decid- ing factor in demonstrating which patients are likely to adapt well to the Raindrop and/or the Flexivue. Contraindications to all inlays include ocular surface disease from any cause, corneal dystrophies and degenerations, immunocompro- mised patients, and thin corneas, to name a few. He explained that all of the inlays may have the effect of slightly reducing distance vision, especially at night, which seemed to be a small trade-off for regaining near vision. However, since the inlay was not placed in the patient's dominant eye, distance vision was still strong, while reading and intermediate vision were reestablished. These technologies allow patients a high degree of spectacle independence, which fulfills patient expectations and makes the options very appeal- ing. As the technologies evolve, Dr. LiVecchi hopes to see further im- provements in presbyopic solutions in the coming months and years. One such improvement may evolve using an allograft inlay from human donor tissue. Dr. LiVecchi is current- ly setting up simultaneous trials in both the U.S. and other countries. "Inlays provide a solution for near and far vision, allow binocular vision, are safe, reversible, which holds a strong appeal for patients, and can be combined with other types of refractive surgery. Some disadvantages include glare, halos, night vision disturbances, in most cases a minimal loss of contrast sen- sitivity, and the associated expenses of surgery," Dr. LiVecchi said. Continued follow-up is crucial in these patients to understand the long-term visual development as aging continues. Long-term biocom- patibility of the inlays also needs to be observed, he said. EW Editors' note: Dr. LiVecchi has no financial interests related to his comments. Contact information LiVecchi: jtlivemd@aol.com Corneal continued from page 99 Dr. Canedo presents her poster at the 2017 ASCRS•ASOA Symposium & Congress. Source: ASCRS

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