Eyeworld

Reporting from the XXXV Congress of the ESCRS, October 7–11, Lisbon, Portugal EW MEETING REPORTER 84 November 2017 of topics in pharmaceutical pat- terns in cataract surgery, including sustained drug delivery, obtaining a large pupil, antibiotics, and the uveitic eye. Also during the session was a discussion of the results of the ESCRS Prevention of Macular Edema (PREMED) study. Rudy Nuijts, MD, Maastricht, the Netherlands, shared the results in non-diabetic patients, while Lau- ra Wielders, MD, Maastricht, the Netherlands, shared the results in diabetic patients. Cystoid macular edema (CME) remains a major problem, Dr. Nuijts said. It results from a postoperative inflammatory response and develops within 12 weeks after cataract sur- gery, with incidence peaking at 4–6 weeks. Most cases are self-limiting, Dr. Nuijts said, and it may or may not lead to significant visual loss. Dr. Nuijts noted that there is a disparity in opinions over which an- ti-inflammatory eye drops are most effective to prevent CME. The goal of the PREMED study was to provide evidence-based recommendations that could serve as a basis for clinical guidelines on the prevention of CME after cataract surgery. The study was conducted at 12 European study centers, with patient recruitment from July 2013 to February 2016. Dr. Nuijts discussed 914 non-di- abetic patients. Drugs were started 2 days before cataract surgery, with one-third of patients in the topical bromfenac group, one-third receiv- ing topical dexamethasone, and one-third receiving a combination of bromfenac and dexamethasone. Fol- low-up took place at 6 and 12 weeks postop and consisted of refraction and corrected distance visual acuity (CDVA), slit lamp exam and fun- doscopy, spectral domain OCT, and ETDRS retinal thickness map. Dr. Nuijts specified that CME was defined as an increase in central subfield mean macular thickness (CSMT) of greater than or equal to 10% as compared to baseline and cystic changes on OCT. Additionally, clinically significant macular edema (CSME) was defined as CME with less than 0.2 logMAR CDVA im- provement as compared to baseline. This year's Binkhorst Medal Lec- ture was given by Boris Malyugin, MD, PhD, Moscow, Russia. He began by discussing the contributions of Cornelius Binkhorst, MD, and Svyatoslav Fyodorov, MD, and then went on to discuss cataract surgery in high risk eyes and pupil manage- ment. Small pupil management was a challenge from the beginning, he said. In intraoperative floppy iris syndrome (IFIS), the pupil might be bigger at the beginning of the case but could constrict and prolapse during surgery, which can create a lot of difficulties. Poor mydriasis is not a purely geometrical issue, he said. It is an indicator of various systemic and/ or local comorbidities including but not limited to zonular pathology, blood aqueous barrier disruption, and IOP spikes. A small pupil is associated with an increased compli- cation rate as well. Dr. Malyugin shared surgical techniques to manage small pupils, showing video case presentations. He also highlighted small pupil and phaco. An experienced surgeon can handle small pupil phaco success- fully, Dr. Malyugin said. He recom- mended using phaco chop, holding instruments at the center of the anterior chamber, and using appro- priate viscoelastic. Different tools may also be use- ful in these cases, and Dr. Malyugin noted several options in rings and hooks. He said that he finds iris capsule hooks useful because not only can they expand the pupil, but they can stabilize the capsular bag in patients with compromised zonules. He noted that he does not prefer iris hooks because they tend to overex- tend the pupil with a square rather than circle perimeter. Dr. Malyugin went on to high- light the Malyugin Ring (Micro- Surgical Technology, Redmond, Washington) and other rings, noting that this September marked 10 years since the Malyugin Ring entered the market. Changing pharmaceutical treatment patterns in cataract surgery A symposium highlighted a variety angle glaucoma was significantly more likely to go undiagnosed compared to pseudoexfoliation glaucoma. Dr. Topouzis presented the prevalence of over diagnosis as a range—1.3% on the conservative side and 5.5% on the higher end. Over diagnosis, he said, is associated with poor visual acuity, family histo- ry of glaucoma, and association with cataract. A false positive glaucoma diagnosis can affect the patient's quality of life (side effects related to treatment and accompanying fear of blindness) and results in a loss of clinical resources. Panayiota Founti, MD, Lon- don, U.K., discussed the effective- ness of glaucoma referrals, noting that several studies show the accuracy of glaucoma referrals is low. She described a multicenter study in Europe that looked at new glaucoma referrals from five coun- tries and found that 50% of patients are discharged without the need for glaucoma management or follow-up; 37% of these were ophthalmologist- initiated referrals. The researchers then looked at the predictive value of the criteria used for glaucoma referrals, finding that with singular criteria—IOP, fam- ily history, suspect visual field, or suspicious disc—the predictive value was low. But Dr. Founti said that when the IOP criterion of 22 mm Hg or more was combined with other criterion—suspicious disc or visual field—confirmation of a positive glaucoma diagnosis was 90%. Opening ceremony and Binkhorst Medal Lecture David Spalton, MD, London, U.K., welcomed attendees and noted that the meeting would include 492 free papers, 1,257 posters, 125 courses, and 64 wet labs. During the opening ceremony, the recipients of the ESCRS Peter Barry Fellowship, which was estab- lished last year to commemorate Dr. Barry's contributions to ESCRS, were recognized. This year's awards went to Myriam Böhm, Frankfurt, Germany, Luis Fernandez-Vega, Barcelona, Spain, and Nino Hirn- schall, Vienna, Austria.

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