Eyeworld

EW MEETING REPORTER 148 Reporting from the 2018 Surgical Summit, February 1–3, Park City, Utah Twelve total repositionings were required: four from a lack of CTR use; four on a planned basis prior to the introduction of scleral fixated CTRs; one from too large of a capsulorhexis, which caused the device edge to pop out with capsule contraction; and three from contrac- tion of prominent fibrous ingrowth. In all cases, glare, photophobia, and cosmesis improved. Dr. Snyder added that research has shown an adequate view of the retina is still possible with these devices. With breakthrough device status from the FDA and meeting study landmarks, Dr. Snyder said they are hoping for 2018 approval of the device. Dr. Fram presented a couple of cases where the artificial iris device was used in the sulcus. If you are planning on suturing the device, you need to order one with a fiber meshwork (those placed in the bag do not come with this meshwork). There are many other techniques, such as vitrectomy and how to lasso, that Dr. Fram said are important to know before you start handling these sutured artificial iris cases. Overall, she said, the artificial iris has shown that it's well tolerat- ed, it can be placed in the bag or in the sulcus, but it cannot be put in the anterior chamber. is using Xiidra more often due to how quickly it acts. Other treatment options include autologous serum, punctal occlu- sion, microblepharoexfoliation, intense pulsed light treatment, thermal pulsation, and intranasal neurostimulation. Amniotic mem- brane, Dr. Fram said, can be used to prepare a dry eye patient for surgery in order to get good biometry, but she doesn't think it should be used to provide a long-term effect. Editors' note: Dr. Garg has financial interests with Shire and TearScience. Dr. Fram has financial interests with Shire. Cataract general session A cataract surgery general session covered some basics and some not- so-basic situations and techniques. Michael Snyder, MD, Cincin- nati, led the session, speaking about custom, flexible iris devices, which are not yet approved in the U.S. The retrospective study he described included 59 eyes part of his compas- sionate use cohort (not data includ- ed in the FDA IDE study) where the artificial iris device was placed in the bag. One of the lessons learned from some of these early cases, Dr. Snyder said, is the importance of using a CTR for the device when it's placed in the bag to reduce the risk for second surgery. Massachusetts), TearLab (San Diego), and TearScience (Morrisville, North Carolina). Sumit "Sam" Garg, MD, Irvine, California, and Nicole Fram, MD, Los Angeles, discussed the various diagnostic and treatment options available and how to use them on patients with ocular surface disease (OSD). Some form of dry eye disease af- fects 14–33% of the population, Dr. Garg said. A healthy ocular surface is also key for surgical success; thus, you want to treat that first before you get to surgery. Traditional testing for OSD includes questionnaires/histories, slit lamp exams, tear breakup time, corneal staining, and Schirmer's test- ing, though Dr. Garg said he doesn't perform Schirmer's anymore. Newer testing options include osmolarity, MMP-9, lactoferrin microassays (Ad- vanced Tear Diagnostics, Birming- ham, Alabama), meibomian gland imaging, tear film analysis with the HD Analyzer (Visiometrics, Costa Mesa, California), and topography looking at the quality of the mires. "You don't need to use all of these, but I think you should consid- er incorporating some of these into your practice," Dr. Garg said. Dr. Fram presented the various treatment options. Initially, she starts patients on preservative-free artificial tears. Hypochlorous acid lid hygiene has also "changed the way that I manage blepharitis in our practice," Dr. Fram said. Before initiating cyclosporine A (Restasis, Allergan) or lifitegrast (Xiidra, Shire), Dr. Fram uses topical steroids to help reduce sting. "There is a role for topical steroids," Dr. Fram said. "Before we start any treatment, we want to calm the eyes down." Deciding between Restasis, which decreases inflammatory cytokines and improves goblet cell density, and Xiidra, which blocks an inflammation cascade, can be difficult, Dr. Fram said. If a patient looks more allergic, she avoids Xiidra, as itching is a com- mon symptom, while patients with blepharitis do well on Xiidra in Dr. Fram's experience. Dr. Garg said he March 2018 continued on page 150 View videos from the 2018 Surgical Summit: EWrePlay.org Douglas Koch, MD, describes innovations in measuring the posterior cornea and how to adjust toric IOL calculations to address posterior corneal astigmatism. Sponsored by

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