Eyeworld

EW MEETING REPORTER 152 Reporting from the Asia-Pacific Academy of Ophthalmology (APAO) Congress, February 8–11, Hong Kong Innovative approaches in keratoconus and ectasia management Innovative approaches to manage- ment were highlighted in a sympo- sium covering the treatment and de- tection of keratoconus and ectasia. According to session co-chair Arthur Cheng, MD, Hong Kong, there are three main treatment options for keratoconus: stabilizing the cornea through crosslinking, al- tering the corneal architecture using devices such as intracorneal stromal rings, and using a combination of ablation and crosslinking to both alter the corneal shape and stabilize the treatment. Focusing his talk on topogra- phy-guided ablation in keratoconus, Dr. Cheng said that the aim is to reverse ectatic changes. He described the procedure in four steps. Step 1 is phototherapeutic keratecto- my, removing uneven epithelium in preparation for PRK. Step 2 is topography-guided PRK, "based on the principle of fitting the best fit aspheric surface and removing the excess tissue in order to turn the irregular cornea into a rotationally symmetric aspheric cornea." The last two steps are corneal collagen crosslinking and the application of mitomycin-C 0.02% for 1 minute to minimize haze formation. Following these steps, topog- raphy-guided ablation provides an alternative treatment option for irregular corneas. Long-term re- sults regarding the stability of the treatment need to be established, but it is a good alternative to corneal transplants in patients with poor vision not amenable to other optical measures, Dr. Cheng concluded. Spinning off from his work on SMILE, Xingtao Zhou, MD, Shanghai, China, offered another alternative: He described the results of a pilot observational study on the reuse of lenticules extracted during SMILE surgery to treat post-LASIK ectasia. To begin with, Dr. Zhou said that SMILE may have a lower impact on corneal biomechanics, possibly decreasing the risk of post-LASIK ectasia. However, because of the significant incidence of myopia in China, post-LASIK ectasia remains a concern. Dr. Zhou's team evaluated the safety, efficacy, stability, and pre- dictability of implanting autologous lenticules obtained from SMILE for the treatment of hyperopia. Their preliminary conclusions were that tissue addition is safe and effective for increasing the corneal thickness for post-LASIK ectasia. The proce- dure may have further benefits in terms of corneal biomechanics and may delay or altogether avoid the need for keratoplasty. Dry eye and ocular surface disease During a session focusing on dry eye, ocular surface disease, and March 2018 Reporting from the Asia-Pacific Academy of Ophthalmology (APAO) Congress continued on page 154 Sponsored by

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