Eyeworld

EW MEETING REPORTER 154 Reporting from the Asia-Pacific Academy of Ophthalmology (APAO) Congress, February 8–11, Hong Kong March 2018 a hyperprolate region of increased power for focusing on near. Since stromal rejection remains a possibility, the tissue is decellular- ized using 0.1% SDS, a mild reagent. Based on their findings, Dr. Liu said that lenticule implantation has potential for the management of presbyopia. The clinical trial is ongoing. Rather than altering the corneal architecture or replacing the lens, might it be possible, asked session co-chair Ronald Krueger, MD, Cleveland, to safely restore accom- modation through lens and scleral modification? Dr. Krueger described two con- cepts currently under investigation. One concept involves softening the natural crystalline lens, theoret- ically restoring the presbyopic eye's natural ability to accommodate. This can be done either by ultra-short pulse lasers or by drops that cleave disulfide bonds within the lens structure. The second concept seeks to modify the sclera rather than the lens. The idea is to change the elastic properties of the sclera to en- hance regional compliance—thereby altering the entire accommodative apparatus. Historically, Dr. Krueger said this was attempted with the use of scleral bands; new scleral expansion technology similarly involves a other cornea topics, Darby Miller, MD, Jacksonville, Florida, presented on the diagnosis and treatment of recurrent corneal erosion (RCE). Many cases of RCE are associat- ed with trauma or epithelial base- ment membrane dystrophy (EBMD). In trauma, inflammation disrupts the extracellular adhesion in the corneal epithelium and matrix metalloproteinases degrade scaffold- ing proteins. With EBMD, abnormal epithelial basement membrane protrudes forward into the corneal epithelium. Symptoms may include mild to severe pain with sudden onset, pain usually upon eye opening during sleep or upon awakening, pain last- ing from seconds to days, photopho- bia, lacrimation, blurred vision, and foreign body sensation, he said. Upon exam, Dr. Miller said ero- sions usually occur in the interpal- pebral region where shearing of the lids is greatest. The entire epithelial sheet is often loose and may wrinkle with pressure on the globe. He said it's important to examine both eyes for EBMD. There are medical and surgical treatment options for RCE. Medical treatment of RCE includes lubri- cation, antibiotics, pain relievers, punctal occlusion, bandage contact lens, MMP-9 inhibitors, topical corticosteroids, and blood derived serum eye drops. Surgical treatments include anterior stromal micropunc- ture, debridement and superficial keratectomy, and excimer laser pho- totherapeutic keratectomy. For patients and ophthalmol- ogists, RCE can be frustrating, Dr. Miller said. Trauma and EBMD are two major causes of RCE. First line medical treatment includes lubrica- tion, cycloplegia, and antibiotic cov- erage. Bandage contact lenses can be used for large or painful abrasions. Long-term nighttime lubrication is encouraged, Dr. Miller said, and healthy tear film can be maximized with oral doxycycline and omega-3 fatty acids. Diamond burr debride- ment and polishing is convenient to the patient and physician with a lower recurrence rate. Excimer laser phototherapeutic keratectomy can be used for recalcitrant cases. Presbyopia treatments on the horizon Current approaches to the treat- ment of presbyopia tend to rely on altering the corneal architecture and/or replacing the lens to restore the accommodative range of vision without actually restoring natural accommodation. As far as relatively innovative alternatives to these ap- proaches go, Yu-Chi Liu, MD, and her colleagues at the Singapore Eye Research Institute are investigating the possibility of using lenticules derived from SMILE. Typically, corneal architecture is modified using either laser abla- tive procedures or synthetic inlays. Synthetic inlays, however, carry a risk of haze. Dr. Liu suggested that biological inlays may improve bio- compatibility and create less stromal inflammation, while allowing better passage of oxygen and nutrients to create more stable corneal condi- tions, thereby decreasing the risk for corneal necrosis and melt. But where to get this ideal bio- logical inlay? Tissue extracted from the SMILE procedure is one option. Dr. Liu initially studied safety and efficacy of using SMILE lenticules for presbyopia in four patients. For these purposes, a three-dimensional SMILE lenticule was trephined to a 3-mm diameter. The lenticule itself has no intrinsic refractive power but implanted in the cornea creates View videos from the 2018 APAO Congress: EWrePlay.org Bennie Jeng, MD, discusses the use of serum-derived agents for dry eye disease. continued on page 156 Sponsored by

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