Eyeworld

EW MEETING REPORTER 164 Reporting from the Asia-Pacific Academy of Ophthalmology (APAO) Congress, February 8–11, Hong Kong March 2018 incidence is high. Rates of glaucoma found in the study were comparable to those found in literature. The pathophysiology is multi- factorial, Dr. Reiser said. There may be physical distortion of the angle with collapse of the trabecular mesh- work, postoperative inflammation, and high and long duration of post- PKP corticosteroids. She stressed the importance of a preoperative evaluation in manag- ing risk, which includes controlling preexisting glaucoma, doing a preoperative evaluation, and using intraoperative imaging. In terms of managing risk, Dr. Reiser highlighted an intraoperative suture and trephination technique. She stressed short and deep versus long and shallow suture bites, less than more tight sutures, a smaller re- cipient diameter, and a larger donor diameter. Postoperatively, Dr. Reiser said that corticosteroids remain the gold standard. For surgical management, she encouraged caution with aque- ous shunt placement and suggested the consideration of cyclodestructive techniques. In conclusion, Dr. Reiser said post-PKP glaucoma is a well-known risk and the cause is multifactorial. There is a higher rate of post-PKP to stop progression using corneal collagen crosslinking, and visual rehabilitation. She went on to describe the use of intracorneal ring segments (ICRS) to treat the condition. In a study conducted at her institution, they found that the implantation of ICRS significantly improved uncorrect- ed visual acuity (UCVA), spherical equivalent, asphericity, astigmatism, and Kmax at 1 month, with all parameters remaining stable to 6 months. Mean UCVA improved 1–2 lines, SE and astigmatism decreased 3.0–4.0 D, and Kmax decreased 2.0–3.0 D. Meanwhile, improvement was observed in all grades of kerato- conus, with mild keratoconus cases showing more improvement in best corrected visual acuity (BCVA), and advanced keratoconus cases showing more reduction in refrac- tive parameters. Dr. Puangsricharern conclud- ed that ICRS are the treatment of choice for visual rehabilitation in keratoconus patients after glasses and contact lenses have failed. Anand Parthasarathy, MD, Chennai, India, noted some intra- operative difficulties surgeons can encounter when using ICRS. These difficulties include inadequate chan- nel depth from superficial channel dissection, segment decentration and asymmetry of implants, and an- terior chamber perforation. He cited issues such as segment migration or extrusion and corneal melt, cor- neal neovascularization, epithelial plugging at the initial incision site, channel deposits, and others. While he agreed that ICRS implantation is a successful surgical alternative in patients with kerato- conus, providing improvement in both UCVA and BCVA, he cited the importance of correct selection of patients to avoid sight-threatening complications. Meanwhile, combin- ing implantation with treatments such as corneal collagen crosslink- ing, topo-guided PRK when neces- sary, and the use of femtosecond laser channel creation will help surgeons deal with what he called "suboptimal outcomes." Medical, laser, and surgical treatment in glaucoma Bibiana Reiser, MD, Los Angeles, discussed glaucoma after penetrating keratoplasty (PKP) in children. First, she said to be mindful of the risks. Glaucoma is a well-known post-PKP complication, and there is a higher rate of glaucoma in pediatric cases. Dr. Reiser specifically discussed an IRB-approved, retrospective study of pediatric corneal transplants from 2014–2016. The study included 63 eyes of 58 children, with ages ranging from 1 month to 18 years. Follow up was between 10 and 37 months. In the study group, 50 PKPs were done, 10 Descemet's stripping automated endothelial keratoplasties (DSAEK), one laser-assisted lamellar anterior keratoplasty, one limbal tectonic, and one superficial kera- tectomy. All cases of glaucoma were well controlled on medications or shunt, Dr. Reiser said, and there was no graft rejection following seton implantation. The overall incidence of post- PKP glaucoma was 54% in her study, and Dr. Reiser noted that the evidence of glaucoma usually pre- sented 4–5 months later. If you look at higher risk patients, for example those undergoing regrafting, the View videos from the 2018 APAO Congress: EWrePlay.org Jorge Alio, MD, PhD, discusses corneal stromal regeneration with stem cell therapy for patients with advanced keratoconus. continued on page 166 Sponsored by

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