Eyeworld

EW MEETING REPORTER 68 July 2018 Reporting from the BRASCRS annual meeting, May 16–19 São Paulo, Brazil He compared penetrating keratoplasty with DALK. Both have excellent BSCVA. There's a risk of endothelial re- jection with penetrating keratoplas- ty but no such risk with DALK. Both may have post-keratoplas- ty astigmatism. There is reduced structural integrity with penetrating keratoplasty, but there is less reduc- tion of structural integrity in DALK. With penetrating keratoplasty, there is an increased glaucoma risk, but there is less of a risk with DALK. Penetrating keratoplasty also has greater reduction in endothelial cell density (ECD), the AC is open during the procedure, and topical steroids are needed for a longer peri- od of time. Meanwhile, with DALK, there is less reduction of ECD, the AC is closed during the procedure, and topical steroids are needed for a shorter period of time. There is, however, more OR time needed with DALK. Dr. Reidy offered suggestions for how to achieve the big bubble. He said to place a small bubble into the anterior chamber (with or without diluted triamcinolone). The able tips and cleans the lid margins. It can be done by technicians. MiBo Thermoflo applies anterior heat to the eye in a series of three treatments, as opposed to heat and thermal pulsations from both sides of the lids. Dr. Macsai highlighted the value of using eyelash shampoo. She mentioned a number of other tips for these patients, including using ofloxacin ointment, intense pulsed light therapy, topical azithromycin, and omega-3s. She also noted that Demodex is present in 50% of pa- tients and that stopping prostaglan- din inhibitors in glaucoma patients may be helpful for blepharitis/mei- bomitis. Challenges in surgical cornea James Reidy, MD, Chicago, dis- cussed deep anterior lamellar kerato- plasty (DALK) and tips for achieving the big bubble. In the U.S., the indications for keratoplasty are decreasing because of new technologies, such as cross- linking, but there's still a role for keratoplasty and DALK, Dr. Reidy said. Challenges in ocular surface and infections Marian Macsai, MD, Glenview, Illi- nois, presented on chronic blephari- tis and meibomitis. Why is bleph- aritis/meibomitis important? Dr. Macsai said this is the most common complaint in comprehensive prac- tice and the most common source for postoperative infections. It can be a possible source of MRSA, and meibomian gland dysfunction leads to changes in meibum quality and quantity that can cause evaporative dry eye and ocular surface disrup- tion, leading to dry eye symptoms. Blepharitis may be anterior or posterior and involves eyelid inflammation, Dr. Macsai noted. An- terior blepharitis is rarely seen, but posterior blepharitis may involve meibomian glands and result in papillary hypertrophy of the tarsal conjunctiva and/or corneal punctate epitheliopathy. To diagnose meibomitis, Dr. Macsai said to express the meibo- mian glands with pressure. The role of the meibum is to create the refrac- tive surface and stabilize the tear film. If it's abnormal, it could cause rapid tear breakup time and corneal disease. These problems could be a source of endophthalmitis, Dr. Mac- sai said. She added that blepharitis/ meibomitis may have symptoms similar to those of dry eye, includ- ing burning, irritation, redness, and decreased or fluctuating vision. Dr. Macsai suggested using lipid layer analysis with tear film interfer- ometry and meibography. She also mentioned several in-office treat- ments that can be used: LipiFlow (Johnson & Johnson Vision, Santa Ana, California), BlephEx (Franklin, Tennessee), and MiBo Thermof- lo (Mibo Medical Group, Dallas). LipiFlow uses heat and thermal pulsations from both sides of the lids. BlephEx includes small dispos- Reporting from the 2018 BRASCRS annual meeting

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