EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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EW MEETING REPORTER 70 Reporting from the BRASCRS annual meeting, May 16–19 São Paulo, Brazil Following Dr. Campos' lecture, Ricardo Queiroz Guimaraes, MD, Nova Lima, Brazil, was recognized. Dr. Guimaraes was not present at the meeting, but his wife spoke on his behalf. Also during the session, the Ig- nácio Barraquer Award was present- ed to Roberto Pineda, MD, Boston. Dr. Pineda gave a lecture focusing on "Brillouin microscopy: new technol- ogy for evaluating corneal biome- chanics and lens elasticity." Corneal biomechanics are important for understanding IOP, ectatic disorders, and at-risk corneas, Dr. Pineda said. In addition, suc- cessful corneal treatments, such as crosslinking, depend on biological and biomechanical tissue factors for effectiveness. There are several devices to test and measure biomechanical properties of the cornea, Dr. Pineda said, specifically mentioning in vivo nondestructive tests. However, there are some limitations with current in vivo testing. He went on to discuss Brillouin microscopy, which he described as an in vivo non-contact technique capable of recording and imaging elastic modulus of the cornea and lens in high resolution. He spoke about Brillouin scattering and how it is measured and noted current Bril- louin imaging devices available. Dr. influence outcomes. IOL design is already taking advantage of inno- vation in capsulotomy creation, he said, and creating primary posterior capsulotomies may help eliminate PCO. Awards and lectures A special session featured awards and two lectures. During the session, the Ednei Nascimento Medal was given to Mauro Silveira de Queiroz Campos, MD, São Paulo, Brazil. Dr. Campos gave the corre- sponding lecture, discussing the excimer laser in refractive surgery over the last 30 years. He described the evolution of the excimer laser and procedures, including PRK and LASIK. Dr. Campos highlighted the use of PRK, the popularization of LASIK, and the discovery of patients with corneal ectasia showing progression. At the end of the 1990s, Dr. Campos said that PRK was somewhat of an "abandoned technique." He noted that advances in surgery and laser usage at this time revolved around the ability to customize surgery. Surgeons were able to do more non-convention- al treatments of the cornea, and topography-guided surgeries began to be used in 2000. He highlighted wavefront-guided treatment and stressed the importance of precise aberrometry and the tear film. The femtosecond laser allows for capsulotomies of a given size, that are truly circular, in a given position, with little risk of tear out, and without variables of a manual technique. However, there are a number of caveats involved with us- ing the femtosecond laser: a second room might be needed for the laser; it may interfere with surgical flow; the device has a high cost; there are running costs to consider; and the advantages of the femtosecond laser still need to be shown. Dr. Packard noted that the majority of femtosecond laser users value its ability to do an automat- ed capsulotomy. Are there other ways to do this? He described how the CAPSULaser can help with this process. By staining the anterior cap- sule with a very pure trypan blue, a selective target for the laser is creat- ed, he said, adding that the laser is not pulsed but continuous, and is scanned in a single circular pattern to create the continuous curvilinear capsulotomy. Dr. Packard said that in the region of irradiation, the laser energy facilitates the molecular phase change of capsular collagen IV to elastic amorphous collagen. As the collagen undergoes this phase change, it creates the capsulotomy with a rim that has a high degree of elasticity and tear strength associat- ed with amorphous collagen. Dr. Packard said the CAPSULaser takes up little space in the operating room, with the device attached un- der the operating microscope. Clinical results show no pupil constriction after laser use and no untoward AC activity postoperative- ly. He noted that these results are from 20 patients with more than 24 months of follow-up. All corneas were clear, the endothelial cell count was as expected, the capsulotomies were well-centered and not contract- ed, and there was no change in IOL position. An additional 400 eyes have now been operated on with similar results, and a CE marking trial of 125 eyes has been submitted. Physicians now have devices to enable more precise capsuloto- mies, Dr. Packard said, adding that it remains to be seen how these will July 2018 continued on page 72 View videos from the 2018 BRASCRS: EWrePlay.org Amar Agarwal, MD, reviews a video of a glued IOL in the eye of a patient with Marfan syndrome.