EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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56 EW MEETING REPORTER Reporting live from AAO/APAO 2012, Chicago December 2012 he said. In cases of lacerations, sometimes removing muscle to get better visualization is the best course. Surendar Dwarakanathan, M.D., Chicago, relayed a message his mentor gave him: ���Don���t be afraid to do nothing���sometimes you don���t have to fix an injury right away.��� Depending on where the trauma is, ���regular phaco may be the best management,��� providing the surgeon avoids zonular stress. In cases of an injured iris, don���t cut it off, said M. Bowes Hamill, M.D., Houston. Use cryotherapy to remove damaged epithelial cells ���and you���ll have iris left to work with later when you repair it,��� he said. The iris won���t heal, so he recommended using nonbiodegradable sutures (10-0 polypropylene), but if surgeons need to sew an IOL, using 9-0 prolene sutures is better, he said. ���In cases of dilated pupils and cataract, perform a pupillary cerclage,��� Dr. Hamill said. Editors��� note: The physicians have no financial interests related to their comments. Sunday, Nov. 11, 2012 Techniques to improve toric IOLs; contact lens and HOAs Editors��� note: This Meeting Reporter contains original reporting by the EyeWorld news team from AAO/APAO 2012, Chicago. Toric IOLs have stable and predictable results, but they come with an extra out-of-pocket cost to patients and are only available in limited sizes, said Bonnie An Henderson, M.D., Boston, at the Sunday symposium on optimizing optics. The symposium, which was held during the joint meeting of the American Academy of Ophthalmology and Asia-Pacific Academy of Ophthalmology, was sponsored by the Contact Lens Association of Ophthalmologists. To maximize the use of toric IOLs, surgeons should perform careful, accurate measurements and have soft contact lens patients remove their contacts for at least 2 weeks before measurements���and even longer for rigid gas-permeable lens wearers. Surgeons should mark the eye with the patient sitting up, to avoid cyclorotation. Dr. Henderson recommended marking the steep axis and aligning properly for solid outcomes. In another talk during the symposium, Deborah Jacobs, M.D., Boston, addressed the use of contact lenses to correct higher-order aberrations (HOAs). She noted that contact lens technology may currently have an edge over refractive surgery for the correction of HOAs. In cases of bullous keratopathy, crosslinking may be able to improve corneal transparency and corneal thickness, but ���there are no studies to determine long-lasting results,��� he said. In short, Dr. Donnenfeld said, crosslinking ���may be useful��� for stabilizing the cornea, as an antimicrobial treatment, as a method of sterilizing corneal ulceration, and as a treatment for corneal edema. Editors��� note: Drs. Henderson and Jacobs have no financial interests related to their comments. Editors��� note: Dr. Donnenfeld has no financial interests related to his comments. Crosslinking not limited to just keratoconus Inaugural session on innovation highlights successes Collagen crosslinking may be useful in other indications aside from keratoconus, said Eric D. Donnenfeld, M.D., Long Island, N.Y. Not every infection will respond to surface therapy, he said, and crosslinking has ���a long history in sterilization and halting��� corneal ulcers. ���In addition to treating the infectious component, crosslinking has been shown to stop the melting process,��� he said. The post-radial keratometry patients ���represent some of the most problematic patients we have. Their vision can vary 2-3 diopters a day,��� Dr. Donnenfeld said, but some studies have shown these patients respond well to UV crosslinking. Over the past 50 years, several ophthalmic advances have come from all over the place���while at a dentist���s office, while on call, during a chance clinical observation���and those innovations cross medical specialties as well, according to Daniel M. Schwartz, M.D., San Francisco. For instance, the idea for a foldable intraocular lens may not have come to fruition had it not been for Tom Mazzocco, M.D.���s work with a dental company to develop a prototype handpiece. ���The creative physician is critical in driving the innovative process,��� he said. Richard L. Lindstrom, M.D., Minneapolis, told attendees ���many View this video at www.EWrePlay.org/ AAO2012 Thomas W. Samuelson, M.D., director, glaucoma service, and instructor, ophthalmic pharmacology, Regions Hospital, St. Paul, Minn., andattending surgeon, Minnesota Eye Consultants, Minneapolis, talks about the Hydrus 1 study that discusses the 8-mm ab interno implant without or without cataract surgery.