 | | Clinical News Live from the 3rd Annual Regional Meeting of the International Society of Refractive Surgery of the American Academy of Ophthalmology (ISRS/AAO) in Beijing
SUNDAY, MAY 27, 2007 |
Editor-in-Chief: H.Dunbar Hoskins Jr., MD
Chief Medical Editor: Ronald R. Krueger, MD | Managing Editor: Susanne Medeiros
Advisory Panel: Andrew Iwach, MD, Terry L. Forrest, MD, Jean E. Ramsey, MD,
Franco M. Recchia, MD, James C. Tsai, MD and Helen K. Wu, MD
Routine use of topical NSAIDs in cataract surgery may be justified clinically and economically Cataract surgeons are increasingly using topical non-steroidal anti-inflammatory drugs in combination with steroids in cataract patients at high-risk for postoperative inflammation. But Carlos Buznego, MD, today presented his study suggesting that it’s time to start using NSAIDs in all patients. Two recent studies provide the clinical justification. One found that NSAIDs combined with prednisolone acetate was more effective than prednisolone alone in preventing macular edema in uncomplicated cataract surgery in low-risk eyes. Another study comparing different regimens of a preoperative NSAID to placebo found statistically significant improvements in intraoperative pupil size, shorter surgery time, quicker ultrasound time, less intraoperative discomfort, less postoperative discomfort and better visual outcomes. The economic benefit, said Dr. Buznego, is derived from fewer postoperative visits and increased referrals from happy patients who see better faster. Back to Top
Surface ablation, 20 years on: still a good treatment option This 20-year-old procedure has been on the rise recently due to its excellent safety profile, improved clinical results and advances in pain control. It has been estimated that 225,000 surface ablation surgeries will occur in the United States this year. " Will it ever replace LASIK?,” asked Marguerite McDonald, MD, FACS in her keynote address. “I don’t think so, but it will always have a place in the laser vision correction industry, and it will continue to grow in popularity.” Dr. McDonald cited some studies that show wave-front guided surface ablation actually achieves better visual acuity compared to LASIK. While visual recovery is still slightly slower than with LASIK, the gap is closing due to smoother ablations and better postoperative drug regimens. In her practice, 96 percent of her patients see 20/25 or better on day one. Her patients also report low pain on day one, two on a scale of one to 10. Dr. McDonald has been conquering pain with her own strategy which includes a short-course of oral prednisone that tapers off rapidly over six days (80mg a half hour before surgery and 80mg the day after surgery; 40mg on day two; 20mg on day three; 10mg on day four and 5mg on day five) and 0.05percent tetracaine allowed up to every hour while awake for the first three days. She also uses NSAIDs four times a day for three days, lots of chilled BSS during surgery and sterile BSS popsicle applied to closed eyes after surgery. Physicians are tackling haze in myopic surface ablation with prophylactic mitomycin C (MMC), reported Ronald Krueger, MD. In his two-year study, patients treated with low-dose MMC (0.002 percent) after LASEK experienced less corneal haze compared with controls. His recommendation: in myopic patients with a refractive error of 6 D or less, and less than 75 microns of ablation, use 0.002 percent MMC for 30 seconds. In patients with a refractive error above 6 D and more than 75 microns of ablation, use 0.02 percent MMC for 30 seconds. Time of exposure seems to be less important than concentration. Another study presented here today showed better outcomes with LASEK compared with LASIK for eyes with larger pupils. However, for patients with small pupils, LASEK and LASIK outcomes were comparable. Back to Top
More evidence supporting benefits of torsional phacoemulsification In this study, which was voted best-of-session by attendees, Yizhi Liu, MD, concludes that this new technique removes the lens more effectively and with less damage to the cornea, compared with conventional ultrasound. Mean ultrasound time was less with torsional phaco, andtemporal corneal thickness increased less. At 30 days, central endothelial cellloss was higher in the conventional group compared to the torsional group (732.79 v. 583.69, P < 0.05). Torsional phaco is performed with an angulated or gently curved phaco tip that oscillates 32,000 times per second, as it cuts tissue left to right. This is in contrast to traditional ultrasound, which vibrates approximately 40,000 times per second but cuts only on the forward motion. Back to Top
AcuFocus corneal inlays show promise in treating presbyopia Marguerite McDonald, MD, FACS, reported that this new treatment option has shown positive early results in a world-wide clinical trial in 20 sites in Turkey, Europe, Singapore and the United States. Mean uncorrected near visual acuity improved from 20/50 J6 to 20/16 J1 at one year postop. Uncorrected intermediate vision also improved. These improvements were achieved without significantly affecting uncorrected distance visual acuity. McDonald noted other advantages: it’s removable, reversible and repeatable, takes less than 30 minutes to perform and is not cosmetically disturbing, even in blue-eyed patients. The U.S. Food and Drug Administration trial began in February 2006. “Acufocus has promise and is moving steadily through the FDA process,” Dr. McDonald reported. The AcuFocus corneal inlay is an opaque disc with a small aperture in the center, much like that of a camera, where the peripheral rays are obscured while the central rays pass unaffected. This pinhole disc placed in front of the eye, allows them to see at near by reducing the size of the blur circle. The implant is placed under a flap, similar to the one created during LASIK surgery, in the non-dominant eye to increase the depth of focus of the eye by reducing the circle of blur. Back to Top
Intraoperative interface steroids can reduce the incidence and severity of DLK in LASIK patients Eugene Ng, MBBChB, presented his analysis of 1,210 consecutive LASIK procedures in a prospective interventional trial. Patients in the treated group were three times less likely to develop diffuse lamellar keratitis. Patients who did develop DLK, developed only stage 1 disease, which Dr. Ng said suggests intraoperative interface steroids can actually reduce the severity of DLK. Back to Top | 
