 | | 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
SATURDAY, MAY 26, 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
More than 600 attend third annual ISRS/AAO international meeting in Beijing, China The International Society of Refractive Surgery of the American Academy of Ophthalmology (ISRS/AAO), the world’s largest and strongest eye care organization solely dedicated to refractive surgery, is pleased to hold its 2007 Regional Meeting in partnership with the Chinese Ophthalmological Society and the Asia Pacific Association of Cataract and Refractive Surgeons. The educational program is being presented by more than 70 world renowned faculty hailing from 13 different countries. Back to Top
Advances in cataract surgery are paving the way to eradicating global blindness Despite great effort from the Chinese government and Chinese ophthalmologists to increase the number of cataract surgeries performed here – which have increased from about 100,000 per year in 1988 to 600,000 per year in 2005 – cataract remains a major cause of blindness. Several speakers here presented novel ideas for how to best serve developing countries where millions of poor people in rural areas go untreated. Dennis Lam, MD, described the SLIMCE technique he and his colleague Srinivas Rao, MD, developed. SLIMCE, is sutureless, large-incision, manual cataract extraction, and it delivers excellent visual results for a fee of just $90. Dr. Lam said patients in rural China have been eager to pay the fee (700 RMB or one or two months salary) for the chance to see again. A recent study of 178 patients, most of whom were blind before surgery, finds that 96 percent of patients could see 6/18 or better. Because the wound is self-sealing, no sutures are required, which reduces the cost of surgery and the risk for later infection, Dr. Lam said. The temporal scleral wound produces little astigmatism and manual lens extraction saves money by eliminating the phaco machine and preserves corneas that might otherwise absorb the high energy levels associated with emulsification of extremely dense cataracts. He has also observed little endothelial cell loss with this technique. “The key to this surgery is to avoid touching the endothelium,” Dr. Lam said. “If you do it right, no component is touching the endothelium.” Another key to it success is that it’s easy to teach. Through a program he started called Project Vision, he has successfully trained surgeons in rural county hospitals to perform SLIMCE with the same excellent results. Sanduk Ruit, MD, another leader in the effort to bring high-volume cataract surgery to developing countries, presented his study showing that small-incision cataract surgery is also relevant for high-volume cataract surgery. Dr. Ruit presented his prospective, randomized trial that finds modern small-incision surgery produces results comparable to phacoemulsification. Dr. Ruit is the director of the Himalayan Cataract Project and medical director for Tilganga Eye Centre. Another speaker, Amar Agarwal, MD, described how he uses the microphakonit technique, bimanual phaco performed with a .7 mm phaco tip and .7 mm irrigating chopper, on “hyper-mature” cataracts with excellent results. He has also used this technique in cases of combined cataract and glaucoma surgery, with 25-gauge vitrectomy and in patients with small pupils and hard cataracts. But, he said that the real benefit of microphakonit will be realized only when high-quality IOLs capable of fitting through a sub 1 mm incision become available. Back to Top
Femtosecond laser gains in popularity, from the U.S. Navy to Hong Kong Capt. Steven Schallhorn, MD, who recently retired as director of the Cornea Service at the Naval Medical Center, San Diego, said that IntraLase had become the procedure of choice in all seven refractive surgery centers in the U.S. Navy. Why? Patients recover faster, have better uncorrected visual acuity and better contrast sensitivity, under both photopic and mesopic conditions. John So-Min Chang Jr., MD, said IntraLase, introduced in Hong Kong in 2004, has also been quickly adopted mainly due to its higher safety profile. “We are seeing 50 percent fewer complications, less lost vision due to surgery, and we can treat higher myopia and thinner corneas,” Dr. Chang said. In 10,000 cases performed at his center, the flap complication rate with IntraLase was .86 percent, compared with 1.53 percent with the keratome. A review of his cases (3,400 patients, 610 cases with a 90 micron flap and 2,400 with a 100 micron flap) finds a flap complication rate of .5 percent. “DLK (diffuse lamellar keratitis) leads the list of complications, but this is a manageable complication,” Dr. Chang said. In his series, three patients in the 90 micron group experienced DLK; two in the 100 micron group. Two eyes lost two lines of vision and three lost one line. Despite the better safety profile and fewer flap cutting complications, Ronald Krueger, MD, noted a few of the drawbacks, including increased inflammation and more interface scatter, leading to tracking difficulties and the optical phenomena, “rainbow glare.” But he said newer generations of the femtosecond laser, with higher repetition rates and lower per-pulse energy, may reduce problems with light scatter. Dr. Krueger believes the benefits outweigh the drawbacks, including the higher costs and additional time for execution associated with this procedure, noting that physicians who offer it in the United States are getting higher fees. “Safety seems to be winning out,” said Dr. Krueger. “I use it in 100 percent of my LASIK patients, but it is not a risk-free procedure. Ongoing modifications are continually making this better.” Back to Top
High myopes with thin corneas may have better outcomes with femtosecond laser compared to epiLASIK David C. Chang today presented his study comparing outcomes between these two techniques when performed in patients with a corneal thickness of 500 microns or less. At one month, 55 percent of patients in the epiLASIK group reported mild dry eye, compared to 35 percent in the femtosecond group. At three months, 95 percent in the epiLASIK group could see 20/25 uncorrected, compared to 98 percent in the femtosecond group. No patient in either group lost any BCVA, while four eyes in the epiLASIK group gained one or two lines, and 10 eyes in the femtosecond laser group gained one or two lines. “While both methods are safe to treat patients with high myopia and thin corneas, the femtosecond approach offers slightly better results in the short term,” said Dr. Chang. Back to Top
Rigid gas permeable contact lenses can be used to treat ectasia following LASIK David Chao-Kai Chang, MD, presented his experience with two patients fitted with contact lenses to treat LASIK-induced ectasia. At one year, both patients experienced improved UCVA, BSCVA and improved topography. Dr. Chang described another case study that demonstrates the importance of taking contact lens history before performing refractive surgery due to the possibility of lens-induced warping. He described one patient who wore soft contact lenses for nine years and appeared to have keratoconus based on her topography and pachymetry. After eight weeks without lens wear, corneal maps were again performed, and there was no evidence of keratoconus. Back to Top
Alcon-sponsored live cataract surgery sessions prove popular Moderated by Haike Guo, MD, the sessions demonstrated techniques with the ReSTOR lens and the latest in torsional phacoemulsification. Back to Top
View information and resources from the Academy that are of special
interest to ophthalmologists from outside the United States in the
Academy's International Center . |
