Though it was not during the warmest week in Florida, the weekend meeting was a welcome escape from the snow for the hundreds of ophthalmologists heading south for the Winter ASCRS 2011 meeting held at the Ritz Carlton in Palm Beach, Florida. For three days physicians presented on topics, both general and specific, and used videos and user feedback devices to maximize efficiency. Below are some of the top take-home messages of the meeting.
Never place a single piece lens in the sulcus. These intraocular lenses were never designed for placement in the sulcus. Because of their design, they are prone to decentration as well as chafing of the posterior iris which can result in iritis, hyphema, and even glaucoma. While this has been discussed previously in articles here, it is worth mentioning as Dr. Rosa Braga-Mele recognized that a significant percent of the attendees had not realized this was not recommended.
In cases of vitreous loss, a pars approach is preferable. While an anterior vitrectomy can be performed, it should always be performed through watertight incisions and the original keratome incision should be avoided. Speaking on advantages of a pars approach, Dr. Keith Warren elaborated that "instead of pulling vitreous anteriorly causing traction, you are cutting the vitreous and pulling it back from the anterior chamber into the center of the eye."
Severe peripheral ulcerative keratitis can have devastating effects, and may need systemic treatment. Speaking on different therapies, Dr. Ed Holland outlined several of the following options for patients with significant ocular and/or systemic disease: corticosteroids (IV or orally 1/mg/kg/day x 2-3 months), methotrexate (orally or IM 7.5-20mg q week), TNF alpha inhibitors (Remicade, Humera, Enbrel), or Cytoxan (100-200 mg/day orally)
Pre-operative therapy is important for cataract surgery. Speaking on corneal considerations for cataract surgery, Dr. W. Barry Lee outlined his regimen based on pre-operative findings; For dry eye disease - restasis with steroid or punctal plugs postoperatively as needed. For patients with concomitant blepharitis he prescribes Azasite beginning one week prior to surgery.
Adjust your technique for hard cataracts. For "at risk" corneas Dr. Terry Kim had the following recommendations: Use a dispersive OVD, reinject viscoelastic as necessary, and deepen the anterior chamber. In severely shallow chamber this can involve a limited vitrectomy via pars plana incision with the anterior vitrector.
Protect the puncta. It is important to remember that medications have side effects. Speaking on the treatment of CIN, Dr. F. Rick Palmon discussed that while topical therapies such as MMC, interferon, and cidofovir are effective, that punctal occlusion should be performed to prevent punctal stenosis.
While smaller in attendance than the annual ASCRS meeting, the more intimate atmosphere allowed for all physicians to attend nearly all courses and have their questions answered almost immediately. A great success full of clinical and surgical pearls, it is an event I recommend everyone who can attend do so. The 2012 winter ASCRS symposium has already been scheduled for February 16-20th in Playa del Carmen, Mexico.