This year the ASCRS meeting was held in conjunction with the World Cornea Congress in Boston. With speakers from throughout the US and abroad, new ideas were exchanges for improving clinical and surgical outcomes, and new technologies were also displayed for the first time. This article reviews many of these exciting developments.
In the pharmaceutical arena, Dr. Eric Donnenfeld presented data comparing cataract surgery patients treated with prednisolone acetate or difluprednate (Durezol, Sirion now acquired by Alcon). While dosing regimens were the same between both patient populations, those treated with difluprednate had significantly better vision and thinner corneal pachymetry on postoperative day #1. While this was more of an immediate benefit and two weeks out vision was equivalent, he also found that patients treated with difluprednate at 30 days post-op had significantly higher endothelial cell counts and significant thinner maculas. While seemingly excellent in improving cataract surgery outcomes,Drs. Ed Holland and William Trattler touted the benefits of this stronger steroid for enhancing corneal and pterygium surgeries as well.
Another advance that may greatly improve surgical outcomes is the release of ocular sealants. Designed to be very biocompatible, these offer the ability to more securely close wounds and expedite recovery times. Dr. Steven Dell presented his experience on the ReSure Ocular Bandage (Ocular Therapeutix, Inc., Bedford, MA) and noted that it was well tolerated by his patients. Additional future options for this technology include I-Zip Ocular Bandage (I-Therapeutix, Inc) and the Ocuseal Liquid Ocular Bandage (Becton, Dickinson and Company).
Early US clinical results with improved surgical devices were also presented, particularly the Tan Endoglide (watch video) for use with Descemet Striping Endothelial Keratoplasty (DSEK) surgery. Data presented by Dr. Tan himself at the World Cornea Congress, as well as several others during the ASCRS meeting, demonstrated that this device may allow the donor button to be delivered into the anterior chamber with minimal tissue manipulation allow greater adherence rates and lower overall endothelial cell loss than traditional folding techniques.
Another new technology coming soon will be the Acufocus corneal inlay. This device, appearing like a black ring, is implanted under a femtosecond laser-created corneal flap to create a pinhole effect. In preliminary data, uncorrected near vision is greatly improved. “This may be a great option for our presbyopic patients,” stated George Waring IV in a presentation to the Vanguard Ophthalmology Society.
A new use of an older technology was presented by Dr. Elizabeth Yeu, whose presentation “Using Corneal Topography Analysis in Diagnosis and Management of Dry-Eye Syndrome” received multiple accolades. Dr. Yeu, in conjunction with Drs. Mitchell Weikert and Stephen Pflugfelder, discovered that rather than obtaining details on the corneal curvature with topography, that the actual scanning of the cornea with this technology can yield significant information about the ocular surface and can even be used to evaluate the effects of different treatments on the ocular surface.
Regarding surgical techniques, more data was presented on the advantages of DMEK (compared to DSEK), and DALK (to PKP). While overall rejection rates were lower for these procedures, they required much greater technical skill to perform and, in the case of DALK, sometimes required conversion to full thickness transplantation due to perforation of the patient’s descemet membrane.
A more simple and easy surgical approach for conjunctivochalasis was presented by Dr. R. Phillip Doss (in conjunction with Linden Doss and Lauren Doss) at the World Cornea Congress. In this technique, a small incision was created in the area of conjunctivochalasis and fibrin sealant was injected underneath. The loose conjunctiva was then grasped, advanced, and placed against the sclera to reinforce it. Once adhesion to the new location had taken place, the excess conjunctiva was excised.
One of the most exciting surgical innovations was presented by Arup Bhaumik “Out or In: It's the Same Door” which won best film of the ASCRS Film festival. There have been multiple techniques for explanting intraocular lenses – cutting the IOL, folding the IOL, enlarging the wound – each with its own challenges. In their video, a wire loop snare (constructed from 20 gauge needles and the ‘A’ string of a guitar) was used to engage the optic and remove it via original small corneal incision. The way the authors were able to do this was by filleting the tip of the Monarch D cartridge a few mm on either side to allow it to open wider. They then placed the wire loop snare through the cartridge into the eye and around the IOL, then pulled the optic towards the cartridge at which point it would fold upon itself into the cartridge negating the need for any further intraocular manipulation.
Overall, the meeting was regarded as excellent by nearly all attendees with most physicians returning to their practices with new ideas and pearls to take home. Though many innovations presented can be incorporated today, the future technologies that physicians were able to glimpse has everyone excited about the future of ophthalmology.