Surgery

Dorado, Puerto Rico-Have you ever wondered what you as a cataract surgeon can do to improve your patients' outcomes? Steve A. Arshinoff, MD, FRCSC, may have some answers.

At this year's ARVO meeting, glaucoma specialists can broaden their clinicalknowledge of topics ranging from surgery and wound healing to neuroprotectionto retinal nerve fiber layer imaging. Members of Ophthalmology Times'Editorial Advisory Board reviewed dozens of glaucoma abstracts to be presentedat the meeting. Some of the board's selections are highlighted here.

Cincinnati, OH-Spencer Thornton, MD, is guest host on the third volume of the 2003 Video Journal of Cataract and Refractive Surgery to review the surgical options in the treatment of presbyopia.

Anaheim, CA-Performing cataract surgery in an eye with a failing filtering bleb is a tricky business, which has been addressed by a few different procedures. Successful intervention can be achieved in carefully selected patients. However, in those in which intervention might be problematic, a new investigational device is under study to lower IOP, according to Reay H. Brown, MD.

Anaheim, CA-Selective laser trabeculoplasty (SLT) seems to be as effective for treating patients who had undergone argon laser trabeculoplasty (ALT) as the initial treatment for glaucoma, and may be more effective for re-treatments, but data and fol- low-up are limited, said Douglas N. Johnson, MD, at the annual meeting of the American Academy of Ophthalmology.

New Orleans-The AquaLase liquefaction device (Alcon) is a new technology for lens removal that provides the advantages of excellent safety for the cornea and posterior capsule without sacrificing efficiency, said Stephen F. Brint, MD.

Anaheim, CA-Myopic patients considering refractive lens exchange (RLE) for correcting their myopic refractive errors should be aware of the risk of retinal detachment (RD) and the retinal re-attachment rate and outcomes, said Barry S. Seibel, MD.

Anaheim, CA-Refractive lens exchange (RLE) for high hyperopia is another option for patients hoping to achieve a good refractive outcome and preserve the normal architecture of the cornea, said Raymond M. Stein, MD.

Washington, DC-Micro-thin prescription inserts (Intacs, Addition Technology), which received FDA approval in the United States in 1999 for the treatment of mild myopia, are an alternative to tissue-ablating laser vision procedures and have a number of advantages.

The FDA has approved Refocus Group's request to begin phase II clinical trials of its scleral implants and scleral spacing procedure for the surgical treatment of presbyopia.

Salt Lake City-The Light Adjustable Lens (LAL, Calhoun Vision) is an exciting new technology for the future, said Nick A. Mamalis, MD.

Anaheim, CA-The recently approved model AT-45 accommodative IOL (Crystalens, eyeonics inc. [formerly C&C Vision]) is expected to be a very useful practice addition for surgeons in their management of presby-opia, said D. Michael Colvard, MD, at the International Society of Refractive Surgery/ American Academy of Oph-thalmology subspecialty day meeting.

Kansas City, KS-The foldable acrylic AR-40E IOL (Sensar with OptiEdge, AMO) contin-ues to provide positive results as the number of eyes with implants and duration of follow-up increase, said John D. Hunkeler, MD.

Dorado, Puerto Rico-The 26th annual "Current Concepts in Ophthalmology" meeting, sponsored by Johns Hopkins University School of Medicine/Wilmer Eye Institute and supported by Ophthalmology Times, will be held Feb. 20 to 23 at the Hyatt Dorado Beach Resort.

Atlanta-The FDA has given CIBA Vision permission to print that its Clear Care solution provides clinically significant improvements in frequency of dryness and end-of-day comfort over three multipurpose solutions.

Cataract surgeons who participated in the premarketing clinical trials for the model AT-45 accommodative IOL (Crystalens, eyeonics inc. [formerly C&C Vision]) are heralding that technology as an important advance. The lens affords patients clear uncorrected vision at near, intermediate, and distance. FDA approval for marketing of the lens was granted in November.

As the end of 2003 approaches, it is estimated that nearly 100 million people around the globe wear contact lenses. This translates into approximately 4% to 5% of all spectacle wearers. Quite a large marketplace.

Antwerp, Belgium-Patients who have received the CrystaLens AT-45 accommodating IOL (eyeonics, formerly C&C Vision, Aliso Viejo, CA) after cataract extraction achieve very good distance and intermediate vision as well as improvements in their near vision, according to Erik L. Mertens, MD, FEBO, director and ophthalmic surgeon at Antwerp Eye Center, Antwerp, Belgium.

Developments in refractive surgery are interdependent and encompass diagnostics, surgical technology, and supportive therapeutics, all of which have a common goal: emmetropia. A number of advances have grabbed the attention of refractive surgeons over the past year, such as improvements in lasers, materials, and refinements in indications for certain refractive procedures. Wavefront technology is still taking center stage.

Munich, Germany-The aspheric Z9000 IOL (Tecnis, Pfizer) is associated with better mesopic contrast sensitivity relative to conventional IOLs, but does not maintain its superiority to spherical implants when testing is performed under mesopic conditions with glare, said Mike P. Holzer, MD, at the European Society of Cataract and Refractive Surgeons annual meeting.

Leaders in cataract surgery agree the past year has been a time of significant developments in both technique and technology.

Parma, Italy-YAG laser iridotomy has a protective effect in patients with pigment dispersion syndrome (PDS) who are at high risk of developing pigmentary glaucoma, according to the results of a 10-year follow-up study from the Institute of Ophthalmology in Parma, Italy.

Bethesda, MD- Ten patients with late-stage retinitis pigmentosa (RP) will be the first humans to receive intraocular, polymer implants containing genetically modified human retinal epithelial cells that researchers hope will prevent further vision loss.

Refractive lens exchange is a safe and effective procedure for providing multifocal vision, and will ultimately become the treatment of choice for presbyopia, said Stephen F. Brint, MD.

The Terry-Schanzlin Astigmatome System with vacuum speculum (Oasis Medical Inc.) is a disposable microsurgical cutting instrument designed to make uniform and controlled paralimbal incisions that are often used in combination with cataract and lens implant pro-cedures to reduce astigmatism.

The incidence of overcorrection after LASIK for myopia is low, but the results of re-treatment are variable. Re-treating often results in a shift back to myopia, leaving the patient unhappy. To improve the results of LASIK enhancement surgery, a new formula is warranted. In 1999, Drs. Lindstrom and co-workers noted that laser treatment achieved different effects in eyes with primary versus secondary hyperopia. They attributed this effect to dynamics of wound healing.

El Paso, TX-Laser presbyopia reversal (LAPR) is showing promise in the treatment of presbyopia in early clinical trials, according to Bobby Maddox, MD.

Detroit-Ptose-Up (FCI Ophthalmics Inc.) is a viable alternative to traditional sling materials for ptosis repair. Ease of use, durability, and low complication rates are just some of the benefits of this new material.

Although patients with uveitis are at increased risk of complications following cataract surgery with IOL implantation, due to pre-existing inflam- mation, improvements in technology, materials, and surgical techniques have greatly improved outcomes.

Stanford, CA-Tube shunt surgery is an efficacious way to lower IOP in complicated glaucomas, according to Mary Ann Lloyd, MD.