EyeWorld Asia-Pacific September 2012 Issue

September 2012 57 EWAP MEEting REPoRt The XXX Congress of the European Society of Cataract and Refractive Surgeons (ESCRS) ran from 8–12 September 2012, and was held in Milan. EyeWorld was on the ground, reporting live throughout the Congress. E UCornea & Day 1 EUCornea began the day before the ESCRS Congress and closed on the first day of the Congress’s scientific program, with a joint symposium with the ESCRS focusing on corneal neovascularization. Likewise, ESCRS paired up with EURetina in a symposium to discuss cataract surgery and macular disease. Perfecting crosslinking Transepithelial crosslinking works, but the best UVA-riboflavin formula to use is still in question, according to one of the pioneers of the procedure, who spoke during the second day of EUCornea. Milan 2012: The XXX Congress of the ESCRS by EyeWorld Staff “The optimal pharmacological formula remains to be found, but hypoosmotic solutions, benzalkonium chloride [BAC], and other drugs may be involved,” said Theo Seiler, MD, Zurich. New profiles and higher irradiance are helping to improve the procedure, causing significant flattening in a high number of keratoconus patients, Prof. Seiler said. This more optimized profile may mean that indications for crosslinking may go beyond progressive keratoconus patients and result in fewer additional PRK treatments, he said. Because the depth of crosslinking (CXL) falls off toward the periphery, Prof. Seiler suggested that irradiation with a top-hat profile is not good enough to create a homogenous CXL effect. Instead, intensity should be increased by at least 25% 3 mm away from the center of the light, he said. Though not every keratoconic patient can adapt to the same surgical approach, George D. Kymionis, MD, Crete, Greece, said in the same session that simultaneous topography-guided PRK followed by CXL appears to be the most promising approach for the best functional vision results. In the past, he said, post-CXL patients were unhappy because their vision had not improved. “We were in a situation where the patients were stable, but they could not see,” he said. Advancements in corneal surgery New donor inserters to be used during Descemet’s stripping automated endothelial keratoplasty help improve endothelial preservation, making ultrathin DSAEK with minimal stroma an attractive endothelial reconstruction surgery, according to Donald Tan, FRCS , Singapore. The Tan EndoGlide (Network Medical Products, North Yorkshire, UK) is ideal for the ultrathin DSAEK procedure, Prof. Tan said during his talk at the Asia Cornea Society sponsored session titled “Endothelial cell-based therapies for corneal reconstruction”. continued on page 58 In response to the challenges of Descemet’s membrane endothelial keratoplasty (DMEK) graft insertion, including manipulation and unscrolling of the donor membrane into the anterior chamber without damaging the endothelium, researchers have developed the 50-µm thick D-Mat carrier, a new device that is 9 mm in diameter and shaped like a spatula, which helps support the endothelial graft and lift it into the eye. “Our new approach to DMEK surgery using a disposable mat device also enables us to just transplant the DM and the endothelial layer without the stroma,” Prof. Tan added. “The donor lamella adheres to the D-Mat surface and does not wrinkle up.” Further, advancements in femtosecond laser technology, coupled with high-resolution corneal imaging, may enhance lamellar corneal surgery as well as stromal lenticule preparation, Dr. Tan said.