EyeWorld Asia-Pacific September 2013 Issue

62 September 2013 EW PHARMACEUTICALS Wing Kwong Chan, MD , Singapore, introduced the award for the APACRS Lim Lecture and said that he has known Prof. Tchah both professionally and personally for nearly 10 years. “When you first meet him, you get the impression that this is a very soft-spoken, humble, and reserved man. An introvert. But as you get to know him better, you will realize that this man is an intense intellectual with a very broad sense of humor and wit and a very kind friend. Professor Tchah is the quintessential strong, silent man of ophthalmology,” Dr. Chan said. Prof. Tchah delivered the APACRS Lim Lecture at the Opening Ceremony and said he was honored and privileged to be chosen to give the lecture this year. He invited the audience to follow his experiences studying the modulation of corneal wound healing following surface ablation, assisting patients with haze issues, in his presentation. “It’s been a long and winding road, like the Beatles song,” he said. Prof. Tchah showed a slide of the progression of corneal wound healing as a cascade of events—beginning with epithelial or stromal injury and the release of cytokines. This release leads to inflamed cells, which leads to myofibroblasts—which then leads to the release of growth factors, epithelial proliferation, and finally, regression—and keratocytes, apoptosis and, eventually, haze. Corneal keratocytes play a key role in corneal wound healing, Prof. Tchah emphasized. Keratocytes become myofibroblasts and create synthesized collagens following trauma. In a rabbit study looking at LASIK and PRK results on the corneal surface at one month, “there was a decreased number of keratocytes in the early stage then increased amount of keratocytes with a greater degree of reaction and more abnormal collagen deposits in the PRK group,” he said. He said the name of his talk should be “modulation of keratocytes after surface ablation” to be more accurate with what actually occurs. Mitomycin C has been shown to have an effect on keratocytes, he said. “There is a close relationship among corneal haze after PRK, number of activated keratocytes, and the amount of apoptosis,” he said. “After UVB exposure, Mitomycin soaking has the most potent suppressive effect on post- PRK haze formation.” However, because of the toxicity of MMC, alternatives should be explored, he said. He proposed the possibility of bevacizumab (Avastin, Genentech, South San Francisco, Calif., USA) and rapamycin (Rapamune, Pfizer, New York, NY, USA), in corneal wound healing, which he and colleagues have been investigating. He said these drugs might be safe alternatives to MMC during refractive surgery to prevent postoperative corneal haze by “affecting the keratocyte number.” The next step is a clinical trial of bevacizumab, Prof. Tchah said. Physicians, industry face off on femtophaco Ophthalmologists debated femtophaco machines in a heated debate questioning each technology offering in the “Femtophaco Face-Off” Symposium at the APACRS meeting Friday. The symposium was chaired by Graham Barrett, MD , Australia, Bonnie An Henderson, MD , U.S., Zoltan Nagy, MD , Hungary, and Ronald Yeoh, MD , Singapore. The companies with femtosecond laserassisted phacoemulsification machines on the market – LensAR (Orlando, Fla., USA), LenSx (Alcon, Fort Worth, Texas, USA/Hünenberg, Switzerland), OptiMedica Catalys Precision Laser (Sunnyvale, Calif., USA), and the Victus (Bausch + Lomb, Rochester, NY, USA) – had one presentation each by a physician using the technology and an industry representative from the respective company. Nick Curtis , CEO of LensAR, spoke about that machine, while Harvey Uy, MD , Philippines, discussed his experience using it as a clinical investigator. “I think this technology is here to stay because it’s going to give us better results and because it’s going to make life easier for cataract surgeons,” said Dr. Uy. “I love this LensAR machine because it’s very ergonomic and easy to use. And it’s really been optimized for all aspects of refractive cataract surgery.”