EyeWorld Asia-Pacific June 2014 Issue

49 EWAP rEfrActivE June 2014 MORIA S.A. 15, rue Georges Besse 92160 Antony FRANCE Phone: +33 (0) 1 46 74 46 74 - Fax: +33 (0) 1 46 74 46 70 moria@moria-int.com - www.moria-surgical.com Moria complete offer for the Big Bubble technique in DALK Single-Use Vacuum Trephine Reusable Instruments Adjustment ring New instruments developed with Dr. Fontana and Pr. Busin (Italy) • Ready to use: ultra-sharp pre-loaded blade • Top lateral window • Vacuum evenly distributed over the cornea • Diameters 6 to 9.5 mm • Precise, straight-walled and uniform cuts • No parallax errors • Limbial suction for better vacuum • Diameters from 6 to 10 mm Single-Use Donor Punch and pressure checks. Treatment protocols for patient who start to develop elevated pressure are the same as for any other patient with suspected glaucoma, Dr. Horn said. Extending life of PiOLs One of the selling points of PIOLs is that they require little to no maintenance compared to traditional contact lenses. But ocular trauma can cause the PIOL to shift, become dislodged, and even come into contact with the crystalline lens and induce a cataract. The most common traumas that Dr. Devgan has seen in these patients are due to airbag injuries during car accidents. Another long-term issue is the higher chance of visually significant cataract formation. Recent research found the rate of development of a significant cataract was slightly less than 5% within 8 years postop. 1 “We are finding patients with PC IOLs seem to be developing visually significant cataracts at a higher rate than was seen in the FDA trial,” Dr. Horn said. Cataracts tend to occur in the higher myopes and patients over 40. Particularly in those patients, he monitors visual acuity, conducts functional vision tests, and monitors the vault of the lens with ultrasound biomicroscopy or anterior segment optical coherence tomography. Anterior subcapsular cataract formation is the only time Dr. Rivera recommends a phakic IOL explantation. If the vault has become low, he considers exchanging the ICL for a longer one in order to increase the vault, which may allow the patient several more years of excellent unaided vision. A key to long-term success is patient education. “It is important to educate patients as to the need for ongoing follow-up given that their eyes remain genetically, if not physiologically, nearsighted,” Dr. Rivera said. “With that comes an increased incidence of retinal pathology, glaucoma, and other issues; the better educated patients are, the more likely they will be to present routinely or to come in sooner if they notice any changes in their vision.” EWAP reference 1. Igarashi et al. Eight-year follow-up of posterior chamber phakic intraocular lens implantation for moderate to high myopia. Am J Ophthalmol . 2013 Nov 13. pii: S0002-9394(13)00728-9. doi: 10.1016/j.ajo.2013.11.006. [Epub ahead of print] Editors’ note: Dr. Devgan has financial interests with Alcon (Fort Worth, Texas, U.S.). Dr. Horn has financial interests with Alcon. Dr. Rivera has financial interests with STAAR Surgical (Monrovia, Calif., U.S.). contact information Devgan: devgan@gmail.com Horn: jeff.horn@bestvisionforlife.com rivera: rpriveramd@aol.com