EyeWorld Asia-Pacific December 2015 Issue

45 EWAP REFRACTIVE December 2015 were deemed to be refractive surgery candidates. After surface optimization for a mean of 3.2 months, 32 patients who had previously been described as having moderate dry eyes underwent refractive surgery. Of these patients, 28 ultimately underwent LASIK, while four were slated for PRK, he reported. “I think the key result is that there is a large population of patients with dry eyes that can be successfully treated with LASIK or PRK if you pretreat them,” Dr. Wilson said. However, it’s important not to give up too early, he stressed, pointing out that in the Restasis phase 3 clinical trial, in many cases a significant effect was not seen until 3, 4, or 5 months after treatment was started. Treating preclinical patients Meanwhile, there were some patients who showed no signs of dry eye preoperatively who went on to develop LASIK-induced neurotrophic epitheliopathy postoperatively. “Cyclosporine is again very successful in treating those patients and lessening their symptoms and signs,” Dr. Wilson said. Investigators found that just five eyes continued to be dry postoperatively after 12 months or more of cyclosporine treatment. “Cyclosporine is very successful in treating those patients and lessening their symptoms and signs.” He said refractive surgery is a kind of stress test in these patients. “They actually had underlying dry eye disease but it was subclinical to the point that we didn’t detect it prior to surgery,” he said. “Having LASIK brings it out and tells us that these patients have an underlying dry eye that we want to treat.” With such treatment, not only will their vision fluctuation and other symptoms typically improve, but there is also evidence that treatment with medications like cyclosporine can halt disease progression and keep them from becoming worse later in life, Dr. Wilson said. “In some ways catching it after refractive surgery may be fortuitous for those patients because they’ll get earlier treatment and I think are less likely to progress to more severe dry eye later in life,” he said. Overall, Dr. Wilson said that dry eye isn’t the barrier that it once was to refractive surgery. “Most patients with proper diagnosis and treatment can go on to become good candidates for the surgery,” he said. EWAP Editors’ note: Dr. Wilson has financial interests with Allergan. Contact information Wilson: WILSONS4@ccf.org How has the femtosecond - from page 38 When it comes to removing cortex, you don’t have strands of cortex sticking out beyond the edge of the capsule because they’ve been cut with the laser. I use a curved I/A tip that lets me comfortably put the aspiration port right up under the capsule, and then tangentially (diagonally) engage until I have cortex and strip it in a circumferential manner. I prefer bimanual I/A for this but an angled/curved coaxialI/A tip also works well. It is clear that you can perform a laser treatment and then wait a little while before you take a patient into the operating room. But if you treat a patient with the laser and you leave them waiting for an hour or two, cytokines and inflammatory mediators can be released into the eye and the pupil can constrict, and that can be more difficult to keep dilated during the procedure. So that is a challenge—to make sure that the timing of the laser pretreatment and the completion of the surgery are appropriately sequenced. What I’ll typically do is I’ll start my day by treating two patients. One will immediately go into surgery and the other will wait and go in when the first one’s done, or go into a second room down the hall. So the delay is no more than 20 minutes. EWAP Editors’ note: Dr. Cionni has financial interests with Alcon. Dr. Talamo has financial interests with Abbott Medical Optics (Abbott Park, Ill.). Dr. Nagy has no financial interests related to this article. Contact information Cionni: +1-801-266-2283 Nagy: nz@szem1.sote.hu Talamo: Jonathan_Talamo@meei.harvard.edu 18 Feb 2016 Deadline for abstract submission 18 May 2016 Deadline for 1 st er early bird registraaon 8 June 2016 Deadline for 2 nd er early bird registraaon AAer 8 June 2016 On-site registraaon rates apply IMPORTANT DATES BALI NUSA DUA CONVENTION CENTER ORGANIZED BY: