EyeWorld Asia-Pacific December 2020 Issue

Imaging, Aerosol Generation, and Retreatment eye disease, after LASIK. Dr. Pahuja concluded that corneal dendritic cell density is associated with sub-basal nerve plexus features and increased ocular surface disease index. Thus, it is crucial to choose a nerve-sparing procedure to maintain the homeosta- sis and cause less injury to the ocular surface and cornea. Dry Eye after Laser Vision Correction (LVC) Next, Prof. Walter Sekundo presented a variety of studies on dry eye after Laser Vision Correction (LVC). In a meta-analysis of 14 studies, there was a significant reduction found in tear break-up time in LASIK as well as a significant reduction of tear osmolarity in LASIK compared to photorefractive keratectomy (PRK). 1 Contrastingly, there was a non-signif- icant reduction of break-up time with SMILE and PRK. 2 In a different large series study of 13,319 patients, it was found that PRK patients had more subjective symptoms than LASIK patients, specifically in women. Addi- tionally and interestingly, patients with worse preoperative dry eye symp- toms were more likely to improve. 3 One study reported that mitomycin C (MMC) did not affect dry eye syn- drome in PRK procedures, and in Dr. Sekundno’s experience in using MMC, he never saw significant traces of haze, even in the worst cases. For the treatment of dry eye after laser refractive surgery, there is no specific algorithm. However, in the lit- erature, tear supplements (lubricants) have been found to work well. These supplements include 0.1% or 0.3% hyaluronic acid and even ointments. Anti-inflammatory preparations may also be used and these include cyclosporine A 0.05%, rebamipide, or liftegrast. Liftegrast works similarly to cyclosporine A, thus making it a good choice for patients who may not be able to tolerate cyclosporine A. For Meibomian Gland Dysfunction (MGD), Prof. Sekundo suggested FIgure 2. During microkeratome LASIK, droplets are dispersed at a maximum distance of 10 to 11 inches on both the surgeon side and the opposite side. Source: Khamar P et al. J Cataract Refract Surg 2020 “ The primary results showed that the conjunctival epithelial cells and the corneal epithelial cells had the highest amount of the priming or entry related genes and interferon response genes present. ” Dr. Pooja Khamar metalloproteinase inhibitors (e.g. low dose tetracycline or azythromycin) given three days prior to surgery and continued for two days after surgery. “We know that the drug is enriched in the tissue and released over the pe- riod of almost one month, so it does help.” Warm compresses and eyelid scrubs may also help with blepharitis symptoms. In Prof. Sekundo’s personal experience, he will pretreat patients with blepharitis symptoms typical- ly with tetracycline for at least six weeks at 50mg per day. He stated that he never uses lipid flow or IPL as a pretreatment due to the cost. For patients complaining of more severe pain, Dr. Sekundo stated that this percentage of patients complaining of such pain is quite small and there has never been a case he hasn’t been able to treat. Aerosol Experiments on Lenticule Extraction Vs. the Rest During COVID Times The next presentation was given by Dr. Pooja Khamar on Aerosol Exper- iments on Lenticule Extraction with SMILE (Carl Zeiss Meditec AG, Jena, Germany). She first began with a touch on current events by discussing whether SARS-CoV-2 related markers are present in ocular tissue. What Dr. Khamar did to study this topic was to take donor human eyes, which are not suitable for transplantation, and dissect them layer by layer. The cor- nea was separated from the epitheli- um, stroma, endothelium, conjunctival cells, retina, etc. The primary results showed that the conjunctival epitheli- al cells and the corneal epithelial cells had the highest amount of the priming or entry related genes and interferon response genes present. Additionally, there were many markers present in the stroma and iris. Interestingly, the retinal pigment epithelium contained the least amount of the priming or entry related genes and interferon response genes. This experiment is important clinically. The Lenticule Ex- traction procedure with SMILE (Carl Zeiss Meditec AG, Jena, Germany) is performed mainly in the corneal stro- ma. The corneal stroma can also be used for cross-linking or implantation in the eyes, resulting in a high impact of safety for the patient. Continuing with her presentation, Dr. Khamar designed a small study to investigate aerosols in refractive Media placement sponsored by Carl Zeiss Meditec AG Not all products, services or offers are approved or offered in every market and approved labeling and instructions may vary from one country to another. The statements of the authors of this supplement reflect only their personal opinion and experience and do not necessarily reflect the opinion of Carl Zeiss Meditec AG or any institution with whom they are affiliated. Carl Zeiss Meditec AG has not necessarily access to clinical data backing the statements of the authors.The statements made by the authors may not yet been scientifically proven and may have to be proven and/or clarified in further clinical studies. Some information presented in this supplement may only be about the current state of clinical research and may not be part of the official product labeling and approved indications of the product.The authors alone are responsible for the content of this supplement and any potential resulting infringements resulting from, in particular, but not alone, copyright, trademark or other intellectual property right infringements as well as unfair competition claims. Carl Zeiss Meditec AG does not accept any responsibility or liability of its content. EN_34_021_0063I