Eyeworld Daily News

MAY 7, 2019 | EYEWORLD DAILY NEWS | 45 ASCRS SYMPOSIA by Ellen Stodola EyeWorld Senior Staff Writer/ Meetings Editor eye was healing normally). The pa- tient had no pain but couldn't see. The patient ended up with a large scar and severe stromal loss and ended up 20/200 with thinning and irregular astigmatism. Another potential complica- tion Dr. Hatch mentioned was infectious keratitis, and she shared several factors associated with this: poor contact lens hygiene, eye rubbing, and rinsing with tap water. She also noted that epithe- lial removal and UV may trigger HSV. Editors' note: Dr. Talley Rostov has financial interests with a number of ophthalmic companies. Dr. Beckman has financial interests with Avedro. Dr. Hatch has financial interests with Avedro. patients who are optically clear but at transplant level, I still think they have an opportunity to get cross- linking," Dr. Beckman said He stressed that steep corneas can be treated, and scleral lenses may work quite well for these patients. Kathryn Hatch, MD, Waltham, Massachusetts, discussed some of the potential complica- tions of crosslinking. It's generally a low-risk procedure, with a usual- ly uneventful recovery. However, complications can sometimes occur. Most are technique-related and mostly related to epithelial removal, she added. Dr. Hatch shared a case of a 22-year-old patient she saw who was presenting with a white mass/ postoperative haze on corneal af- ter crosslinking (though the fellow they can progress rapidly," she said. Meanwhile, in Dr. Talley Rostov's 18-year-old patient with stable tomography, she elected to observe the patient carefully rather than treating. The patient had a lot of astigmatism but it looked reg- ular, and the cornea thickness was regular. If they start to change, they may be developing keratoco- nus, she said. Dr. Talley Rostov's final case example was that of an 8-year-old with high astigmatism (4.5 D in the right eye and 3.7 D in the left) and a corneal thickness of 536. In this case, she elected to observe the patient rather than to treat. Meanwhile, when treating old- er patients, Dr. Talley Rostov said some reasons in favor of this are to prevent progression, to improve irregular astigmatism, to obtain decreased/flattening of K read- ings to allow for better contact lenses fit or glasses, and to obtain more consistent K readings. When considering cataract surgery, Dr. Talley Rostov said to think about patient expecta- tions, look at topography, look at the density of the cataract, and consider a toric IOL. She also said you would usually do cataract sur- gery first, but in a younger patient, it may be better to do crosslinking first. Ken Beckman, MD, Colum- bus, Ohio, discussed the long-term results of crosslinking by sharing several cases. The first was a 17-year- old male who had come to Dr. Beckman for a second opinion because he had been told that he needed a transplant. The patient was very steep, with a Kmax of 67.5. However, Dr. Beckman said that the key was that although the central cone was severe, the pa- tient's cornea was completely clear. Eight months after treatment, the Kmax was down to 65.7, and the patient was spared both a graft and contact lenses. "When I have A combined symposium of the ASCRS Refrac- tive Clinical Committee and the ASCRS Cornea Clinical Committee on Monday morning focused on crosslinking essentials. Audrey Talley Rostov, MD, Seattle, discussed when to treat with crosslinking, both on younger and older patients. She first mentioned that clinical evaluation, keratometry, and topography/tomography are important parts of the evaluation process. She said it's important to be able to treat before seeing Munson's sign or hydrops. Dr. Talley Rostov shared sev- eral cases with young patients and how she evaluated if they should be treated or followed closely. Her first case, a 14-year-old with keratoconus, presented with a clear left eye (which did have some corneal thinning and a typical ker- atoconus pattern) and a right eye that looked to have early keratoco- nus (but it was hard to tell). With the right eye, the signs were subtle. However, given the young patient age and what the left eye looked like, she said she would treat the left eye and give the option to the patient to treat the right eye or follow it. Dr. Talley Rostov noted that it's very important to know if the patient is an eye rubber, if they have allergies, or if they have a family history of keratoconus. Dr. Talley Rostov moved on to discuss a 15-year-old patient who presented with untreated keratoconus for several years. The patient elected to not have cross- linking, and in a period of just a couple years, there was a 15.3 D increase. "If you see someone like this, especially a young patient, Symposium highlights crosslinking essentials Dr. Hatch discusses potential complications of crosslinking

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