EyeWorld Today is the official daily of the ASCRS Symposium & Congress. Each issue provides comprehensive coverage editorial coverage of meeting presentations, events, and breaking news
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14 EW SHOW DAILY Monday, April 22, 2013 ASCRS Symposia Treating patients with retinal disorders by Michelle Dalton EyeWorld Contributing Writer P reoperative planning for cataract removal is a bit more complicated in patients with age-related macular degeneration (AMD) and other retinal disorders, according to a symposium on the topic. Timothy W. Olson, MD, Atlanta, said the literature recommends routine use of prophylactic antibiotics after intravitreal injections be discontinued, as the drops may be having an adverse effect on the ocular flora. "Patients on topical moxifloxacin four times daily have been shown in a study to have statistically significantly higher culturepositivity rates," Dr. Olson said. "These patients are developing more resistant strains of bacteria." Patients with AMD may be receiving up to 24 injections per eye over two years and a significant number of antibiotic drops over the same time frame, he added. "The American Academy of Ophthalmology suggested eliminating post-injection antibiotics as a cost-cutting method, noting there has been no confirmed studies David S. Boyer, MD, takes part in the retina symposium. showing any advantage to them," he said. "In a 2011 ASCRS survey, only 1% report not using prophylactic topical antibiotics." That noted, there are recommendations for endophthalmitis prophylaxis of a preoperative topical instillation of Breaking news Sonomed Escalon to introduce new high-resolution system at meeting by Erin L. Boyle EyeWorld Senior Staff Writer E scalon Medical Corp. (Wayne, Pa.) announced that it will be introducing a new VuMax HDB B-scan system at the meeting here. "The VuMax HDB adds to Sonomed Escalon's repertoire of ophthalmic ultrasound systems, and specifically addresses the needs of retinal and certain other practices for high-resolution B-scan imaging of the posterior segment of the eye," said Barry Durante, Sonomed Escalon's president, in a press release from the company. "Based upon clinical feedback received thus far, we believe the B-scan image quality will clearly set this system apart and enable Sonomed Escalon to serve a previously untapped market," he said. According to the release, the VuMax HDB will help expand the VuMax line of high-resolution ophthalmic ultrasound systems. The press release also noted that Escalon Medical Corp., founded in 1987, creates, markets, and distributes ophthalmic diagnostic and surgical products. "The company seeks to further develop and diversify its product offering through internal development programs, strategic partnerships, and acquisition of technology," the release stated. EW povidone-iodine and an intracameral antibiotic injection at the end of surgery. When planning cataract surgery in patients with AMD, "try to plan it as close to trough levels as possible," Dr. Olson recommended. "That may be as close as a week before their next AMD injection." For cataract surgeons, placing a suture at the wound will help prevent issues for the retina surgeon during an intravitreal injection close to the date of cataract surgery. If a cataract surgeon is comfortable with the idea, providing an anti-vascular endothelial growth factor (VEGF) injection at the end of cataract surgery is a potential resolution, the panelists said. Finally, when patients ask if the cataract surgery will affect their retinal disease, Dr. Olson said, "AMD is a progressive disease, and there are no studies to show that cataract surgery directly progresses the disease. So their AMD is going to get worse regardless of whether or not they have cataract surgery." In general, avoid multifocal lenses in these patients, Dr. Olson said. He added the Age-Related Eye Disease Study 2 results will be released later this month, and at that point ophthalmologists will have data on the effect of lutein, zeaxanthin, and omega-3s on AMD. Cystoid macular edema (CME) is "much less common today than it has been, but it's still an issue," said David S. Boyer, MD, Los Angeles. Further, when macular edema occurs, differentiating between a chronic issue and one that is a manifestation of systemic disorders (such as diabetes) is crucial to treatment, he said. When CME does occur in one eye, however, the patient is now at a much higher risk for CME in the second eye, Dr. Boyer said. Panelists in the symposium unanimously suggested a "hard course" of steroids preoperatively, possibly for as long as one to two weeks before cataract surgery in the fellow eye if the first eye has developed CME. EW Editors' note: The presenters have no related financial interests. continued from page 12 By creating patterns of fenstration in the sclera, essentially softening the tissue, making it more pliant, LaserACE, said Dr. Rowen, potentially delays the progression of presbyopia and, uniquely among the approaches to presbyopia examined during the CSCRS, represents a rejuvenation rather than a correction procedure. EW Editors' note: Drs. Barrett and BissenMiyajima has financial interests wtih Hoya (Chino Hills, Calif.). Dr. Carriazo has financial interests with Moria SA (Antony, France) and Schwind (Kleinostheim, Germany). Dr. Ganesh has financial interests with Schwind. Dr. Grabner has financial interests with AcuFocus. Dr. Pallikaris has financial interests with Presbia. Dr. Rowen has financial interests with Ace Vision Group. Dr. Steinert has financial interests with ReVision Optics. Drs. Cosentino, Izquierdo, and Jackson have no relevant financial interests.