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ASCRS•ASOA SYMPOSIUM & CONGRESS, SAN FRANCISCO 2013 EW SHOW DAILY 49 Meeting Reporter Femto laser papers indicate progress by Chiles Aedam R. Samaniego EyeWorld AP Senior Staff Writer T he best research papers presented in scientific meetings such as ASCRS represent some of the more interesting indicators that a certain technology has, not necessarily "made it," but at least made significant progress. Such is the case with the papers presented at the ASCRS Paper Session on Femtosecond Laser yesterday. Whereas a few years ago a similarly themed paper session would highlight research serving as "proofs of concept" for the technology, the papers of the session defined terms and demonstrated challenging cases and alternative applications, some of which may not even have been considered by the average practitioner. For instance, when presenting the paper "Comparison of Anterior Capsule Tag Formation Rates of 2 Femtosecond Laser Systems for Cataract Surgery," Steven J. Dell, MD, Austin, Texas, proposed defini- tions for terms that had not previously been formally defined but have become common since the advent of modern laser eye surgery: a capsulotomy is free if it floats freely and there are no attachments; an adhesion is a small attachment that separates easily and leaves no trace once separated; a bridge is an untreated skip area that, when torn, can create a tag, a dog-ear or vshaped notch in the capsulotomy. Other papers at the session, such as "Evaluation of Laser Refractive Cataract Surgery: Use in Routine Cases and Complicated Preexisting Conditions" presented by Gerd Auffarth, MD, Heidelberg, Germany, and "Femtosecond Laser Cataract Surgery Using Broad Inclusion Criteria" by H. Burkhard Dick, MD, Bochum, Germany, showed a trend for demonstrating the safety of the laser in cases that aren't just routine. In the best paper of the session, "Femtosecond Laser-Assisted Tech- nique for Bag-in-the-Lens IOL Implantation," the authors, represented by Ana Paula Fraga Santini Canto, MD, Miami, used the laser in a relatively uncommon procedure involving another relatively new technology. The non-FDA approved bag-inthe-lens IOL, designed primarily for pediatric patients, is a lens that snaps onto the anterior capsule, creating a platform with a screw-on optic that can be replaced to compensate for any changes in power necessitated by the natural growth of the juvenile eye. In addition to the usual anterior continuous curvilinear capsulorhexis (CCC), the lens requires primary posterior CCC to prevent posterior capsule opacification (PCO). Dr. Canto and her colleagues used the femtosecond laser to perform both capsulotomies. They concluded that this use of the laser: eliminates PCO; eliminates the difficulty of manual posterior CCC; performs both anterior and primary posterior capsulotomies at the proper size, centration and symmetry; is reproducible. "Studies with a larger number of patients and a long-term follow-up are necessary to evaluate the final refractive outcomes and possible adverse effects," said Dr. Canto. EW Editors' note: Dr. Auffarth has financial interests with Abbott Medical Optics (AMO, Santa Ana, Calif.), Bausch + Lomb (Rochester, N.Y.), and Carl Meditec Zeiss (Jena, Germany). Dr. Dell has financial interests with AMO, Alcon (Fort Worth, Texas), and Bausch + Lomb (Rochester, N.Y.). Dr. Dick has financial interests with AMO, Bausch + Lomb, and OptiMedica (Sunnyvale, Calif.). Dr. Canto has no related financial interests, but the paper she presented was co-authored by Dr. Dick. Around the world and back again: Global perspective on corneal transplantation and corneal disease by Ellen Stodola EyeWorld Staff Writer C ornea Day's final session focused on corneal transplantation and recurrent disease from a worldwide perspective. Donald TH Tan, FRCS, Singapore, kicked off the session by highlighting trends and techniques of corneal transplantation around the world. He said that over the past decade there has been a significant shift in the paradigm for forms of selective lamellar keratoplasty. Some of these new procedures include anterior lamellar keratoplasty (ALK) and types of endothelial keratoplasty (EK), like Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet's membrane endothelial keratoplasty (DMEK). He said the general trend for adopting these lamellar procedures globally is present, however, they have not been implemented in all countries yet. He cited the challenge of obtaining data on various proce- dures around the world. Lack of data collection and lack of recent data creates challenges for determining the use of these procedures around the world. Dr. Tan also said variable responses from surgeons, lack of uniformity, and institution-specific rather than region-specific data make it hard to draw conclusions on this corneal transplantation data from around the world. However, corneal transplantation is shifting from conventional penetrating keratoplasty (PK) to the emerging forms of selective lamellar keratoplasty, and Dr. Tan believes it will continue to grow. In developed western countries, EK is rapidly taking over PK for treatment of endothelial disease, while in developing countries, it is spreading at a slower rate. "Overall, major transplantation centers around the globe are certainly beginning to embrace EK and ALK surgery, and I think they will be the champions to lead the way to the future of corneal transplantation," Dr. Tan said. "The lamellar revolution shows great promise." EW Editors' note: Dr. Tan has no financial interests related to the topic.