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52 | EYEWORLD DAILY NEWS | MAY 18, 2020 DAILY NEWS ASCRS VIRTUAL ANNUAL MEETING Fuchs with an AUC of 0.999, 100% sensitivity, and 97.8% specificity. To view this and other similar paper presentations, see SPS-301. Editors' note: Dr. Eleiwa's study was supported by the National Eye Institute. by Ellen Stodola Editorial Co-Director A paper session on cor- neal disease diagnos- tics covered a variety of studies, including one on diagnostic performance of an artificial intelligence (AI) algorithm in Fuchs endothelial cell dystrophy. Taher Eleiwa, MD, Miami, Florida, first began by sharing that Fuchs dystrophy is con- sidered a bilateral asymmetric disease of the corneal endothe- lium. It is one of the leading indications of keratoplasty and has an estimated 4% preva- lence in the U.S. population above the age of 40, he said. So why is it important to screen for Fuchs? Dr. Eleiwa said it's mandatory before cat- aract surgery. There have also been tremendous advances in Fuchs therapy. Tools available for screening, he said, include a slit lamp exam, specular microscopy, and corneal pa- chymetry. High-definition OCT may also help identify Fuchs. He shared photos comparing a healthy eye and a Fuchs pa- tient, noting that, in healthy eyes, the endothelium/De- scemet is visualized as a band formed by two smooth, regular hyperreflective lines with a hy- poreflective space in between. But in Fuchs, the posterior line showed a wavy, irregular appearance with areas of focal thickenings. Dr. Eleiwa's study was built on OCT images to train an artificial intelligence algo- rithm. There were 41 eyes in this observational, case-control study, he said. All received high-definition OCT imaging, and there were 7,380 images total. Images were acquired using the Envisu R2210 (Leica Microsystems), Dr. Eleiwa not- ed, and scan protocol was 36 radial scans through the cor- neal apex. The algorithm was trained, validated, and tested on a separate independent dataset. The AI algorithm was able to autonomously diagnose AI algorithm studies shared in paper session on corneal disease diagnostics Dr. Eleiwa demonstrates how high-definition OCT can differentiate between a healthy eye and a Fuchs eye. Source: Taher Eleiwa, MD, screenshot from presentation on more medications preop, and the AC DMK and topical groups had good reductions in glaucoma medications postop, while the PP TMV group had somewhat less of a reduction. "This is likely, partly, be- cause the topical group started on more meds … thereby lowering IOP and glaucoma medications may have been easier to accomplish," he said. There were no statistically significant differences in IOP preop or postop between the groups. These findings led Dr. Evans and his coauthors to conclude that AC DMK and PP TMV with a once-a-day, com- pounded topical are safe and effective, though he said van- comycin is not commonly used anymore due to concern of HORV. The pars plana injection is also an additional procedure and there can be a vitreous depot effect. Dr. Evans said larger, randomized trials are needed to compare the rates of postop endophthalmitis, CME, and other complications, such as TASS. "We also should contin- ue to investigate the role of intracameral NSAIDs, which are new to the intracameral scene," he said. Another paper presented in the session evaluated the safety and efficacy of intracameral steroid, NSAID, and antibiot- ic compared to intracameral antibiotic with topical steroid and NSAID after cataract surgery with CyPass (Alcon). One should note that CyPass, a supraciliary microstent, was re- called in 2018 due to concerns of endothelial cell loss. Lucas Schnaidt, MD, a first- year ophthalmology resident, Fargo, North Dakota, discussed the retrospective, chart re- view study. The intracameral group received dexametha- sone-moxifloxacin-ketorolac in the anterior chamber and used one drop of topical gatifloxa- cin, prednisolone acetate, and bromfenac for 1 month, while the topical group received moxifloxacin intracamerally followed by topical ofloxacin (four times a day), tapered loteprednol, and nepafenac (one time a day) for 1 month. The topical group at 1 week and continuing out to 6 months had a higher IOP compared to the intracamer- al group, though over time the difference was closing. In terms of number of medi- cations patients remained on following surgery at 6 months, there was a difference in the number of glaucoma-control medications with the topical group requiring more medica- tions. There was no difference in the number of IOP spikes between the two groups. "You can see that cataract surgery plus CyPass resulted in significant intraocular pres- sure lowering and decreased the medication burden up to 6 months in both groups," Dr. Schnaidt said, noting the intracameral method proved safe and effective for delivery of these medications. For these and other papers in the session, look for SPS- 304. Editors' note: Dr. Evans and Dr. Schnaidt have no financial interests related to their presentations. continued from page 48

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