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EW SHOW DAILY 34 ASCRS Symposia Tuesday, April 21, 2015 by Erin L. Boyle EyeWorld Editor Editors' note: Drs. Barry, Chang, Dupps, Mamalis, and Wilson have no financial interests related to their comments. Dr. Mehta has financial interests with Carl Zeiss Meditec. Drs. Donnenfeld and Yeu have financial in- terests with Alcon (Fort Worth, Texas), Abbott Medical Optics (Abbott Park, Ill.), and Bausch +Lomb (Bridgewater, N.J.). Cleveland, argued that LASIK is still a viable option for refractive surgery, and that while the SMILE (small in- cision lenticule extraction, Carl Zeiss Meditec, Jena, Germany) procedure has advantages, caution should be taken with new technologies to ensure best clinical results. "I think this procedure has a lot of promise but we need to temper our exuberance," he said. "Please be- ware of the traditional risk factors of ectasia and don't think this is nec- essarily going to be an ectasia-free procedure." Jodhbir S. Mehta, MD, FRCS(Ed), Singapore, argued for the SMILE procedure, saying that while he performs LASIK, he thinks that the new possibilities that the SMILE procedure present are exciting. "The initial refractive results with SMILE are already matching the most matured femto LASIK results," he said. LRIs: Laser or manual? In the "Astigmatism Correction: Femtosecond Laser or Blade?" head- to-head debate Eric D. Donnenfeld, MD, Rockville Centre, N.Y., and Elizabeth Yeu, MD, Norfolk, Va., debated whether femtosecond or manual limbal relaxing incisions (LRIs) are better, respectively. Dr. Donnenfeld said that femtosecond laser astigmatic incision-created LRIs are more elegant and accurate than manual incisions. "The femtosecond laser is clear- ly the advantage," he said. "Novel technology provides image-guided laser incisions that are superior to manual incisions. They increase surgeon and patient acceptance, safety and accuracy, and incisions are customizable, adjustable, and repeatable." Cost is a major issue that Dr. Yeu cited as one of the reasons that manual incisions should still be used (though she admitted that she uses the femtosecond laser in 55% of her LRI cases). All a physician needs for a manual incision is an astigmatic gauge, LRI marker, and LRI knife, none of which match the cost of a femtosecond laser, she said. "There are benefits to both laser and manual LRIs," she concluded. EW ic?" 65% physicians in the 2014 sur- vey said they were "not convinced" about use, which was lower than the same response in 2007, at 89%. "Mixing risk" was the next highest response, with 49% of physicians answering that for why they were not using intracameral antibiotics in the 2014 survey, up from 45% in 2007. Peter J. Barry, MD, Dublin, Ireland, gave an overview of the world perspective on intracameral use, including saturation rates in dif- ferent countries in Europe and the world. He highlighted how countries including France, Italy, and Sweden have high rates of intracameral cefuroxime use, while countries such as Germany, Russia, and Japan have low rates of use. "In Sweden, withholding intra- cameral cefuroxime is considered unethical," Dr. Barry said. SMILE versus LASIK In the "Femtosecond Lenticule Extraction Versus LASIK" head-to- head debate, Steven E. Wilson, MD, A head-to-head discussion of hot topics in oph- thalmology highlighted differences in opinion in the "Controversies in Ophthalmic Surgery: Head to Head" symposium, sponsored by the Jour- nal of Cataract & Refractive Surgery (JCRS). The session was moderated by William J. Dupps Jr., MD, PhD, Cleveland, and Nick Mamalis, MD, Salt Lake City, editor of JCRS. Endophthalmitis prevention In the "Prevention of Endophthal- mitis: U.S. Versus Rest of the World" head-to-head debate, David F. Chang, MD, Los Altos, Calif., gave an overview of antibiotic prophy- laxis use and attitudes in the U.S. He outlined 2 surveys done by the ASCRS Cataract Clinical Commit- tee in 2007 and 2014 on antibiotic prophylaxis practice patterns, and the impact of the 2006 ESCRS study of prophylaxis of postoperative en- dophthalmitis after cataract surgery. For the question "Why are you not injecting intracameral antibiot- Hot topics in ophthalmology debated in head-to-head session Dr. Barry discusses intracameral use around the world in a segment on the topic.

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