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EW SHOW DAILY 6 Volk Transcend TVG is developed in collaboration with: Transcend Medical + Dr. Steven D. Vold volk.com/tvg [ Buy Today ] Just $1200 .00 at ASCRS Visit Volk # 1955 for SAVINGS TVG Surgical Gonio Lens ASCRS News Today Saturday, May 7, 2016 Dr. Rhee's presentation covered decorative contact lenses, particu- larly circle lenses that are popular for making the eyes look big. These have become quite popular and are easy to get on the Internet, she said. Although not all decorative lenses are bad, the problem comes with those that are used without a prescription, Dr. Rhee said. Many of these lenses come from questionable sources and are often linked to in- fections. Other ocular problems, like limbal stem cell deficiency, could occur with these lenses. Dr. Rhee said it's important to ask every patient about decorative contact lens use and to educate them about the potential concerns and problems that can occur. She also recommended that physicians collaborate with colleagues on this issue and report any cases of infec- tions and adverse events, as well as any knowledge of illegal sale of the lenses. EW Editors' note: The physicians have no financial interests related to their comments. antifungal therapy, natamycin may be a better and more accessible ther- apeutic, she said. Kristin Hammersmith, MD, Philadelphia, presented on corneal neovascularization and HSV. Physi- cians know that corneal transparen- cy is essential to optimal vision and function, she said. Corneal neovas- cularization can block and disrupt light, can deposit lipids and proteins into the stroma, can damage the structural integrity of the cornea, and can worsen the prognosis of PK. The prevalence of corneal neo- vascularization is 4% of the general ophthalmic eye service in the U.S., Dr. Hammersmith said. There is an estimated incidence of 1.4 million Americans per year, she added, and HSV is the major cause of blindness in the developed world. Dr. Hammersmith's presenta- tion focused on a 43-year-old with HSV, and she offered information on some of the tools that surgeons can use to address these cases. Possible options include steroids, anti-VEGFs, argon laser, and diathermy cautery. Steroids are widely used and prob- ably the most common treatment, but physicians may want to have other options as well. Cosmetic procedures The second session of Cornea Day focused largely on a variety of cos- metic procedures. Denise de Freitas, MD, Sao Paulo, Brazil, highlighted the controversial topic of conjunc- tival tattoos. There are a number of concerns associated with these tat- toos, the first of which is the types of ink used. There are dermal tattoo inks, Dr. de Freitas said, but there are also tattoo inks that contain metals. "Another problem is the people doing this procedure have no train- ing at all," she said, and a process of trial and error is needed in doing these tattoos. There is injection into the subconjunctival space and staining of the conjunctiva, epis- clera, and sclera. There are a variety of complications associated with conjunctival tattooing, both short term and long term. Short-term complications may include headaches, photophobia, foreign body sensation, allergic reaction, infections, and globe pen- etration. Long-term complications may include granulomatous inflam- mation, uveitis, ink migration, and carcinogenic change. The possibility of "homemade tattoos" are also a concern. In these cases, the quality of the injected ink and sterilization of surgical instru- ments are 2 serious concerns, Dr. de Freitas said. Currently there is no legisla- tion in the majority of countries and states, she said, because this is a technique that was only recently introduced. Some states and coun- tries have, however, started making efforts to pass laws against these procedures. Michelle Rhee, MD, New York, highlighted another cosmetic procedure that may be of concern. Her talk focused on complications of large-diameter cosmetic contact lenses, and she highlighted 3 main questions: What are large-diameter cosmetic contact lenses? What are the problems associated with them? What can be done about the prob- lems? Dr. Rhee discusses large-diameter cosmetic contact lenses. role for topical steroids in bacterial keratitis? Dr. Suh said the pros are that they can reduce the severity of stromal melt and scarring. Topical steroids could also inhibit neutro- phil chemotaxis and collagenases. However, there could be a delay in epithelial healing, and the steroids could prolong infections and may allow for fungal infections. The next step for this type of patient, Dr. Suh said, would be to reculture, and do a confocal micros- copy and biopsy. This particular pa- tient was recultured from the cornea and contact lens case. Fortified van- comycin and tobramycin was used, but the patient still complained of severe pain. Dr. Suh said that she and col- leagues asked themselves if there was a role for collagen crosslinking in infectious keratitis. In order to talk about crosslinking, you have to talk about the antimicrobial effect of riboflavin and UVA demonstrat- ed in vitro in animal studies, she said. Crosslinked corneas may have increased resistance to degradative enzymes. Studies have shown that crosslinking appears to be a reason- able adjunctive therapy for corneal ulcers, Dr. Suh added. With still negative cultures, the patient did admit to having uncon- trolled diabetes mellitus. When a confocal microscopy was performed, many branching organisms were found throughout numerous scans, which was consistent with filamen- tous fungal organisms. Cultures showed Fusarium spp., and eventu- ally a penetrating keratoplasty was performed for this patient. In conclusion, Dr. Suh high- lighted the answers to 3 important questions: Is there a role for topical steroids in bacterial keratitis? Is there a role for collagen crosslinking in infectious keratitis? And what is the first line of antifungal therapy in fungal ulcers? She said there may be a role for topical steroids for certain culture positive bacterial ulcers, and preliminary reports show efficacy with crosslinking, but more clinical experience is needed. In terms of continued from page 4

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