Eyeworld Daily News

EW SHOW DAILY 32 ASCRS Symposia Sunday, April 15, 2018 by Ellen Stodola EyeWorld Senior Staff Writer Treatment is often a bigger stressor for patients and their fam- ilies than the disease itself or fear of blindness, Dr. Kedhar said. He noted the importance of checking for refractive errors, as this is still the most common reason for reduced visual acuity. Dr. Kedhar cited a study saying that inflammation should be at its best level of control for 3 months or longer before elective surgeries to reduce the risk of vision-limiting complications. In addition to this consideration, Dr. Kedhar suggested pretreating with corticosteroids, and he said it is not necessary to stop IMT prior to cataract surgery. When performing cataract surgery, an anterior approach is preferred for most cases over lensec- tomy. Dr. Kedhar suggested opening the posterior capsule during surgery, especially if the child is unlikely to be cooperative for a YAG capsuloto- my. There should also be consider- ation of whether or not to implant an IOL. Dr. Kedhar said it's important not to forget that complications can cause vision-deprivation amblyopia. But he said that it does not occur so rapidly that you must rush into surgery without controlling inflam- mation. He suggested patching the opposite eye, if practical, based on the visual acuity of the eye to be operated on. Finally, he discussed glaucoma and elevated IOP. Disease-associated glaucoma is more common than corticosteroid-induced ocular hy- pertension. Do not sacrifice control of inflammation by switching to a "weak" corticosteroid for the sake of IOP control. Dr. Kedhar also noted that glaucomatous optic neuropathy can progress rapidly in children, and he said to avoid the temptation to per- form laser peripheral iridotomy in eyes with nearly secluded pupils, as this could result in paradoxical angle closure. EW Editors' note: Drs. Zaidman and Kedhar have no financial interests related to their comments. Dr. Zaidman described the "sandwich technique," which in- volves excision of the cornea, man- agement of potential lens prolapse, and interrupted sutures to adhere the graft. For postoperative care, Dr. Zaidman said that during the first 2 months, he will see the patient 2–3 times a week, with frequent postop- erative EUAs and early suture remov- al. He will also use a long-term slow taper of topical steroids over 1 year. He suggested no vaccinations for 1 year. Sanjay Kedhar, MD, Irvine, California, discussed children with chronic anterior uveitis and offered considerations for anterior segment surgeons. Chronic anterior uveitis is the most common form in children. Vision-limiting complications are common and often require surgical management. Additionally, most children with chronic anterior uve- itis will require systemic immuno- suppression for long-term control. Also, he noted that children are not responsible for their own care. Preoperative assessment is import- ant, and during this time, you should evaluate the social situation. Dr. Zaidman suggested educating the parents about the "marathon" of exams, drops, and other things involved in treatment. He said it's important to realistically discuss success rates and multiple EUAs and office visits. For infants, Dr. Zaidman said that he would have an office visit prior to 3 weeks of age and EUA at 4–6 weeks of age. He would do surgery in the first eye around 8–12 weeks of age and the second eye 4–6 weeks after the first. In terms of surgical technique, Dr. Zaidman uses general anes- thesia. He also noted that he will oversize the donor by 0.5 mm, will use a scleral support ring, and will carefully enter the AC and inject viscoelastic. A symposium on Saturday afternoon sponsored by the Cornea Society focused on the topic of pediatric cornea. The session was moderated by Antho- ny Aldave, MD, Los Angeles, and Elmer Tu, MD, Chicago. Gerald Zaidman, MD, Valhalla, New York, presented on penetrating keratoplasty in the pediatric popula- tion. First, Dr. Zaidman stressed that doing an exam under anesthesia (EUA) is crucial to accurately diag- nose and manage a pediatric patient with a cloudy cornea. Indications for corneal trans- plant surgery in children and adults are completely different, Dr. Zaidman stressed, and there are a number of particular challenges of pediatric corneal transplants: severe ocular pathology, technical diffi- culty, young age, poor cooperation, hard to examine, and sudden rapid rejection. Symposium covers topics in pediatric cornea Dr. Kedhar presents on children with chronic anterior uveitis.

• Cover