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33 EW SHOW DAILY 2018 ASCRS•ASOA Annual Meeting, Washington, D.C. by Liz Hillman EyeWorld Staff Writer merits of anterior chamber IOLs, iris-fixated IOLs, and sutureless scleral-fixated IOLs, respectively, for visual rehabilitation in aphakic patients. Dr. Little said anterior chamber IOLs are a good lens with a bad rep- utation due to their association with UGH syndrome and risk for sec- ondary glaucoma. There have been design and manufacturing changes, he said, that have virtually eliminat- ed incidence of UGH syndrome and have resulted in positive experimen- tal and clinical outcomes with a low complication rate. These IOLs do require deep chambers, adequate iris support, and normal drainage of the angle. Dr. Condon said the merits of iris-fixated IOLs are their small incision, ability to perform under topical anesthesia, fast visual recov- ery, easy anatomy, no conjunctival or scleral needle passes, and no su- tures. He cited research that says iris fixation has the lowest rate of CME compared to anterior chamber IOLs and scleral-fixated IOLs. Dr. Hamill described the flanged, double-needle intrascleral haptic fixation technique pioneered by Shin Yamane, MD, PhD. He called this his method of choice in the absence of capsular support due to its small incision, its ease, adjustability, and potential for easy removal. The final topic was treating in- flammation after intraocular surgery. Henry Perry, MD, Rockville Centre, New York, described how topical ste- roids are all you need, while Thom- as Kohnen, MD, PhD, Frankfurt, Germany, took the position that topical NSAIDS are all you need, and John Sheppard, MD, Norfolk, Virginia, said he thinks both are needed. "I encourage you to give your patients what you'd give your mom. Use the best medications for all of your patients," Dr. Sheppard said. EW Editors' note: Dr. Sheppard has finan- cial interests related to his comments. Drs. Masket, Mamalis, Hoffman, Little, Condon, Hamill, Perry, and Kohnen have no financial interests related to their comments. could result in haze, all of which could negatively impact outcomes with multifocal IOLs, Dr. Masket said. He added that he thinks Fuchs', being a progressive disease, is a contraindication due to the tenden- cy for guttae to reduce vision and scatter light and the possible need for EK surgery, which could result in refractive misses. Virtually all macular diseases re- duce contrast sensitivity and are typ- ically progressive, leading Dr. Masket to also consider these contraindica- tions for presbyopia-correcting IOLs. Based on data from his practice of 33 cases of extracted multifocal IOLs, 10 were due to macular disease and eight were due to corneal disease. "In my view, are these lenses contraindicated with corneal and macular disease? Absolutely," Dr. Masket said. Richard Hoffman, MD, Eugene, Oregon, held the opposite perspec- tive, admitting, however, that he would agree placing premium IOLs in patients with corneal and macular pathology is "perhaps pushing the envelope." If you are to consider multifocal or extended depth of focus lenses in such patients, he said you have to consider what the patient might actually tolerate and their willingness to undergo IOL exchange. You also have to assess their disease risk in terms of sever- ity, progression, and potential for reversibility. Dr. Hoffman presented a few examples of cases where a presby- opia-correcting IOL in the presence of corneal or macular disease still resulted in happy patient outcomes. One was a case of Fuchs' where the patient already had a multifocal IOL implanted. Dr. Hoffman said he performed a DMEK and the patient's vision improved. Another case involved a referral with a multifocal IOL in a patient who had anterior basement membrane dystrophy that was missed or ignored by their previous surgeon. This patient was requesting an explant, but Dr. Hoffman performed a superficial keratectomy and the patient ended up happy with their vision. Next, Brian Little, MD, Lon- don, U.K., Garry Condon, MD, Bradenton, Florida, and M. Bowes Hamill, MD, Houston, debated the The first topic addressed was the use of presbyopia-correcting IOLs in the presence of corneal or macular pathologies. Samuel Masket, MD, Los Angeles, presented his case that these conditions are contraindica- tions for presbyopia-correcting IOLs (considering only those available in the U.S.). Diffractive IOLs, he said citing research, result in an 18–20% loss of light energy passing through to the retina. "If we're going to have a re- duced central field visual quality … we need to be careful in patients who might have disease affecting central vision," Dr. Masket said. When it comes to corneal disorders, such as astigmatism, Dr. Masket demonstrated how quality of vision through a multifocal lens degrades significantly even with low amounts of astigmatism. Mild keratoconus and post-RK are also contraindications, he said, because of the difficulty of nailing optical outcomes with these IOLs. Epithelial basement membrane dystrophy can prevent good biome- try, it could be a reoccurring condi- tion after treatment, and treatment Symposium addresses perspectives in presbyopia- correcting IOLs, options when there's no capsular support, and treating inflammation A Monday afternoon sym- posium sponsored by the Journal of Cataract and Refractive Surgery looked at three topics that could be considered controversial in anterior segment surgery. Before getting into the debates, the session's co-moderator Nick Mamalis, MD, Salt Lake City, an- nounced the first Stephen Obstbaum Award for the best scientific paper published in JCRS for the prior year. The award recognized the paper by Rosa et al. "Functional magnetic resonance imaging to assess neuro- adaptation to multifocal intraocular lenses." The Emanuel Rosen Award given for the best technique paper published in JCRS will be presented at the ESCRS Congress this year, Dr. Mamalis said. Three topics debated in 'Controversies in Anterior Segment Surgery' Dr. Hoffman sits on the panel at the JCRS-sponsored symposium after sharing his perspective that premium IOLs can be used in some cases of corneal or macular pathologies.

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