ESCRS meeting features small incisions, wavefront

The meeting on the Mediterranean coast focused on the shrinking cataract incision and customized ablation.

NICE, France – Last month, 2,800 ophthalmologists from around the world gathered here for the European Society of Cataract and Refractive Surgeons meeting.

In the area of cataract, the main theme of the meeting seemed to be the increasing possibility of using ultrasmall incisions for phaco and IOL implantation. As if to emphasize this growing area of interest, a “thin” IOL capable of insertion through an incision of less than 2 mm received the CE Mark during the meeting.

In the area of refractive surgery, the dual themes of wavefront-guided ablation and non-excimer options for refractive correction received close attention at the meeting. Papers on wavefront-guided ablation using lasers from a number of manufacturers filled a number of sessions, and presentations on both anterior and posterior chamber phakic IOLs were almost as numerous.

In addition to the clinical news, the ESCRS announced that its first woman president will take office in 2004, Denmark’s Marie-José Tassignon, MD.

ESCRS president Ulf Stenevi, MD, announced Dr. Tassignon’s election during his opening remarks. “We are very excited for her and for the inauguration of our first female president,” Dr. Stenevi said.

In this article we present a roundup of topics covered by Ocular Surgery News reporters at the meeting. Most of this information appeared first in “live” daily reports from the meeting on the OSN Web site, OSNSuperSite.com.

Binkhorst Medal Lecture

Kensaku Miyake, MD, discussed the effects that the preservatives in glaucoma medications have on pseudophakic patients in his 2002 Binkhorst Medal Lecture, “Pseudophakic preservation maculopathy.”

According to Dr. Miyake, the preserved vehicle, not the antiglaucoma agent, is the cause of cystoid macular edema (CME) in pseudophakic patients.

The acceleration of blood-aqueous barrier disruption and the heightened incidence of CME in early postop pseudophakes is induced by the preservative benzalkonium chloride, not the glaucoma medication itself, Dr. Miyake said.

“From the results of our studies, we believe the addition of the preservative contributes significantly to CME produced by antiglaucoma eye drops rather than the main agents, such as latanoprost and timolol,” Dr. Miyake said.

Citing multiple studies, Dr. Miyake noted that it has been well documented that antiglaucoma drugs — specifically epinephrine, dipivefrin, latanoprost and timolol — have been reported to induce CME in postoperative aphakic and pseudophakic eyes.

“This is very remarkable and is an interesting phenomenon,” he said.

The purpose of Dr. Miyake’s study was to investigate the influence of antiglaucoma eye drops on the blood-aqueous barrier and CME.

In 1977, Dr. Miyake developed the hypothesis that the addition of a preservative to glaucoma drugs may contribute to the incidence of CME. Citing published studies and his own multiple prospective, randomized controlled trials, he illustrated that a preservative may indeed be cause of CME formation.

To confirm these clinical suspicions, Dr. Miyake investigated the effects of latanoprost, timolol and benzalkonium chloride on cell morphological damage and expression of prostaglandin-E2.

“The results of our study indicate that benzalkonium chloride, as a preservative in eye drops of latanoprost and timolol maleate, damages lens epithelial cells and stimulates the expression of chemical mediators,” Dr. Miyake said.

In a phenomenon he termed preservation maculopathy, the preservative accelerates biosynthesis of prosta glandins by intraocular cells during the wound-healing process.

Dr. Miyake noted that these results correspond well to his 1977 hypothesis. He said further study is needed relative to the reaction induced by other postoperative eye drops.

Cataract

IOL explantation survey

Incorrect IOL power calculation was the overall most common reason for foldable IOL removal, according to a survey of European and American surgeons. However, calcification of the IOL was the most common reason for removal specifically of hydrogel IOLs, a growing trend noted in this year’s survey.

Results of the fourth annual survey of foldable IOL explantation among members of the ESCRS and the American Society of Cataract and Refractive Surgery were presented by Nick Mamalis, MD.

The survey was available for response by all ASCRS and ESCRS members throughout 2002. Respondents were asked to fill out a form for each explanted foldable IOL. Preop data was collected, as well as the type of IOL removed.

The survey results focused on one-piece plate-haptic IOLs, one-piece loop-haptic IOLs, three-piece IOLs and multifocals. The materials consisted of silicone, acrylic and hydrogel. The survey results were analyzed for signs and symptoms leading to removal, preoperative and postoperative visual acuity and other surgical outcomes.

The data collected demonstrated that three-piece hydrogel IOLs were the most commonly removed, most often because of calcification of the IOL. The second most commonly removed IOLs were three-piece silicone, most often because of incorrect lens power calculation, followed by dislocation or decentration.

The three-piece acrylic lens was the third most commonly removed, again most often for incorrect power calculation, followed by glare or optical aberrations, then dislocation or decentration.

The fourth most commonly removed IOLs were one-piece lenses with loop haptics; these were most often removed due to incorrect power calculation, dislocation or decentration, then glare and optical aberration. Next were one-piece plate-haptic IOLs, most often removed due to dislocation or decentration.

Multifocal silicone IOLs were most often removed due to glare or optical aberrations and dislocation or decentration.

Visual acuity data was analyzed comparing preoperative acuity with postoperative acuity. Dr. Mamalis and colleagues concluded that patients who had hydrogel IOLs explanted “did quite poorly postoperatively due to calcification of the lens. Once this lens was removed and replaced, patients did quite well,” he said.

According to Dr. Mamalis, it is a continuing trend to see incorrect power calculations, dislocation or decentration, and glare or optical aberrations as the main complications occurring with IOLs that require explantation or secondary intervention. A new trend observed through these survey results, he said, is the increasing rate of IOL explantation or secondary intervention due to calcification of the lens.

Dr. Mamalis told surgeons that the most common complications involving foldable IOLs may be avoided by using good surgical techniques, careful IOL folding and insertion, accurate IOL power calculation and proper patient selection.

Endophthalmitis survey

Surgeons who routinely use preoperative povidone iodine or intracameral antibiotics seem to reduce the occurrence of endophthalmitis in their cataract patients, according to W.S. Wishart, MD.

“We found these forms of prevention significantly reduced the development of this vision-threatening disease,” Dr. Wishart said.

A survey was sent to 620 consultant ophthalmologists across the United Kingdom and Ireland during a 1-year period; 347 responded.

“An overwhelming 92.2% of surgeons used intraoperative antibiotics,” Dr. Wishart said. Surgeons who injected antibiotics intracamerally at the end of surgery reduced the overall rate of developing endophthalmitis to a ratio of 1 occurrence in 6,400 eyes, she said.

The researchers also noted that surgeons who did not apply povidone iodine for at least 3 minutes before surgery had a higher rate of occurrence of endophthalmitis.

“A longer application of this anti-infective is significantly more effective,” Dr. Wishart said.

Use of intraoperative topical antibiotics alone was ineffective in reducing the incidence of endophthalmitis, she said.

Endophthalmitis study

Clinical sites throughout Europe will participate in a large, long-term study to assess the incidence of postoperative endophthalmitis, according to Peter Barry, MD, the lead investigator of this prospective study.

Dr. Barry said centers in Austria, Belgium, England, France, Germany, Portugal and Spain will enroll 40,000 patients and randomize them to one of four equal-size groups undergoing cataract surgery. All patients will receive levofloxacin 0.5% postoperatively on days 1 through 6; all patients will also be treated with povidone iodine preoperatively as well. Patients will be randomized to receive either placebo intraoperatively, cefuroxime intraoperatively alone, cefuroxime and levofloxacin intraoperatively or levofloxacin intraoperatively alone. Researchers plan on a 3- to 6-week follow-up to identify proven endophthalmitis or presumed endophthalmitis.

Dr. Barry said he expects to present results of the study at the 2004 ESCRS meeting in Paris.

CE Mark for ThinOptX

The ThinOptX Rollable IOL received CE-Mark approval during the ESCRS meeting, allowing the lens to be officially marketed throughout Europe, the company announced.

News of the IOL’s approval attracted attention from many of the meeting attendees. The company’s tiny booth received a steady stream of visits from surgeons interested in its Rollable IOL, which can be inserted through an incision of about 1.5 mm.

“I am very excited about this news because now everyone in Europe will have the advantage of working through sub-3 millimeter incisions for cataract surgery,” said Jorge Alìo, MD. Dr. Alìo has been involved in the European trials of ThinOptX, He said he has been very pleased with the results.

According to ThinOptX, the IOL’s marketer, this IOL is the first “thin lens” approved for clinical use, and it can retain the optical quality of popular, thicker IOLs while folding for insertion through an incision of 1.5 mm.

The ThinOptX lens is not available for use in the United States.

Achieving ultrasmall incisions

With the approval of an IOL that fits through an ultrasmall incision, there was also heavy interest in performing cataract removal through an incision of that size.

“Our goal is 1-mm-incision surgery,” said Jack Dodick, MD, developer of the Dodick laser photolysis system.

Dr. Dodick said certain IOLs such as the ThinOptX and the rollable IOL made by Acri.Tec can be inserted through these ultrasmall incisions, eliminating the need to widen the incision for implantation.

Richard Packard, MD, said ultrasound phaco, too, can be used in micro-incision cataract surgery successfully. Surgeons can avoid corneal wound burns with some of the newer technologies, he said.

“In this case, size really does matter,” he told the audience. With the White-Star technology (AMO), the normally uninterrupted ultrasound is broken into bursts of energy alternating with rest periods. “The technology allows for very rapid cooling” of ocular tissues, he said.

Dr. Packard said he has not encountered any cases of induced astigmatism using the WhiteStar technology.

Ehud Assia, MD, said mini-incision phaco can also be safely performed using an anterior chamber maintainer as the sole fluid source. He reported on 12 patients who underwent cataract removal through a 1.5-mm incision with only this slight technique modification. None of the patients experienced thermal burns to their corneal incisions, Dr. Assia said.

“The advantage for surgeons is you don’t have to buy a new machine, and you don’t have to modify your technique,” he added.

Regarding laser cataract surgery, Carlos Vergés, MD, PhD, said the technology “is not safe for all types of cataracts.” He advised surgeons to continue to use ultrasound on hard cataracts. He said current laser-phaco tech nology uses more energy with harder cataracts, which could lead to complications.

But Dr. Dodick said laser cataract surgery is not as time-consuming as has been reported.

“It’s an urban myth that laser cataract surgery is a slow procedure,” Dr. Dodick said. He noted that Wolfram Wehner, MD, has reported using the Dodick laser technology in 849 cataract cases in which “skin to skin time is under 10 minutes.”

Dr. Dodick said recent modifications to his laser cataract removal system are “resulting in greater vacuum creation.” The modified tubing he now uses for IOL implantation is currently in beta testing, and he said he expected the tubing to be available in the first quarter of 2003.

Prevention of PCO

Posterior capsular opacification was not found on hydrophobic acrylic IOLs months after IOL implantation because of a “sandwich” effect that prevents excessive cell growth, according to a study presented here.

“We found that the lack of PCO was due to the ‘sandwich’ theory,” said Liliana Werner, MD.

According to Dr. Werner, the sandwich theory says that with proper implantation technique, an IOL material that is compatible with human tissue will allow only a single layer of epithelial cells to sandwich between the IOL and the capsule. This in essence bonds IOL and capsule together, preventing further epithelial cell proliferation.

In the study she presented, eight postmortem eyes that had been implanted with the single-piece AcrySof SA30AL (Alcon) were analyzed macroscopically to identify the level of cell migration that had occurred.

“Observing the eyes in histological examinations, we found no capsular bag opacification months after implantation of the IOLs,” Dr. Werner said. Studies of three-piece hydrophobic acrylic IOLs showed similar results, she said.

Dr. Werner speculated that adhesion proteins such as fibronectin may be responsible for the bioadhesion.

Avoiding complications

Proper use of viscoelastics during surgery can prevent unnecessary viscoelastic-related complications, said Steve Arshinoff, MD, FRCSC.

In order to inject the viscoelastic properly and ensure that the anterior chamber is neither over- nor underfilled, Dr. Arshinoff recommended injecting the material through the primary incision, allowing the aqueous to egress. He also advised against injecting immediately past the incision.

Dr. Arshinoff advised surgeons to add more viscoelastic as soon as they determine the need for it — for example, when the capsulorrhexis is going astray. Surgeons must also ensure the viscoelastic has been completely removed at the end of surgery to avoid postoperative complications, he said.

Posterior capsule rupture

A hydrophilic acrylic IOL with four haptics may be helpful in cases of posterior capsular rupture, according Bruno Smeets, MD.

If a capsule breaks, two of the IOL’s four haptics can inserted behind the capsulorrhexis and the other two placed in front for a crossed bag-sulcus fixation, Dr. Smeets said.

The Akreos Adapt IOL (Bausch & Lomb), a 26% hydrophilic acrylic lens, can be delivered into the anterior chamber through a 3.2-mm limbal incision using either a syringe or the Hydroport injector, Dr. Smeets said.

Patients with 6 months follow-up after implantation had no inflammation, vitreous loss or refractive shift, Dr. Smeets said. The IOLs also maintained good centration and stability, he added.

The crossed bag-sulcus placement allows the surgeon to remove the viscoelastic from the capsular bag without having to move the IOL out of place, Dr. Smeets said.

Among the benefits of this implantation technique are that topical anesthesia can be continued in case of capsule rupture, and the lens does not put pressure on the ciliary body, said Dr. Smeets. The technique also reduces the risk of cystoid macular edema, he added.

The Akreos IOL is not currently available in the United States.

IOL choice

With more than 1,300 available IOLs on the market, the “best” IOL for a patient is the one that balances essential properties most effectively in relation to the patient’s functional visual requirements, Olivia Serdarevic, MD said.

The properties most imperative to a successful IOL implant are the handling/insertion qualities of the IOL, its capsular and uveal biocompatibility, its anatomic and refractive stability and the optical quality of the lens, she said.

“We as surgeons do not yet understand all the factors involved in biocompatibility,” she said. Increasingly lately, emphasis has been placed on lens design for prevention of PCO.

“It is the square edge that really helps, regardless of whether it’s an acrylic or silicone lens,” Dr. Serdarevic said. A number of available IOLs incorporate the square posterior lens edge that seems to prevent epithelial cell proliferation and resulting PCO, she said.

“Keep in mind, edge design will affect patients with larger pupils more than your other patients,” she advised.

MDR IOL opacification follow-up

Opacification in one particular model of hydrophilic acrylic IOL appears to related to the material used in the lens manufacture, according to a follow-up study.

The SC60B-OUV one-piece foldable acrylic IOL from Medical Developmental Research has previously been reported by Apple and others to be associated with postoperative opacification in a large number of cases. A poster presentation here documented the postoperative behavior of the IOL in a number of patients.

Alaji Gadzama Gashau, MD, and associates implanted 155 of the MDR SC60B-OUV lenses in cataract patients at their facility in the United Kingdom. After time revealed that many of the IOLs clouded after implantation, their surgical use was discontinued at the hospital. However, the team continued to document the patterns of opacification in patients for 4 years. They documented Snellen acuity, capsular changes, patient medical history and medications. Posterior capsulotomy and IOL ex change were performed as needed, and the explanted IOLs were also examined.

It was noted that 67% of the lenses clouded within 8 to 24 months. Between 24 to 48 months, 17 more IOLs opacified. The haptics and the periphery of the optic remained clear in all cases; in 90% of the opacified IOLs , the opacification occurred in the center of the optic.

No cells or deposits were found on the explanted lenses. Probable granules of hydroxyapatite were found well below the IOL surfaces.

According to the poster, the haze did not seem to be associated with viscoelastics, other agents or the IOL’s environment. It is theorized that the IOL material itself is the problem, the authors said.

Contrast sensitivity and Tecnis

A new IOL with a modified prolate anterior surface provides better contrast sensitivity than other IOLs, according to several studies presented here.

“Contrast sensitivity is becoming the gold standard for functional vision,” said Mark Packer, MD, during his presentation on Pharmacia’s Tecnis IOL. In a head-to-head comparison with AMO’s SI40 IOL, Dr. Packer found the Tecnis gave patients the same contrast sensitivity in low light conditions as the SI40 did in bright light conditions.

Leif Corydon, MD, also found the contrast sensitivity performance of the Tecnis to be superior to other IOLs. In a study, he compared contrast sensitivity with the Tecnis to an older model Pharmacia lens, the 911A.

“I found the new lens to have better contrast sensitivity than the ordinary IOL, and just about any other ordinary one,” Dr. Corydon said.

In Dr. Corydon’s study, 10 patients were implanted with the 911A IOL in one eye and the Tecnis IOL in the other eye. “Patients were able to use themselves as controls. This helped to really tell which eye allowed more definition with contrasting elements,” he said. Dr. Corydon analyzed patients’ levels of contrast sensitivity with low contrast charts for far and near vision.

“I found that there was much better contrast in the eye with the Tecnis,” he said. Dr. Corydon attributes the improved contrast sensitivity to the negative aberration and aspheric design of the Tecnis IOL.

CIBA lens easily implanted

The CIBA Vision CV232, a new pre-rolled IOL, helps make cataract surgery more efficient, according to Doug Katsev, MD. He described his experience with the thermoplastic IOL in a poster presentation here.

The CV232 is delivered pre-rolled and requires no folding instruments or injector, resulting in less work and less stress for the ophthalmologist, Dr. Katsev said.

The square posterior edge facilitates 360° capsular contact to minimize posterior capsular opacification. The rounded anterior edge decreases glare when compared to a square edge, Dr. Katsev said. The lens is made of a highly biocompatible material with resistance to cellular deposits and a low rate of protein binding to its hydrated surface, according to the poster.

The pre-rolled lens provides a consistent presentation, Dr. Katsev reported. The stiff body allows easy placement of the leading haptic in the bag, and the lens design allows the trailing haptic to be readily dialed into place, he said.

The CV232 lens, CIBA’s latest design using a thermoplastic material, slowly unrolls as the lens warms to body temperature. This allows easy removal of viscoelastic, Dr. Katsev said. There is no sudden uncontrolled unrolling, and risk of capsular breakage is low, he said.

For the physician, there is no folding. The lens is removed from its delivery system and inserted with forceps. The CV232 is implantable through a 3 to 3.2 mm incision, Dr. Katsev said.

Refractive

Surgeon’s choice: LASEK, LASIK, PRK

Ease of surgical performance, high patient satisfaction, minimal complications and surgeon comfort — These are the leading reasons that LASIK, photorefractive keratectomy and laser epithelial keratomileusis are all viable options for the correction of many refractive errors, according to a panel of experts here.

Assembled during the European Society for Cataract and Refractive Surgeons meeting, the panel was moderated by Daniel Epstein, MD.

Dr. Epstein asked Michael Knorz, MD, Niels Ehlers, MD, and Daniel S. Durrie, MD, to address whether LASIK deserves the popularity it has achieved, why surgeons should still consider PRK as a refractive procedure and whether LASEK is a “flash in the pan.”

As a refractive surgeon who has undergone LASIK himself, Dr. Knorz said the procedure “is popular because you get good results. It’s a pleasant surgery, with no pain during or after the surgery and instant visual rehabilitation.”

In his clinics, Dr. Knorz has seen the number of LASIK refractive procedures increase from around 3,500 in 1998 to more than 13,500 in 2002.

From a surgeon’s perspective, Dr. Knorz said he believes LASIK is the easiest and most reliable of the three procedures. “On day 1 [postop], I always see happy patients,” he said.

Dr. Ehlers said he has compared corneal aberrations after LASIK and PRK using the same Asclepion-Meditec MEL-70 G-scan flying spot excimer laser. He conducted optical analysis and tonometry preoperatively and at 1, 3, 6 and 12 months postoperatively.

“There is no real difference between the two techniques in terms of corneal aberrations,” he said. The sum of aberrations was more variable after PRK, but the difference was not statistically significant after 1 year. The PRK group had slightly higher astigmatism initially, but there was no difference between the groups at 1 year. Coma was more variable and larger after PRK, which remained true after 1 year. There was more spherical aberration in the LASIK group initially, and that held at the 1-year follow-up as well.

“Corneal and ocular aberrations after PRK and LASIK for myopia are about the same,” Dr. Ehlers said. “There’s no clear winner between these two techniques. There’s more pain and a longer recovery for patients who undergo PRK, but there are potential flap complications with LASIK.” He advised surgeons to use the technique they are most comfortable with performing.

Dr. Durrie equated the epithelial flap technique he uses during LASEK to making a capsulorrhexis. He said he creates an epithelial break, then extends the break around to move the epithelium superiorly.

Dr. Durrie said LASEK offers surgeons the best possible refractive procedure because, like LASIK, the patient does not experience pain, “but it’s safer because there are no flap complications. You’re not cutting across nerves, so you don’t have a problem with dry eye.” In addition, Dr. Durrie said, LASEK creates less induced higher-order aberrations, “and it may be a better procedure for wavefront-guided ablations.”

After using non-customized, conventional excimer lasers from Bausch & Lomb and Alcon to treat more than 500 eyes, Dr. Durrie said, “I get a better uncorrected visual acuity with LASEK than I can get with LASIK.”

Zyoptix reduces aberrations

Bausch & Lomb’s Zyoptix custom ablation system for myopia decreases higher-order aberrations from preoperative levels in some patients, according to Stephen Slade, MD, who discussed early results from a multicenter U.S. trial of the wavefront-guided system.

In the study, 340 myopic eyes were bilaterally treated with Zyoptix. Sixty-one of the eyes had greater than 5 D of myopia.

Postoperatively, at 1 month, 69.7% of patients had uncorrected visual acuity (UCVA) of 20/16 or better, 91.5% had UCVA of 20/20 or better and 99.4% had UCVA of 20/40 or better, Dr. Slade said. For refraction, 87.5% were within 0.5 D and 95.7% were within 0.75 D, he said.

Results for the first 300 patients indicated 65% showed a decrease in third-order aberrations from preoperative values, Dr. Slade said. “The occurrence of higher-order aberrations was not linked with the level of myopia,” he said.

Visx wavefront satisfaction

The Visx WaveScan ablation method for custom laser vision correction appears to be safe and effective in the early results of a multicenter trial

Douglas Koch, MD, presented the 1-month data from five centers in the United States using the Visx Star S3 laser for wavefront-guided ablation.

At 1 month postoperatively, 95% of 103 eyes that underwent bilateral wavefront-guided LASIK treatment achieved 20/20 UCVA, and more than 70% achieved 20/16 UCVA. Mean spherical equivalent was –0.1 ±0.2, compared to a preoperative mean manifest spherical equivalent of –3.1 ±1.5 D (–0.8 to –6.5). Ninety-seven percent of patients were within ±0.5 D of emmetropia.

Postoperative UCVA was the same or better than preoperative best corrected visual acuity (BCVA) in 79% of eyes.

Mean higher-order root mean square (RMS) changed from 0.263 µm ±0.110 preoperatively to 0.324 µm ±0.096 postop. In 21% of eyes, higher-order RMS values improved, and they either improved or increased by 0.1 µm or less in 66% of eyes.

No eye lost more than one line of BCVA.

Additionally, 86% of patients reported that they never or rarely experience halos, and 86% of patients were very satisfied with their night vision.

Stereo topography

A stereo topography unit that may improve upon the shortcomings of monocular topography units was described by Jack T. Holladay, MD.

The system, which is currently in development by LaserSight Technologies, will provide more accurate measurements of the surface of the cornea, according to Dr. Holladay, LaserSight’s medical director.

“This system gives you the ability to calculate every single individual point on the cornea because you have a reference of more than one point to go from,” Dr. Holladay said.

Traditional topography units focus one camera on the central vertex of the cornea, allowing only one reference point. The system in development by LaserSight uses three cameras; two cameras can triangulate each individual point of the cornea while a third is focused on the central vertex. The central camera has a symmetrical view of the cornea, and the other two cameras have oblique views of the center of the cornea, he said.

The unit will also measure pachymetry using slits projected on the cornea and a patented 8-point cross in a scan that takes 2.3 seconds. It will also be capable of pupillometry and run a Holladay Diagnostic Summary, as do several other LaserSight devices, Dr. Holladay said.

STAAR ICL

Highly myopic patients had better visual results with the STAAR ICL than with LASIK, according to John Vukich, MD.

Dr. Vukich presented results of a concurrent, comparative series of LASIK and ICL implantation in patients with 8 to 12 D of myopia. In this retrospective study, Dr. Vukich concluded that postoperative results with LASIK were generally worse than with the ICL for patients with more than 7 D of myopia.

Dr. Vukich compared 559 eyes that underwent LASIK to 210 eyes that received the ICL, a phakic posterior chamber IOL. At 1 week postop, recovery of preop BCVA was achieved by 60% of LASIK eyes and 82% of ICL eyes. At 1 year postop, recovery of preop BCVA was achieved by 82% of LASIK eyes and in 90% of ICL eyes.

At 1 year postop, 11% of LASIK eyes had lost one or more lines of preop BCVA, compared to 6% of ICL eyes. Also at 1 year postop, 36% of LASIK eyes achieved UCVA of 20/20 or better compared with 52% of ICL eyes, Dr. Vukich said.

Manifest refraction within 1 D of prediction was achieved in 79% of LASIK eyes and 94% of ICL eyes, and more ICL eyes had manifest refraction of ±1.5 D of target.

“We believe that the ICL is a viable and reasonable alternative to LASIK, certainly in the face of customization of refractive surgery with LASIK,” Dr. Vukich said. “These results will probably remain similar, and, therefore, customized ablation may not be viable for the majority of patients above –8 D and certainly not in patients with –10 to –12 D.”

STAAR Surgical markets the ICL in South America, South Africa, the Middle East, China and some European countries. The device is in clinical trials in the United States.

CIBA phakic IOL

A phakic posterior chamber IOL from CIBA Vision appears to be effective in treating both myopia and hyperopia, according to study results presented by Bo Philipson, MD, one of the study participants. He discussed 6-month results of the study, currently being conducted on the CIBA Vision PRL in 11 centers across Europe.

“This lens is very promising, especially in the myopic cases,” Dr. Philipson said.

Dr. Philipson said 220 patients are enrolled in the study; he presented results on the first 180 patients with 6-month results.

Preoperatively, the mean BCVA in myopic patients was 0.72. Postoperatively, the mean was 0.9. UCVA was within 0.5 D of target in 50% of the myopic patients and within 1 D in 80% of the patients. Almost all of the myopic patients gained lines of acuity, he said.

Among the patients with hyperopia, the mean preop BCVA was about 0.4. The postop BCVA remained about the same or improved slightly, he said.

The few complications reported included glare and halos. There was also one case of postoperative cataract.

OII phakic lens

The Safety Flex Phakic anterior chamber lens seems to be effective and safe in correcting high myopia, according to Giovanni Alessio, MD, and colleagues, who had a poster presentation here. Their study evaluated efficacy, predictability, safety, stability and quality of vision with the Safety Flex Phakic 6H2 lens (Ophthalmic Innovations International) in 21 eyes of 11 patients.

After implantation of the anterior chamber lens, the authors said there was no loss of Snellen BCVA in any eyes. UCVA improved in all eyes. Spherical equivalent refraction improved from a mean of –13.8 D to –0.68 D. Refractive correction was stable from 2 days after surgery until the final follow-up examination at a mean of 11 months.

No complications were reported in the study. The authors noted that previous studies have shown a possibility of glare, pupil ovalization and other complications with the Phakic 6H2 lens, an older model from OII.

Endothelial cell loss was noted to be 2% at 2 months after surgery. The authors noted a progressive increase in cellular density in later follow-up.

Kelman Duel phakic IOL

Another anterior chamber phakic IOL, the Kelman Duet, shows promise for surgical treatment of myopia and hyperopia, according to one surgeon who has used the lens in a handful of patients. The two-part lens is also useable in patients with astigmatism, the surgeon said.

Dr. Alío described the implantation of the Duet IOL (Tekia Inc.), which has separate haptics and optics. The Duet IOL haptics are first snaked through a 2-mm incision. The optic is then inserted through the same oblique incision using an injector. The optic is then attached to the haptics within the eye.

Should power adjustments be needed later, Dr. Alío said, the optic can be detached from the haptic frame, removed and replaced.

Dr. Alío has implanted the lens in a pilot study in three patients. All cases were successful, he said. After more than a year postop, the patients reported experiencing either no glare or only minimal glare.

Glaucoma and miscellany

Antibody for trabeculectomy

An anti-scarring agent, used before and after trabeculectomy, seems to be safe and effective in lowering intraocular pressure, according to early clinical results presented here.

“CAT-152 is capable of neutralizing the scarring effects of transforming growth factor beta-2, which is the most potent stimulator of scarring after surgery in the eye,” said P. Meade, MD.

In two pilot clinical trials, Dr. Meade and colleagues assessed the safety and efficacy of the antibody CAT-152 from Cambridge Antibody Technology, a cytokine inhibitor.

“In 24 patients in the first study, we found that CAT-152 brought on fewer side effects and complications than placebo, and all blebs were diffuse,” she said.

In a second study, 56 patients were monitored for up to 18 months to determine the level of IOP-lowering in surgery with adjunctive CAT-152.

“Results here too were encouraging,” Dr. Meade said. “IOP was significantly reduced to a mean 14 mm Hg for patients in the CAT-152 group, and a mean of 16.6 mm Hg for patients receiving placebo.”

In light of the promising results, a multicenter trial will be performed throughout Europe.

New ESCRS division, awards

Dr. Stenevi, in his opening remarks, announced the launch of a new division of ESCRS devoted to ophthalmic nurses and technicians. “The European Society of Ophthalmic Nurses and Technicians will be devoted to those who also work very hard in the ophthalmic field every day,” Dr. Stenevi said.

After Dr. Stenevi’s introduction, the winner of this year’s best poster presentation, Susanne Krag, MD, was announced, along with the winner of this year’s best poster presentation for surgical topics, Melanie Jaeger, MD.

Additionally, the winners of the 2002 Video Awards, co-sponsored by Alcon and ESCRS, were announced. First place winners were: Oliver Findl, MD, for most artistic video; Gerd Auffarth, MD, for most educational; Anthony Maloof, MD for most innovative; Robert Osher, MD, for most scientific; Joseph Hagege, MD, for the special cases category; and Scott Burk, MD, overall best video.