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New corneal laser therapy stirs interest
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NEW ORLEANS — Although it is not approved for use in the United States, corneal collagen cross-linking with riboflavin instillation has demonstrated promising results in addressing corneal ectasia, according to a speaker here at the American Academy of Ophthalmology meeting.
At Refractive Surgery Subspecialty Day, A. John Kanellopoulos, MD, described the technique as an alternative to conventional collagen cross-linking, which involves stripping the epithelium.
The technique utilizes a femtosecond laser, which creates a pocket 100 µm in depth and 7 mm in diameter in the corneal surface, Dr. Kanellopoulos said. The pocket aids in the instillation of riboflavin.
“We have to balance how much riboflavin we want in the eye and how much toxicity that riboflavin can create,” he said.
The laser is used to irradiate the epithelium and help instill the riboflavin. Outcomes have been favorable, and the procedure appears to be more comfortable than conventional corneal cross-linking, Dr. Kanellopoulos said. In one group of patients, keratometry was reduced by 1.7 D and spherical equivalent was reduced by 1.5 D.
The procedure takes about 15 minutes, with no epithelial cell damage, rapid visual recovery and minimal discomfort, Dr. Kanellopoulos said.
Most of these items appeared originally as daily coverage from the meeting on OSNSuperSite.com. Look for more in-depth coverage of these and other topics in upcoming issues of Ocular Surgery News.
Pterygium removal technique cuts complication rate
A modified pterygium removal method was found to yield fewer recurrences than earlier techniques, according to a study.
Lawrence W. Hirst, MD, MBBS, reported data from a prospective study in which 250 patients underwent pterygium surgery with what Dr. Hirst called the “perfect” technique (pterygium extended removal followed by extended conjunctival transplant) rather than with conventional conjunctival autograft.
Existing pterygium treatments have a high complication rate, Dr. Hirst said.
“The world’s literature on the treatment of pterygium discloses that all methods result in recurrence rates of between 5% and 15%,” he said. The new procedure had a recurrence rate of one in 250 (0.004%), he said.
At 1-year follow-up, Dr. Hirst and colleagues reported one recurrence, and no patients lost best corrected visual acuity.
“I would defy anyone at the slit lamp to deny that the surgery was successful,” Dr. Hirst said.
He pointed out that pterygium is a common ocular disease in his native Australia, affecting about 10% of the population older than 18 years.
‘Top hat’ and ‘zigzag’ incisions stable, safe for PK
Penetrating keratoplasty with femtosecond laser offers rapid visual recovery and a low rate of astigmatism, according to two surgeons.
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Francis W. Price Jr., MD, discussed the “top hat” incision and Marjan Farid, MD, discussed the “zigzag” incision.
Dr. Price said that mastering PK incisions with the IntraLase femtosecond laser (Advanced Medical Optics) is easier than learning the technique for endothelial keratoplasty.
“With the endothelial keratoplasties, there’s a tremendous learning curve,” Dr. Price said. “With the IntraLase-enabled keratoplasties, at least the way we’re doing them now, there is really not a big transition from standard PK. The biggest issue is whether you can get a good cut.”
Dr. Price said the top hat incision, so named because of its shape, heals quickly with relatively few sutures, while Dr. Farid showed that the zigzag incision was stable and resulted in a low rate of astigmatism.
Dr. Farid described results treating 30 eyes of 27 patients, with a follow-up of up to 1 year. At 3 months, astigmatism averaged 2.6 D (range, 0.2 D to 7.1 D) and best corrected visual acuity averaged 20/30 or better in 84% of patients.
More than half of patients saw 20/25 or better at 3 months, and 100% of those followed up to 6 months had 20/30 or better vision, Dr. Farid said.
“We found the suturing is very easy,” Dr. Farid said. “Just go right through and come out about 50% depth and it looks beautiful.”
Loteprednol plus cyclosporine provides rapid relief of dry eye
Loteprednol etabonate and topical cyclosporine relieved dry eye disease more rapidly than cyclosporine and artificial tears, a group of surgeons reported.
In a poster presentation, OSN Cornea/External Disease Section Member Eric D. Donnenfeld, MD, FACS, and colleagues reported results of a prospective, multicenter, randomized, masked, controlled study designed to assess the effects of loteprednol on cyclosporine therapy.
The study involved 120 patients with dry eye disease. Patients received either Lotemax (loteprednol etabonate ophthalmic solution 0.5%, Bausch & Lomb) or artificial tears for 2 weeks before starting Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan).
At 2 months follow-up, patients in the loteprednol group had improved corneal staining, conjunctival staining and Schirmer test results and less stinging with cyclosporine induction than those in the artificial tears group. The difference was statistically significant (P < .05).="">
“Loteprednol with topical cyclosporine improves patient compliance, reduces stinging and provides more rapid relief of dry eye disease than topical cyclosporine alone,” the authors said.
A note from the editors:
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