Eurotimes Articles

Feb

February

The preservatives contained in some glaucoma eye drops have side effects which can reduce the quality of life over the short term and the efficacy of treatment over the long term, said Frances Meier-Gibbons MD, Rapperswill, Switzerland. “The adverse effects of preservative agents lead to reduced compliance and therefore to higher costs. There are alternatives to preserved eye drops and many patients would benefit from using them,” she said at a Glaucoma Day session of the XXXI Congress of the ESCRS in Amsterdam.

Will geographic atrophy (GA) be treatable by 2020? Based on current rates of progress and the growing momentum behind clinical trials related to the disease, the answer is a guarded “yes”, according to Monika Fleckenstein MD.

Evidence is accumulating that, rather than the intraocular pressure (IOP) itself, it is the impact of a pressure imbalance between IOP and cerebrospinal fluid pressure on the lamina cribrosa, in favour of IOP, that makes the optic nerve more vulnerable to damage in eyes with open-angle glaucoma, said Jost B Jonas MD, University Eye Clinic, Mannheim, Germany. “The ocular cerebrospinal pressure is the real anatomical and physiological counter-pressure against the IOP across the lamina cribrosa.

Femtosecond lasers are becoming very useful tools in paediatric patients with cataracts and those who require corneal transplantation, according to two presentations at Femto 2013, an international meeting on anterior segment surgery, in Verona. Burkhard Dick MD, PhD, Ruhr University Eye Hospital, Bochum, Germany, noted that he has developed a technique for performing cataract surgery in the eyes of infants using the Catalys femtosecond laser system (AMO, Santa Ana, CA) for anterior and posterior capsulotomy and lens division (if necessary at all).

While femtosecond laser cataract surgery is currently very expensive it will become more cost-effective as it becomes more established and its future looks bright, according to Paul Rosen FRCS, FRCOphth, consultant ophthalmic surgeon, Oxford Eye Hospital, UK.

Dr Rosen discussed the economics of the surgery during a presentation at the XXXVII UKISCRS Congress in Manchester, maintaining that there are a number of variables that need to be considered when weighing up whether it is currently economically viable.

 

Pros

There are a number of compelling reasons for making the switch from traditional phaco to femtosecond laser-assisted cataract surgery including faster visual rehabilitation, reduced complications and reduced exclusion criteria for cataract surgery, according to Burkhard Dick MD. “Femtosecond laser technology has come a long way in a very short space of time and I am amazed how quickly this technology is developing. In my practice, we are now close to completely eliminating ultrasound for cataract removal.

In 2010 and 2011, early clinical reports convinced Shachar Tauber MD that femtosecond laser-assisted cataract surgery would improve outcomes and reduce complications. But he also believed the technology should be available to all patients – not just those who can pay extra.

A minimally invasive retrobulbar episcleral brachytherapy device (SalutarisMD™, Salutaris Medical Devices) has shown promise in the treatment of a small cohort of exudative AMD patients, according to Kamaljit Balaggan MRCOphth, PhD. Dr Balaggan, Moorfields Eye Hospital, London and Department of Genetics at the University College London Institute of Ophthalmology, reported the feasibility and tolerability of the SalutarisMD investigational treatment for wet AMD using a single dose of episcleral brachytherapy in conjunction with intraocular anti-VEGF injections.

A new decision tree for the management of eyes with incomplete visual rehabilitation after DMEK offers a systematic approach for determining the underlying cause and guidance on targeted intervention for improving clinical outcomes. Developed by investigators at the Netherlands Institute for Innovative Ocular Surgery (NIIOS), the decision tree is based on findings from a retrospective study analysing data from 178 DMEK eyes. The information was recently published [AJO, 2013;156:780-8], and presented by Isabel Dapena MD, PhD at the 4th EuCornea Congress in Amsterdam.

Advanced imaging techniques allied to potent new anti-VEGF and steroid therapies have radically transformed the prognosis and management of patients with diabetic macular oedema and other debilitating retinal diseases over the past decade, according to Francesco Bandello MD, FEBO. “We are living in exciting times for retinal experts. We have new diagnostic tools and new therapeutic options where we are able to modify the management of many retinal diseases.

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