Las Vegas was host to the 2015 American Academy of Ophthalmology Annual Meeting, which concluded last week. This year’s scientific program consisted of the usual format of various activities including spotlight sessions, symposia, original papers, instructional courses, scientific posters, skills transfer programs, videos, technology pavilion learning lounge, and breakfast with the experts. Below is a summary of the topics I found to be most interesting:
Cataract:
Dr. Timothy Roberts studied the integrity of the anterior capsule after femtosecond laser capsulotomy with the LenSx Laser System from Alcon. His group found a very low rate of anterior capsular tears (0.18%) and no evidence that the laser produced intrinsic weakening of the capsulotomy.
Dr. Nilufer Yesilirmak compared phaco parameters (ultrasound time, cumulative dissipated energy, and consumed BSS) between traditional surgery and surgery with three femtolaser platforms (CATALYS Precision Laser System from AMO, LenSx from Alcon, and VICTUS Femtosecond Laser Platform from B+L. There were no significant differences between the groups for CDE, but the CATALYS laser showed shorter ultrasound times and less BSS consumption.
Dr. Jeewan Titiyal evaluated the use of FS laser capsulotomies in white cataracts. This study found a greater than 97% complete capsulotomy rate with the laser as opposed to the need for a 2-stage capsulorhexis in the conventional surgery group.
Dr. Ahad Mahootchi reported on the benefit of adding topical steroids versus NSAIDs to patients receiving intraocular Tri-Moxy-Vanc with respect to the incidence of CME. Data showed that NSAID drops reduced the postop rate of CME.
Dr. Robert Cionni investigated the use of intraoperative aberrometry or a toric calculator for determining toric IOL cylinder power and axis. There was less residual astigmatism in the group utilizing intraoperative aberrometry.
Dr. Robert Lehmann studied intraoperative aberrometer measurements obtained with BSS versus an ophthalmic viscosurgical device (OVD). He found that there was a significant difference in aberrometry readings that was large enough to result in a different IOL power recommendation.
Dr. Nicole Fram compared various methods of IOL calculations in eyes with axial lengths > 25 mm. The study found that the accuracy of intraoperative aberrometry is comparable to various formulae, and the Wang-Koch method was the best.
Dr. Louis Nichamin presented 2-year data of the FluidVision Accommodating IOL, which produced excellent binocular distance, intermediate, and near acuity in the study patients.
Refractive surgery:
Dr.Lucia Gualdi presented data for microelectrostimulation of the ciliary body as a new method for noninvasive presbyopia treatment. The technique appears promising as a method for improving presbyopic symptoms but further follow up is necessary to evaluate the stability of the results.
Dr. Pooja Jain assessed the use of toric IOLs in patients with high astigmatism from complex corneal conditions (lamellar keratoplasty, penetrating keratoplasty, and CXL). Toric IOLs were effective in astigmatism management of these patients.
Dr. Antonio Oliveira evaluated the use of femtosecond laser arcuate keratotomy under a flap for correcting high astigmatism. The study showed that this procedure is safe, effective, and has a number of advantages over surface FS laser AK.
Dr. John Kanellopoulos compared corneal biomechanics in myopic laser vision corrections with the SMILE procedure versus LASIK. The results demonstrated comparable reduction in corneal biomechanics for low myopia treatments, but for high myopia, LASIK causes more reduction of corneal biomechanics.
Cornea:
Dr. Lucia Lapenna reported 2-year results of transepithelial corneal collagen crosslinking by iontophoresis (I-CXL) in pediatric and adolescent patients with progressive keratoconus. The study concluded that this technique is safe and effective in stabilizing KC in this population.
Dr. Marianne Price assessed the risk of graft rejection in DMEK patients who discontinued topical steroids after 1 year. Although the risk of rejection increased compared to those who continued topical steroids once a day, the incidence was low (3.25%).
Dr. Alain Saad evaluated intraoperative OCT to aid tissue orientation in DMEK surgery and found that OCT reduced unfolding time and eliminated primary graft failure.
Dr. Massimo Busin reported that using a tissue tri-fold technique for delivering DMEK graft tissue reduces damage to the donor cells and facilitates spontaneous graft unfolding.
Glaucoma:
Dr. Margaret McDougal discussed optic nerve regeneration with C3 tranferase gene therapy. She found that continuous delivery of C3 produced more axonal growth across the injury site and longer ganglion cell survival.
Dr. Ernesto Calvo evaluated supraciliary microstent implantation with viscoexpansion in glaucoma patients. At 1 year, patients had lower IOP and less glaucoma medication use.
Dr. Anthony Khawaja examined the relationship between retinal nerve fiber layer thickness and cognitive function in more than 5,000 patients with a mean age of 67 years. The findings indicate that RNFL thickness may be useful as a biomarker for cognitive function.
Dr. Rohit Varma presented 1-year results of the ab interno XEN 45 Gel Stent from AqueSys to reduce IOP in patients with POAG and showed that this technique is safe and effective. Patients experienced a mean reduction of IOP and medications of 44% and 65%, respectively.
Dr. Juan Battle reported on a study of the InnFocus MicroShunt for glaucoma, which confirmed the safety and efficacy of the device and showed a 55% lowering of IOP during the first 2 years.
Retina:
Dr. Steven Schwartz investigated the rate of reoperation and incidence of retinal detachment after macular hole surgery. The reoperation rate was 2.4% - 8% and lower for ILM-peeling surgeries, and postoperative RD was 3.7% - 5.7%.
Dr. Nathan Steinle compared three nonsurgical treatments for vitreomacular traction and found that C3F8 was superior to SF6 as well as ocriplasmin.
Dr. Charles Wykoff presented 1-year results a prospective, randomized trial comparing treat and extend to monthly ranibizumab for neovascular AMD. The two groups had similar visual outcomes, but there was a significantly reduced treatment burden for the treat and extend group.
Dr. Jeffrey Heier reviewed the results of the VISTA and VIVID trials of intravitreal aflibercept injection versus laser for the treatment of diabetic macular edema. The studies demonstrated significantly improved visual acuity with both medication regimens compared to laser.
Dr. Justin Ehlers discussed 1 year results of the DISCOVER study, which is assessing the use of microscope-integrated OCT for vitreoretinal surgery. The OCT device provides important surgical feedback in a significant number of cases.