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Across the Pond | Oct 2012

Video Highlights from the ESCRS Annual Meeting in Milan

This installment of Inside Eyetube.net shines a spotlight on interviews conducted with presenters during the annual meeting of the European Society of Cataract and Refractive Surgeons (ESCRS) in Milan. To view these and other interviews, visit eyetube.net/series/eyetubetv-dailycoverage- milan-2012.


In 2006, the ESCRS Endophthalmitis Study Group reported that, in patients who received 1 mg intracameral cefuroxime in 0.1 mL of normal saline solution at the end of cataract surgery, the incidence of endophthalmitis was reduced by sevenfold. In an effort to discover how, 6 years later, the results of the study have influenced surgeons’ use of intracameral cefuroxime, a drug that is not commercially available in a single dose, the ESCRS Endophthalmitis Study Group conducted a computer-assisted telephone survey.

Peter Barry, FRCS, Chair of the Endophthalmitis Study Group, reported that, of 193 respondents across 31 European countries, 91% had heard of the ESCRS Endophthalmitis Study and 76% reported routinely using intracameral antibiotics during cataract surgery. Of that 76% of respondents, 82% reported using cefuroxime; the other 18% reported using vancomycin, moxifloxacin, or gentamicin.

According to Dr. Barry, the main reason cited among the 26% of respondents who do not use an intracameral antibiotic was no need. Other reasons included lack of availability or protocol for administration and concerns about the risk of contamination. Seventy-six percent of respondents said they would use intracameral cefuroxime if a commercial preparation were available. The remaining 24% said they would not switch to a commercial preparation of the drug. Of those who said they would not switch, half said they would continue to use cefuroxime prepared by a compounding pharmacy for economic or other reasons. These results, Dr. Barry said, confirm a strong desire for a commercially available intraocular formulation of cefuroxime.


Paolo Vinciguerra, MD, discussed the use of iontophoresis to enhance riboflavin penetration into the corneal stroma during corneal collagen crosslinking (CXL). Iontophoresis is a noninvasive technique that applies an electric current to augment the mobility of molecules through cells and tissues primarily through electrochemical repulsion. Dr. Vinciguerra called iontophoresis “the possible future of CXL technology,” based on his preliminary investigations in eye bank corneas. He said it offers the combined benefits of the standard epithelium-off CXL treatment, which are deep penetration of riboflavin and ultraviolet light and a strong postoperative cornea, without the need to remove the epithelium, thus giving patients a fast, pain-free recovery. A clinical study of iontophoresis with CXL will begin soon, Dr. Vinciguerra said.


Zoltan Nagy, MD, shared his experience performing laser cataract surgery in eyes with penetrating trauma. The LenSx femtosecond laser (Alcon Laboratories, Inc.), he said, can be used successfully in certain instances of traumatic cataract after penetrating eye injury, even if an anterior capsular laceration is present, as well as after blunt trauma that results in a white cataract. More specifically, Dr. Nagy said that the femtosecond laser is useful in these cases because it can perform a wellcentered capsulorrhexis and, unlike in a manual approach, pressure is not exerted on the capsule during fragmentation. The absence of pressure during fragmentation is especially beneficial in eyes with zonular dehiscence, Dr. Nagy said.


Sunil Shah, MD, FRCOphth, discussed visual outcomes of a preliminary study of cataract patients implanted with an accommodating IOL (Tetraflex HD; Lenstec, Inc.) in one eye and a multifocal IOL (Lentis Mplus IOL; Oculentis GmbH; distributed by Topcon) in the other eye. This strategy, he explained, was intended to provide presbyopic patients with excellent distance, good intermediate, and some near vision in one eye with the accommodating lens and provide distance, reading, and some intermediate vision in the other eye with the multifocal IOL.


Dr. Shah said patient satisfaction was very high with this mix-and-match approach. Without conducting a large study, it is hard to compare the results with the two lenses, he explained, but based on his experience with other IOLs, the results and patient satisfaction in his preliminary study are very good. Contrast sensitivity was equal in both eyes, and patients experienced fewer photopic symptoms compared with those typically experienced by patients implanted only with a multifocal IOL, he reported.

Section Editor Elena Albé, MD, is a Consultant in the Department of Ophthalmology, Cornea Service, Istituto Clinico Humanitas Ophthalmology Clinic, Milan, Italy. Dr. Albé states that she has no financial interest in the products or companies mentioned. She may be reached at e-mail: elena.albe@gmail.com.

Section Editor Damien F. Goldberg, MD, is in private practice at Wolstan & Goldberg Eye Associates in Torrance, California. Dr. Goldberg states that he has no financial interest in the products or companies mentioned. He may be reached at tel: +1 310 543 2611; e-mail: damien.goldberg@wolstaneye.com.

Section Editor Mark Kontos, MD, is the Senior Partner at Empire Eye Physicians in Spokane, Washington. Dr. Kontos states that he has no financial interest in the products or companies mentioned. He may be reached at tel: +1 509 928 8040; e-mail: mark.kontos@empireeye.com.