EXECUTIVE SUMMARY OSSA 2014

With a world class panel on hot topics including femtosecond lasik, current treatment modalities for diabetic maculopathy, and the inaugural meeting of the South African strabismus and Paediatric Society, OSSA 2014 was bound to be an academic overload.

Below is the tip of the iceberg regarding take home points:

Graham Barrett: (cataract and refractive surgeon)

1 .2.5mm surgical incisions for phaco surgery induce minimal astigmatism.

2. 2.2mm-2.4mm corneal incisions are the ideal size.

3. Monovision cataract surgery of <1.5DS preserves both contrast sensitivity as well as stereoacuity.

4. A new suggestion for monovision is modest monovision: 1.25D of ametropia maintains spatial convergence. Ocular dominance also does not seem to be an issue with modest monovision. Essentially one is extending the depth of focus with this form of monovision.

Neil Bressler:( Medical retina expert)

The burning question of when enough is enough regarding anti-VEGF for diabetic macular oedema answered:

1.If with OCT scanning after initial baseline injections, there is improvement on central subfoveal thickness of more than 10%, or improvement in VA of >1 line, then continue treatment.

2.If either OCT or VA is worsening-inject.

3.If the clinical course is stable ie. no improvement nor deterioration, this must stay the same for 2 consecutive injections. Follow the patient up at 1 month, then if stable, defer treatment to 8 weeks, then 12 etc.

4.IF OCT analysis shows central subfield thickness(CSF) >250 micron or VA <20/20, and this is inside 6 months of treatment, then inject.

If OCT shows CSF >250 microns, or VA better than 20/20, then defer treatment for 4 weeks, then double the follow up if normal. If it worsens-inject.

If outside 6 months of treatment for above criteria, then defer injections.

focal laser can be used if thickening remains on OCT and there is no improvement after injections. Laser should only be done to microaneurysms.

5. If at follow up, there is a more than 10 letter loss, then consider corticosteroid injections plus laser. Alternatively after 1 year of treatment with no response, then consider corticosteroid injections.

6.for macula oedema related to central retinal vein occlusions: One can use Ozurdex with no sooner then 4 monthly intervals.Gold standard however is Lucentis 1 injection per month for at least 6 months.

What do you do when you have a patient with retinal thickening and good vision????

1. The ETDRS had 90% of its patients with DME in the 20/25 VA range or better…so do we do:

A. focal/grid laser???

B. Lucentis/Avastin and deferred laser???

C. Observation with treatment when visual loss occurs???

The answer is still at large..we still have no definitive approach but none of the above options are incorrect..

Johan De Lange:(Refractive surgeon)

1.Trans PRK procedure: PTK with excimer laser for 55 microns with a gradual increase to 65 microns in the periphery. This is followed by the excimer laser treatment. Thereafter MMC 0.02% for 20 seconds.

2. The procedure works for myopes up to -6DS and astigmats up to -6DC.

3.Compared to standard Excimer laser with keratome, lasik results are slightly better than trans PRK in groups with lower cyl.

4. Lasik is better in low myopia and high cyl.

5. Trans PRK seems better in high myopes and low cyl.

 

Mark Wevill( Refractive surgeon)

Femtosecond laser flaps vs keratome:

1. Healing process has been shown to be the same with both modalities.

2.Complications show higher incidence of suction breaks with manual keratome. Corneal abrasions also seem to be more in this group. Remember that DLK and striae are higher in cases with abrasions.

3. Buttonholes are higher with the Intralase.

3.Incomplete flaps also more frequent with Intralase due to suction breaks.

4. TBUT is slightly worse after femto cut flaps.

 

As mentioned..this was the tip of the iceberg, but points I found most relevant to my clinical practice. Looking forward to the next one!!