HONG KONG – Transplantation of a patient’s own bone marrow stem cells showed promise in the repair of macular holes, a surgeon showed here.

“We have entered into a new era,” Raj Vardhan Azad, MD, FRCS, FAMS, said during the World Ophthalmology Congress. “The technique of transplantation of bone mar-row [stem] cells in the subretinal space is safe with no side effects and is a new concept.”

In this study, 10 patients who had previously failed macu-lar hole surgery underwent bone marrow aspiration from the iliac crest and intravitreal implantation of those stem cells into their retina.

“We thought that this was something that could give us a benfi t in the sense that it may close the hole and also in-crease the visual acuity,” Dr. Azad said.

WOC DAILYA Special Presentation of

Day 3 July 1, 2008

Toric ImplantsUse of toric phakic lenses following crosslinking improved uncorrected visual acuity for patients with keratoconus, according to study.

PAGE 3

Pediatric LASIKRefractive procedure to correct anisometropia in children shown to be safe and eff ective.

PAGE 8

Retina Risk FactorSiblings of patients with disease are at greater risk for developing AMD and CNV.

PAGE 13

Congenital CataractsSurgeon reports successful results using 25-gauge tools to remove cataracts in pediatric patients.

PAGE 16

Highlights

Featured Activities

Stem cells show promise for repair of macular holes

9:00-10:30Live Manual Sutureless Cataract SurgeryRoom 606-607

14:00-15:30End Stage Ocular Surface DiseaseHall 7B

16:00-17:30Meet the ProfessorsRoom 608

大会特别报道WOC DAILY 将提供

一项特殊服务，在第

6页和第7页用中文报

道“中华眼科学会第

八届大会 (XIII Con-

gress of the Chinese

Ophthalmological So-

ciety)。请在以后几期

中阅读重点关注这些

重要报告的文章。

Nanotechnology has potential to alter ophthalmic treatment paradigmsHONG KONG – Nanotech-nology could signifi cantly change the treatment of ocu-lar diseases, providing such improvements as regenera-tion of the optic nerve and 24-hour IOP measurement, a clinician said here.

“Nanotechnology is going to completely revolutionize our lives and alter civiliza-tion as we know it,” Robert Ritch, MD, FACS, FICS, FRCOphth(UK), DSc(Hon),said at the World Ophthalmol-ogy Congress meeting.

Dr. Ritch presented the Timothy KC Liu Memorial Lecture at the Asia-Pacifi c Academy of Ophthalmology Symposium (APAO) held at

Robert Ritch, MD, FACS, FICS, FRCOphth(UK), DSc(Hon), present-ed the Timothy KC Liu Memorial Lecture at the Asia-Pacifi c Academy of Ophthalmology Symposium. Ritch, continued on page 3

Stem cells, continued on page 1

WOC DAILY | Day 3 July 1, 2008 3

Toric phakic implant successfully treats refraction post cross-linking therapy for keratoconusHONG KONG – Toric ICL implanta-tion 1 year after corneal collagen cross-linking for patients with keratoconus improves uncorrected visual acuity, according to a study presented here.

Alaa El Danasoury, MD, FRCS, chief of refractive sur-gery at Maghrabi Eye Hospi-tal in Saudi Arabia, presented results from a study on toric ICL (STAAR Surgical) im-plantation in 32 eyes of 22 keratoconus patients 1 year after cross-linking therapy.

Dr. El Danasoury said a stable cor-nea is not enough to satisfy keratoco-nus patients.

“At about one year after cross-linking therapy, the keratoconus patients come in and say, ‘OK, doctor, I came in origi-nally to improve my vision. Now you are telling me my cornea is stable, and

for that I thank you very much, but I still cannot see.’ So, we offer them a toric ICL,” he said.

Dr. El Danasoury said he waits 1 year to ensure corne-al stability before implanting the ICL.

“We conducted this study 2 years ago to assess the safety, the effi cacy the stability of to-ric intraocular lens to correct the compound myopic astig-matism normally associated

with keratoconus post corneal cross-linking,” he said.

Patients ranged in age from 19 to 36 years for a mean age of 24.1 years. Fifty-eight percent were males. Baseline mean spherical equivalent was –8.56 D ± 4.38 D. Mean baseline cylinder mea-sured –3.44 D ± 1.68 D. A total of 30 eyes completed 1 year examination.

Dr. El Danasoury performed ICL

implantation through a 3-mm clear corneal incision under topical anesthe-sia and also performed surgical iridec-tomies.

“In these cases, the technique of im-plantation of the ICL is not much differ-ent than that in a virgin eye,” he said.

According to Dr. El Danasoury, at 1 day postop 94% of uncorrected eyes could see 20/40, 81% could see 20/30 or better and 56% could see 20/20 or better. This compares with preop BCVA of 100% at 20/40 or better, 84% at 20/30 and 44% at 20/20 or better.

At 12 month follow up, 30 eyes had a mean cylinder of –0.26 D at 144.4 inches.

“The toric ICL is highly predict-able in correcting compound myopic astigmatism after cross-linking, he said. “Refractive correction is stable after one year, the lens is stable inside the eye with no rotation occurring.”

Alaa El Danasoury

the meeting. The symposium was a continuation of an awards and honor lecture ceremony held by the APAO on Sunday.

Dr. Ritch also received the Timo-thy KC Liu Memorial Award at the symposium.

In his presentation, he said that nano-technology could make corneal repair and regeneration; artifi cial corneas; lens repair and regeneration; retinal regen-eration and artifi cial retinas all treatment realities. Also, it could revolutionize treatment for glaucoma, fi nally eliminat-ing the need for eye drops to be admin-istered by patients and more accurately measure IOP, he said.

“The holy grail of glaucoma has been the 24-hour monitoring of intra-ocular pressure,” Dr. Ritch said. “If I see a patient four times a year, I can check his pressure four times. That gives me almost nothing, except if it’s

in the normal range. We want to know what’s happening at night, during sleep, climbing stairs, doing exercise and when the drugs wear off.”

Nanotechnology is based on the molecular self-assembly production of new or improved materials, as can be observed in nature, Dr. Ritch said. It creates and uses materials and devices at a scale size of intracellular structures and molecules. Regenerative ophthal-mology uses stem cells, tissue bioen-gineering and gene therapy to effect treatment, he said.

He compared the medical innova-tion technology with the world-chang-ing impact of the Internet, and said that it could be more important, in the scope of world history, than harness-ing electricity or the invention of the internal combustion engine.

Also at the symposium, Yoshihito Honda, MD, PhD, presented the De Ocampo Lecture, highlighting the struc-ture of the retina. The Susruta Lecture was given by Prof. Shad Mohammad,who presented on cataract blindness

rates around the world, with special em-phasis on Pakistan. Li Xiaorong, MD,presented the Holmes Lecture, outlin-ing the rate and treatment of blindness from various ocular diseases in China.

In addition, Timothy YY Lai, MD, FRCS, received the Nakajima Award. He presented the award lecture on the use of multifocal electroretinography to evaluate retinal dysfunction associated with pharmacological agents.

continued from page 1

Ritch

Chi Kin Ho, MD, (right) Asia-Pacifi c Academy of Ophthalmology treasurer, presents the Susruta Lecture to Prof. Shad Mohammad.

WOC DAILY | Day 3 July 1, 20084

HONG KONG – A panel of retina experts at the World Ophthalmology Congress here debated about the merits of laser, anti-VEGF and triamcinolone treatment for diabetic retinopathy.

Donald D’Amico, MD, Charles Wilkinson, MD; Dennis SC Lam, MD, FRCS, FRCOphth; George A. Williams, MD; Peter E. Liggett, MD; Quan-Dong Nguyen, MD; and Thomas J. Wolfensberger, MD,participated in the panel, led by Dr. D’Amico.

Dr. D’Amico began by asking the participants their opinion on laser as a fi rst-line treatment for non-traction diabetic retinopathy.

“I still consider photocoagulation in the ETDRS technique the standard of care for most patients presenting with non-traction diabetic retinopathy,” Dr. Williams began.

Dr. Lam quickly countered that there are many other choices available if fl uorescein angiography and optical coherence tomography do not show structural abnormalities.

“With structural things, we go for surgery, but if not, then there is a choice and laser is only one of the choices,” Dr. Lam said. “I would say less than 20% of the patients are re-ceiving quick laser. The majority might get IVT or Avastin or combina-tion treatment.”

He said if he does choose to do laser, he will administer Avastin (be-vacizumab, Genentech) 2 weeks prior to maximize the effect of the laser therapy.

Dr. Liggett agreed, saying, “I agree with Dr. Lam. I’m a little leery of the laser except when it’s very focal

leakage. I think you can do a lot more damage.”

The differentiation between focal and diffuse leakage was Dr. Wolfen-sberger’s requirement for choosing between laser therapy and an alternative.

“I agree with George Williams on the laser for focal leakage. I think prob-ably everyone on the panel would agree on that. I think the problem starts when you have diffuse leakage either straightaway for the fi rst time or after laser treat-ment,” he said. “I actually do a lot of sub-tenon injec-tions of triamcinolone and I’ve been quite encouraged by later literature in the last year in Japan and Korea.”

Depending on the anatomy of the sub-tenon space, Dr. Wolfensberger said you can inject up to 40 mg of triamcinolone, but Dr. Lam said he found that amount ineffective.

“We are using 80 mg, which has a very prolonged effect, and the ocu-

lar side effects are minimal, especially on the ocular hypertension,” Dr. Lam said.

Dr. D’Amico asked if the panelists agreed that “the blush is off the rose” of triamcinolone overall.

“Long-term follow-up is a diffi cult thing and the longer I follow my tri-amcinolone patients, the more disap-

pointed I am with the results,” Dr. Wil-liams answered.

“I think triamcinolone alone is not adequate, but it is a very strong agent. It’s better than Avastin alone,” Dr. Lam said, suggesting combination therapy.

Experts debate best fi rst-line treatment for diabetic retinopathy

Fundus picture of proliferative diabetic retinopathy with active new vessels. Image: Hussain N

Meet the ProfessorsDiscuss the current state of ophthalmology around the world and what the future holds with some of the leaders in eye care. On Tuesday, Dennis SC Lam, MD, FRCS, FRCOphth; Stephen Ryan, MD; Bruce E. Spivey, MD; Yasuo Tano, MD; Peter Watson, FRCS, FRCOphth; and Jialiang Zhao, MD, will be available to answer your questions on a wide range of topics, including research, career planning and subspecialty training. Don’t miss this unique opportunity.

Tuesday, July 1 • Room 608

Preoperatively, the mean best cor-rected visual acuity (BCVA) was 6/60 and the mean optical coherence to-mography (OCT) measurement was 792 μm. At 1 week postop, BCVA was 4/60. At 3 months postop, BCVA was 6/60 and the OCT measurement was 629 μm.

Dr. Azad presented the OCT im-ages that showed the macular hole had closed or become smaller in the 10 pa-tients and said they had stable vision.

“Experimental evidence following intravitreal implantation of bone mar-row stem cells indicates integration and proliferation of stem cells into dif-ferent retinal layers,” Dr. Azad said. “Clinical evidence, as shown in our study, indicates that it is safe, however further studies with large same size are required.”

The researchers conducted a similar study for retinitis pigmentosa and dry age-related macular degeneration, but there were no statistically signifi cant changes to report after 6 months fol-low-up..

“We have the evidence that stem cell productivity could eventually be used to treat deteriorating vision in hu-mans,” Dr. Azad said.

continued from page 1

Stem cells

WOC DAILY | Day 3 July 1, 200866

中华医学会眼科学分会向全国眼科医师发出倡议全国眼科医师共同关注、关心灾区

灾情，向灾区及受灾人民表达关心

与祝福。在灾区的眼科医师发扬大

无畏的精神，在保障自身安全的前

提下，尽一切可能为灾区人民提供

帮助，认真诊治病情，给予人文光

怀。其余地区的眼科医师以极大的

热情投入到本职工作中，行动起

来，为灾区捐款捐物，作好准备，

为灾区的恢复重建贡献力量。

中国医学会眼科学分会

2008-5-14

抗震救灾，COS在行动

上海第一人民医院眼科许迅教授在抗震

救灾前线

我们并不孤独，我们懂得感恩

尊敬的黎教授及全国眼科同仁：

2008年5月12日，突如其来的一场

波及半个中国，让世界震惊的四川汶

川8.0级特大地震发生了，灾难给四川

造成巨大的损失。位于重灾区的绵阳

市中心医院，地震不仅造成房屋与设

备损坏，还遭受失去同仁的悲痛和心

灵的创伤!天灾无情人有情，在抗震救

灾的路上，全国各地不计其数的眼科

同仁关心着我们，温暖着我们，我们

收获了太多的感动!

地震发生后，我们的通讯中断，

无法与外界联系。当通讯恢复的那一

瞬间，我们收到了眼科同仁数千条短

信问候：“闻听四川地震，送去问

候，保重身体”。“情况如何？多保

重”。“震情如何，是否安全，挂念

中”。“我们和你们在一起”⋯⋯

中华医学会眼科学分会主任委员

黎晓新教授第一时间发来短信：“望

你们保重，需要提供哪些帮助，请告

知”。当得知目前的伤员以骨科伤员

为主后，黎教授回短信：“好，我们

待命”。5月20日黎教授再次发来短

信“余震不断，保重”这些简短的话

语让大家感动得热泪盈眶，也增加了

我们抗灾救灾的信心！香港中文大学

林顺潮教授代表香港眼科同仁发来邮

件：“希望四川同胞都能尽快从此次

灾难中走出来，我们迫切希望能够致

电问候有关人士并尽绵力⋯⋯。”

从5月12日地震发生至今，黎晓

新、林顺潮、魏文斌、宋维贤、鲍

永珍、余敏斌、张少冲、张铭志、张

军军、陈晓明、李敏、王延俊等眼科

专家以及北京、上海、广东、辽宁、

山东、山西、陕西、广西、贵州、云

南、新疆⋯⋯各地眼科同仁或致电或

短信安慰、鼓励我们，并不约而同地

表示愿提供一切支持。

山西太原马自勤医生汇来5000元人

民币，并深情写到：“请收下给需要

帮助的人！”

这些关心和支持陪伴着我们度过抗

震救灾一个个不眠之夜。在你们的激

励下，在为灾区人民减轻伤痛、减少

伤残信念的支撑下，我们夜以继日救

治患者。

震灾只有数秒，却足以摧毁一切；

生命如此脆弱，多少人离我们而去；

余震不断，让我们时刻胆颤心惊；高

悬在头的堰塞湖，让我们疲于奔命。

危难时刻，有你们的支持我们并不孤

单!你们热情的关怀让我们坚信，什么

灾难也摧毁不了我们民族的坚强!我

们正在践行中华医学会眼科分会的

倡议：发扬大无畏的精神，尽一切可

能为灾区人民提供帮助，认真诊治病

情，给予人文关怀。

有你们，我们并不孤单；对你们，

我们感恩，每时每刻。

绵阳市中心医院眼科全体医护人员

2008-05-28

一封来自地震灾区眼科医生的来信

地震后8分钟---身穿手术衣和拖鞋转运手术病人的医护人员

尊敬的黎晓新教授我谨代表美国眼科学会及我本

人，向中国人民，尤其是中国眼

科学会会员表达对这次四川省

7.8级大地震的慰问与关心。

在接下来的恢复重建中，望能

克服所有困难，并对您及您的同

事表达我们最真诚的祝愿。

Dr. Hoskins

美国眼科医学会

美国眼科

学会地震

慰问函

WOC DAILY | Day 3 July 1, 2008 77

中华眼科学会海外华人杰出成就奖

本次眼科大会白内障学组共收到来自

100余家单位516篇有关晶状体疾病的

论文，内容涉及白内障超声乳化手术

技巧、复杂白内障手术、白内障手术

并发症、新型超

声乳化手术设备

和新型人工晶状

体的运用、晶状

体屈光手术等各

个方面。

目前，白内障

手术已从复明手

术成功转向于屈光手术，学者们越来

越关注白内障术后患者功能性视力和

视觉质量的恢复。人工晶状体设计结

构的日趋完善和白内障手术技巧的不

断改进，使得白内障患者术后获得完

美的视觉效果，成为近期白内障研究

的新热点。此次会议投稿内容更多涉

及了白内障术后散光的矫正、术后调

节力的恢复、术后像差的控制、以

及手术方案和人工晶状体的个性化选

择，使白内障患者术后不仅视力提

高，还能重建清晰、舒适、持久的生

理视觉质量。

此次会议投稿的学术亮点包括如

下：

● 微创超声乳化手术技术

● 新型超声乳化仪器和设备

● 复杂白内障手术

● 人工晶状体置换术

● 可调节人工晶状体

● 非球面人工晶状体

● Toric人工晶状体

● 人工晶状体个性化选择

● 晶状体屈光手术

● 功能性视力的建立

会议亮点

姚克

何世坤教授获奖感言

首先衷心感谢中华眼科学会给予

我如此高的荣誉，我感到非常荣幸。

在这里，我还要感谢曾经给予我支持

和帮助的黎晓新教授、赵家良教授、

胡诞宁教授，66视觉等，特别是海

外华人视觉与眼科研究联合会的全体

同仁。今天的这个奖，我想并不是属

于我个人的，而是属于为了祖国眼科

事业的发展做出贡献的所有海外学子

的。

对于中国与海外的眼科合作交

流，我只是尽了一点绵薄之力，只是

一个海外学子对生我、养我、培养我

的祖国的一点回报，实在是微不足道

的，而我要说真正为祖国眼科事业发

展做出巨大贡献的是你们在座的各

位，是你们在用自己的智慧和双手推

动着中国眼科事业的发展。

我一直有一个梦想，就是有一

天，中国的眼科水平能够屹立于世界

前列，中国能够成为世界眼科研究的

中心，我想这也是我们在座每一个中

国眼科人责无旁贷的梦想，我也坚信

这个梦想终会有实现的一天，在这里

我愿与各位同道共勉，愿全球的华人

学者团结一心，携手奋进，为了中国

眼科的明天而不懈奋斗，再创辉煌。何世坤教授获海外华人眼科学及视觉科学

杰出成就奖

第13届全国眼科大会青光眼学组学术亮点

第13届全国眼科大会青光眼学组学术亮点青光眼学组入选论文的特点是将最基本的临床科学问题与最前沿的

基础研究热点有机结合起来，荟萃全国各个层面的青光眼通道的富有

创见与切合临床实际的信念、观点、技术、理论和

方法，以期在临床基本诊疗技术与前沿的青光眼基

础研究方面达到共识，例如在临床诊疗方面，密切

围绕眼压波动与浪涌、激光治疗、抗青光眼手术技

术、药物治疗趋势、图像形态与功能研究等；在青

光眼基础研究方面则涉及前沿领域，如干细胞与视

神经再生、特定基因的筛选与功能、神经胶质细胞

功能、纳米释药系统。葛坚

WOC DAILY | Day 3 July 1, 20088

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HONG KONG – LASIK in childrenwas shown to be safe, effective and fairly stable over 10 years of follow-up in a long-term study presented here.

“LASIK in children has the same ef-fi cacy, predictability and safe-ty margin of others. Of course, your nomogram should be changed depending on the condition of the other eye,” Osama Ibrahim, MD, said during the World Ophthal-mology Congress.

Dr. Ibrahim said he has been performing surgical re-fractive procedures on pediatric patients since the introduction of refractive kera-tometry and has completed more than 800 LASIK cases to treat myopia, hy-peropia and astigmatism.

In the study he presented, Dr. Ibrahim showed 10-year safety, effi cacy and stabil-ity data for 264 eyes of 264 patients who all had 10-year follow-up data.

Parameters of success in this study were the ability to wear spectacles, best spectacle-corrected visual acuity (BSCVA), the ability to resume or main-tain occlusion therapy and the stability

of the procedure, he said. He reminded the audience that he only performs unilateral LASIK in children in hopes that they can resume their vi-sion therapy, not in an effort to reach emmetropia.

Preoperatively, about one-third of the patients could see 20/100 or better and the major-

ity had a BSCVA of less than 20/100. “After LASIK, we were able to

achieve 27% to 20/20 best corrected vision,” he said. “About half could see 20/40 and two-thirds were able to see 20/100.”

None of the group lost any BSCVA, he explained, showing that the majority gained lines. Two-thirds gained at least

one line and one-third of patients gained more than three lines of BSCVA.

“Stability was very interesting,” Dr. Ibrahim said. “There was reasonable stabilization up to 3 years and then when they reached the age of puberty and normal growth, there was addi-tional regression up to 10 years.”

A “striking fact” of the stability was that patients who had residual myopia, continued to regress or have progres-sive myopia while patients who re-ceived overcorrection had less regres-sion or less progression as compared to the non-operated eye, he added.

“Remember that pediatric LASIK is not to get rid of glasses. It’s not to avoid the occlusion therapy, as most of the par-ents would love, and it’s not to stop the progression of myopia. And defi nitely it’s not for bilateral patients. It’s only to help these poor patients to correct their anisometropia and help them to wear the spectacles,” Dr. Ibrahim said.

Pediatric LASIK safe, eff ective, stable over 10 years

Osama Ibrahim

Special Edition, No. 3 • 2008

CONTENT SPONSORED BY AN EDUCATIONAL GRANT FROM AMO

Best Results Demand Latest TechnologyMICHAEL C. KNORZ, MD

I n my clinical experience, the combi-nation of state-of-the-art ablation, registration and flap-making technol-

ogies that we have with iLASIK provides patients with the best chance of achieving better than 20/20 uncorrected visual acu-ity and excellent quality of vision. iLASIK is an IntraLase femtosecond flap combined with a wavefront-guided ablation with iris registration (Advanced CustomVue).

We now have a long list of studies dem-onstrating that wavefront-guided LASIK produces better results than conventional LASIK. A study conducted at the U.S. Naval Medical Center in San Diego has also dem-onstrated that we can achieve signifi cantly better uncorrected visual acuity with femto-second laser fl aps than with microkeratome fl aps, especially in the early postoperative period.

One week post-op, 76% of femtosecond

eyes (IntraLase 15 Khz, 300 eyes) were 20/16 or better, com-pared to 58% of the microkeratome eyes (Bausch & Lomb Hansatome and AMO Amadeus, 436 eyes total). By three months, there were still more femtosecond patients with better than 20/20 vision, but the microkeratome group was catching up.

In another study of femtosecond fl ap creation and wavefront-guided ablation per-formed specifi cally in U.S. Navy aviators David Tanzer, MD, reported rapid visual recovery, with 94% of the eyes 20/16 or bet-ter uncorrected by two weeks. The subjects also had improved quality of vision: over half gained low-contrast acuity.

I recently conducted a comparative

Preop RMS Matters: Wavefront-Guide LVC Reduces Higher Order AberrrationsJACK T. HOLLADAY, MD, MSEE, FACS

T he wavefront-guided LASIK pro-cedure induces significantly fewer higher order aberrations, spherical

aberration, trefoil and coma than wave-front-optimized LASIK procedure, ac-cording to a recent study. In many cases, wavefront-optimized LASIK induced ab-errations. As such, wavefront-guided abla-tions provide the best results for the vast majority of patients over conventional and wavefront optimized LASIK.

AberrationReduction

Studies from Pablo Artal, PhD, and Steve Schallhorn, MD, show that less higher order aberrations in the eye result in better qual-ity of vision. All LASIK procedures are not equal. Conventional LASIK induces higher order aberrations. With wave-

[Holladay continued on page ii]

[Knorz continued on page iii]

Michael C. Knorz

Jack T. Holladay

S p o t l i g h t o n :

Laser Vision Correction

翻译见内文

REFRACTIVE SURGERY QUARTERLY

REFRACTIVE SURGERY QUARTERLY is presented as a professional service of AMO, Inc. The opinions expressed here are those of the authors and do not necessarily refl ect the views of the editors, publisher or sponsor.

REFRACTIVE SURGERY QUARTERLY

is published by SLACK Incorporated, 6900 Grove Road, Thorofare, NJ 08086-9447. For more information, contact Norma Hanna, managing editor: Telephone: 856-848-1000; FAX: 856-848-6091;E-mail: nhanna@slackinc.com

Copyright © 2007, SLACK Incorporated. All rights reserved. No part of this publication may be reproduced without written permission.

CHIEF MEDICAL EDITOR

Kerry D. Solomon, MDCharleston, SC

EDITORIAL ADVISORY BOARD

Kerry K. Assil, MDSanta Monica, CA

Hiroko Bissen-Miyajima, MDTokyo, Japan

Y. Ralph Chu, MDEdina, MN

Eric D. Donnenfeld, MDRockville Center, NY

Jonathan M. Frantz, MDFort Myers, FL

Jose L. Güell, MDBarcelona, Spain

David R. Hardten, MDMinneapolis, MN

Michael C. Knorz, MDMannheim, Germany

Colman R. Kraff, MDChicago, IL

Michael Lawless, MDChatswood, Australia

Richard L. Lindstrom, MDMinneapolis, MN

Terrence P. O’Brien, MDBaltimore, MD

front optimized LASIK, the goal is to not induce spherical aberration, and therefore does not address the patient’s preoperative spherical aberration or oth-er higher order aberrations. However, few patients

have zero spherical aberration; those that do, are in their early 20s or younger. By the time most patients reach their 40s, they have positive ocular spherical aberration. With wavefront-guided LASIK, the goal

is to reduce all higher order aberrations. The spheri-cal aberration target is zero.

Study ResultsOur study compared the effi cacy of wavefront-

optimized and wavefront-guided procedures. The retrospective chart review study of more than 200 IntraLase procedures included 102 IntraLase (AMO) Wavelight (wavefront-optimized) eyes and 109 In-traLase CustomVue (wavefront-guided) eyes. The chart review took place in 2006 and early 2007.

These study results demonstrate that wave-front-guided ablation with femtosecond tech-nology is optimal for the majority of patients. Overall, the wavefront-guided treatment induc-es signifi cantly fewer higher order aberrations, spherical aberration, trefoil and coma than the optimized procedure. (Figure 1). There was sig-nifi cantly more variation with the wavefront-optimized eyes. For the study for all higher or-der aberration in the wavefront-guided group, about 12% of patients were better, 76% were the same, and 12% were worse post-op. With wavefront–optimized, about 8% were better, 51% were the same, and 41% were worse (Fig-ure 1). All procedures used the IntraLase laser for the most advanced fl ap creation.

Overall, the wavefront-guided procedure had the greater effi cacy for spherical aberration, coma, trefoil and total higher order aberrations and the better safety with the lowest induced spherical aberration, coma, trefoil and total higher order aberrations. Therefore, wavefront-guided LASIK has the best chance of maintaining or improving higher order aberrations and has the best chance of providing optimal visual quality.

Jack T. Holladay, MD, MSEE, FACS is clinical professor of ophthal-

mology at Baylor College of Medicine, in Houston, Texas. Contact

him at holladay@docholladay.com.

[Holladay, continued from page i]

波前引导激光视力矫正加IntraLase飞秒激光制作角膜瓣、可获得更好的视觉功能

使用IntraLase飞秒激光制作角膜瓣并行波前引导切削、可在大多数患者中获得最佳结果、并且、与传统LASIK和波前优化LASIK相比、再治疗率最低。2006年及2007年早期、在对200多例IntraLASIK手术进行的一项回顾性病例分析研究中，纳入了100多例 IntraLase (AMO) Wavelight (波前优化)治疗眼、及100多例IntraLase CustomVue (波前引导)治疗眼。总体上、研究结果表明、波前引导治疗诱导的高阶像差、球差、trefoil差和慧差显著少于波前优化术。所以、波前引导LASIK维持或改善高阶像差的可能性最大、并且实现最佳视觉质量的可能性也最大。

Figure 1: Wavefront-guided ablations were shown to improve or have no change in higher order aberrations (HOA) in 88% of all patients in the study.

Figure 2: Wavefront-optimized ablations worsened higher order aberrations (HOA) in 41% of all patients treated in the study, compared to 12% with wavefront-guided ablations.

SPECIAL EDITION, NO. 3 • 2008: LASER VISION CORRECTION iii

measurement of fl ap tensile strength by vary-ing side-cut angles in rabbits with the iFS laser, which is the 5th generation femtosecond laser from IntraLase/AMO, and an Amadeus micro-keratome. We measured the tension required to dehisce each fl ap 75 days after fl ap creation. The fl ap tensile strength differences was statistically signifi cant among all the groups (p=0.001). When the side-cut angle was 140°, the fl ap was more than three times as adherent as a micro-keratome fl ap (Fig 1).

In addition to advanced customization ca-pabilities such as the elliptical fl ap option and inverted bevel-in side cut angle, the iFS laser is also considerably faster, with the ability to cre-ate a fl ap in less than 10 seconds. This signifi -cantly reduces the risk of suction loss, decreases suction-related stress on the eye, and improves patient comfort.

Wavefront measurement is also undergo-ing important changes. The iDesign Advanced WaveScan Studio will have a much higher reso-lution than our current WaveScan; it captures over 1250 data points over a 7mm pupil. It also has a higher dynamic range for the potential treatment of irregular corneas. It will also in-corporate new full-gradient topography, which may enable us to perform treatments based on topography and wavefront data.

Wavefront-guided LASIK with IntraLase and Advanced CustomVue represents the best refractive procedure performed today and our results will only improve as new components are added to the iLASIK platform.

Prof. Knorz is the founder and medical director of the FreeVis LASIK

Center in Mannheim, Germany, and a professor of ophthalmology

at the University of Heidelberg, Medical Faculty Mannheim, Ger-

many. Contact him at knorz@eyes.de or +49-621-383-3410.

[Knorz, continued from page i]

开展最先进的LASIK术，提高视觉质量和视力结果

· iLASIK是一种将IntraLase飞秒激光制作角膜瓣与虹膜定位波前引导LASIK相结合的技术。

· iLASIK治疗眼有更好的低对比度视力、且更有可能实现20/20以上的矫正视力。

· 将来、iLASIK技术能继续获得改进：

· 利用iFS飞秒激光、能够根据生物力学原理设计角膜瓣、使每个角膜瓣具有个性化的参数、包括：在侧切角内含有反斜面、可制作椭圆形角膜瓣、更密集的点间隔、并可缩短手术时间、角膜瓣制作时间多于10秒。

· 迈克尔·克诺兹(Michael Knorz)医生最近的研究表明、140度侧切LASIK角膜瓣的强度比机械微角膜刀制作的角膜瓣高3倍。

· iDesign Advanced WaveScan Studio将有更大的动力学范围、并将整合下列功能：像差测量、新角膜地形图检查技术、自动验光、瞳孔测量和角膜散光测量。它可在7mm的瞳孔上获取超过1250个数据点。

Figure 1: Femtosecond fl ap creation with a 140 degree side cut angle is more than three times stronger than a mechanical microkeratome fl ap.

Figure 2: The increased resolution aberrometer captures over 1250 data points over a 7mm pupil, expanding the dynamic range for the potential treatment of irregular corneas.

Reference:1. Data on fi le. CustomVue procedure clinical trials, 2003, 2004, 2005.* In Print. Journal of Refractive Surgery, 2008.©2008 Advanced Medical Optics, Inc. All Rights Reserved. The AMO logo is a registered trademark and iDesign, iFS, iLASIK and the iLASIK logo are trademarks of Advanced Medical Optics, Inc. in the United States and other countries. Advanced CustomVue and WaveScan are registered trademarks of AMO Manufacturing USA, LLC in the United States and other countries. 2008.05.16-IL458

innovation to the ixtremetechnology so advanced, it must be iLASIK™

Advanced CustomVue®

TreatmentCan potentially produce better

vision than is possible with glasses and contact lenses1

Broadest range of approvalsincluding the fi rst and only FDA-approved wavefront-guided monovision treatment

iDesign™ AdvancedWaveScan® Studio

The industry’s highest-resolution Hartmann-Shack wavefront sensor with Fourier algorithms — 1,257 data points

Five measurements in one device with a single push of a button: pupillometry, keratometry, refractometry, aberrometry and topography

Effi cient, fl exible footprint via integrated computer monitor design

iFS™ AdvancedFemtosecond Laser

Introducing the 10-second iLASIK fl ap

Tighter spot alignment means virtually effortless fl ap lifts

Proprietary inverted bevel-in side cut enables biomechanically engineered fl aps to promote wound healing*

High-resolution video microscope: > Ergonomic surgeon comfort and utility > Touch-screen magnifi cation

WOC DAILY | Day 3 July 1, 2008 13

24th Congress of the Asia-Pacifi c Academy of OphthalmologyMay 16-19, 2009 • The Westin Resort • Nusa Dua, Bali

Mark your calendars for one of the most prestigious ophthalmology meetings of 2009, the 24th Congress of the Asia-Pacifi c Academy of Ophthalmology, to be held May 16-19 in Bali, Indonesia.

World-renowned experts from the Asia-Pacifi c region will be present to discuss the latest topics and challenges within the fi eld of ophthalmology.

Don’t miss the opportunity to visit beautiful Bali for a unique educational experience.

For more information, please visit apao2009bali.org.

Save the Date

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HONG KONG – Siblings of age-relat-ed macular degeneration patients are at a 14 times greater risk of developing AMD than controls and 54 times as likely to develop choroidal neovascu-larization, a study showed.

“Age and smoking are known to be signifi cant risk factors for AMD and, if we do an adjusted logistic regression analysis to account for these factors, then siblings are 14 times more likely to have AMD than control subjects of a similar age and smoking history,” Humma Shahid, MRCOphth, said here at the World Ophthalmology Congress.

The prospective, multicentered study Dr. Shahid presented was conducted from 2001 until 2006 and looked at sib-lings and spouses of AMD patients.

“We aimed to determine the preva-

lence of age-related macular degen-eration and age-related maculopathy (ARM) in siblings of a cohort of AMD cases,” Dr. Shahid said.

The researchers recruited 171 siblings regardless of ocu-lar status of 122 patients with AMD. They also studied 292 control subjects, who also were not screened to be free of ocular disease.

Findings were based on medical and family history, an oph-thalmic examination and fundus pho-tographs, she said.

There was a signifi cant difference between the siblings and controls in terms of age, with average age being 73 years in siblings and 75 years in controls. There was no signifi cant dif-ference in gender or smoking status.

If CNV or geographic atrophy was present in at least one eye of the sib-

lings or controls, then AMD was said to be present, Dr. Shahid explained.

AMD was seen in 2.7% of controls and 22.2% of sib-lings, she said. Siblings were more likely to have CNV and controls were more likely to have geographic atrophy.

The ratio was 14:1 for AMD and 54:1 for CNV for siblings compared to controls of similar age and smoking history, she said.

“Siblings of AMD cases have a sig-nifi cantly higher risk of developing AMD compared to controls. We fi nd no signifi cant difference in the preva-lence of ARM between siblings and controls,” Dr. Shahid said.

AMD and CNV far more likely to develop in siblings of patients with disease than controls

Humma Shahid

WOC DAILY | Day 3 July 1, 200814

WOC DAILY Editorial Board Editor Clement CY Tham, MD

Glaucoma

Associate Editor Philip TH Lam, FRCS, FRCOphth Cataract

Editorial Advisors Dennis SC Lam, MD, FRCOphth Bruce E. Spivey, MD Yasuo Tano, MD

Members Srinivas Rao, MD, FRCS Corneal & External Eye Diseases

Arthur Cheng, MD Refractive Surgery

Benson Cheung, MD, FRCS Retina

OCULAR SURGERY NEWS

Chief Operating Offi cer John C. Carter

Vice President, Publishing Operations Joan-Marie Stiglich, ELS

Director, Custom Publishing Group Chris Rosenberg

Managing Editor Bryan Bechtel

Writers Katrina Altersitz Erin Boyle David Mullin Lauren Wolkoff

Creative Director Linda Baker

Operations Manager Cheryl McKeown

Information Technology Chas White

WOC DAILY is published during WOC 2008 as a service for all who attend.

©2008 SLACK Incorporated

Published bySLACK Incorporated

6900 Grove Road, Thorofare, NJ 08086Phone: 856-848-1000

WOC DAILYA Special Presentation of

WOWW C20000 8HONG KONG

DALK rapidly overtaking PK in popularity in terms of safety, visual outcomesHONG KONG – Deep anterior lamel-lar keratoplasty is fast becoming the procedure of choice due to its excel-lent visual results and safety profi le, ac-cording to a surgeon presenting here.

Donald TH Tan, MBBS, FRCSG, FRCSE, FRCOphth, FAMS, told at-tendees of the World Ophthalmology Congress that his utilization of pen-etrating keratoplasty (PK) has declined dramatically in favor of deep anterior lamellar keratoplasty (DALK).

“I now only do PK for 25% of my

patients. So this shift is occurring quite rapidly,” Prof. Tan said.

The indications for DALK are var-ied, and the procedure can be done in most cases in which PK would be indicated. Prof. Tan said that in other parts of Asia, tectonic and therapeu-tic grafts are becoming increasingly prevalent.

Prof. Tan and colleagues conducted a cohort study evaluating 21 consecu-tive cases of therapeutic DALK (15 months follow-up), 89 non-perforated cases of therapeutic PK (23 months follow-up) and 20 perforated cases of therapeutic PK (14 months follow-up).

The 21 cases of therapeutic DALK included cases of severe infection. No-tably, none of these cases developed

postoperative endophthalmitis. In contrast, in the therapeutic PK groups, 64% developed the endophthalmitis.

DALK also has been shown to offer a better graft survival rate than PK as well as better visual results.

In another study, Prof. Tan said he and colleagues compared results from PK and two DALK techniques in 128 patients. The three groups included 64 PK patients, 31 manual DALK patients and 33 automated DALK patients.

Visual results were better with automated DALK than with either manual DALK or PK, Prof. Tan said. Of the automated DALK group, 52% had 20/20 vision, 76% had 20/30 vi-sion and 86% had 20/40 vision post-operatively.

HONG KONG – In cases where there is a loss of barrier between the ante-rior chamber and vitreous, an artifi cial posterior chamber can help maintain a safe cataract surgery, according to a speaker here.

Kenneth Lu, MD, described his ar-tifi cial posterior chamber technique as a means to help avoid bigger problems in cases where there is a loss of barrier between the anterior chamber and the vitreous.

In cases of posterior chamber rupture during phaco, the artifi cial posterior chamber can help surgeons avoid more diffi cult and potentially harmful previ-ous solutions such as enlargement of the incision and conversion to an extra-capsular technique which can lead to a diffi cult closure, postoperative astigma-tism or cystoid macular edema, Dr. Lu said. Continuing phaco after posterior chamber rupture risks pulling vitreous into the anterior chamber, causing reti-nal traction or dropping the nucleus.

For these cases, Dr. Lu has reshaped

a lens glide into a head and shoulder style confi guration that is foldable. His goal is to maintain a small incision site while still being able to create a tem-porary barrier between the anterior chamber and vitreous.

“The head stays inside the eye and acts as a barrier, and the shoulder al-lows the lens guide to stay in place without advancing further into the eye,” Dr. Lu said. “Basically, you just fold it like an IOL and then insert it underneath the cataract. You will need a lot of viscoelastic in the eye in this situation. The temporary barrier al-lows you to continue phaco as usual.”

At that point Dr. Lu pulls the lens guide from the eye without the need of refold-ing because of the slope of the design.

“This method allows for successful completion of phaco after rupture of the posterior capsule when there are still some fragments left,” Dr. Lu said.

Dr. Lu added that it is important to identify the rupture quickly before the lens drops for this method to work.

Artifi cial posterior chamber saves capsular rupture cases during phaco

WOC DAILY | Day 3 July 1, 2008 15

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HONG KONG – Posterior-assistedlevitation is the preferred method to retrieve a nucleus or dropped posterior chamber IOL that has fallen into the posterior chamber during phacoemul-sifi cation, according to a surgeon here.

Soon-phaik Chee, MD, of the Sin-gapore National Eye Center, described her method and gave pearls for poste-rior-assisted levitation or PAL at the World Ophthalmology Congress here.

In her method, originally described by Charles D. Kelman, MD, in 1996, Dr. Chee fi rst fi lls the anterior cham-ber with dispersive viscoelastic. Then she inserts a 1-inch, 25 gauge needle through a 3.5-mm incision in the lim-bus and guides the needle behind the nucleus or IOL. The needle is carefully inserted behind the nucleus. Dr. Chee does not inject any more viscoelastic until the nucleus is guided back into

the anterior chamber and retrieved. “The procedure must be performed

as soon as possible, and the nucleus

fragment or PCIOL must be identifi -able through a surgical microscope,” Dr. Chee said.

“You must be very careful when put-ting the needle in, and observe in what direction the lens has descended, so that the needle can best support it,” she said.

“Move the eye in the direction of the fragment using forceps, and indent the sclera with a cotton tip,” she said.

She said she introduces a Sinskey hook to position the fragment in the anterior chamber “OVD trap” while the needle is being removed.

Dr. Chee offered surgical pearls for this technique including the suggestion to bend the distal shaft of the needle; avoid injecting viscoelastic into the vit-reous cavity; delay vitrectomy until af-ter removal of the nucleus fragment or PCIOL; to attempt PAL only once; and to seek a retinal consult postoperatively to check for any retinal tears that may have occurred.

PAL is contraindicated if the sur-geon cannot see the fragment, if the nucleus or IOL is touching the retina, or after a single attempt has failed.

Dr. Chee reviewed cases at the SNEC between 1996 and 2006. She found 2 out of 14 cases had a complication. One case had a macula-off pseudophakic inferior retinal detachment at 20 months. The other was minor and resolved.

Posterior-assisted levitation best solution for dropped nuclei

The procedure must be performed as soon as possible, and the nucleus fragment or PCIOL must be identifi able through a surgical microscope.−Soon-phaik Chee, MD

WOC DAILY | Day 3 July 1, 200816

HONG KONG – Carefully selected IOLs in conjunction with femtosec-ond-fl ap creation and wavefront-guid-ed LASIK can assist surgeons in their quest to provide spectacle indepen-dence for patients, according to a sur-geon speaking here.

Michael C. Knorz, MD, explained his approach to bioptics using IntraLase (Advanced Medical Optics) and a vari-ety of phakic and multifocal IOLs at the World Ophthalmology Congress.

“Phakic IOLs or diffractive multifo-cal IOLs can be combined with Intra-Lase fl ap creation and … wavefront-driven ablations to achieve perfect vision,” he said.

He said his approach consists of offering an IOL and subsequent re-fractive surgery to correct residual re-fractive error as a package so patients know what to expect.

Yet he cautioned that “the multifocal and phakic IOLs work only if a patient is ametropic,” because the goal is for the pa-tient to achieve spectacle independence.

Dr. Knorz said he has two main approaches to bioptics. The fi rst is to perform customized LASIK with the Visx Star S4 excimer la-ser (Advanced Medi-cal Optics) about 3 months after IOL im-plantation if there is unexpected refractive error.

“This is if there is [preexisting] corneal astigmatism less than 2 D because I feel I can manage the astig-matism with my inci-sion during the sur-gery,” he said.

The second option is geared for patients with preexisting astigmatism greater than 2 D. Dr. Knorz said he does not expect to be able to eliminate that level of astigmatism in the course of the IOL implantation, and antici-pates having to do another refractive

procedure later. In these cases, he creates an Intra-

Lase fl ap prior to IOL implantation but does not lift it. He performs custom LASIK 3 to 4 months later.

He opts for custom LASIK because it “provides a perfect match of the

measured and treated area and this gives you better astigmatism cor-rection.”

“If you have just 10° of error at the axis that means 30% under correction. In these patients it’s very im-portant that we align treatment and mea-surement areas and this is only possible custom LASIK,” he said.

Custom LASIK compensates for cyclo-torsion as well as chang-

es in the pupil center position, he said.One caveat Dr. Knorz offered is

that wavefront-guided LASIK works with diffractive IOLs such as the Tec-nis (AMO) or ReSTOR (Alcon) but not with a refractive IOL such as Re-Zoom (AMO).

Congenital cataracts successfully removed with 25-gauge vitrectomy toolsHONG KONG – Use of 25-gauge vit-rectomy tools in pediatric patients was successful for removal of congenital cataracts, a surgeon said here.

“Our opinion is that the 25-gauge system confers several advantages. It’s a very safe procedure and it allows for precise control of surgery,” Kevin YH Chee, MBBS,said. “Issues with instrumen-tation are not signifi cant and we feel this system really does make a huge difference.”

The retrospective noncomparative case series looked at 20 eyes of 14 pa-tients, in whom surgery was performed at a mean age of 14 weeks.

“We did surgery as early as 10 days

and as late as 48 weeks,” Dr. Chee said. Each of the patients underwent diag-

nostic screening to look for an under-lying cause for the congenital cataract. Fifty percent had no obvious cause.

The technique involved making two limbal side port incision approximately 120° to 180° apart, Dr. Chee explained. He said these ports could be made with a trocar from the 25-gauge vitrectomy pack or a separate 0.6 mm knife.

Dr. Chee said the fi rst 17 cases were performed with the trocar and 16 of these cases had wound leaks, but in the last three procedures, the surgeons used the knife and did not have any leakage.

The patients underwent anterior cap-sulotomy, lens aspiration, posterior cap-sulotomy and anterior vitrectomy and were left aphakic, he said. The wounds were hydrated and sutured. Postopera-tively, all of the patients received treat-ment for amblyopia, Dr. Chee said.

“Of our 20 cases we were able to successfully complete the surgery in 95% of patients,” he said. One case had a fi brous anterior capsule that re-quired the surgeon to switch to a 20-gauge system, Dr. Chee explained.

There were no intraoperative com-plications and mean follow-up was ap-proximately 18 months, in which no major complications occurred except one eye developed ocular hyperten-sion, he said.

Kevin YH Chee

Understanding choices in bioptics will greatly enhance outcomes

Michael C. Knorz, MD, explainedhis approach to bioptics.

WOC DAILY | Day 3 July 1, 2008 17

HONG KONG – Laser peripheral iridotomy is an effective treatment for patients with primary angle-closure glaucoma patients and can be consid-ered a primary procedure for the dis-ease, a physician said.

Tin Aung, PhD, FRCS(Ed), FR-COphth, spoke at the World Oph-thalmology Congress meeting here. He said that while laser peripheral iridotomy requires close monitoring in follow-up for possible progression or increased IOP, and then further treat-ment if indicated, it appears to be an effective surgical option to lower IOP in primary angle-closure glaucoma (PACG) patients.

“Laser peripheral iridotomy is recom-mended fi rst therapy for primary angle closure glaucoma,” Dr. Aung said.

He cited a consensus reached by the

World Glaucoma Association (WGA) regarding laser peripheral iridotomy and other surgical options for patients with PACG. Dr. Aung was a co-chair of the WGA consensus meeting.

The WGA found that laser peripheral iridotomy is a pro-phylaxis against acute angle closure and can be performed on an outpatient basis, Dr. Aung said.

“This outpatient basis will allow time to undertake elective surgery in those with uncontrolled IOP, those with advanced disease or with co-exist-ing cataract,” he said.

In addition to iridotomy, new medi-cal treatments are also viable options for the treatment of patients with PACG, signifi cantly reducing IOP, Dr.

Aung said. However, compliance is-sues still remain with drugs, he said.

Other surgical options for PACG include trabeculectomy, combined surgery, glaucoma implants, gonio-synechialysis and cyclodestructive pro-cedures, Dr. Aung said.

He said the aim of all treatment for patients with PACG, whether surgical or medical, is to pre-vent optic nerve damage, visu-al fi eld loss and progressive an-gle closure. The indications for surgery, he said, include IOP not reaching the target pres-sure, lack of patient adherence to the medication regimen, co-existing cataract and possible

progression of synechia closure.More prospective studies are needed

to determine long-term safety and effi -cacy of other surgical management treat-ments for patients with PACG, he said. Extended studies on lens extraction and goniosynechialysis are especially need-ed to explore their viability as treatment options, Dr. Aung said.

Professional Congress Organizer:(PCO )Porstmann Kongresse GmbHpco@woc2010.de

Venue:ICC Berlin

www.woc2010.dewww.dog.org

WOC® Organizing Committee:

Congress PresidentProf. Dr. med. Gerhard K. Lang

Congress General SecretaryProf. Dr. med. Anselm Kampik

Congress TreasurerProf. Dr. med. Jochen Kammann

Scientific Programme DirectorProf. Dr. med. Gabriele E. Lang

DOG Managing DirectorDr. Philip Gass

WOC® 2010ICO (Sponsor)DOG (Host)AAD (Co-Host)

WOC® 2010 See you

World Ophthalmology Congress5-9 June 2010 Berlin, Germany

XXXII International Congress of Ophthalmology (ICO)108th DOG Congress (German Society of Ophthalmology)AAD Congress 2010 (German Academy of Ophthalmology)

in conjunction withFEOph (Federation of European Ophthalmology)SOE (European Society of Ophthalmology)AAO (American Academy of Ophthalmology)DOC (German Ocular Surgeons)

Iridotomy viable treatment option for patients with PACG

Tin Aung

WOC2008HONG KONG

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