Research updates at three ESCRS Symposia, Nice

By Roibeard O’hEineachain

The latest advances in cataract surgery and the treatment of ocular surface disorders and presbyopia will feature in three of the main symposia at the XX Congress of the ESCRS in Nice this year.
In the symposium entitled Unsolved Problems of Cataract Surgery (Sunday, 8th September 11.00 a.m. to 1.00 p.m.), chaired by Albert Galand MD, Belgium, presenters will examine the more persistent obstacles to an ideal visual outcome in cataract patients.

Portuguese ophthalmologist José Cunha-Vaz MD, PhD will discuss the latest research into the aetiology, diagnosis and treatment of macular oedema as well as the optimal means for preventing the condition.

Marie-Jose Tassignon MD will provide an overview of the theoretical considerations involved in restoring accommodation to cataract patients. She will describe the problems encountered with current approaches, such as multifocal and accommodative IOLs, and suggest ways to overcome them.
Italy’s Roberto Bellucci MD will discuss the problems of optical aberrations in the pseudophakic eye which IOL manufacturers have only lately begun to address. In particular he will describe his own results with the latest IOL designs which can correct for the positive spherical aberration of the cornea.

He will also suggest ways in which corneal topography might be used to provide an individual customisation of that approach.

Philippe Sourdille MD, France, will examine the under-researched topic of the iatrogenic ageing of the vitreous and retina in the pseudophakic eye. He will discuss the effects that cataract surgery and refractive lens replacement can have on the posterior segment, including vitreous detachment, vitreous modification and the acceleration of macular degeneration.

New York-based ophthalmologist Olivia Serdarevic MD will highlight recent innovations in IOL materials and designs to address unsolved problems related to ease of insertion, incision size, wound healing, immune response, optical quality and refractive stability.

The UK’s David Spalton MD will address the question Does the IOL material matter? He will describe the behaviour of different IOL materials in the eye with regard to PCO, anterior capsular opacification and the inflammatory cell reaction to the implant.

Dr Albert Galand will summarise the current state of affairs with posterior capsule opacification. He will suggest how improvements in surgical technique and the use of capsular rings and new designs of IOL may further reduce its incidence.

Irish ophthalmologist Peter Barry MD will review the latest research on the aetiology of acute postoperative endophthalmitis in cataract surgery patients. He will also describe the ESCRS study, planned to begin in October of this year, which will involve 30,000 patients and will compare the incidence of endophthalmitis with and without intraocular antibiotics.

And finally Swede Bo Philipson MD will discuss how the establishment of standard guidelines in training will help to avoid mistakes and improve the quality of cataract surgery.
New approaches to ocular surface disorders

In the symposium entitled "Ocular Surface Disorders" (Monday, 9th September, 11.00 - 13.00), chaired by Spain’s Josep Güell MD will cover a broad range of techniques for restoring a damaged corneal surface.

British specialist John Dart MD will discuss the various approaches to ocular surface reconstruction after the eye has been severely damaged through trauma, alkali burns or disease. He will describe his experience with limbal transplantation, amniotic membrane, conjunctival transposition and corneal transplantation.

Another British ophthalmologist, Harminder S Dua MD, will provide an update on auto- and allo- limbal transplantation in stem cell reconstruction. His presentation will cover the latest research into auto grafts, allografts from living relatives and from cadaver eyes, as well as ex vivo expansion of donor-derived limbus cells.

Francois Malecaze, MD, France, will describe in further detail some of the progress that has been made in culturing limbal stem cells in the laboratory and explain some of the problems involved in actually transporting the cells to the recipient eye.

Dr Güell will review the worldwide clinical experience using amniotic membrane in for a range of different indications including epithelial disease after limbal surgery, penetrating keratoplasty in high risk cases pterygium surgery where amniotic membrane can be useful in restoring the ocular surface
German Chris Lohmann MD and the UK’s C McGhee MD will talk about the importance of the epithelial layer in corneal refractive surgery, focusing mainly on the ability of the epithelium to restore the corneal contour.

Joseph Colin MD, France, will discuss new medical approaches in the management of corneal herpetic disease and Gunther Grabner MD, Austria, will present an update on keratoprosthesis.

Presbyopia - the next frontier
Ophthalmologists concerned about how they should treat the next big wave of patients - the presbyopic baby-boomers - should gain a lot of useful and up-to-date information from the symposium entitled "Understanding of Presbyopia and Accommodation" (Wednesday, 11th September, 11.00 - 13.00), chaired by Ioannis Pallikaris MD, Greece. They can also expect a lively debate on the Helmholtz versus Schachar controversy.

The US’s Ronald Schachar MD will present his theories about presbyopia and how accommodation can be restored with scleral expansion bands. He will also describe their use in glaucoma, a possibility which arose from the serendipitous discovery that the bands appear to lower IOP.

Japanese ophthalmologist Hideharu Fukasaku MD will explain his modified version of Schachar’s theory and review recent advances in silicone expansion plug implantation in deep sclerotomy over the ciliary body for the correction of presbyopia.

George Kymionis MD, PhD, Greece, will suggest ways of improving the sclerectomy approach.

George Baïkoff MD, France, will describe his results with supraciliary segments to correct presbyopia, but will suggest a different mode of action for the scleral approach that supports conventional Helmholtz theory. He will also describe the results of ongoing trials with his Vivarte presbyopic IOL.
Continuing on the IOL theme, American specialist Stuart Cumming MD will trace the history of the development of an accommodating intraocular lens, the CrystaLens and will present the latest clinical results with the lens.

Germany’s Burkhard Dick MD will discuss changes in refraction and aberrations after implantation of accommodative IOLs.

Sophia Panagopoulou BSc, Greece, will explain how the Asclepion Aberrometer can be used to improve the understanding of the accommodation, and Dr Ioannis Pallikaris will conclude the symposium with a presentation on dynamic refractometry for the evaluation of the accommodation process.

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