HONG KONG – Even though science has advanced in devel-oping therapies to treat diabetic retinopathy, public education is needed to help reduce the disease, a physician said here.

“The human factor in prevention of diabetic retinopathy is important – the eating habits, the exercise patterns, knowledge and self-discipline,” Ian Constable, AO, MBBS, FRACS, FRACO, FRCS(ED) said. “Whether ophthalmology can have any impact on those cultural factors remains to be seen.”

Dr. Constable spoke about diabetic retinopathy and its causes at the Arthur Lim Lecture. He received the Arthur Lim Award at the Asia-Pacifi c Academy of Ophthalmology Symposium held here at the World Ophthalmology Con-gress meeting.

He outlined the historical change in the world’s food supply with the introduction of mass-produced sugar 135 years ago. He said the increase in processed sugars in packaged foods,

HONG KONG – Remarks delivered during the opening ceremony Sunday conveyed a sense of pride with Hong Kong serving as host of the World Ophthalmology Con-gress, but acknowledged a tinge of sadness over recent tragedies that have beset the Chinese people.

After the leaders of doz-ens of international societies fi led in front of several thou-sand audience members in the ceremonial procession-al, Dennis SC Lam, MD, FRCOphth, president and organizing chairman of the WOC, told attendees in his

Opening ceremony speaks to pride of Hong Kong’s shining moment

Increased public awareness of DR needed for prevention

WOC DAILYA Special Presentation of

Day 2 June 30, 2008

‘Bag-in-the lens’ IOL SafeNew IOL safe due to its minimal contact with biomaterial.

PAGE 4

Microincisional Techniques ComparableSurgeon reports similar quality of incisions in bimanual microincision surgery and microincision coaxial phacoemulsifi cation.

PAGE 14

Bevacizumab Benefi tBleeding reduced, visual outcomes improved in diabetic vitrectomy procedures following preop use of bevacizumab.

PAGE 16

Anticipating AMDUnderstanding risk factors for AMD assists clinicians in preventing progression to symptomatic disease.

PAGE 8

Highlights

Featured Activities

9:00-10:30APAO Symposium and AwardsTheatre 2

11:00-12:30SEAGIG Symposium: Angle-Closure Glaucoma Theatre 1

16:00-17:30Live Surgery: Modern Sutureless Manual Cataract Extraction Convention Hall A&B

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。

Bruce E. Spivey, MD, MS, MEd, ICO president; John Tsang Chun-Wah, JP, acting chief executive, Hong Kong Special Administrative Region; Dennis SC Lam, MD, FRCOphth, WOC president and 2008 organizing chairman; and Yasuo Tano, MD, APAO president and ICO treasurer, stand with their hands on the ceremonial “pearl” to com-mence the 31st World Ophthalmology Congress.Ceremony, continued on page 3

APAO, continued on page 4

WOC DAILY | Day 2 June 30, 2008 3

opening speech that he “stands before you with mixed emotion.”

“As a global citizen and as a Chinese, my heart goes to the people affl icted with pain in China,” he said, referring to the snow storms and earthquakes in recent months that left death and destruction in their wake. He asked the audience to observe 1 minute of silence.

Striking a lighter tone, Prof. Lam congratulated the organizers of the con-gress for its success, calling the WOC the “Olympics of ophthalmology.”

Just as Beijing lost to Sydney in 1994 in its bid to host the 2000 Olympic Games, Hong Kong also lost to Sydney in its bid to host the WOC in 2002, he said. Yet this year Hong Kong is host-ing the WOC and Beijing will host the summer Olympics in August.

“There is a saying that failure is the mother of success, which is coinciden-tally applicable to … both Olympics,” he said.

Prof. Lam’s comments were followed by those of John Tsang Chun-wah, JP, acting chief executive of the Hong Kong Special Administrative Region, who discussed how the WOC started in 1857 with a meeting of 150 ophthal-mologists in Brussels.

“At that time, Hong Kong was little more than a fi shing village on the China coast. How things have changed,” Mr. Tsang said. “This year, the con-gress brings together some 10,000 eye specialists from around the world, including 3,000 from mainland China. And Hong Kong has evolved from a little fi shing village into a mod-ern, international business and fi nancial center that is the event capital of Asia.”

Bruce E. Spivey, MD, MS, MEd, the ICO president, and Yasuo Tano, MD, Asia-Pacifi c Academy of Ophthal-mology president, also offered welcom-ing remarks. Dr. Spivey noted that the

Olympic slogan of “One World, One Dream” is also applicable to the WOC.

“I challenge every one of us to com-mit [ourselves] … to the eradication of blindness, particularly in developing countries,” he said.

The speeches were followed by an award presentation ceremony and performances in Chinese martial arts, traditional “face changing” and a fl uo-rescent dragon dance.

HONG KONG – A specially designed “bag-in-the-lens” IOL is safe and effec-tive in pediatric cataract cases due to its minimal contact with biomaterial, the lens’ developer said in a presentation here.

Marie-Jose Tassignon, MD, said the new IOL was developed specifi cally for chil-dren to minimize contact with biomaterial that can cause lens epithelial cell damage and the resulting loss of elasticity in the capsular bag.

Dr. Tassignon said she performs this implantation primarily for pediatric cataracts, which is what she encounters in European children.

The three pieces of the lens create a groove around the optic and between the haptics where the IOL can secure the edges of both the anterior and posterior capsulorrhexis, leaving the only contact of the lens with the capsular bag edges.

The surgical procedure to implant the lens consists of standard cataract

removal with the exception of her technique for anterior and posterior capsulorrhexis, which she performs with the aid of a specially designed

tension ring, she said. Dr. Tas-signon described the unique aspects of the procedure. She admitted that the procedure required more skill and was more diffi cult than standard cataract removal procedures.

After removing the cataract, Dr. Tassignon said she does not fi ll the capsular bag with visco-

elastic, but instead she places viscoelastic in front of the anterior capsule to force the anterior and posterior portions of the bag together and then she cleans the bag with both capsules touching.

Dr. Tassignon performs her ante-rior chamber capsulorrhexis with the aid of the ring and then uses the ante-rior chamber capsulorrhexis outline to guide her creation of a posterior capsu-lorrhexis of the same size.

“The vitreous body behind the cap-

sule is very important because it is the space used to implant the posterior part of the haptic,” she said.

“The posterior capsule comes out more anteriorly and close to the border,” she said.

The lens size is selected based on preoperative biometry using the lens sizing formula of Abhay R. Vasavada, MD, she said.

Dr. Tassignon said that in almost all cases she has implanted, at postop fol-low up, the axis remains clear provided both capsules are in the groove.

“I had one case where I didn’t look carefully enough to ensure the ante-rior and posterior portions were in the groove and an opacifi cation of the lens developed,” she said.

The advantage of using this IOL is that the capsular bag remains fl exible and the lens can be reimplanted, she said.

“The technique doesn’t allow epi-thelial cells to migrate into the capsule, which is sealed and within the lens haptic,” she said.

New IOL safe, eff ective in pediatric cataract cases

Marie-Jose Tassignon

continued from page 1

Ceremony

A performance of “face changing,” or Bian Lian, an ancient Chinese dramatic art, was presented at the conclusion of the WOC 2008 Opening Ceremony.

WOC DAILY | Day 2 June 30, 20084

coupled with change from a labor-inten-sive culture to a predominately seden-tary culture, has contributed to what he called the type 2 diabetes “epidemic.”

Advances in ophthalmic medicine, including intravitreal triamcinolone and intravitreal vascular endothelial growth factor (VEGF), have scientifi -cally contributed to treating the disease, but the human behavioral element is still an important factor in preventing the disease, Dr. Constable said.

Also at the symposium, Ronald

LS Yeoh, MBBS, FAMS, FRCSE, FRCSG, FRCSE(Hon), FRCOphth, DO, was awarded the International Council of Ophthalmology Golden Apple Award for the Best Teacher in Clinical Ophthalmology in the Asia-Pacifi c Region 2008. The award is

presented to honor the work of edu-cators in ophthalmology.

Hugh Taylor, AC, MD, gave the Sir John Wilson Lecture at the sym-posium, speaking about the history of trachoma and how it can be prevented by improving facial hygiene.

Live Cataract Surgery SessionAttendees will have the opportunity to view three live cataract surgery demonstra-tions, with commentary by a panel of experts. Srinivas Rao, R Ravindran and Ying-peng Liu will moderate discussions following procedures involving sutureless large incision manual cataract extraction performed by Victoria Wong, Douglas Lam, San-duk Ruit, Dennis SC Lam and Alex Fan.

Monday, June 30 • Convention Hall A&B • 16:00 - 17:30

HONG KONG – Advanced surface ablation with mitomycin-C has shown a trend toward visual improvement in ametropic patients who have under-gone penetrating keratoplasty, accord-ing to a presenter here.

Michael A. Lawless, MB, BS, FRACO, FRACS, FRCOphth, pre-sented 3-month results from a study involving 44 eyes of 16 female patients and 26 male patients who had previous PKP. Dr. Lawless and two colleagues, Gerard L. Sutton, MB, BS, FRACO, FRACS, and Christopher M. Rogers, MB, BS, FRACO, FRACS, performed surface ablation using two excimer lasers: the LADARVision 4000 and LADAR6000 platforms (Alcon) in 29 cases, and the Allegretto (WaveLight) in 15 cases.

They applied mitomycin-C 0.02% with an 8-mm corneal sponge for an average of 35.45 seconds. Dr. Lawless reported on outcomes at 1 month and 3 months follow up, noting an overall “trend toward improvement.” He also said 100% of patients remained in the study through the 3-month follow up period.

“Our postoperative results at 1 and 3 months showed statistically signifi -cantly improvement of all parameters,” Dr. Lawless said.

Preoperatively, pa-tients had a mean sphere of -1.41 D, -4.93 D cyl-inder, -4.22 D spheri-cal equivalent, 46.42 D average K value and 6.27 D central corneal thickness cylinder. At 3 months, mean sphere had improved to -0.64 D and cylinder was -2.26 D. Average K value was 44.28 D at 3 months and central corneal thickness cylinder was 4.85 D.

Dr. Lawless also said there is a trend towards improvement in BCVA, in that 25% of eyes had 20/20 vision at 3 months postoperative compared to 10% preoperatively.

“There is a trend toward improve-ment in visual acuity and that trend tends to increase with time,” he said. “We had excellent follow up at 3 months, and that tends to trail off, but anecdotally, certainly [the improve-ment in visual acuity] with surface treatment continues at 12 months.”

Dr. Lawless compared these results to a previous study he helped conduct that evaluated LASIK to treat myopia and astigmatism following penetrating keratoplasty. That study, published in

1999 in the British Journal of Ophthal-mology, evaluated 26 eyes that under-went LASIK with a variety of micro-keratomes. In comparing the 3-month results of both studies, Dr. Lawless and colleagues found the results with ad-vanced surface ablation to be superior.

“If you go to 3 months … there is a statistically signifi cant difference. [Ad-vanced surface laser ablation] patients were statistically better than LASIK patients in spherical equivalent and re-fractive astigmatism,” he said.

As more research is conducted in this area, one question that will need to be answered is whether or not topogra-phy-guided treatment would yield bet-ter results.

Advanced surface ablation superior to LASIK in post-keratoplasty patients at 3 months

Presented here are Chairs Dimitri Azar (5th from left), Peter J. McDonnell (far left) and Emily Yeung (6th from left), who with their colleagues presented the Management of Refractive Sur-gery Complications during yesterday’s scientifi c program.

continued from page 1

APAO

WOC DAILY | Day 2 June 30, 200866

2008香港世界眼科学术大会简介“世界眼科学术大会(World Ophthal-

mology Congress, WOC)”由国际眼科

理事会(International Council of Oph-

thalmology, ICO) 于1857年创办，易

名前称为国际眼科会议，是历史最悠

久的国际医学会议。也是全球最大规

模的眼科会议，每两年举行一次，旨

在促进相关眼科学学术水平的发展。

2008年的世界眼科大会是WOC第

三十一届大会，同期将举行“第二十

三届亚太地区眼科学术大会”、“第十

三届中国眼科学会年会”及“第二十

届香港眼科学术交流大会”。本次大会

是150年来首次在香港举行的眼科界盛

会，香港特别行政区处理行政长官曾

俊华先生应邀主持开幕典礼。

本次大会预计有超过10,000名来自

110多个国家/地区的代表云集香港，

会议设立的各种科学研讨内容可为世

界各地眼科医生提供一个难得的学术

交流机会。

连续五天的会议将占用几乎所有

香港国际会展中心的场地，会议邀

请了1,140名国际著名眼科专家，就

28个不同的眼科专题，分别在314个

科学研讨会上进行演讲，为中国大陆

参会者的需要，主办机构更特设了由

英文至中文的同声传译服务。

此外，148家来自15个国家/地区的

公司将会于同期举行的展览会上展示

他们的最新产品，包括各种设备、仪

器、植入物、激光技术、药物及刊物

等。

香港是一个充满活力的国际大都

市，连系世界各地，对举办大型国际

会议经验丰富。国际会展中心坐落于

景致迷人、闻名中外的维多利亚港，

拥有完善的会议展览场地、物流和通

讯设施，交通便捷，可租用总面积达

七万平方米，可举行世界级的大型展

览及国际会议。这些都是保证本次大

会成功的重要因素。相信在大会全体

组织者及参会者的共同努力下，本次

大会一定能取得圆满成功。

视觉生理和视觉科学学组部分

学术亮点

2 0 0 8 世 界 眼 科 学 术 大 会

(WOC2008)暨中华医学会第13次全

国眼科学术大会视觉生理和

视觉科学学组部分共分为两

个单元，每个单元包括专题

讲座和自由论文，此次会议

将聚焦于近两年来在视觉科

学和视觉生理学两方面的重

大进展和研究热点，本次会

议学术亮点如下：

1.为促进香港与内地在视

觉生理和视觉科学方面的学术交流，

特邀香港中文大学眼科及视觉科学学

系Timothy Y.Y. Lai 教授做多焦视网膜

电图在评估药物性视网膜病变中应用

的专题讲座；

2.就当前多焦电生理的应用在学科

发展中仍处于薄弱环节，本次大会

将多焦电生理作为重点，对多焦在

青光眼、视路疾病和视网膜移植之

后功能检测进行多方面交流，期待

今后在学科交叉的探索研

究中进一步开拓创新；

3.视觉生理学作为眼科、

视觉科学和神经科学之间的

桥梁，本次会议将引入基础

科学的成熟技术和最新成

果, 将临床电生理与基础电

生理相结合，推动眼科临床

和应用基础研究发展，阴正

勤教授将做双眼形觉剥夺再激活成年

大鼠视皮层可塑性的机制研究的专题

讲座；

4.对功能性核磁共振fMRI在眼科疾

病诊断和治疗中的应用进行探讨，提

高眼科疾病的诊疗水平。

第13次全国眼科学术大会

角膜病组学术亮点角膜病学组参加本届眼科大会的学

术特点：

就全国投稿而言，质量较高的文

章仍集中在一些大学的附属医院和大

的专科医院。研究内容方面，以往重

视不足的大宗流行病学的文章数量增

加。临床方面，在我国主要致盲性眼

病，尤为感染性眼病的研究更加深

入。新的诊断技

术，如基因芯片已

在一些角膜病方面

开始尝试应用。此

次临床研究文章的

内容广泛，几乎包

括所有的角膜及眼

表疾病，特别是对

近年发病有上升趋势的过敏性结膜炎

的研究均有特色。

临床治疗方面，主要是一些传统手

术与现代手术的进一步结合，治疗各

类复杂的眼表及角膜疾病的研究。

基础方面，基因水平对一些角膜发

病机理的研究仍是主流，另外对角膜

瘢痕、角膜内皮的再生等，仍有较多

的涉足。

此次WOC的专家讲座，尽可能达

到继续教育的目的，所选的讲座题目

内容广泛，是临床上常见、多发病的

规范化治疗，同时结合这领域的最新

的研究成果的内容，均为这领域的知

名专家讲演。分析上届全国眼科大会

上，很多医生对疑难病人讨论反映良

好的经验。此项WOC上，继续保留

疑难病例讨论并增加了内容。

阴正勤教授

谢立信教授

WOC DAILY | Day 2 June 30, 2008 77

WOC DAILY | Day 2 June 30, 20088

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HONG KONG – Knowledge of eas-ily discernable risk factors for age-re-lated macular degeneration, such as

age, family history and smoking status, could help primary care physicians an-ticipate the disease in their patients, a presenter said here.

“We aimed to identify the major risk factors for late

AMD that could be evaluated by non-specialists like family doctors,” Paul Mitchell, MD, PhD, FRANZCO, said during the World Ophthalmology Con-gress, where he presented his meta-anal-ysis study of past research.

“I think the knowledge of these risk factors could assist physicians providing

primary health care to identify people at the greatest risk of progression to late AMD,” he said.

The meta-analysis considered major risk factors identifi ed in late AMD cases examined through many previous popu-lation-based studies, but excluded genet-ic and dietary factors as those could not be easily identifi ed by a non-specialist, Dr. Mitchell said.

Of the 16 risk factors analyzed, the meta-analysis identifi ed very strong; moderate but consistent; and borderline associations with late AMD.

Very strong correlations were seen with increasing age, family history of AMD, which showed an overall odds ra-tio of 3.7, current smoking status, which had a combined odds ratio of 2.0, and previous cataract surgery, with an odds ratio of 1.8.

Moderate, but consistent associa-tions were identifi ed with high body mass index, an odds ratio of 1.3 for a “relatively modest effect”; history of cardiovascular disease, which showed an odds ratio of 1.4; history of presence of hypertension, at an odds ratio of 1.3; and elevated plasma fi brinogen.

Borderline associations were seen with diabetes and dark iris color.

“I think this meta-analysis confi rms family history and smoking as key risk factors for AMD in addition to the known risk associated with increasing age and diet and genetic factors,” Dr. Mitchell said. “I think it also highlights the signifi cant risk of progression to late AMD after cataract surgery… And even though we need further long-term data, I think these are reasonably strong data already.”

Knowledge of general risk factors could help primary care physicians anticipate AMD

Paul Mitchell

Special Edition, No. 2 • 2008

CONTENT SPONSORED BY AN EDUCATIONAL GRANT FROM AMO

Innovative Design, Materials and OpticsMARK PACKER, MD, FACS

Today, the Tecnis 1-Piece IOL is the gold standard of aspheric optics with its -.27 microns of spheri-

cal aberration correction. Its high perfor-mance acrylic material, design and optics make this lens a good choice for surgeons and patients.

OpticsThe optical quality of the Tecnis optic is

the best that can be attained today. It is simi-lar to the young natural lens in the normal, healthy eye. The optic for the Tecnis 1-Piece IOL is essentially the same aspheric design as the time-tested 3-piece Tecnis that we have been working with for six years or more. This lens gives the least residual spherical aberra-tion of any of the aspheric lenses on a popula-tion average. It is closest to the mean in terms of correcting the widest range of corneal spherical aberration. As a clinical investigator

for the original Tecnis lens, I can attest to the high performance of this optic.

Materials & Design

The material used for this lens is the same proven hydrophobic acrylic as used with the Sensar IOL, which has a great track record for clarity. It is vacuole free with less glisten-ing. It also transmits blue light for scotopic sensitivity and healthy circadian rhythms.

The 1-piece platform is familiar and com-fortable for many surgeons. The Tri-Fix de-sign of the lens provides stability with three points of capsular bag fi xation. That means when it is placed in the bag it remains cen-tered and has excellent stability. Also, the lens has the 360-square-edge which prevents the

Mark Packer

Next-Generation PhacoHAN-BOR FAM, MD

U ntil recently, we have always needed to sacrifi ce some effi cacy in phacoemulsifi cation in order

to remove the cataract as safely as possible. Today, this compromise has been mini-mized with the WhiteStar Signature system from AMO. This system enhances effi cacy while actually making the procedure safer.

In addition to all the advanced power modulation we have come to expect from WhiteStar technology, the new Signature system also incorporates Fusion Fluidics, a powerful and responsive new approach to

fl uidics control that samples the anterior chamber frequently allowing the system to respond to change faster than the sur-geon can (Fig 1). It creates a cocoon-like anterior chamber (A/C) environment that is extremely stable, even with high power and vacuum settings and a low infusion bottle height.

With the smooth fl uidics, nuclear frag-

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

Innovations in Cataract Surgery

[Fam continued on page ii]

[Packer continued on page iii]

Han-Bor Fam

翻译见内文

REFRACTIVE SURGERY QUARTERLYii

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

ments are drawn quickly to the phaco tip and held there securely. But in the periphery, near the angles, iris, and posterior capsule, there is a pe-ripheral ring of relative calm and serenity. The po-

tential for surge, soft tissue damage, and posterior capsule break have been signifi cantly minimized.

The benefi ts of this stability in the anterior chamber are many. For the surgeon, there is less

stress and fatigue and the surgery be-comes more effi cient. With a stable A/C, we can expect fewer traumatic complications from surgery. Especial-ly with a lower infusion bottle, there is also less stress on the endothelium and zonules, which should result in less endothelial and zonular damage, reducing corneal edema and improv-ing vision after surgery.

I have also been able to routinely use a 2.2-mm micro-incision without fear of strangulating the infusion and causing A/C instability. More impor-tantly, I can use the same settings as in normal incisions and without the need to change my technique of sur-gery. The device responds so quickly that I do not worry about chamber collapse, so I can take advantage of smaller phaco incisions to induce less higher order aberrations.

All of these factors contribute to better outcomes and greater patient satisfaction. They give us the oppor-tunity to truly add value to the pa-tient experience, especially for those patients who have opted for pre-mium lenses. I believe that state-of-the-art phaco surgery is a pre-requi-site for premium IOL implantation because it provides the best chance of meeting the high expectations of our premium IOL patients.

Dr. Fam practices at Tan Tock Seng Hospital and

The Eye Institute in Singapore. Contact him at +65-

9635-6816 or famhb@singnet.com.sg.

IOL，

WhiteStar Signature

A/C

( )

[Fam, continued from page i]

Figure 1: With Fusion Fluidics there is approximately 56% less surge with a 20-gauge tip.

Figure 2: ELLIPS Transversal ultrasound technology allows the phaco tip to move in an elliptical fashion by blending the traditional longitudinal ultrasound motion with side to side, or transversal motion.

SPECIAL EDITION, NO. 2 • 2008: INNOVATIONS IN CATARACT SURGERY iiiiii

opportunity for lens epithelial cells to grow in at the haptic-optic junction. This has been known as the Achilles’ heel of the AcrySof single-piece acrylic. A frost-ed-edge design minimizes edge glare.

In addition, the Tecnis optic is on an easy-use, stable, one-piece platform. Some surgeons – myself included – have been implanting it through a 2.2-mm incision using the wound-assisted technique. This enables the surgeon to use a smaller inci-sion size, which is an advantage. The lens unfolds more slowly than the silicone lenses; therefore, it is an especially good choice if the surgeon has a case with any bag or zonular concerns and a gentler in-troduction of the IOL is required.

Overall, this exciting new lens com-bines the many benefi ts of the Tecnis 3-piece acrylic lens with the ease-of-implan-tation of a 1-piece platform.

Mark Packer, MD, is clinical associate professor of ophthal-

mology at Oregon Health & Science University, and in private

practice in Eugene. Contact him at mpacker@fi nemd.com or

visit his blog at http://www.fi nemd.com/theexpertview/.

[Packer, continued from page i]

建议修改为：

Tecnis一片式IOL的设计优点Tecnis一片式丙烯酸人工晶体有Tecnis三片式丙烯酸人工晶体的许多优点，并兼有一片式人工晶体容易植入的优点。

和三片式Tecnis IOL一样，该新型一片式人工晶体的目标是在大多数患者中实现零球差，改善患者的视觉质量，提供夜间驾车能力，并改善安全性。

该Tecnis IOL中使用的丙烯酸材料不含空泡，闪辉很轻。与传统的单片式IOL不同，该人工晶体植入到囊袋中后可保持居中性，并且稳定性极佳。

360。的后方形边缘及其独特的襻型设计可确保光学部与后囊紧密接触，降低后囊混浊(PCO), 并有助于居中性。磨砂边缘设计可减少边缘眩光。

Figure 1: The mesopic or dim light contrast sensitivity obtained with the Tecnis IOL is equivalent to the photopic or bright light contrast sensitivity obtained with a spherical IOL (AR40e).

Figure 2: The Tecnis optic provides higher peak contrast sensitivity than that of healthy normal subjects in their twenties.

Overall, this exciting new

lens [Tecnis 1-Piece IOL]

combines the many benefi ts

of the Tecnis 3-piece acrylic

lens with the ease-of-

implantation of a 1-piece

platform.—Mark Packer, MD

WOC DAILY | Day 2 June 30, 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

08-1705

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HONG KONG – Femtosecond laser technology has fi rmly taken root as an important tool in refractive surgery, however, an assessment of potential complications can hold valuable clinical lessons, according to one surgeon pre-senting here.

Roy S. Chuck, MD, PhD, presented an overview of his personal complication profi le from his fi rst 1,000 cases using the IntraLase femtosecond laser (Advanced Medical Optics).

Dr. Chuck has been using the Intra-Lase for approximately the past 5 years and “it now comprises 90% of my refrac-tive surgery practice,” he said during the World Ophthalmology Congress.

The fi rst complication Dr. Chuck outlined is an incomplete fl ap, which he said occurred in four cases of the 1,000-case series. He said these complications were resolved fairly easily by passing the

IntraLase again using the same patient interface. If the fl ap is lifted and adhe-sion is minimal, he suggested attempting blunt instrument lysis. If there is signifi cant adhesion, he recom-mends replacing the fl ap and performing PRK at a later date.

He described having “a few” cases of decentered or small fl aps, yet none were de-centered or small enough to abort the procedure. His solu-tion is to make a slightly larger fl ap of around 9 mm to 9.5 mm, because it is easier to accept a slight decentration than to recenter a smaller one, he said.

Dr. Chuck had two cases of slipped fl aps, as well as two cases of partially slipped fl aps induced by trauma. He said neither of the traumatically induced cases had to be re-treated.

The highest complication rate was

with diffuse lamellar keratitis, which oc-curred in 20 to 30 cases. All but one case was mild, and most were associated with power adjustments and upgrading to higher-frequency pulse engines.

The most interesting complication Dr. Chuck described was that of gas bub-bles in the anterior chamber. He said he

had two cases in the 1,000-case series, but since then has had between eight and 10 more cases.

He said these are of un-known etiology and are not related to fl ap perforation. He said once it is determined that there is no perforation, the excimer laser procedure may

proceed. Yet surgeons might experience some gas bubble interference with iris registration and pupil tracking.

Dr. Chuck said that since about 20% to 30% of all fl aps in the United States are made with IntraLase, “it’s a technology that appears is here to stay,” so surgeons should be aware of potential complica-tions and how to address them.

Assessment of femtosecond fl ap complications has clinical value

Roy S. Chuck

WOC DAILY | Day 2 June 30, 200814

HONG KONG – An analysis of the quality of incisions in both bimanual microincision surgery and microinci-sion coaxial phaco showed equivalent good incision quality in both proce-dures, according to a speaker here at the World Ophthalmology Congress.

Jorge L. Alio, MD, PhD, of the Vissum Institute in Alicante, Spain, presented the results of a study using the Visante OCT (Carl Zeiss Meditec) corneal incision analysis model on 25 eyes of 16 patients that underwent bi-manual microincision cataract surgery (MICS) and 25 eyes of 18 patients who underwent microphaco coaxial phaco-

emulsifi cation. Prof. Alio performed all surgeries and postoperative analy-sis was performed by an independent observer.

Prof. Alio said that the main differ-ence between the two surgeries is that MICS employs a sleeveless or unpro-tected phaco tip, while microphaco uses a sleeved or protected phaco tip. He noted that the bare titanium tip in MICS is potentially harmful to the incision wound. Prof. Alio said he performs MICS with a 1.2-mm inci-sion and microphaco with a 2.2-mm incision.

Incisional angle geometry assessed using Visante OCT showed “excellent quality in both groups with no statisti-cally signifi cant differences,” he said.

The only notable difference ob-served in the study between MICS and microphaco was less corneal edema in MICS cases at postop day 1.

“MICS showed less corneal thick-ness in an area of 3 mm and 5 mm of the cornea but only on day 1,” Prof. Alio said.

Prof. Alio noted that all other OCT

outcome parame-ters including top-ographic corneal and ocular aber-rometric variables did not differ sig-nifi cantly.

“At month 1, all of the incisions in both groups were perfect, without any gaping or endo-thelial bulge or Descemet’s detach-ment,” he said.

“MICS is associated with less cor-neal edema in the short-term outcomes and less induction of corneal aberra-tions in the long-term results,” Prof. Alio said.

Because incision quality has a tre-mendous influence on the overall outcome of cataract surgery, Prof. Alio said he found Visante OCT corneal incision analysis model use-ful in assessing the quality of the in-cisions in cataract surgery. He also noted that smaller incisions mini-mize trauma to the eye and create a better surgery.

Jorge L. Alio

Study: Bimanual MICS, microphaco incisions comparable

Spivey targets ‘big three’ goalsThe 2008 World Ophthalmology Congress, which built its foundation on education and fostering growth within the ophthalmic community, con-tinues that tradition, said Bruce E. Spivey, MD, president of the Interna-tional Council of Ophthalmology.

“We always look to have a superb educational program. On top of that there’s always a number of social events that allow interaction from those who are present from all around the world,” Dr. Spivey said.

His “big three” goals for the 2008 WOC are an “outstanding scientifi c program fi rst, outstanding social interactions second, and thirdly, enough money to support the programs of the ICO going forward,” he said.

Part of the Congress focuses on furthering existing programs within the ICO. The registration fees, for example, will largely go to help fund those programs and will also help to foster the growth of new programs, Dr. Spivey said.

“We have programs in Sub-Saharan Africa. We have programs interna-tionally. We’ve got a whole series of programs that are under way and that we’re underfunded to implement, but we’re doing it anyway,” he said. “So my expectations are the big three there. My hope is that this will be the best meeting ever. We like to have every successive meeting better than the last – and the last one was superb in São Paulo.”

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

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WOC DAILY | Day 2 June 30, 2008 15

Give SONOMED a call today and find out how the VuMaxTM can enhance your practice.(800) 227-11285 � www.sonomedinc.com

© Copyright 2008 Sonomed Inc., All Rights Reserved. Sonomed, Inc. is a subsidiary of Escalon Medical Corp

HONG KONG – Infants born from assisted conception, such as in vitro fertilization, are at a higher risk of needing treatment for retinopathy of prematurity than those born of natu-ral conception, a presenter said here.

“Assisted reproductive technology is not without its risks. About 50% of those babies born are born through multiple births,” Grace Sun, MD,said during the World Ophthalmol-ogy Congress. “Multiple births are associated with greater health risk for both mothers as well as infants. There’s an increased risk of [caesar-ean]-sections, of infant death and disability and, of course, of prema-turity and low birth weight… The singletons as well are born early and very light.”

“Of course when we hear prematu-rity and low birth weight, we always

think of ROP,” Dr. Sun said. “Our question was: ‘Is assisted conception associated with treatment-requiring ROP?’”

The study conducted was a retrospective study of 358 infants born and screened for ROP between June 2002 and August 2007. Of those infants, 135 of those were conceived via assisted con-ception.

The study showed a sta-tistically signifi cant relation-ship between assisted conception and ROP cases requiring treatment, Dr. Sun said.

Of infants with very low birth weight of less than 750 g, 11.54% of natural conceptions required ROP treatment while 45.45% of assisted conceptions required treatment. Of infants with

low birth weights between 750 g and 1,499 g, 2% of natural conceptions re-quired ROP treatment while 5.62% of

assisted conceptions required treatment.

“Assisted conception placed infants at a greater risk for ROP requiring treat-ment and the risk was high-er in the infants who were born of the lightest weight,” Dr. Sun said. “Very interest-ingly, the mean gestational age at which treatment was

required was higher for assisted con-ception patients rather than in natural conception patients.”

She continued, “In the future we hope to try and understand what it is about assisted conception that is asso-ciated with an increased risk of reach-ing ROP that needs treatment.”

Grace Sun

Assisted conception more than traditional results in more treatment-necessary cases of ROP

WOC DAILY | Day 2 June 30, 200816

HONG KONG – Preoperative injec-tions of bevacizumab seem to improve results of diabetic vitrectomy procedures, one surgeon showed here.

“Preoperative Avastin (bevacizumab, Genentech) appears to improve visual outcomes, decrease postop-erative complications and reduce postoperative proce-dures in this group of patients. It appears particularly useful in the more complex cases,” Maria Berrocal, MD, said during her presentation at the World Ophthalmol-ogy Congress.

Dr. Berrocal presented a prospective, randomized, unmatched study of 82 eyes of 80 patients. Of those patients, 41 were pretreated with 1.25 mg of Avastin,

4 days to 8 weeks prior to vitrectomy.Both groups were made up of pa-

tients with vitreous hemorrhage, trac-tion retinal detachment and rhegmatogenous retinal de-tachment and had similar baseline characteristics.

“Looking at the different etiologies, we saw better vi-sion in the Avastin group but it was more notable in the more complicated cases,” she said.

Final analysis showed 76% of eyes treated with bevacizumab had improved visual acuity, compared to 53% in the vitrectomy-only group. Mean visual acuity in the bevacizumab group was 20/100 and in the vitrecto-my group was 20/400.

Postoperative complications also

showed more residual vitreous hem-orrhage and more bleeding in the vit-rectomy-only group in all cases, Dr. Berrocal said. When looking at post-operative procedures, 69% of the vit-rectomy-only group needed additional treatments, she said.

“These surgeries were very chal-lenging in the past, and they’re still challenging now, but the biggest prob-lem was controlling bleeding during the surgery,” Dr. Berrocal said. “You can just cut all these membranes with-out signifi cant bleeding.”

“What’s interesting about these cases is that they become fairly avascu-lar,” she said. “It allows us to basically do these surgeries in a much simpler way than we used to.”

Dr. Berrocal said there are still un-answered questions regarding timing of the preoperative injection, whether there is a role of postoperative injec-tions and any unknown complications of bevacizumab.

Preop bevacizumab improves visualization in complicated diabetic vitrectomies

Maria Berrocal

HONG KONG – While glaucoma pa-tients with mild disease often do not complain of visual loss and appear to be asymptomatic, an analysis of ques-tionnaire results showed their quality of life is signifi cantly reduced com-pared to nonglaucomatous controls.

The prospective cross-sectional study looked at quality of life responses from 121 open angle glaucoma patients and 31 nonglaucomatous patients in a control group, according to Ivan Gold-berg, MBBS, FRANZCO, FRACS. He spoke at the World Ophthalmology Congress meeting here about the study, which he conducted with colleagues.

“Patients with mild glaucoma ap-pear to be asymptomatic, and may not report vision-related diffi culty, but compared with controls, even they ex-perience signifi cant reductions in qual-ity of life,” Dr. Goldberg said.

He said the study showed that early diagnosis and treatment are crucial to improving patients’ quality of life in all stages of the disease. Visual loss from

glaucoma progression is of-ten portrayed as occurring suddenly, he said, similar to “falling over a ledge” in visual ability. The reality might be closer to a gradual loss, pro-gressing steadily over time from onset of the disease, he said. That fi nding would ren-der early diagnosis and treat-ment especially important, Dr. Gold-berg said.

Asking patients to fi ll out the quality of life questionnaire could help physicians monitor patients’ progression from mild to later stages of the disease, he said.

“We should think about adminis-tering a simple questionnaire like the Glaucoma Quality of Life question-naire, which is freely available, so that we actually have the information about which patients are already hav-ing problems,” he said.

In the study, glaucoma patients in different stages of disease severity an-swered a condensed version of the

Glaucoma Quality of Life 15 questionnaire developed by Patricia Nelson, PhD, and her colleagues. The study divided patients into three groups ac-cording to disease severity, with 49 patients with mild glaucoma, 34 with moderate and 38 with severe.

After patients responded to the questionnaire, Dr. Goldberg and col-leagues scored for four subscale factors. Those subscale factors assessed central and near vision issues, such as reading and recognizing faces; tasks affected by peripheral vision, such as walking on uneven ground and steps; dark adapta-tion and glare, such as seeing at night; and outdoor mobility, such as crossing the road, according to Dr. Goldberg.

Patients with all stages of glauco-matous progression had diffi culty with those tasks, he said, showing that qual-ity of life signifi cantly decreased with progression of the disease, as well as in early stages.

Ivan Goldberg

Study fi nds that even mild disease impacts glaucoma patients’ quality of life

WOC DAILY | Day 2 June 30, 2008 17

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)

HONG KONG – A bleb leak that does not close spontaneously is a sign of hy-potony, and should be treated to prevent endophthalmitis, a glaucoma expert said.

Marlene R. Moster, MD, out-lined the causes and best treatment of hypotony at the World Oph-thalmology Congress meeting here. She said the incidence of hypotony, a serious, sight-threatening condition, has increased from 10% to more than 30%. Pinpointing why it has occurred and revising the bleb is important to treating the condition, she said.

“Treat hypotony associated with a bleb chamber in a timely manner,” she said. “Try conservative treatment fi rst, and then move on to surgical interven-tion if necessary.”

She said the fi rst line of treatment for the condition is bandage contact lens and antibiotics. Patching, changing topical steroid drops either up or down, cryotherapy or the use of Nd:YAG laser are also effective treatments, she said.

However, if a patient shows no improvement after those treatments, then surgical inter-vention is indicated, she said.

Hypotony occurs for nu-merous reasons, Dr. Moster said. A hole or leak in the bleb or overfi ltration can be main causes of the condition, she said. Overfi ltration, another

cause of hypotony, can happen because of various surgical factors, she said. Sev-eral causes involve performing surgical steps at the wrong times, including cut-ting too early with the laser or removing

releasable sutures too soon, she said. Also, not tying the fl ap down tightly

enough, or a suture that comes undone accidently, can also cause overfi ltration, Dr. Moster said.

Additional causes of hypotony can be aqueous suppression with the com-bination of beta blockers and carbonic anhydrase inhibitors, she said.

Wills Eye Institute, where Dr. Mo-ster is based, has devised a grading system to rate hypotony, she said. The fi rst grade is shallowing of the anterior chamber. The second grade is cornea-to-iris touch, but not with pupil-lens in-volvement, she said. The third and last grade is complete touch of lens, iris and cornea.

Dr. Moster called the fi nal grade an “ophthalmic emergency” that must be treated immediately.

Find causes for hypotony, take conservative approach to treatment fi rst

Marlene R. Moster

WOC2008HONG KONG

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