Today's news from the 2010 APAO meeting brought to you by EyeWorld magazine.Preventing corneal graft rejectionOver the last 15 to 20 years, the survival of major organ transplants has improved significantly. Unfortunately, the same can't be said of corneal transplants. The problem is that the pharmacological immunosuppression that has been the mainstay for preventing rejection in major organ transplants has too many serious adverse effects to justify use for preventing corneal graft rejection, which, strictly speaking, isn't a life-threatening condition, said Sonja Klebe, M.D., in a lecture on molecular interventions in corneal graft rejection delivered at a symposium on the hottest topics in ocular pathology held Sunday. As a result, the approach to preventing corneal graft rejection has generally revolved around modifying surgical technique. SICS vs. phacoNo one can question the value of phacoemulsification technology in cataract surgery. However, in developing countries, manual small incision cataract surgery (SICS) continues to have a "big role," said Ravindran Ravilla, M.D., Aravind Eye Care System, India. The procedure, he said, is most suitable for the advanced, hyper-mature cataracts seen in rural areas around the world that generally cannot be dealt with using phaco, or at least not without causing some degree of endothelial damage. Dr. Ravilla chaired a symposium Saturday which focused on SICS techniques. SICS provides a safe, straightforward technique that requires no special equipment other than the most basic instruments of ophthalmic surgery; this alone makes SICS the obvious choice for any serious public health program aimed at eradicating cataract blindness. Some may wonder if cataract patients aren't being shortchanged when surgeons resort to this decidedly less advanced mode of cataract surgery. The answer, according to data presented by Geoffrey Tabin, M.D., University of Utah, is a resounding "No." In a head-to-head comparison of phaco and SICS, with the techniques performed respectively by David Chang, M.D., and Dr. Ruit to treat 180 "typical cases"—patients with hyper-mature cataracts in Nepal—SICS was comparable in terms of safety. It also showed a distinct advantage in terms not only of cost, but also of ease, time, and visual outcomes in these cases. About 70% of the Nepalese patients who underwent phaco in Dr. Chang's hands achieved 20/60 or better vision; more than 90% achieved 20/60 or better after SICS with Dr. Ruit. Preventing fireworks eye injuriesAmong those with ocular injuries due to firecrackers in India, minors, those hurt by unexploded firecrackers, and those injured by falling rockets experienced the worst visual outcomes, according to a congress poster presented by Sanjoy Chowdhury, M.S., D.O., Senior Deputy Director, Bokaro General Hospital, India. In one study of 82 eyes of 66 patients admitted between 2000 and 2005 for fireworks-related eye injuries in one hospital in India, 60% were hit by rocket-type firecrackers and the mean age was 14 years. Ten percent of eyes experienced severe injuries "mostly due to falling rocket stick and unexploded crackers," the poster reported.
Dr. Chowdhury also shared U.S. data on fireworks injuries, which have been studied rigorously, to offer further insights. Eyes are involved in 20% of fireworks injuries, with bottle rockets accounting for 2/3 of them. A third of the eye injuries result in permanent blindness. "Half of those who receive eye injuries are simply bystanders," Dr. Chowdhury reported. Children who are left unsupervised also are 11 times more likely to receive fireworks injuries. Unfortunately, injuries involving firecrackers also are more than visually threatening; they're also life threatening. "In 1999, nineteen people died from fireworks-related injuries," Dr. Chowdhury reported. Early intervention for visually impaired children neededVisual impairment in children negatively affects a variety of functions, including communication, interaction, motor functions, spatial concepts, object permanence, orientation in space, incidental learning, and language, according to Lea Hyvarinen, M.D., Ph.D., Technical University of Dortmund, Finland. "With appropriate early intervention, the development of visually impaired infants/children can be kept close to normal development milestones," Dr. Hyvarinen reported in a congress poster.
Once visual impairment is determined, selected hospital nurses can train mothers/fathers to support the child's development, Dr. Hyvarinen reported. "Nurses can also function as liaisons to local federations or associations of the blind, facilitating a connection to continuing services and contact with families of visually impaired infants and children." Although the early months of visually impaired children are important in terms of supportive instruction, the need for assistance continues. "The need for support continues through other potential crisis times such as the start of kindergarten and school," Dr. Hyvarinen reported.
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