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Focus on the three C's - Cornea, chalazion & Cross Linking

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Surgical Partners
Surgical Partners

A presentation by ophthalmologist Dr Con Petsoglou at an optometrist CPD event on Cornea, Chalazion & Cross Linking

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Cornea, Chalazia & Cross-Linking DR C PETSOGLOU Tues 21st Oct 2014 UPDATE 1
Cross-Linking AIM: Prevent progressive corneal ectasia WHO: Keratoconus, kerectasia, pellucid marginal degeneration WHEN: Documented change in cornea â—¦ Increase in keratometry readings â—¦ Change in refraction â—¦ NOT in every keratoconus or newly diagnosed patient yet! ADVISE: â—¦ Very painful for 24hrs!!!! â—¦ 90% halt progression â—¦ Up to 50% may show some improvement in BCVA, Tues 21st Oct 2014 UPDATE 2
Tues 21st Oct 2014 UPDATE 3 Preop: UCVA 6/18 BCVA 6/9 Postop: UCVA 6/9 BCVA 6/6
Audit Results Of 15 Eyes at least 6 months follow up: â—¦ 3 Improved > 1D (1.6, 2.7, 3.5) â—¦ 4 Improved by 1D â—¦ 4 stayed the same +/- 0.5D â—¦ 3 Worsened (1.5, 1.8, 3.0) â—¦ 80% Improved or stable â—¦ 20% Progressed Tues 21st Oct 2014 UPDATE 4 0 10 20 30 40 50 60 AVERAGEKERATOMETRY Audit 15 Patients Preop Post-Op
Chalazia Tues 21st Oct 2014 UPDATE 5 Meibomian gland cyst / Infected = Hordoleum 57% pts >19yo for excision have Rosacea â—¦ Lempert SL Arch Ophthal 1979; 97: 1652-3 Low Serum Vitamin A in Children (China study) â—¦ Chen L et al Am J Ophthal 2014; 157(5):1103-8 MANAGEMENT: â—¦ Heat and Massage â—¦ Oral Antibiotics if infected: Doxycycline 50mg bd or Dicloxicillin 500mg qid â—¦ Topical Antibiotic No benefit â—¦ One RCT: H+M, Incision, Triamcinolone injection â—¦ 3 weeks: H+M 46%, Incision 87%, Triamcinolone 84% â—¦ Clinical and Experimental Ophthalmology, 2007;35(8):706- 12
Chalazia Demodex brevis story High prevalence of demodex brevis infestation in chalazia. Liang L. et al Am J Ophthal. 157(2):342-348.e1, 2014 Feb Skin Mite- Increasing prevalence with age Classic teaching – NOT Pathogenic DIAGNOSE: Eyelash epilation and view under microscope TREATMENT: ◦ 5 drops tea tree oil shampoo in ½ cup boiled water ◦ 1:4 tea tree oil with olive oil as scrub BUT: Some doubts still remain! Tues 21st Oct 2014 UPDATE 6
Cornea Lions NSW Eye Bank Waitlist for Corneal Transplants Wait time <3 Months WHY? 1. Organ Culture 2. Scheduled Surgery 3. 5 Coordinators 4. Hospice Planning Tues 21st Oct 2014 UPDATE 7 466472461 448440 407 351 320 285278 250 263 234223 200 227 204192181170 155151160161162 176178167162 0 50 100 150 200 250 300 350 400 450 500 Jan Feb Mar Apr May June Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May 2012 2013 2014 EBAANZ definition

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Focus on the three C's - Cornea, chalazion & Cross Linking

  • 1. Cornea, Chalazia & Cross-Linking DR C PETSOGLOU Tues 21st Oct 2014 UPDATE 1
  • 2. Cross-Linking AIM: Prevent progressive corneal ectasia WHO: Keratoconus, kerectasia, pellucid marginal degeneration WHEN: Documented change in cornea â—¦ Increase in keratometry readings â—¦ Change in refraction â—¦ NOT in every keratoconus or newly diagnosed patient yet! ADVISE: â—¦ Very painful for 24hrs!!!! â—¦ 90% halt progression â—¦ Up to 50% may show some improvement in BCVA, Tues 21st Oct 2014 UPDATE 2
  • 3. Tues 21st Oct 2014 UPDATE 3 Preop: UCVA 6/18 BCVA 6/9 Postop: UCVA 6/9 BCVA 6/6
  • 4. Audit Results Of 15 Eyes at least 6 months follow up: â—¦ 3 Improved > 1D (1.6, 2.7, 3.5) â—¦ 4 Improved by 1D â—¦ 4 stayed the same +/- 0.5D â—¦ 3 Worsened (1.5, 1.8, 3.0) â—¦ 80% Improved or stable â—¦ 20% Progressed Tues 21st Oct 2014 UPDATE 4 0 10 20 30 40 50 60 AVERAGEKERATOMETRY Audit 15 Patients Preop Post-Op
  • 5. Chalazia Tues 21st Oct 2014 UPDATE 5 Meibomian gland cyst / Infected = Hordoleum 57% pts >19yo for excision have Rosacea â—¦ Lempert SL Arch Ophthal 1979; 97: 1652-3 Low Serum Vitamin A in Children (China study) â—¦ Chen L et al Am J Ophthal 2014; 157(5):1103-8 MANAGEMENT: â—¦ Heat and Massage â—¦ Oral Antibiotics if infected: Doxycycline 50mg bd or Dicloxicillin 500mg qid â—¦ Topical Antibiotic No benefit â—¦ One RCT: H+M, Incision, Triamcinolone injection â—¦ 3 weeks: H+M 46%, Incision 87%, Triamcinolone 84% â—¦ Clinical and Experimental Ophthalmology, 2007;35(8):706- 12
  • 6. Chalazia Demodex brevis story High prevalence of demodex brevis infestation in chalazia. Liang L. et al Am J Ophthal. 157(2):342-348.e1, 2014 Feb Skin Mite- Increasing prevalence with age Classic teaching – NOT Pathogenic DIAGNOSE: Eyelash epilation and view under microscope TREATMENT: â—¦ 5 drops tea tree oil shampoo in ½ cup boiled water â—¦ 1:4 tea tree oil with olive oil as scrub BUT: Some doubts still remain! Tues 21st Oct 2014 UPDATE 6
  • 7. Cornea Lions NSW Eye Bank Waitlist for Corneal Transplants Wait time <3 Months WHY? 1. Organ Culture 2. Scheduled Surgery 3. 5 Coordinators 4. Hospice Planning Tues 21st Oct 2014 UPDATE 7 466472461 448440 407 351 320 285278 250 263 234223 200 227 204192181170 155151160161162 176178167162 0 50 100 150 200 250 300 350 400 450 500 Jan Feb Mar Apr May June Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May 2012 2013 2014 EBAANZ definition