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Use of intravitreal triamcinolone acetonide has quickly gained favor among retinal specialists as a first-line treatment for treatment of macular edema associated with retinal vein occlusion (RVO). However, findings from an evidence-based literature review indicate published data to support what has become a widespread clinical phenomenon are broad but not deep, said Robert Bhisitkul, MD, PhD, at the World Ophthalmology Congress."The purpose of this analysis was to look beyond the clinical impression that this therapy results in improved vision and reduced macular thickness by considering its long- versus short-term clinical effects. Its results show our best available evidence is inconclusive at best, but results of ongoing studies should give us a greater level of confidence in using intravitreal triamcinolone to treat patients with RVO," said Dr. Bhisitkul, professor of clinical ophthalmology, University of California San Francisco, in the United States.

Glaucoma implants may fail for a number of reasons, said Felix Gil Carrasco, MD, at the World Congress of Ophthalmology on Wednesday. However, inappropriate patient selection and improper placement of the shunt are probably the most common reasons.

New techniques and technology in cataract surgery was the theme of a symposium Wednesday night at the World Ophthalmology Congress. The symposium touched on new phacoemulsification technology, the use of a new ophthalmic viscophthalmic device (OVD), anti-infectives, and the latest intraocular lens technology.

Challenging phacoemulsification cases can present problems for the cataract surgeon. How a surgeon manages those challenging cases can prevent the case from turning into a nightmare.

Early detection of glaucoma is critical. According to the AGIS study, by the time a reproducible visual field defect is detected, 20% to 50% of the retinal nerve fiber layer (RNFL) can be damaged, said Remo Susanna, Jr., MD, at the World Ophthalmology Congress on Wednesday.

Performing "safe surgery" remains as the sine qua non for using antimetabolites safely and effectively as an adjunct to trabeculectomy. However, there are some strategies that can be incorporated in the surgical technique to reduce the risk of complications resulting from the application of anti-scarring medication, said Richard K. Parrish, II, MD, at the World Ophthalmology Congress.

Deep sclerectomy is not the holy grail of glaucoma surgery, but available evidence indicates that it is definitively safer than trabeculectomy and that it can result in long-term success rates matching those of trabeculectomy when performed with proper technique by experienced hands, said Tarek M. Shaarawy, MD, at the World Ophthalmology Congress.

Exfoliation syndrome (XFS) is a global disease that is important to recognize because of its association with other visual-threatening ocular pathologies, said Alan H. Robin, MD, of the Wilmer Eye Institute at Johns Hopkins University in the United States.

Ophthalmologists are familiar with the use of optical coherence tomography (OCT) for the back of the eye. Now, there also is a role for OCT in anterior segment corneal procedures and complications, reported Ronald Smith, MD, of the United States at the World Ophthalmology Congress on Wednesday.

Encouraging results have been achieved in a pilot clinical trial of selective epiretinal brachytherapy for exudative age-related macular degeneration (AMD), reported Eugene de Juan, Jr., MD, at the World Ophthalmology Congress.

New technologies and surgical techniques are redefining the refractive surgery arena in ophthalmology. With the progress of customized wavefront-guided LASIK and the use of phakic intraocular lenses (IOLs), today's refractive surgeon can offer a wider range of services to the patient.

With the world's population getting older and the rate of blindness increasing in regard to that aging population, cataract surgeons worldwide are facing some clinical challenges in the years ahead, according to Stephen A. Obstbaum, MD, of United States.

With an aim to further improve efficacy and safety outcomes achieved with anti-VEGF therapy for AMD, ongoing studies with pegaptanib sodium (Macugen, OCI/Eyetech Pharmaceuticals) are evaluating the potential benefits of early treatment initiation and of using an induction/maintenance approach, said Anthony P. Adamis, MD, at the World Ophthalmology Congress.

Favorable Phase I study results have led to the launch of a Phase I/II trial evaluating the efficacy and safety of AdPEDF (GenVec) treatment of exudative AMD, said Timothy Stout, MD, at the World Ophthalmology Congress.

In the new treatment era for exudative age-related macular degeneration (AMD) heralded by the availability of locally administered anti-VEGF drugs, intravitreal monotherapy with triamcinolone injection may no longer be considered as a current therapy for this neovascular condition, said Jost Jonas, MD, at the World Ophthalmology Congress.

Interim results from a Phase I study suggest that intravitreal injection of VEGF Trap (Regeneron Pharmaceuticals) is a promising new approach for the treatment of exudative age-related macular degeneration, said Quan Dong Nguyen, MD, at the World Ophthalmology Congress.

Suggesting a change in the way physicians diagnose glaucoma, Robert Weinreb, MD, outlined a new paradigm for diagnosis of the disease in his Glaucoma Society of International Ophthalmology Congress (GCIOC) Day Lecture, presented Monday at the World Ophthalmology Congress.Dr. Weinreb said that the glaucoma field is undergoing a revolution in diagnosis. He said there is a transition from reliance solely on visual fields to the increased use of structural analysis of the optic disk and RNFL."It's something that was initiated 20 years ago," explained Dr. Weinreb. "Changes are very, very slow in glaucoma, as it does in all medical disciplines. We have reached an infliction point in glaucoma diagnosis where we are about to reap the benefits of this revolution."

There is a wide range of technology available in cataract surgery today and it's easy for ophthalmologists to get excited and carried away by the technology. However, it's the attention to detail; going back to basics about incisions; pre- and post-surgical management; and the proper use of intraocular lenses that also need to be stressed.

Age-related macular degeneration (AMD) is a common cause of vision loss worldwide, particularly in industrialized nations, where it is the main cause of blindness among people of 65 and older, explained Paul Mitchell, MD, at the World Ophthalmology Congress.

Imaging is an essential part of glaucoma management, but while structural damage is frequently apparent before identifiable visual field loss occurs, both functional testing and quantitative imaging should always be performed in eyes with either early or moderate disease, said David F. Garway-Heath, MD.

A target IOP should be set whenever the diagnosis of ocular hypertension or glaucoma is first made, and it should be re-evaluated at each follow-up visit as part of the assessment of the efficacy of treatment for stopping visual field progression and protecting the optic nerve, said Curt Hartleben, MD, at the World Congress of Ophthalmology.

Evidence-based medicine has provided some guidance on the management of herpes simplex virus (HSV) keratitis, but there are still many questions left unanswered, said Thomas J. Liesegang, MD, at the World Congress of Ophthalmology.

Establishing the correct diagnosis and modifying therapy appropriately based on response are fundamental in the successful management of bacterial keratitis, said Richard L. Abbott, MD, at the World Congress of Ophthalmology.

For six days S?o Paulo, Brazil, will be the "Mecca" of ophthalmology. On Sunday, it was "get-acquainted day" as ophthalmic colleagues met to renew friendships with fellow colleagues and friends in industry. The Exhibit Hall opened late in the morning, drawing crowds of physicians to view the latest technology in ophthalmology.

More than 15,000 ophthalmologists from more than 110 countries are registered to attend, and more than 4,000 scientific papers were submitted for consideration. The schedule features more than 400 sessions in addition to subspecialty days, with some 2,400 speakers from all regions of the world.

The 2006 World Ophthalmology Congress (WOC) commenced Sunday in São Paulo, Brazil. With the first non-governmental organization (NGO) forum on vision and blindness prevention. The forum promoted the visibility of non-profit organizations that focus both on blindness prevention and assisting the visually impaired, contributing to an exchange of experiences between entities from all continents and from different socioeconomic realities, as well as organizing and providing a complete record of entities that cater to this area.

Cincinnati—Tamsulosin HCl (Flomax, Boehringer Ingelheim), an alpha-1 blocker used to treat benign prostatic hyperplasia, has been implicated in the development of floppy iris syndrome during cataract surgery, according to Robert H. Osher, MD. Healon 5 (AMO) is his viscoadaptive agent (OVD) of choice to manage this challenging iris behavior during cataract surgery.

San Francisco—The American Academy of Ophthalmology (AAO) has developed an ophthalmology curriculum of more than 800 topics that it believes represent the material that is most relevant to clinical practice.