7/23/2015 Terry E. Burris, MD Northwest Corneal Services Portland, OR Co- Medical Director, Lions VisionGift Oregon Associate Clinical Professor of Ophthalmology Oregon Health Sciences University 1 2015 Update in Corneal Procedures & Surgery 1 7/23/2015 Proverbs The physician is only nature’s  assistant—Galen Proverb Surgery is an admission that we  have failed medical treatment-- Anonymous 2 7/23/2015 Proverb Surgery does the ideal thing, it  separates the patient from the disease—Logan Clendening, MD Surgery & Surgeons 3 7/23/2015 Surgical Decisions Between two evils, I always like to take the one I’ve never tried before —Mae West, American actress 1893-1980 Lecture Outline Tissue glue Advance  Management of OSSN  Corneal Transplantation: Selected  techniques and advances Surgical Options for Keratoconus  4 7/23/2015 I learned a long time ago that minor  surgery is when they do the operation on someone else, not you —Bill Walton, NBA legend Tissue glue Indications Perforated bacterial ulcers  Neurotrophic ulcers seen with HZV, HSV,  s/p surgery for acoustic neuroma Corneal surgery wound leaks  5 7/23/2015 Tissue glue: Neurotrophic ulcer Sterile cyanoacrylate glue  (e.g. dental glue (Periacryl, Histoacryl  [Canada]) Tissue glue: Neurotrophic ulcer Resistant to patching, punctal plugs,  bandage contact lenses, AMT 6 7/23/2015 Perforations: cyanoacrylate glue Emergency closure  Usually only temporizing measure  while surgery is being scheduled New ReSure Corneal Sealant Is there a place for clinic use?  –Currently approved for cataract surgery 7 7/23/2015 Resure Corneal Sealant ReSure tissue glue  –Polyethylene glycol(PEG) hydrogel technology Corneal Laceration Repair ReSure tissue glue  –Potential adjunct for complex laceration repair 8 7/23/2015 OSSN: Ocular surface squamous neoplasia (CIN) Often overlooked with pterygium dx  OSSN: Ocular surface squamous neoplasia Treatment Options paradigm shift  Traditional: –Excisional biopsy with adjuvant MMC, cryopexy and AMT Advantage is histologic confirmation 9 7/23/2015 OSSN: Ocular surface squamous neoplasia Recent trend:  –Topical MMC 0.4 mg/ml –Topical Interferon (IFN a2b-1M units/ml) –Topicals have equal or fewer recurrences and later time of recurrence than surgical treatment –Most recurrences within 2 years Besleyet al AJO 2014 jFeb; 157(2):207-93 Corneal Grafting: Selected Technique Update 10