More news from the 2012 American Academy of Ophthalmology Meeting

In an overview of recent advances, speakers made it clear that oculoplastics isn’t what it used to be.

Blepharospasm. Botulinum toxin has dominated the field for two decades—“I haven’t frowned since 1987,” quipped Jean D. Carruthers, MD. The next phase: topical medications. He cited research on the RT001 molecule, which is showing effectiveness comparable to that of Botox. Research on injectable Botox continues, as recent findings of white matter abnormalities in the brain has raised concerns about long-term side effects.

Thyroid eye disease. Immunomodulatory therapy—specifically the drug rituximab—can prevent progression of Graves disease if used early enough, said Simeon A. Lauer, MD. “Don’t use it as a last resort.” However, he cautioned that many patients won’t need it, as thyroid eye disease is often self-limiting. In addition, he reminded the audience that rituximab is not FDA approved for this condition.

Periocular hemangioma. Propranolol has emerged as a highly effective treatment for periocular hemangiomas, said François M. Codère, MD. A flurry of positive research reports documenting high rates of regression have been published in just the past four to five years, he said, and his institution has developed a protocol for the use of the drug. He cautioned that much remains unknown, particularly optimal dosing and possible long-term side effects. He also recommended that surgeons develop a multidisciplinary team to work with patients.

Dacryocystorhinostomy. Endonasal dacryocystorhinostomy (DCR) is elbowing external DCR aside, thanks to such advantages as smaller incision size, minimal patient discomfort and limited bruising, said Nancy A. Tucker, MD. The success rate of endonasal DCR rivals that of external DCR, she said, adding that its slow acceptance probably owes more to the learning curve than to equipment expense, as most institutions have the equipment on hand for otolaryngology use.

Basal skin carcinoma. While topical 5-fluouracil (FU) remains a mainstay for basal cell carcinoma, the immunomodulator imiquimod (Aldara) is making inroads, said Timothy J. Sullivan, MBBS. Its advantages include use in cases of nodular and periocular disease; in contrast, 5-FU cannot be used for nodular disease, and there are no studies of its use for periocular disease. Side effects of imiquimod include keratitis and conjunctivitis, Dr. Sullivan said. In discussing the future of treatment, he noted, “I’ve spent a lot of time wondering why tropical fish don’t get sunburned,” and concluded, “The future is with the molecules.”

Enhancements. Surgical enhancements that were acceptable just a few years ago now look inappropriate to Robert A. Goldberg, MD. Treatment needs to be driven by questions such as “How do we age?” and “How do we lose tissue?” Given the current understanding that the aging process involves loss of volume and facial descent, Dr. Goldberg noted that he now prefers dermal fillers to surgical approaches, and he described his approach as an “additive rather than a subtractive” one. He also discussed the current fad of “stem cell facelifts” and characterized it as the “Wild West of stem cell treatment.” The field desperately needs careful, controlled trials, said Dr. Goldberg. He offered his summation of regenerative medicine: “future promise; current morass.”—Jean Shaw

Dr. Carruthers is a consultant for Allergan, Kythera and Merz. Drs. Codère, Lauer, Sullivan and Tucker report no related financial interests. Dr. Goldberg is a consultant to Merz.