Physicians Update FALL 2016 Ophthalmology Issue Corneal Transplantation p. 1 Molded Lens p. 3 Cataract Surgery p. 6 Thyroid Eye Disease p. 8 Strabismus p. 10 TRANSPLANT Improvements in Corneal Transplantation Achieving Better Outcomes Corneal transplantation is the most customized corneal transplantation,” says common and most successful type of human Anthony J. Aldave, MD, Walton Li Chair in transplant surgery. With improvements in Cornea and Uveitis and chief of the Cornea surgical approaches over the last decade, and Uveitis Division at the UCLA Stein Eye major eye centers such as UCLA are Institute. “Rather than always transplanting achieving better visual results with fewer the full-thickness cornea the way we used postoperative complications. to, we now replace only the portions of the cornea that are diseased. That means we are “There have been significant advances not altering the natural anatomy as much, as we have moved toward more continued on p. 4 treatment options available or imminent for UCLA patients with kidney, bladder or prostate cancer. UCLA Eye Care Robotic Technology Extends Locations Clinical Updates Minimally Invasive Colorectal Surgery Colorectal robotic-assisted surgery is the latest Learn about the Latest advance in minimally invasive procedures for UCLA Stein Eye Institute Advances from UCLA colon and rectal diseases, including colorectal Westwood cancers, diverticulitis and inflammatory bowel 100 Stein Plaza UCLA disease (ulcerative colitis and Crohn’s disease). Los Angeles, CA 90095 UCLA Adult Cystic Fibrosis Program (310) 825-5000 UCLA has an adult cystic fibrosis clinic focused on 4 Radiation Therapy for Patients with patients 18 years and older that provides careful Recurrent Glioblastoma attention to the seamless transition of pediatric This external beam radiation therapy, which UCLA Stein Eye Center patients to adult care. can deliver a dose of radiation more precisely, Santa Monica is currently available only at UCLA as part of a 1807 Wilshire Blvd., Suite 203 Low-Testosterone Diagnosis and Treatment Phase 1 clinical trial for patients with recurrent Santa Monica, CA 90403 A significant decline in testosterone can produce glioblastoma multiforme. (310) 829-0160 symptoms ranging from low sex drive and memory Spinal Deformity Program problems to fatigue and depression. Doheny Eye Center UCLA The Spinal Deformity Program at UCLA offers Pasadena Undiagnosed Diseases Network comprehensive clinical care services for infants, 625 S. Fair Oaks Avenue As part of the nationwide Undiagnosed Diseases children, adolescents and adults with scoliosis Network, UCLA’s Department of Human Genetics and other spinal deformity disorders. Suites 280, 285, 240, 227 and other clinical departments are now treating Pasadena, CA 91105 select patients at no cost to them or their insurance Pediatric Blood and Marrow (626) 817-4747 in an attempt to diagnose rare and difficult conditions. Transplant Program UCLA has been a pioneer in many alternative Doheny Eye Center UCLA Minimally Invasive Diagnoses and transplant protocols, including the use of Arcadia Treatment for Chest Diseases haploidentical bone-marrow transplantation, and 622 W. Duarte Road, Suite 101 UCLA’s Interventional Pulmonology Program continues to find new ways to improve survival Arcadia, CA 91007 offers an expanding list of minimally invasive rates and decrease complications. (626) 254-9010 procedures, giving patients the most advanced and comprehensive clinical care while benefitting Surgery for Congenital Anomalies of from shorter recovery times. the Kidney and Urinary Tract Doheny Eye Center UCLA Congenital anomalies of the kidney and urinary Orange County Immunotherapy Checkpoint Blockers tract are birth defects that are often discovered in 18111 Brookhurst Street, Suite 6400 Immunotherapy checkpoint blockers are a new a routine fetal ultrasound during pregnancy. While Fountain Valley, CA 92708 class of drugs that help release restraints on the some resolve on their own after birth, others (714) 963-1444 immune system. require close monitoring and corrective surgery, often within the first year of life. Immunotherapy Approaches for For more information, go to: Genitourinary Cancers To download these and other clinical uclahealth.org/eye Breakthroughs in immunotherapy are revolutionizing advances at UCLA Health, go to: the treatment of genitourinary cancer, with new uclahealth.org/clinicalupdates UCLA pushes the boundaries of minimally invasive Pediatric Blood and Marrow Transplant Program Program focuses on unique needs colorectal surgery with robotic technology offers new therapies for cancer and blood disorders of adults with cystic fibrosis A major advance in Patients benefit Convenient care colorectal surgery from expanded for adult CF patients on the Westside Overcoming the challenges donor pool and limitations of traditional “Children without traditional The adult cystic fibrosis open and laparoscopic surgery, marrow donors can increasingly program at UCLA offers colorectal robotic-assisted surgery find transplant donors today convenient and coordinated using the da Vinci Surgical thanks to alternative donor care to better serve patients on System is becoming the approach transplants,” says Theodore B. the Westside of Los Angeles, of choice for the surgical Moore, MD, director of the says Patricia H. Eshaghian, MD, treatment of both benign and Pediatric Blood and Marrow adult director, Cystic Fibrosis malignant colorectal diseases. Transplant Program and division Program, and assistant professor “The application of robotic chief of Pediatric Hematology/ of medicine in Pulmonary and surgery in treatment of complex Oncology. “Advances in drug Critical Care Medicine. conditions of the colon and therapy that prevent the patient “Because there are so many rectum has revolutionized the from rejecting donated marrow guidelines on how you manage field of colorectal surgery,” says have made possible haploidentical cystic fibrosis, it’s important Kevork Kazanjian, MD, associate bone-marrow transplants — that patients receive care at a professor of surgery and chief of using half-matched cells from a specialized center,” she says. “We the Section of Colon and Rectal first-degree relative. And because have access to all the specialists Surgery. “With this innovative, an infant’s immune system is a patient might need.” minimally invasive technique, immature, umbilical-cord blood Colorectal robotic-assisted surgery (CRS) Careful attention is devoted to the is the latest advance in minimally invasive surgeons gain more vision, transplantation requires less Blood and marrow transplantation (BMT), also called stem-cell transplantation, About half of all cystic fibrosis patients seamless transition of pediatric procedures for colon and rectal diseases including colorectal cancers, diverticulitis and precision and control while making precise recipient tissue matching. in the United States today are adults, can be a lifesaving treatment option for children with cancers and blood disorders, CF patients to adult care. inflammatory bowel disease (ulcerative colitis and Crohn’s disease). smaller, less invasive incisions.” according to the Cystic Fibrosis Patient Registry. This remarkable statistic represents including leukemia, lymphomas, neuroblastomas and sickle cell disease, as well as “The outcomes associated with significant progress in the care of patients with the autosomal recessive disorder. More “What used to be a pediatric While laparoscopic surgical techniques have provided an alternative to the large “The continued evolution of disorders of metabolism and the immune system. these alternative donors for disease has become a disease of robotic technology will further effective therapies in childhood and the emergence of detailed treatment guidelines abdominal incision and long recovery period required by conventional open surgery, the treatment of hematologic adulthood,” she says. “As these facilitate the widespread BMT replaces stem cells — blood-cell precursors found in hematopoietic (blood- have extended the median predicted survival age to 40 years. laparoscopy has presented technical challenges with limited, two-dimensional malignancies and non-malignant patients enter adulthood, they application of robotic surgery cell-forming) bone marrow — injured or destroyed by disease, chemotherapy or hematologic disorders have The growing number of adults with cystic fibrosis has created a need for specialized have to take more responsibility visualization and tight pelvic space in which to maneuver instruments. to colorectal disease,” says radiation treatment. After entering the bloodstream via IV catheter, the stem cells reached the point where they are in caring for themselves. Dr. Kazanjian. “We are seeing the services unique to this population. UCLA has an adult CF clinic focused on patients Robotic-assisted laparoscopic surgery — using the da Vinci Surgical System — offers make their way to the bone marrow. In a process called engraftment, they begin to nearly the same as transplants Education about the disease tip of the iceberg. What we 18 years and older. The clinic is part of UCLA’s Cystic Fibrosis Program, which is a minimally invasive alternative to both open and standard laparoscopic colorectal- from closely matched sibling becomes very important. It can thought was impossible 10 years produce new blood cells, restoring the patient’s hematopoietic and immune system. accredited by the Cystic Fibrosis Foundation. related interventions. donors,”