Microincision vitrectomy surgery has rapidly gained increased popularity. It is associated with many advantages, but there have been some reports of disadvantages such as a significantly higher incidence of endophthalmitis postoperatively, though more recent reports do not substantiate this conclusion. Advances in the technology likely will facilitate safer and more efficient vitrectomy.
A topical eye drop (OT-551, Othera) is being investigated to treat geographic atrophy in dry age-related macular degeneration. The treatment is an antioxidant that in vitro protects against antioxidative damage and in vivo protects against light damage. One-year data are expected to be reported in the spring.
A new surgical platform (Constellation Vision System, Alcon Laboratories) incorporates advanced design features for improved surgical efficiency and safety. Vitrectomy probes (Ultravit, Alcon) facilitate high-speed cutting and control of the duty cycle.
In a small pilot study with limited follow-up, early application of micropulse laser trabeculoplasty (MLT) using a specific diode laser (IQ810, Iridex Corp.) appeared promising. Use of this multifunctional laser may have practical advantages in a clinical setting. Further study of the technology is needed to determine the role of MLT in the treatment of glaucoma.
A phase 1 trial of rapamycin (Sirolimus, MacuSight) indicated that the drug is safe and has biologic activity in patients with diabetic macular edema when injected intravitreally and subconjunctivally.
JPE1375 (Jerini Ophthalmic), a peptidomimetic inhibitor of the complement factor 5a receptor, blocks the mechanism that draws inflammatory cells into the disease process of age-related macular degeneration. When blocked, the numbers of neutrophils and macrophages decrease substantially and in turn the choroidal neovascularization also decreases.
The Micro-Surgical Safety Task Force analyzed potential complications associated with sutureless vitrectomy and disseminated guidelines to reduce the rate of endophthalmitis associated with 25-gauge vitrectomy.
Retinal specialists seemed to hold their collective breaths in 2008 in anticipation of the results of a number of ongoing trials of drugs for various retinal pathologies. Medical retina and the anti-vascular endothelial growth factor therapies were center stage again this year. Some of the highlights include bevacizumab (Avastin, Genentech) for retinopathy of prematurity, sustained-release ciliary neurotropic factor for dry age-related macular degeneration, anti-complement drugs, and the results of the Diabetic Retinopathy Clinical Research study.
Collagen cross-linking, the newest advancement in the refractive arena, possibly will stabilize keratoconic and ectatic corneas. LASIK, an area that always is improving, has seen changes in flap sizes and lasers. Knowledge of corneal biomechanics also is progressing to provide more information than ever before with new instrumentation. The phakic IOL market has expanded considerably, catering to those with high myopia. IOL options for pseudophakia also are expanding, and refractive lens exchange remains popular for hyperopia. In addition, questions of patient satisfaction postLASIK are being answered by an FDA task force.
Clinical trials provide far more information than just the safety and efficacy of a treatment. Information about the natural course and the risk factors of the disease can be gathered. Of equal importance is the collaboration of clinical investigators as they develop and carry out protocols facilitates incorporation of new ideas into medical practice.