Cheryl Guttman

Articles by Cheryl Guttman

An in vitro kill kinetics study evaluated eradication of 18 human ocular Staphylococcus isolates by commercial formulations of gatifloxacin 0.3% (Zymar, Allergan) and moxifloxacin 0.5% (Vigamox, Alcon Laboratories). Gatifloxacin demonstrated superior activity, which may be attributed to the presence of benzalkonium chloride 0.005% in its formulation.

A retrospective study analyzed outcomes of 345 consecutive eyes with the proprietary glaucoma minishunt (Ex-PRESS, Optonol) implanted, including 114 eyes having combined cataract surgery. During a mean follow-up of about 2 years, the implant provided effective IOP control whether used alone or in a combination procedure and was associated with few complications.

Endocyclophotocoagulation (ECP) can be performed easily in patients with medically controlled glaucoma who are undergoing cataract surgery, to provide additional IOP lowering and reduce medication use. Misunderstanding that ECP is a completely different procedure than transscleral cyclodestruction contributes to under-use of this very safe procedure, according to one ophthalmologist.

The efficacy and tolerability of continuing latanoprost 0.005% (Xalatan, Pfizer) after 6 weeks of latanoprost monotherapy versus switching to bimatoprost 0.03% (Lumigan, Allergan) was investigated in an investigator-masked, randomized, parallel-group trial. The results showed good efficacy and tolerability in patients whose therapy was switched to bimatoprost and suggest that bimatoprost may be tolerated better after latanoprost pre-treatment.

The first microincisional IOL (Akreos MICS IOL, Bausch & Lomb) has been introduced in the U.S. market. The lens is a single-piece hydrophilic acrylic IOL designed for delivery through a 1.8-mm incision. Its material and design offer several advantages, according to three surgeons who have used it.

The current version of a proprietary phaco system (WhiteStar Signature, Abbott Medical Optics) features fluidics control software that allows automatic switching from longitudinal ultrasound to transversal (Ellips) on recognition of occlusion and back again to longitudinal on occlusion break. Results of a prospective study show the benefits of this technology for optimizing the efficiency of cataract removal.

Ketorolac tromethamine 0.45% (Acuvail, Allergan) is a preservative-free ophthalmic NSAID recently approved for twice-daily use in treating pain and inflammation after cataract surgery. Its novel formulation is designed to promote drug delivery and tolerability.

A new formulation of lubricant eye drop (Systane Ultra, Alcon Laboratories) contains polymer network and demulcent ingredients that have been proven in multiple studies to provide benefits in patients with dry eye disease, according to one ophthalmologist. The drop, however, reformulates these agents in a system designed to further enhance ocular surface comfort, protection, and symptomatic relief. Initial patient impressions are very positive, he said.

A compromised lipid layer plays a key role in the development and perpetuation of dry eye disease because it allows increased aqueous evaporation and fails to protect against friction between the blinking lid and the ocular surface. A proprietary brand of emollient eye drops (Soothe XP. Bausch & Lomb) was created to re-establish the tear film lipid layer and restore moisture, and it is an effective choice for providing symptomatic relief in patients with dry eye disease, says one optometrist.

A review of the world literature shows that about one-third of patients who are undergoing LASIK already suffer from dry eye, and the proportion affected after surgery is similar. In most cases, however, dry eye does not appear to affect postoperative vision and satisfaction outcomes adversely. Identification of patients at risk and pre-treating may reduce the postoperative incidence of dry eye.

Oral fenretinide (Sirion Therapeutics) is being investigated in a phase II study as a treatment for advanced geographic atrophy associated with age-related macular degeneration. It is hypothesized that this agent may limit disease progression by preventing delivery of circulating retinol to the eye, thereby reducing the accumulation of retinol-derived metabolites that are toxic to the retinal pigment epithelium and photoreceptor cells.

Although 2008 was not a year of major advances in glaucoma, it still was a time of progress. Structural imaging devices continue to improve; more data are emerging on surgical alternatives to trabeculectomy; and some novel medical therapies appear interesting, even though they are just in very early stages of clinical investigation. Perspectives on recent developments and current controversies are discussed.

Cataract surgery is a modern success story because of the advances in techniques and technology that have been made over the years. Excellent outcomes are becoming routine, and the field only continues to progress, thanks to a steady stream of innovations. Three cataract surgeons share their thoughts on some of the most noteworthy innovations and trends of 2008 and beyond.

1-year results from the HORIZON open-label extension study of ranibizumab (Lucentis, Genentech) for the treatment of exudative age-related macular degeneration show that treatment beyond 2 years relatively is safe and well tolerated, but previously treated patients who received ranibizumab monthly for 2 years may be susceptible to loss of vision with less-frequent dosing during the third year of treatment.

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