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Several preoperative features have been identified as important risk factors for ectasia after laser refractive surgery, particularly in patients undergoing LASIK for high myopia or myopic astigmatism. This complication can occur in the absence of any of these findings, however.

Fourier-domain optical coherence tomography allows detailed visualization of the retinal layers, especially the photoreceptor layer.

Three-dimensional optical coherence tomography (OCT) has improved on the speed with which scans are obtained and has added more detailed information about the retina in various retinal diseases. Two-dimensional OCT, however, should remain a staple in retinal practice for some time to come.

An in-office test is offering hope for many patients with age-related macular degeneration.

Spectral-domain optical coherence tomography (SD-OCT) offers several major advantages over conventional OCT: faster image acquisition time, improved resolution, and improved image processing. In addition, the technology decreases patient motion artifact, which is especially useful when obtaining images in children.

Ultrasound still has a place in ophthalmology. Several new developments in the technology facilitate detailed visualization of the posterior segment.

Independent studies show promising potential of topical azithromycin 1% ophthalmic solution (AzaSite, Inspire Pharmaceuticals) for the treatment of both posterior and chronic anterior blepharitis.

Clinical trials are advancing frequently, which is why the Association for Research in Vision and Ophthalmology is offering a series of courses to help eye researchers keep up.

A 50-year-old Haitian-born woman pre­sented to the Bascom Palmer Eye Institute with a complaint of suddenly decreased vision in her right eye over the previous 4 days. The patient denied other symptoms of pain, redness, photophobia, floaters, or photopsias.

Patients desiring laser vision correction are treated with phototherapeutic kertectomy and PRK with mitomycin-C either simultaneously or in a staged approach depending on the absence or presence of epithelial ingrowth. A retrospective review of 15 eyes that developed a buttonhole or near buttonhole during LASIK flap creation shows favorable visual outcomes can be achieved.

Vaccines may have a role in corneal and external ocular disease, specifically for herpes zoster virus and human papilloma virus infections, because of the successes of the vaccines in preventing systemic diseases.

Immunohistochemical studies have shown that the receptor for advanced glycation end products (RAGE) is elevated in the optic nerves of patients with Alzheimer's disease. Future studies are expected to provide more information about the role of RAGE in Alzheimer's disease and other neurodegenerative diseases and could lead to new therapeutic options if RAGE is determined to be a causative agent.

The National Ophthalmic Disease Genotyping Network (eyeGENE), developed in 2007 by the National Eye Institute, is a repository of inherited eye disease DNA samples that can be used anonymously for research. The hope is that eyeGENE will facilitate discovery of new ophthalmic disease genes, help researchers identify genetic modifiers of disease, and enhance patient enrollment in clinical trials.

Both subconjunctival and intravitreal injection of the broad-acting, small molecule sirolimus were shown to be safe in a phase I study of patients with diabetic macular edema. Promising efficacy signals also were observed.

The development of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor drugs is a rare event, with an incidence of 0.03% for treated cases and 0.02% for culture-positive cases.

Three monthly injections of ranibizumab, 0.3 and 0.5 mg, appear to provide benefit to patients with macular edema due to central retinal vein occlusion or branch retinal vein occlusion. Foveal thickness decreased significantly with both doses, and there was a concomitant increase in the visual acuity. Most patients require more than three injections to maintain the benefit. The average duration of treatment and the final visual outcomes are not yet known.

Researchers have successfully used hollow microneedles to deliver minute particle suspensions into the suprachoroidal space in rabbit, pig, and human eyes in vitro.

The neuroprotectin D1 (NPD1) molecule showed potential as a therapy for neovascular age-related macular degeneration in a recent study. Lesion leakage and lesion diameter were both significantly reduced following administration of NPD1 in a mouse model of laser-induced choroidal neovascularization.

A comparison of two doses of intravitreal bevacizumab (Avastin, Genentech) showed that both resulted in stability or improvement in visual acuity and central macular thickness in patients with diffuse diabetic macular edema (DME) over a 12-month period.

Pegaptanib sodium (Macugen, [OSI] Eyetech/Pfizer) used as an adjunct to laser therapy has a significant impact in the treatment of patients with progressive diabetic retinopathy, offering much hope for the prognosis of patients who have this disorder.

The focus was on innovation at this year's annual meeting of the Association for Research in Vision and Ophthalmology. Among the highlights were the latest developments in the areas of retinal disease, allergy, dry eye, and lid margin disease.

Berlin, Germany, will host the XXVI Congress of the European Society of Cataract and Refractive Surgeons from Sept. 13 to 17. The annual meeting will feature a diverse agenda that includes symposia, a workshop on visual optics, training courses, and exhibits.

Neovascular age-related macular degeneration treated with long-term use of intravitreal ranibizumab (Lucentis, Genentech) was safe and well tolerated in a group of patients participating in an extension study. Between the original studies and the extension trial, patients were followed for approximately 4 years, during which no safety signals were observed. Although problems linked to vascular endothelial growth factor inhibition were suggested, the lack of a control group makes proving a correlation difficult.

An immediate vitrectomy should be considered in patients with retained intravitreal fragments of the crystalline lens after complicated cataract surgery. Eyes that underwent immediate vitrectomy had better visual acuity and a lower retinal detachment rate than eyes that underwent delayed vitrectomy.

Before prescribing alpha blocker treatment, a primary care physician (PCP) should consider involving the cataract surgeon when treating a patient with a known diagnosis of cataract. So says an educational statement that is part of an initiative by the American Society of Cataract and Refractive Surgery and the American Academy of Ophthalmology launched to further educate PCPs about the connection between alpha blockers, such as tamsulosin (Flomax, Boehringer Ingelheim Pharamceuticals), and intraoperative floppy iris syndrome during cataract surgery.

Results of a recent survey by the American Society of Cataract and Refractive Surgery Cataract Clinical Committee provide insight into the clinical issues facing cataract surgeons and their patients taking alpha blocker drugs. Intraoperative floppy iris syndrome continues to challenge cataract surgeons and especially seems to be associated with tamsulosin (Flomax, Boehringer Ingelheim Pharmaceuticals), according to respondents.

To reduce the risk of endophthalmitis after cataract surgery a multimodal approach is needed. Assuring a water-tight wound closure without the use of stromal hydration and use of a fourth-generation fluoroquinolone are two important factors. An analysis of data from patients undergoing clear corneal cataract extraction at the University of Texas Southwestern Medical Center supports these recommendations.

Congress was able to block a pay cut for physicians who serve Medicare patients. Even though the American Society of Cataract and Refractive Surgery (ASCRS) and the American Academy of Ophthalmology (AAO) are pleased for the delay in the pay cut they maintain that the hard work is just beginning.