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Although leaking filtering blebs often can be managed with conservative measures, surgery to stop the leak is indicated in some cases. A surgical approach may be indicated especially in certain high-risk eyes, such as those with a history of bleb-related infection. Several surgical techniques may be used to control a leaking bleb effectively.

Customized hyperopia treatment with the Technolas 217z Zyoptix wavefront excimer laser system (Bausch & Lomb) has excellent predictability, with 69% of patients within 0.5 D of the intended correction.

Centering the corneal ablation profile over the corneal vertex when treating hyperopia using an excimer laser platform (Schwind Esiris, Schwind eye-tech-solutions) results in better visual outcomes compared with ablations that were centered over the pupil centroid.

From the sixth postoperative month, the corneal power tended to decrease continuously with respect to preoperative data.

A prospective, randomized, contralateral eye study including an extensive list of outcome measures is under way comparing sub-Bowman's keratomileusis performed with two different femtosecond lasers (IntraLase FS60, Advanced Medical Optics; Femto LDV, Ziemer). Early data show that both lasers create good-quality, planar thin flaps, and their use is associated with excellent vision and safety outcomes.

Equivalent keratometer readings (EKRs) from a novel rotating Scheimpflug camera system (Pentacam, Oculus Inc.), calculated by version 1.16r04 software, are still inaccurate for eyes with a history of LASIK, PRK, or RK. The EKR measures steeper than true corneal power.

A study was conducted in rabbit eyes to compare flap adhesion strength of LASIK flaps created with different techniques and technology. The results indicate that significantly greater force is needed to dehisce flaps created with a 150-kHz femtosecond laser (IntraLase, Advanced Medical Optics) versus a mechanical microkeratome. Femtosecond laser-created flaps with a 150° side-cut design adhere more strongly relative to those with a 70° side-cut design.

Using a simple nomogram can substantially improve flap centration with a proprietary femtosecond laser. When considering the question of how big the LASIK flap should be, a large flap is good because ablation performed on the epithelium induces aberrations. A small flap, however, also is good because corneal strength is impaired less and less dry eye may be induced by the procedure, although the latter is still uncertain.

Patients who have suspected keratoconus based on topography may be candidates for LASIK based on a study that showed refractive stability 1 year after LASIK in patients where keratoconus was excluded preoperatively using epithelial thickness mapping obtained with a VHF ultrasound eye scanner (Artemis 1, ArcScan).

Uveitis associated with juvenile idiopathic arthritis can result in significant vision loss. Systemic immunosuppressive therapy may protect against that outcome. Identifying predictors of ocular complications and vision loss may help to select patients who can best benefit from aggressive medical treatment.

Surgical therapy for age-related macular degeneration in the form of macular translocation, injection of tissue plasminogen activator, and gas tamponade provides some improvements in visual acuity for patients whose conditions do not respond to the anti-vascular endothelial growth factor drugs.

New York-Pfizer officials have decided not to launch global phase III trials of NicOx’s PF-03187207 glaucoma drug but plan to continue collaborating with the French company.

Miami-OPKO Health has acquired Vidus Ocular, a privately held company developing a shunt (Aquashunt) to treat glaucoma.

Santa Ana, CA-Advanced Medical Optics (AMO) has received FDA clearance for a fifth-generation femtosecond laser (iFS).

In a point-counterpoint debate at the annual meeting of the American Academy of Ophthalmology, one clinician contended that the rate of post-LASIK ectasia is declining and that, with careful screening and other preparatory steps, the rate of ectasia can be kept very low. The counter-argument by another clinician suggested that the multifactorial basis of ectasia as well as unknown risk factors make it impossible to prevent a certain percentage of cases from developing.

In a debate at the American Academy of Ophthalmology annual meeting, one surgeon contended that surface ablation is safer and more effective than LASIK because of complications associated with flap creation in lamellar procedures. His counterpart, however, suggested that LASIK is preferable because of risks associated with surface procedures, including ectasia, infections, and haze.

A high risk of graft failure exists after placement of a glaucoma drainage device in the anterior chamber. Strategies to improve outcomes include placing the device farther away from the cornea, use of a scleral tunnel technique for tube insertion, and performing Descemet's stripping endothelial keratoplasty instead of penetrating keratoplasty in eyes with a pre-existing glaucoma drainage device.

Cross-sectional data from the Los Angeles Latino Eye Study were analyzed to examine associations between blood pressure, perfusion pressure, and the risk of having glaucoma. Results of multivariate logistic regression analyses showed low perfusion pressure, low diastolic blood pressure, and elevated systolic blood pressure were independent risk factors.

An analysis of results from visual field tests performed in persons enrolled in the African Descent And Glaucoma Evaluation Study shows that in "healthy eyes," visual function is worse in persons of African descent compared with those of European descent, even though it still is within normal ranges.

Animals undergoing lens removal surgery were treated with non-steroidal anti-inflammatory drugs pre- and postoperatively. On the first day after surgery, aqueous humor samples were taken at times corresponding to trough drug levels. The mean aqueous prostaglandin E2 concentration was significantly lower in animals being treated with ketorolac 0.4% (Acular LS, Allergan) compared with those receiving bromfenac 0.09% (Xibrom, ISTA Pharmaceuticals).

Adults with healthy eyes were studied at day and night visits to evaluate the circadian rhythm of aqueous humor dynamics. The results showed significant decreases in aqueous flow and outflow facility. Nocturnal seated IOP was significantly lower, and nocturnal supine IOP was significantly higher than daytime seated IOP.

In a multi-center, randomized, double-masked study of 306 healthy volunteers, the anti-inflammatory combination of loteprednol/tobramycin was found to produce lower levels of steroid-induced IOP rise than the combination of dexamethasone/tobramycin.

Data integrated from two phase III clinical trials demonstrate that a new, once-daily formulation of bromfenac ophthalmic solution higher in concentration than the commercially available 0.09% formulation (Xibrom, ISTA Pharmaceuticals) is safe, effective, and well-tolerated for the prevention and treatment of inflammation and pain associated with ocular surgery. Increased patient adherence to therapy and improved outcomes are two potential benefits.

Two phase III studies evaluated difluprednate 0.05% emulsion (Durezol, Sirion Therapeutics) for the treatment of significant inflammation after ocular surgery. The investigational agent was dosed twice and four times daily and compared with vehicle. Difluprednate acted quickly to reduce inflammation and pain and achieved significant differences compared with vehicle in the primary efficacy analysis and multiple secondary endpoints. No difference in mean IOP was found between study groups.

In vitro testing shows that the mutant prevention concentration for gatifloxacin against fluoroquinolone-sensitive methicillin-resistant Staphylococcus aureus is significantly lowered by the addition of benzalkonium chloride.

Levofloxacin ophthalmic solution 1.5% (Iquix, Vistakon Pharmaceuticals), used to treat bacterial keratitis, has no adverse effects on the corneal endothelium after 2 weeks of intensive dosing for a total of 224 doses of the drug.

Azithromycin 1% ophthalmic solution (AzaSite, Inspire Pharmaceuticals) is more soluble and able to remain on the ocular surface for a longer period than it would otherwise because of the patented drug delivery vehicle (DuraSite, InSite Vision) with which it is paired.

Significant controversy surrounds selection of antibiotics for endophthalmitis prophylaxis. Richard K. Forster, MD, explains why he believes fourth-generation fluoroquinolones should not replace older antibiotics.