News

University of Rochester researchers recently put to test the bias against corneas from older donors.

Deep anterior lamellar keratoplasty resulted in satisfactory best spectacle-corrected visual acuity levels after 18 months follow-up. The rate of graft clarity was almost 90% and the rate of stromal rejection was low. However, the rate of endothelial cell loss at 18 months postoperatively was high.

The off-label use of intravitreal drugs may have a promising future for treating patients with diabetic retinopathy, but currently the dosing of these drugs is suboptimal. There is no solid track record for the drugs because controlled clinical trials are lacking and all follow-up periods have been too short to reach any definitive conclusions about safety and efficacy.

The periodic assessment of vision function with visual field testing is a standard and important part of the management of primary open-angle glaucoma (POAG). Automated achromatic static threshold perimetry is the preferred technique, although other static and kinetic techniques are acceptable alternatives in patients who are unable to complete automated perimetry reliably or when the technology is not available.

Epi-LASIK provides slightly better refractive outcomes 3 months postoperatively compared with standard LASEK, which may be due to the quicker and smoother separation of the epithelial layer from Bowman's membrane and the absence of alcohol with its negative effect on energy absorption of the excimer laser.

A long-term study of 292 eyes found that LASEK is a safe and effective treatment for patients with low to moderate levels of myopia. A significant difference was seen in spherical equivalent and uncorrected vision acuity preoperatively to postoperatively.

Treatment of substantial levels of coma and trefoil using wavefront-guided excimer surface ablation resulted in very good visual outcomes. These patients fared well when compared with patients who underwent LASIK early after the introduction of the procedure and compared with those with atypical topographies who underwent LASIK in the late 1990s. The results still fell slightly short of the outcomes achieved in patients with normal corneal topographies.

Four femtosecond laser microkeratomes have received FDA approval. An ophthalmologist reviews differences between the devices, why they may be important, and considerations for building a next-generation laser microkeratome.

Clinical trials are under way evaluating a corneal inlay (AcuFocus ACI 7000, AcuFocus) for the treatment of presbyopia. An ophthalmologist summarizes the features of the inlay, its mechanism for improving near vision, and promising safety and efficacy results.

A variety of techniques has been introduced for the surgical management of intraoperative floppy iris syndrome (IFIS). Method selection may be based on preoperative assessment of IFIS severity, although these cases may be unpredictable and surgeons need to be equipped to use a range of alternatives to enable a safe outcome.

Alimera Sciences has entered into a second exclusive worldwide agreement with Emory University to explore oxidative stress management, specifically, the reduction of reactive oxygen species, as a treatment for ophthalmic diseases.

Addition Technology has received regulatory clearance from Health Canada to market its corneal implants (Intacs) for keratoconus and myopia indications.

Posterior capsule rupture (PCR) is the most common major complication occurring during cataract surgery. Although the potential for serious sequelae exists, cases with PCR may have a good outcome if the event is recognized early and managed appropriately according to the features of the individual case.

A new instrument for measuring IOP (iCare Tonometer, Tiolat Oy; available through Rhein Medical) seems to obtain values that correlate well with Goldmann applanation tonometry.

Topical gatifloxacin (Zymar, Allergan) administered either 1 day or 1 hour prior to anterior segment surgery is effective in eliminating conjunctival bacteria.

In a comparison study of two glaucoma operations, patients who underwent tube shunt surgery were more likely to maintain IOP control and avoid persistent hypotony and reoperation, while those who underwent trabeculectomy with mitomycin C needed less supplemental medical therapy. Patients in both treatment groups had large IOP reductions, and there was no significant difference in pressure between them at 6 months and 1 year.

Clinicians have an array of techniques and devices available to them for assessing progression of glaucoma, and more are under development. Such tools rely on either subjective or objective measurements, with the latter generally providing more reliable results. Frequent, long-term follow-up with one or more of those approaches will increase the likelihood of detecting progression early.

Both quantitative and qualitative methods of detecting glaucomatous progression are useful, but optic disk photography remains the gold standard. New software for statistical analysis is helpful but should be an adjunct used with more established approaches.

The steps taken in the search for a cure for Leber's congenital amaurosis can serve as a model for other inherited eye disorders, according to an expert who delivered the Jackson Memorial Lecture at the 2007 American Academy of Ophthalmology annual meeting.

Early detection and treatment of incident choroidal neovascularization in eyes with age-related macular degeneration may offer patients the best opportunity to retain vision. Clinical trials have provided guidance on defining patient risk and the frequency of follow-up. An ongoing study is examining the role of noninvasive technologies as monitoring tools.

A prospective, randomized, open-label study compared bromfenac 0.09% (Xibrom, ISTA) and ketorolac tromethamine 0.4% (Acular LS, Allergan) as part of a postoperative medication regimen in patients undergoing PRK. Control of pain, burning, photophobia, and foreign body sensations were similar in the two treatment groups. Both agents were safe as there was no difference in re-epithelialization between the two agents.

Azithromycin 1% ophthalmic solution (AzaSite, Inspire Pharmaceuticals) has many properties that make it a rational choice for the treatment of blepharitis. Evaluations conducted by two ophthalmologists yielded favorable results in showing azithromycin was safe, well-tolerated, and resulted in rapid and dramatic improvement of both anterior and posterior lid margin disease.

Levofloxacin 1.5% (Iquix, Santen/Vistakon) is the only newer generation fluoroquinolone approved for the treatment of bacterial corneal ulcers. Extensive research indicates levofloxacin has maintained potent broad-spectrum activity against important ocular pathogens and that the 1.5% formulation offers excellent pharmacokinetics and safety profiles.

Analysis of the effect of nepafenac 0.1% (Nevanac, Alcon Laboratories) indicated that compared with diclofenac 0.1% (Voltaren, Novartis Pharmaceuticals) nepafenac might be more tolerable by patients after cataract surgery.

Moxifloxacin hydrochloride ophthalmic solution 0.5% (Vigamox, Alcon) seems to be a safe antimicrobial agent when injected intracamerally following cataract surgery. The eyes that received moxifloxacin had a significantly lower mean intraocular pressure value three months postoperatively compared with the control eyes that received balanced saline solution.

Findings of a recent study show that loteprednol 0.5%/tobramycin 0.3% and dexamethasone 0.1%/tobramycin 0.3% were equivalent in reducing the signs and symptoms of blepharokeratoconjunctivitis. Some safety concerns emerged, however, concerning elevated IOP in patients treated with the dexamethasone/tobramycin product.

Performing ECP at the time of cataract surgery has significant benefits for both patients and surgeons. After cataract removal and IOL implantation, there is plenty of room to get behind the iris with an endoscope and apply laser energy to the ciliary epithelium.

Long-term outcomes of a study of optic neuritis have shown that even one brain lesion ≥3 mm at the time of the first episode can be predictive of development of multiple sclerosis, making a brain MRI an essential part of patient management.