Glaucoma surgery with a novel device (Trabectome, NeoMedix Corp.) is a minimally invasive approach that reduces IOP by about 40% with few complications. Data from a case series of 358 eyes showed that IOP dropped from a preoperative mean of about 24 mm Hg to a mean of 16 mm Hg postoperatively.
The Multicenter Uveitis Steroid Treatment (MUST) trial is a National Eye Institute-sponsored phase IV study comparing the fluocinolone acetonide 0.59-mg implant (Retisert, Bausch & Lomb) with standard systemic therapy for the treatment of noninfectious intermediate, posterior, or panuveitis. Its results are intended to help define the role of implant therapy for the treatment of uveitis. Enrollment is ongoing and referral of potentially eligible patients is encouraged.
Elevated IOP is a common occurrence in patients with uveitis. Management often is quite challenging, however, due to the multiple mechanisms that are at play and the often-countervailing effects of corticosteroids and pressure-lowering agents. Several experts comment on their approaches to managing elevated IOP in patients with uveitis, including the use of drops, laser therapy, and surgery.
Recent advances in anterior segment imaging enable ophthalmic surgeons to evaluate, treat, and follow their cataract, refractive, and glaucoma patients better. Three different technologies-optical coherence tomography, a Scheimpflug camera, and a wide-field contact digital fundus camera-are now being used to assess those patients more precisely for diagnosis, possible treatment, and long-term follow-up.
The methodology of several large, multicenter trials of amblyopia treatment leaves several questions unresolved, according to an orthoptist who reviewed the studies. These questions relate to the association between patient age and treatment results, the treatment protocol, measurement of therapy adherence, visual acuity results, and the definition of therapy success.
The Pediatric Eye Disease Investigator Group has conducted several studies recently that are helping to clarify the effectiveness of various approaches to amblyopia treatment and evaluate the effectiveness of therapies in different age groups.
Prevention of complications associated with implantable contact lenses requires customized sizing based on very high-frequency echography intraocular biometry. The new software, which is based on finite element analysis, is highly predictable and more accurate when compared with the white-to-white rule of thumb.
In a retrospective study including 14 eyes with high astigmatism that was naturally occurring, post-penetrating keratoplasty, or associated with a corneal scar, astigmatic keratotomy using a femtosecond laser (IntraLase FS, IntraLase Corp.) was safe and effective for reducing astigmatism and improving visual acuity.
Frequent follow-up visits are necessary to monitor for endothelial cell loss in patients in whom phakic IOLs have been implanted, according to one surgeon who has 5 years of experience with the lens.
Mistaken patient identity during keratorefractive surgery is devastating for the patient and surgeon. A "foolproof" method for avoiding mistaken identity involves obtaining the patient's autorefraction moments before surgery and taping the autorefractor strip to the patient. The patient's individual autorefraction, cylinder axis, and other data stay with the patient at all times, enabling the surgeon to make sure the information on the laser computer matches the information on the strip.
Implantation of two different multifocal IOLs-an apodized diffractive lens (AcrySof ReSTOR, Alcon Laboratories) and a refractive lens (ReZoom, Advanced Medical Optics)-may provide increased ranges of near and intermediate vision for a patient undergoing refractive lens exchange compared with bilateral implantation of the diffractive IOL, according to a study of 20 patients.
Surgeons reviewing their outcomes with an implantable contact lens (Visian Implantable Collamer Lens, STAAR Surgical Co.) reported high-quality visual acuity results and low complication rates over both short-term and long-term follow-up periods.
A study of a subgroup of 11 patients who participated in a multicenter trial found no significant distance changes between the anterior crystalline lens surface of the eye and the posterior surface of iris claw-style phakic IOLs during accommodation. This finding lends further credence to the belief that the IOL and the iris move forward together as a unit during accommodation.
A study using optical coherence tomography (Visante, Carl Zeiss Meditec) found that a single-piece acrylic, hydrophobic phakic IOL (AcrySof phakic IOL, Alcon Laboratories); a single-piece, hydrophilic acrylic IOL (ICare IOL, Corneal); and a newer, trimmed version of the latter (ICare Evolution IOL, Corneal) did not produce anatomic distortion of the iris or the chamber angle. The study compared angle-to-angle distances ≥6 months after lens implantation.
Creating channels using a femtosecond laser (IntraLase FS, IntraLase Corp.) to insert a corneal implant (Intacs, Addition Technology Inc.) has some advantages, but the procedure also has the potential for complications. Both are detailed.
Multifocal and accommodative IOLs can be implanted safely in patients who have undergone prior refractive surgery, and visual results can be good. Frequently, however, enhancements are necessary, and decreased best-corrected visual acuity may be seen more often than with aspheric monofocal IOL insertion, according to the results of a prospective study of 22 eyes in 18 patients.
To address a perceived unmet need for comprehensive refractive surgery training, Sunil Shah, FRCOphth, FRCSEd, FBCLA, and colleagues in England developed an electronically based course for those wanting to develop their knowledge and skills in cataract and refractive surgery.
The growing popularity and long-term use of phakic IOLs inevitably will lead to more explantations, with cataract removal and with or without clear lens removal. An ophthalmologist outlines key steps to success.
Torsional phacoemulsification reduces chatter and energy delivered to the eye. It is safer than longitudinal phaco because torsional phaco is associated with a reduced risk of wound burn, less fluid usage, better followability, less turbulence, and less second instrument manipulation.
Management of patients with neovascular age-related macular degeneration has evolved, but clinicians are at a crossroads when considering continuation of treatment. Evidence suggests that monthly treatment and less frequent treatment regimens are better than no treatment. The best treatment regimen remains elusive.
In a phase II study, implantation of the artificial silicon retina microchip (ASR, Optobionics) improved visual acuity in some patients for up to two years. A phase III study is possible if someone interested in continuing these trials purchases the company, now in bankruptcy.
The AWARE Study (Analysis of Safety Outcomes with Anti-VEGF Treatment) is expected to expand retinal specialists' knowledge of the short- and long-term risks of anti-vascular endothelial growth factor treatments for neovascular age-related macular degeneration and diabetic retinopathy. The study may help identify a subset of patients susceptible to adverse events.
Testing of a retinal prosthesis shows that blind subjects who receive the implant have predictable spatial vision and that more electrodes provide higher spatial resolution. Scientists at Second Sight Medical Products have tested a 16-electrode prosthesis for several years and have received approval to conduct tests with a newer, 60-electrode device.
The development of customized component corneal transplantation techniques could enable a single donor cornea to be used to treat multiple patients. The practice could help address tissue shortages and reduce the wait time for surgery in developing countries. A researcher formerly practicing in India talks about the first published report of this strategy.
Initial analyses of data collected in the Canadian Glaucoma Study have identified four variables as powerful independent risk factors for glaucoma progression.
A retrospective cohort study revealed a consistent volume-outcomes relationship for adverse events in cataract surgery. Surgeons performing more than 1,000 procedures a year had the lowest complication rate among four volume classifications. The overall adverse event rate, however, was low as well: less than 1 in 200.
The development of cataract and age-related macular degeneration (AMD) seems to be linked with increased mortality rates in older patients (aged 49 or more years), according to results of the Blue Mountains Eye Study. The finding confirms an association between visual deterioration and mortality found in other studies.
Central corneal thickness (CCT) bears an inverse relationship with the risk of developing glaucoma. The risk of glaucoma progression, however, seems to be independent of CCT. New tonometry technology will allow for more accurate risk stratification of patients.
Findings of a study evaluating in vitro susceptibility of clinical fungal keratitis isolates suggest that use of newer antifungal medications may afford better outcomes in these potentially sight-threatening infections
An ophthalmologist details several questions clinicians must answer when deciding whether to use an excimer laser to perform enhancements after PRK or LASIK, lamellar surgery, incisional surgery, lens surgery, or corneal surgery.
