Refractive surgeons can easily obtain accurate IOP measurements following keratorefractive surgery with a non-contact, dynamic bi-directional applanation system (Ocular Response Analyzer [ORA], Reichert Inc.). The device also has been used to measure corneal biomechanical properties in potential refractive surgery candidates as well as after refractive surgery.
Some surprising findings surround phakic IOL implantation. At least in one large Midwest refractive practice, implantation of phakic IOLs is accounting for less than 1% of all refractive procedures. The incidence of enhancement procedures using LASIK or PRK is also very low-only 3%. Outcomes after additional excimer laser correction in patients with extreme myopia receiving one phakic IOL (Verisyse, Advanced Medical Optics) have been excellent.
Pseudoexfoliation (PXF) is a common disorder that mandates special attention when cataract surgery is indicated.
Ophthalmologists who use botulinum toxin type A to help patients improve their appearance should add the use of hyaluronic acid (HA) fillers to their procedures because they have many ideal characteristics, recommends one oculoplastics specialist. HA fillers are made of natural substances; no toxic effects are known. They can be used alone or in combination with permanent procedures such as fat transplantation; they have a combined effect with botulinum toxin; and they can be eliminated, if needed, through the use of hyaluronidase. HA fillers also have a low incidence of side effects, are easily stored, do not need to be refrigerated, and come in preloaded syringes with small needles.
Ketorolac tromethamine 0.4% (Acular LS, Allergan) plus steroid improves the visual outcome following uncomplicated cataract surgery by reducing the incidence of retinal thickening, according to a recent multicenter study. This combination therapy also reduces the incidence of cystoid macular edema. These findings suggest that this therapy would be beneficial in all cataract surgery cases.
In a randomized comparison study of two antibiotic/steroid combinations, tobramycin 0.3%/dexamethasone 0.1% controlled the clinical signs of inflammation more quickly than tobramycin 0.3%/loteprednol 0.5% in patients with moderate blepharokeratoconjunctivitis.
An investigational formulation of bromfenac ophthalmic solution has been developed for once-daily administration. Preliminary analyses of data from two phase III clinical trials indicate it is safe and effective for treating ocular pain and inflammation after cataract surgery.
Administration of nepafenac, a topical nonsteroidal anti-inflammatory drug, and prednisolone resulted in a significantly lower rate of pseudophakic macular edema following cataract surgery compared with the rate in patients who received only prednisolone.
Topical cyclosporine ophthalmic emulsion 0.05% may be a new treatment option for patients with inflamed pterygia that are refractory to conventional therapy of topical steroids and emollients. The modulating effect of the drug also may reduce or delay the need for excision of pterygia.
The fixed combination of loteprednol etabonate 0.5%/tobramycin 0.3% provides a safe and potent corticosteroid with an anti-infective agent that has broad-spectrum activity against important gram-negative and gram-positive organisms.
Rapid eradication of surface flora is critical for effective antimicrobial endophthalmitis prophylaxis. That information is derived from kill-curve studies, not minimum inhibitory concentration data. Results from kill-curve studies for staphylococcal strains show gatifloxacin 0.3% reduces bacterial viability more rapidly and more completely than moxifloxacin 0.5%. The presence of benzalkonium chloride in the commercial preparation of gatifloxacin may contribute to its faster eradication rate.
TRUST and Ocular TRUST are nationwide surveillance programs monitoring antimicrobial susceptibility of specific pathogens to a broad array of antibiotics, including fluoroquinolones.
Soaking acrylic IOLs in a fourth-generation fluoroquinolone for 60 seconds resulted in antimicrobial activity. If confirmed during in vivo studies, this finding could give clinicians another means of preventing endophthalmitis following cataract surgery.
A phase III clinical trial showed that a new ocular solution of azithromycin 1%, formulated with a patented delivery vehicle, significantly shortened the time to clinical resolution and bacterial eradication of infectious bacterial conjunctivitis when used as primary therapy for 5 days.
Recent studies suggest that the rate of endophthalmitis after cataract surgery has been increasing. Antisepsis with povidone-iodine remains the standard of care, and surrogate evidence exists to support the use of a topical antibiotic. Prospective, randomized clinical trial data demonstrated a benefit for intracameral cefuroxime, but the role of intracameral antibiotics is a subject of ongoing debate.
The rate of methicillin-resistant Staphylococcus aureus (MRSA) is increasing in both systemic and ocular infections, according to an analysis of nationwide surveillance data. Increasing rates of resistance and lowered rates of susceptibility could soon reduce the number of drugs that can be successfully used to treat ocular infections.
Retrospective analyses comparing clinical results achieved with wavefront-guided and conventional LASIK and surface ablation procedures convincingly demonstrate the superiority of a customized approach, said Capt. Steven C. Schallhorn, MD, who is affiliated with ClearView Eye and Laser Medical Center, San Diego.
Ophthalmologists who use botulinum toxin type A to help patients improve their appearance should add the use of hyaluronic acid (HA) fillers to their procedures because they have many ideal characteristics, recommends one oculoplastics specialist. HA fillers are made of natural substances; no toxic effects are known. They can be used alone or in combination with permanent procedures such as fat transplantation; they have a combined effect with botulinum toxin; and they can be eliminated, if needed, through the use of hyaluronidase. HA fillers also have a low incidence of side effects, are easily stored, do not need to be refrigerated, and come in preloaded syringes with small needles.
Collagen crosslinking with riboflavin (C3-R) was used to treat six eyes with progressive hyperopia after RK that had experienced further progression after intervention using laser vision correction. Retrospective analyses based on a mean follow-up of 215 days after the C3-R procedure suggests keratometric stabilization.
With periorbital soft-tissue infections on the increase due to methicillin-resistant Staphylococcus aureus (MRSA), physicians must be suspicious of MRSA and aware of local resistance profiles in order to treat these infections effectively.
Although millions of patients worldwide have undergone LASIK to treat myopia, the complication rate is very low. The problems that do arise postoperatively, however, can be serious and include endophthalmitis, retinal tears, retinal detachments, retinal hemorrhages, macular holes, and choroidal neovascularization.
A newer-generation IOL reduces higher-order, spherical, and trefoil aberrations when compared with the previous-generation lens. This reduction in higher-order aberrations may result in better outcomes for patients, specifically, improved contrast sensitivity, reduction in night vision disturbances, and improved visual performance compared with conventional spherical IOLs.
A combination of a refractive and a diffractive multifocal IOL for correction of presbyopia virtually eliminates complaints about intermediate vision that are frequent among patients who undergo bilateral implantation of diffractive lenses.
A multifocal silicone IOL seems to provide better overall vision to patients compared with other lenses available to correct presbyopia.
Multicenter studies are under way in Europe and the United States investigating an angle-supported phakic IOL for the treatment of high myopia.
A toric IOL enables patients with corneal astigmatism undergoing lens surgery to achieve the same clear uncorrected vision on day 1 as patients with minimal astigmatism.
Subjective and objective accommodation in patients with a dual-optic accommodating IOL implanted bilaterally were measured in a pilot study. Accommodation was adequate in subjective testing and significantly greater than in controls with an acrylic foldable monofocal IOL. Objective evaluations demonstrated movement of the anterior optic.
Blue light-filtering IOLs may provide protection against potential blue light toxicity without significantly affecting clinical functioning of recipients, according to one ophthalmologist. Another cataract surgeon, however, contends that blue light filtering is not clinically important for preventing age-related macular degeneration and that further study is needed regarding the potential adverse effect of blue light-filtering implants on melanopsin production and scotopic vision.
