Nepafenac (Nevanac, Alcon Laboratories) administered three times daily after bilateral PRK, facilitated corneal healing that was comparable to ketorolac (Acular LS, Allergan) in a recently reported prospective, randomized, and double-masked study. In addition, pain relief occurred earlier in patients randomly assigned to receive nepafenac compared with patients who received ketorolac or bromfenac (Xibrom, ISTA Pharmaceuticals).
Appropriate management of malignant lesions of the conjunctiva requires detailed knowledge of the appearance and nature of the lesions. Here's how to recognize and treat the most common malignant lesions seen by ophthalmologists.
Keratoconus appears to be a "two-hit" phenomenon, a genetic predisposition propelled by external factors to result in damage to the cornea.
No difference exists regarding the prevalence of amblyopia and strabismus in a population of Hispanic and African-American preschool children, and the prevalence of the two pathologies increases with age, according to findings of the Multi-Ethnic Pediatric Eye Disease Study.
Descemet's stripping endothelial keratoplasty (DSEK) has changed the landscape in cornea surgery. Compared with those who have undergone penetrating keratoplasty, DSEK patients have an easier time postoperatively with rapid visual recovery. DSEK also affects decision-making about cataract extraction, and data appear to indicate that in most cases cataracts should be removed before DSEK or as a combined procedure.
Many patients whose open-angle glaucoma is treated with phacoemulsification plus endoscopic cyclophotocoagulation (ECP) are able to stop taking topical medications shortly after cataract surgery.
In a pooled dataset, the fixed combination of 0.2% brimonidine/0.5% timolol (Combigan, Allergan) showed greater reductions in IOP and a better tolerability profile than another combination agent, 2.0% dorzolamide/0.5% timolol (Cosopt, Merck). The twin advantages of greater pressure lowering and greater tolerability could help guide clinicians in choosing which therapy to choose when the initial treatment has not resulted in adequate improvement.
A retrospective analysis was performed of 54 eyes undergoing pars plana insertion of a glaucoma drainage implant (GDI) with simultaneous penetrating keratoplasty or that had an existing corneal graft. During a mean follow-up of 3 years, IOP control and graft survival rates were considered to be at least as high as rates in eyes with anterior chamber GDI placement and corneal grafts.
Application of the fixed combination 2% dorzolamide hydrochloride/0.5% timolol maleate ophthalmic solution (Cosopt, Merck, Sharp & Dohme) resulted in a significant decrease in IOP 6 and 8 weeks after the onset of therapy in patients with ocular hypertension or primary open-angle glaucoma whose IOP had not been controlled by 0.5% timolol alone. The daytime and nighttime IOP values also were significantly reduced at the same time points compared with baseline.
Thorough patient education about anticipated side effects and benefits of treatment can improve patient acceptance of therapy and potentially increase adherence, concluded researchers who studied the effects of counseling intervention in patients treated with a prostaglandin analogue.
Selective laser trabeculoplasty seems to exert a systemic effect that results in the lowering of IOP in the untreated fellow eyes of patients with open-angle glaucoma.
A proprietary miniature glaucoma device (Ex-PRESS, Optonol Ltd.) implanted under a partial-thickness scleral flap achieved significant decreases in IOP in patients with glaucoma.
Three devices for conducting structural analysis of glaucomatous eyes have pros and cons.
An anti-glaucomatous medication formulated with a less toxic preservation causes less ocular surface toxicity, according to one cornea specialist. The development of travoprost ophthalmic solution 0.004% (Travatan Z, Alcon Laboratories), a prostaglandin analogue preserved with a new ionic-buffered preservative system (sofZia, Alcon Laboratories), seems to be the direction in which pharmaceutical companies will be moving in the future to eliminate harmful side effects caused by chronic application of anti-glaucoma medications.
Results of a prospective, randomized, investigator-masked trial comparing brimonidine 0.15% with oxidative preservative (Purite) (Alphagan P, Allergan) and dorzolamide 2% (Trusopt, Merck) as adjuncts to latanoprost 0.005% (Xalatan, Pfizer) show the addition of either agent results in further IOP reduction, but the IOP-lowering effect was greater in the brimonidine/oxidative preservative group.
A novel route of administration of anecortave acetate suspension (Retaane, Alcon Laboratories) by anterior juxtascleral depot in the sub-Tenon's space may represent a new paradigm in glaucoma treatment.
Implantation of a proprietary glaucoma valve (Ahmed Glaucoma Valve, New World Medical) is an effective method for managing refractory glaucoma in eyes undergoing penetrating keratoplasty (PKP) or with an existing corneal graft, according to results of a retrospective review.
Canaloplasty is being evaluated in an ongoing prospective study that enrolled 94 patients who were candidates for glaucoma surgery. An interim analysis was performed from follow-up through 12 months and showed that the procedure resulted in safe and effective reductions in IOP.
A prospective, randomized comparison of one-site versus two-site phacotrabeculectomy found no statistically significant difference in IOP at 24 months, but surgical time was significantly longer, and endothelial cell counts were significantly lower at 3 and 12 months for the two-site procedure.
Micropulse laser trabeculoplasty seems to be effective in reducing the IOP that previously could not be controlled medically in eyes with open-angle glaucoma.
Patients need to be educated about the importance of glaucoma medication adherence. They should be asked about possible nonadherence and the reasons for it. Such information can guide a targeted plan to overcome treatment barriers.
Several risk calculators are available to help assess the likelihood that a patient with ocular hypertension will develop glaucoma. The decision to treat then can be based on an individual patient's risk. That determination may be guided by expert opinion, results of decision analysis models, personal experience, and discussion with the patient.
Hyperemia is the new scourge of glaucoma therapy, responsible in many cases for poor patient adherence or discontinuation of medication.
A study of the mechanisms involved in nocturnal changes in IOP indicates that a decrease in outflow facility is insufficient to compensate for a decrease in aqueous outflow. Episcleral venous pressure could be a factor in the circadian variations, however.
Progressive myopia rather than glaucoma may be primarily responsible for glaucomatous-appearing optic nerve damage in a subset of young to middle-aged individuals of Chinese descent. In a retrospective study of 16 Chinese men who were glaucoma suspects or patients, visual fields remained stable over a follow-up period of up to 7 years, leading researchers to postulate that this condition may not have the same natural history as primary open angle glaucoma in other populations. A correlation between myopia and glaucomatous optic nerve damage has long been known, and has recently been confirmed in several populations, including China.
A group of leading experts on IOP has issued a consensus document on the topic that aims to optimize care of patients with glaucoma.
Many previous beliefs about ocular toxoplasmosis are proving not to be true.
Phakic IOLs can provide accurate and stable correction of myopia, but their potential to result in serious complications remains a cause for concern. Care in selecting appropriate candidates and the implantation procedure are critical to optimize the risk:benefit ratio.
Ophthalmologists need to warn patients that the use of a phophodiesterase-5 inhibitor may increase the risk of the development of ischemic optic neuropathy.
In a small series of eyes, application of a contact lens after LASIK re-treatment procedures did not help prevent epithelial ingrowth, which is counter to the current thinking and what is in the literature.
