American Journal of Ophthalmology October
Wittpenn et al. evaluated whether adding perioperative topical ketorolac tromethamine 0.4 percent improves cataract surgery outcomes relative to topical steroids in patients without known risk factors for cystoid macular edema. In this clinical trial, patients scheduled to undergo phacoemulsification surgery were randomized to receive either prednisolone acetate 1 percent or prednisolone 1 percent plus ketorolac 0.4 percent four times daily for four weeks postoperatively. In the ketorolac-steroid group, patients also received topical ketorolac 0.4 percent four times a day for three days preoperatively. In both groups, patients received four doses of ketorolac 0.4 percent one hour before surgery. Outcome measures included CME incidence, retinal thickness as measured by OCT, BCVA and contrast sensitivity.
No patients in the ketorolac-steroid group had clinically apparent CME, compared with five patients in the steroid group. No ketorolac-steroid patient had definite or probable CME, compared with six steroid patients. Mean retinal thickening was less in the ketorolac-steroid group, and fewer had retinal thickening of more than 10 µm
Thursday, October 30, 2008
Case series finds increasing incidence of in-the-bag IOL dislocations
Ophthalmology. 2008;115(10):1699-1704.
A retrospective case review revealed that one-quarter of IOL dislocations occurred within the first 24 hours after implantation, but the majority of dislocations occurred after 1 month.In a noncomparative analysis of 284 dislocations in 277 eyes followed by a single surgeon, IOL dislocation occurred in 177 eyes (62%) after 1 month, including 126 occurrences (44%) after 1 year.
A retrospective case review revealed that one-quarter of IOL dislocations occurred within the first 24 hours after implantation, but the majority of dislocations occurred after 1 month.In a noncomparative analysis of 284 dislocations in 277 eyes followed by a single surgeon, IOL dislocation occurred in 177 eyes (62%) after 1 month, including 126 occurrences (44%) after 1 year.
Thyroid disorder may heighten risk of glaucoma
Ophthalmology Times Oct 21, 2008
Birmingham, AL—Patients with glaucoma were 38% more likely to have had a thyroid disorder at some point in their lives than those without, according to a study published in the British Journal of Ophthalmology. Statistics were gathered from 12,376 people who participated in the 2002 National Health Interview Survey.
Participants were asked whether they ever had been diagnosed with a thyroid gland disorder or glaucoma. Slightly more than 4.5% of participants said glaucoma was diagnosed and 12% said a thyroid problem was diagnosed. The percentage of patients with glaucoma who said they had suffered a thyroid problem was 6.5% to 4.4% who had not.
An underactive thyroid can promote chemical deposits in the blood vessels serving the eye, which can spark an increase in IOP, said study authors.
Patients with thyroid problems should see an ophthalmologist or make their ophthalmologist aware of their thyroid condition, "Somebody who has a history of thyroid problems and has not seen an ophthalmologist may have a heightened level of concern about their eyesight," he said.
Birmingham, AL—Patients with glaucoma were 38% more likely to have had a thyroid disorder at some point in their lives than those without, according to a study published in the British Journal of Ophthalmology. Statistics were gathered from 12,376 people who participated in the 2002 National Health Interview Survey.
Participants were asked whether they ever had been diagnosed with a thyroid gland disorder or glaucoma. Slightly more than 4.5% of participants said glaucoma was diagnosed and 12% said a thyroid problem was diagnosed. The percentage of patients with glaucoma who said they had suffered a thyroid problem was 6.5% to 4.4% who had not.
An underactive thyroid can promote chemical deposits in the blood vessels serving the eye, which can spark an increase in IOP, said study authors.
Patients with thyroid problems should see an ophthalmologist or make their ophthalmologist aware of their thyroid condition, "Somebody who has a history of thyroid problems and has not seen an ophthalmologist may have a heightened level of concern about their eyesight," he said.
Wednesday, October 29, 2008
Contact Lens-Induced Corneal Peripheral Swelling Differences With Extended Wear
Cornea October 2008, 27:9
Corneal thickness was measured in 5 corneal locations (central, superior, inferior, nasal, and temporal) with Orbscan II pachymetry 1 week before the wearing of CLs and after 1 week of EW. High-Dk (lotrafilcon A) and low-Dk (etafilcon A) soft CLs were randomly fitted for EW in the right and left eyes of 20 subjects with normal ocular health. Orbscan was also performed before CL removal after 3 and 7 days of EW.
.... Lotrafilcon A induced a lower percentage of corneal swelling in all 5 corneal locations than etafilcon A (P <> 0.05, repeated-measures analysis of variance).
Conclusions: Central and peripheral corneal thicknesses increase more with etafilcon A than with lotrafilcon A during EW, as measured by Orbscan pachymetry
Corneal thickness was measured in 5 corneal locations (central, superior, inferior, nasal, and temporal) with Orbscan II pachymetry 1 week before the wearing of CLs and after 1 week of EW. High-Dk (lotrafilcon A) and low-Dk (etafilcon A) soft CLs were randomly fitted for EW in the right and left eyes of 20 subjects with normal ocular health. Orbscan was also performed before CL removal after 3 and 7 days of EW.
.... Lotrafilcon A induced a lower percentage of corneal swelling in all 5 corneal locations than etafilcon A (P <> 0.05, repeated-measures analysis of variance).
Conclusions: Central and peripheral corneal thicknesses increase more with etafilcon A than with lotrafilcon A during EW, as measured by Orbscan pachymetry
Advanced personalized nomogram for myopic laser surgery: First 100 eyes
Journal of Cataract & Refractive Surgery
Volume 34, Issue 11, November 2008, Pages 1881-1885
To report the results in the first 100 eyes treated for myopia using a new advanced nomogram.This prospective interventional case series comprised 58 patients (100 eyes) consecutively treated for myopia with laser in situ keratomileusis (LASIK) or laser-assisted subepithelial keratectomy (LASEK) performed by the same surgeon. All treatments used a new nomogram for the Zyoptix 217 Z100 excimer laser. Postoperative mean sphere, cylinder, and spherical equivalent (SE) refraction were evaluated 3 months postoperatively. Safety, efficacy, and predictability were also evaluated.
In the LASIK group (34 eyes), the mean postoperative sphere was +0.18 diopters (D) ± 0.47 (SD), the mean postoperative cylinder was −0.10 ± 0.23 D, and the mean postoperative SE was 0.04 ± 0.36 D. In the LASEK group (64 eyes), the respective means were 0.10 ± 0.22 D, −0.05 ± 0.13 D, and +0.03 ± 0.16 D. Hyperopic overcorrection (≥+1.00 D) occurred in 4.1% of patients. Ninety-five percent of eyes in the LASIK group and 97% of eyes in the LASIK group had an uncorrected visual acuity of 1.0 (20/20) or better. Patient satisfaction was slightly higher than that of other laser refractive surgery patients at the clinic.
Conclusions:The use of the advanced nomogram increased treatment accuracy in terms of UCVA and postoperative mean refraction and reduced the rate of hyperopic overcorrection over that in earlier studies. The need for enhancement procedures was reduced, and patient satisfaction was high.
Volume 34, Issue 11, November 2008, Pages 1881-1885
To report the results in the first 100 eyes treated for myopia using a new advanced nomogram.This prospective interventional case series comprised 58 patients (100 eyes) consecutively treated for myopia with laser in situ keratomileusis (LASIK) or laser-assisted subepithelial keratectomy (LASEK) performed by the same surgeon. All treatments used a new nomogram for the Zyoptix 217 Z100 excimer laser. Postoperative mean sphere, cylinder, and spherical equivalent (SE) refraction were evaluated 3 months postoperatively. Safety, efficacy, and predictability were also evaluated.
In the LASIK group (34 eyes), the mean postoperative sphere was +0.18 diopters (D) ± 0.47 (SD), the mean postoperative cylinder was −0.10 ± 0.23 D, and the mean postoperative SE was 0.04 ± 0.36 D. In the LASEK group (64 eyes), the respective means were 0.10 ± 0.22 D, −0.05 ± 0.13 D, and +0.03 ± 0.16 D. Hyperopic overcorrection (≥+1.00 D) occurred in 4.1% of patients. Ninety-five percent of eyes in the LASIK group and 97% of eyes in the LASIK group had an uncorrected visual acuity of 1.0 (20/20) or better. Patient satisfaction was slightly higher than that of other laser refractive surgery patients at the clinic.
Conclusions:The use of the advanced nomogram increased treatment accuracy in terms of UCVA and postoperative mean refraction and reduced the rate of hyperopic overcorrection over that in earlier studies. The need for enhancement procedures was reduced, and patient satisfaction was high.
Friday, October 24, 2008
Decreased Visual Acuity in Preschool Children
October’s Ophthalmology
A study by Friedman et al. of children aged 30 months through 71 months found that bilateral decreased visual acuity in Caucasian and African-American children was infrequent. They also found uncorrected ametropia to be the most common cause. The decreased visual acuity was not consistently associated with age, race or sex..........The researchers included 1,714 children out of the 2,546 in the 30-to-71-months age group of the Baltimore Pediatric Eye Disease Study. Decreased visual acuity was initially detected in 1.2 percent of Caucasian children and 1.8 percent of African-American children. After retesting within 60 days of the initial exam and with children wearing the best refractive correction, the rate of decreased visual acuity in both eyes was 0.5 percent among Caucasians and 1.1 percent among African-Americans.
A study by Friedman et al. of children aged 30 months through 71 months found that bilateral decreased visual acuity in Caucasian and African-American children was infrequent. They also found uncorrected ametropia to be the most common cause. The decreased visual acuity was not consistently associated with age, race or sex..........The researchers included 1,714 children out of the 2,546 in the 30-to-71-months age group of the Baltimore Pediatric Eye Disease Study. Decreased visual acuity was initially detected in 1.2 percent of Caucasian children and 1.8 percent of African-American children. After retesting within 60 days of the initial exam and with children wearing the best refractive correction, the rate of decreased visual acuity in both eyes was 0.5 percent among Caucasians and 1.1 percent among African-Americans.
Black Diaphragm Intraocular Lens for Aniridia
October’s Ophthalmology
While individuals with aniridia have higher-order optical aberrations associated with an increased ratio of pupillary aperture to focal length, they often experience further aberrations following cataract surgery. In 1994, the black diaphragm intraocular (BDI) lens was developed to counter these optical effects. This current study by Aslam et al. evaluated the accuracy of biometry, visual outcomes and long-term changes in 40 eyes of 35 patients with congenital and traumatic aniridia implanted with the BDI lens......Results showed that the mean biometry prediction error was equivalent to 80 percent of target eyes being within 2 D of predicted refraction. The main complication was glaucoma, which occurred immediately after surgery—suggesting a possible direct mechanical effect of the large BDI lens. Visual outcomes were better when using the BDI lens for traumatic aniridia than for congenital aniridia
While individuals with aniridia have higher-order optical aberrations associated with an increased ratio of pupillary aperture to focal length, they often experience further aberrations following cataract surgery. In 1994, the black diaphragm intraocular (BDI) lens was developed to counter these optical effects. This current study by Aslam et al. evaluated the accuracy of biometry, visual outcomes and long-term changes in 40 eyes of 35 patients with congenital and traumatic aniridia implanted with the BDI lens......Results showed that the mean biometry prediction error was equivalent to 80 percent of target eyes being within 2 D of predicted refraction. The main complication was glaucoma, which occurred immediately after surgery—suggesting a possible direct mechanical effect of the large BDI lens. Visual outcomes were better when using the BDI lens for traumatic aniridia than for congenital aniridia
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Risk of Microbial Keratitis in Contact Lens Wearers
October’s Ophthalmology
Findings from a two-year case-control study by Dart et al. suggest that interactions between contact lenses and the ocular surface may be more important in the development of corneal infection than oxygen levels and case contamination.The study involved 367 contact lens wearers with presumed microbial keratitis, 1,069 contact lens wearers with disorders unrelated to contact lenses and 639 contact lens wearers randomly selected from the local area.Compared with planned-replacement soft lenses, daily-wear disposable contact lenses had a significantly increased relative risk of microbial keratitis, rigid lenses had a reduced risk, and there was no difference for silicone-hydrogel lenses. While the risk of microbial keratitis was higher overall in daily-wear disposable lens wearers, the risk of vision loss was less for planned-replacement soft contact lens users.conclusion
The authors conclude that different brands of contact lenses may be associated with significantly different microbial keratitis risks. They hope that the findings from this study can help lead to the development of safer soft contact lenses
Findings from a two-year case-control study by Dart et al. suggest that interactions between contact lenses and the ocular surface may be more important in the development of corneal infection than oxygen levels and case contamination.The study involved 367 contact lens wearers with presumed microbial keratitis, 1,069 contact lens wearers with disorders unrelated to contact lenses and 639 contact lens wearers randomly selected from the local area.Compared with planned-replacement soft lenses, daily-wear disposable contact lenses had a significantly increased relative risk of microbial keratitis, rigid lenses had a reduced risk, and there was no difference for silicone-hydrogel lenses. While the risk of microbial keratitis was higher overall in daily-wear disposable lens wearers, the risk of vision loss was less for planned-replacement soft contact lens users.conclusion
The authors conclude that different brands of contact lenses may be associated with significantly different microbial keratitis risks. They hope that the findings from this study can help lead to the development of safer soft contact lenses
Management of Dislocated IOLs
October’s Ophthalmology
A study by Kim et al. characterizing the management of dislocated IOLs indicates that dislocation most commonly involves foldable IOLs. Effective treatment techniques include IOL exchange or IOL repositioning with or without scleral suture fixation.
The investigators reviewed 284 eyes of 277 patients who underwent surgery for dislocated IOLs. Three-month follow-up data were gathered from 184 eyes. Dislocated lenses included PMMA IOLs, silicone-plate IOLs, three-piece silicone IOLs and acrylic IOLs. In-the-bag dislocations were associated with pseudoexfoliation and ocular trauma. Cystoid macular edema was the most common complication of a dislocated IOL. In 11 eyes, retinal detachment occurred after management of the dislocated IOL.
The authors caution that management approaches depend upon surgeon preferences and subspecialty, yet the wide range of treatment options allows surgeons to customize the optimal treatment approach for each patient.
A study by Kim et al. characterizing the management of dislocated IOLs indicates that dislocation most commonly involves foldable IOLs. Effective treatment techniques include IOL exchange or IOL repositioning with or without scleral suture fixation.
The investigators reviewed 284 eyes of 277 patients who underwent surgery for dislocated IOLs. Three-month follow-up data were gathered from 184 eyes. Dislocated lenses included PMMA IOLs, silicone-plate IOLs, three-piece silicone IOLs and acrylic IOLs. In-the-bag dislocations were associated with pseudoexfoliation and ocular trauma. Cystoid macular edema was the most common complication of a dislocated IOL. In 11 eyes, retinal detachment occurred after management of the dislocated IOL.
The authors caution that management approaches depend upon surgeon preferences and subspecialty, yet the wide range of treatment options allows surgeons to customize the optimal treatment approach for each patient.
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