Visual prognosis of myopic choroidal neovascularization after photodynamic therapy is influenced by age of the patient at onset, report researchers in Israel, based on a consecutive case series.
Twenty-nine consecutive patients (30 eyes) with subfoveal CNV caused by pathologic myopia treated with verteporfin PDT during a three-year period were included in this retrospective comparative study. PDT was administered according to the Treatment of Age-related Macular Degeneration with Photodynamic Therapy (TAP) study protocol, with follow-up every three months for at least six months. Fluorescein angiography was performed in all cases on the initial and all follow-up visits. Information retrieved from the charts included patient age, gender, Snellen visual acuity (VA), greatest linear dimension (GLD), number of treatments, and side effects. Researchers then divided the patients into two groups by age, using the median age of 60 years as the cutoff. One group numbered 12 patients (12 eyes) younger than 60 and the other included 17 patients (18 eyes) aged 60 or older.
|Table 1. Change in Visual Acuity Following PDT|
|Whole Cohort (30 eyes)||Age < 60 yr (12 eyes)||Age ³ 60 yr (18 eyes)|
|Decrease ³ 3 lines||10 (33.3%)||1 (8 percent)||9 (50%)|
|Decrease 1 to 2 lines||3 (10%)||0||3 (16.7%)|
|No change||5 (16.16%)||1 (8 percent)||4 (22.3%)|
|Increase 1 to 2 lines||7 (23.5%)||6 (52 percent)||1 (5.5%)|
|Increase ³ 3 lines||5 (16.16%)||4 (32 percent)||1 (5.5%)|
Mean visual acuity improved in the younger group from 0.63 to 0.39 logMAR (P=.02). Mean VA deteriorated in the older group from 0.71 to 0.99 log MAR (P=.03).
There were no statistically significant differences between groups in initial VA (P=.517), initial and final GLD (P=.173, P=.312, respectively), number of PDT sessions (P=.223), or duration of the follow up (P=.555).
Researchers noted a significant between-group difference for final visual acuity, which measured 0.03 (SD=0.07) in the younger age group and 0.99 (SD=0.09) in the older one (P=.0001). They suggest that clinicians consider the patient's age when selecting a course of treatment for myopic CNV.
(Am J Ophthalmol 2004;138:602-607)
Axer-Siegel R, Ehrlich R, Weinberger D, Rosenblatt I, Shani L, Yassur Y, Priel E, Kramer M
Variables in Calculation of Accommodating IOLs
Researchers in Belgium and the Netherlands have published a formula that could guide selection of candidates for accommodating intraocular lens implantation. They used thin-lens approximation optics to obtain a formula containing the following variables: axial length (AL), mean keratometry (Km), anterior chamber depth (ACD), and presumed anterior shift of the IOL (d(ACD)).
Separate analysis of the influence of each of these variables on the power of the IOL revealed that the accommodative amplitude (AA) decreased with a longer axial length and higher mean keratometry. The AA varied between
-5.4 D and 0 D in eyes with an AL between 20 mm and 28 mm and a Km between 38 D and 52 D. The d(ACD) was also a significant factor influencing the AA. The ACD had less influence on the AA.
Researchers rephrased an accepted formula solving for IOL power (P) with a new formula that takes into consideration a variable anterior chamber depth (ACD') and solves for accommodative amplitude instead of P.
(J Cataract Refract Surg 2004; 30:2084-2087)
Missotten T, Verhamme T, Blanckaert J, Missotten G
Short-term Safety and Efficacy Shown for IVTA
Australian investigators say, in the short term, intravitreal triamcinolone can be effective and safe in treatment of eyes with diabetic macular edema that have failed laser treatment. In this prospective, double-masked, placebo-controlled, randomized clinical trial, 34 of 69 eyes received active treatment and 35 eyes received a placebo injection. Four eyes of three patients were lost to follow up.
Using a 27-ga. needle, 0.1 ml of triamcinolone acetonide was injected through the pars plana. Eyes randomized to placebo received a subconjunctival saline injection using the identical procedure for preparation. For patients with both eyes eligible, the allocated treatment was applied to the right eye, and the left eye received the other treatment.
Fifty-five percent of eyes treated with triamcinolone gained five or more letters of best-corrected visual acuity, compared with 16 percent of eyes treated with placebo (P=0.002).
Macular edema was reduced by one or more grades as determined by masked semiquantitative contact lens examination in 75 percent of treated eyes, compared with 16 percent of untreated eyes (P<0.0001).
Optical coherence tomography showed a mean reduction of central retinal thickness of 152 µm in the treated eyes, compared with a reduction of 36 µm in the placebo-treated eyes.
Adverse events related to treatment with triamcinolone included ptosis (two eyes), conjunctival ulcer (one eye), increase in IOP greater than
5 mmHg (10 eyes), use of glaucoma medication (eight eyes), and one case of infectious endophthalmitis that was treated without loss of visual acuity.
Sutter F, Simpson J, Gillies M
CCT in the Management of Glaucoma
Research teams in New York add weight to the findings that pachymetry-measured central corneal thickness has a significant effect on the clinical management of glaucoma patients and glaucoma suspects.
Using the linear correction scale, 105 of the 188 patients in the study had at least a measurement-significant adjustment in their IOP measurements, while 38 had an outcomes-significant IOP adjustment.
(Arch Ophthalmol. 2004;122:1270-1275)
Shih C, Graff Zivin J, Trokel S, Tsai J