The Cole Eye Institute evaluated the exclusion criteria used to screen patients for refractive surgery, finding that abnormal cornea topography and low or insufficient corneal thickness remain the most common reasons for excluding patients from LASIK or photorefractive keratectomy. Factors such as cataract, too high of correction and severe dry eye were other common reasons for exclusion.

Charts of patients who were screened for initial refractive surgery by a single surgeon at the Cole Eye Institute between 2007 and 2012 were reviewed, resulting in a total of 1,067 refractive candidates enrolled in the study. Mean patient age was 39 ±12 (range: 17 to 78 years); 519 patients (48.6 percent) were male and 548 (51.4 percent) were female. Refractive surgery was performed in 657 patients (61.6 percent); PRK was considered the best option for 106 (9.9 percent). Of the screened patients, 410 (38.4 percent) did not have refractive surgery, and 134 of these patients (12.6 percent) were considered to have contraindications for both LASIK and PRK.

Among the excluded patients, 69 were male (51.5 percent) and 65 were female (48.5 percent), with a mean age of 40 ±14 (range: 18 to 78 years). Abnormal corneal topography (34.3 percent) and low or insufficient corneal thickness (23.1 percent) were the most common reasons for exclusion. Other factors for exclusion included: high myopia (10.5 percent); insipient or definite cataract (9.7 percent); high hyperopia (3.7 percent); need to wear reading glasses after surgery (3.7 percent); and severe dry eye unresponsive to treatment (3.7 percent).
Cornea 2014;33:1051-1055.
Torricelli A, Bechara S, Wilson S.

Avoiding Recurrence of Epithelial Ingrowth After LASIK
In order to
avoid the recurrence of epithelial ingrowth after LASIK, Spanish researchers recommend cleaning the corneal interface (epithelial cyst extraction) and suturing the corneal flap. Doing so appears safe and led to an extremely low recurrence of epithelial ingrowth.

From a total of 7,520 LASIK refractive eyes, 13 eyes with epithelial ingrowth were identified and treated in this retrospective, noncomparative interventional case series. The main outcome measures were uncorrected distance visual acuity; corrected distance visual acuity; refractive cylinder; spherical equivalent; regrowth of epithelial cells; and complications.

Mean patient age was 46.9 years. The mean preoperative logMAR UDVA was 0.34 (standard deviation: 0.19). At two months, the mean postoperative logMAR UDVA was 0.18 (SD: 0.17) and at one year was 0.12 (SD: 0.18; p=0.01). Two months and one year postoperatively, the mean logMAR CDVA was 0.05 (SD: 0.08) and 0.03 (SD: 0.06), respectively (p=0.03). The mean spherical equivalent before surgery was 0.3 D (SD: 1.09). The mean spherical equivalent two months and one year after surgery was -0.07 (SD: 0.53) and -0.004 (SD: 0.18; p=0.04). The mean CYL before surgery was -0.92 D (SD: 1.09); the mean CYL two months and one year after surgery was -0.6 (SD: 0.84) and -0.18 (SD: 0.75; p=0.26). No epithelial ingrowth recurrence was observed up to one year after epithelial removal.
Cornea 2014;33:1046-1050.
Güell J, Verdaguer P, Mateu-Figueras M, Elies D, et al.

Long-term Effect of IVI Bevacizumab for AMD on IOP
Researchers from South
Korea evaluating long-term intraocular pressure changes after intravitreal injection of bevacizumab for age-related macular degeneration discovered no significantly higher intraocular elevation than baseline IOP. In addition, neither the number of injections nor pre-existing glaucoma negatively affected IOP changes.

A total of 83 eyes that received IVI of bevacizumab for AMD were enrolled in this study. Measurements of IOP were taken at baseline, six, 12, 18 and 24 months and at the last follow-up after injection; these were then analyzed for changes over time. The changes in IOP were also compared on the basis of the median number of injections. The mean number of injections was 3.71 ±1.62. There was no significantly higher elevation than baseline IOP (14.11 ±2.76 mmHg) after multiple IVI of bevacizumab (p>0.05). In the group that had ≥4 injections, mean IOP measurements were not higher compared with the group that had < 4 injections during the follow-up period (p>0.05). In the patients with pre-existing glaucoma (three eyes), there was no significant increase of IOP during the follow-up period.
J Glaucoma 2014;23:446-448.
Kim D, Nam W, Kim H, Yi K.

Reproducing SD- and TD-OCT Measurements in DME Patients
The primary objective
of a new study from the Diabetic Retinopathy Clinical Research Network Writing Committee was to evaluate the reproducibility of retinal thickness measurements from optical coherence tomography images of diabetic macular edema patients obtained by time-domain (Stratus, Carl Zeiss Meditec) and spectral-domain (Cirrus, Carl Zeiss Meditec; Spectralis, Heidelberg Engineering) instruments, in an effort to formulate equations converting retinal thickness measurements from SD-OCT to equivalent values on TD-OCT. Reproducibility appears better with Spectralis than with Cirrus and Stratus. Conversion equations to transform Cirrus or Spectralis measurements to Stratus-equivalent values, within 10 percent of the observed Stratus thickness values, appear feasible. Central subfield thickness changes beyond 10 percent when using the same machine or 20 percent when switching machines, after conversion to Stratus equivalents, are likely due to a change in retinal thickness rather than measurement error.

A cross-sectional observational study was conducted in private and institutional practices. Patients with DME, defined as Stratus central subfield thickness of 250 μm or greater, participated. An additional normative cohort (individuals with diabetes but without DME) was also enrolled. Each study eye underwent two replicate Stratus scans followed by two replicate Cirrus or Spectralis scans (real-time image registration used) centered on the fovea. The Bland-Altman coefficient of repeatability for relative change in CST (the degree of change that could be expected from measurement variability) was lower with Spectralis (7 percent) compared with Cirrus (14 percent) and Stratus (12 percent within Cirrus/Stratus groups and 15 percent Spectralis/Stratus groups). For each cohort, the initial Stratus CST was within 10 percent of the replicate Stratus measurement nearly all of the time; the conversion equations predicted a Stratus CST within 10 percent of the observed thickness 86 percent and 89 percent of the time for Cirrus/Stratus and Spectralis/Stratus groups, which is similar to the agreement on Stratus re-test. The Bland-Altman limits of agreement for relative change in CST between machines (the degree of change that could be expected from measurement variability, combining within and between instrument variability) were 21 percent for Cirrus and 19 percent for Spectralis when comparing predicted vs. actual Stratus measurement.
JAMA Ophthalmol 2014;139:1113-1122.
Diabetic Retinopathy Clinical Research Network Writing Committee.

Adalimumab as Steroid-Sparing Treatment for TED
Adalimumab and other
immunosuppressive agents may have a role in the treatment of active thyroid eye disease with prominent inflammatory symptoms, mitigating some of the metabolic and psychiatric side effects of pulsed steroid treatment, according to research from the Jules Stein Eye Institute.

In a retrospective study of all patients (n=10) in the inflammatory phase of TED who were treated with adalimumab, a subcutaneously administered tumor necrosis factor-α antagonist, data concerning visual acuity; optic nerve function; extraocular motility restriction; binocular visual fields; and proptosis was extracted from patient charts. Masked orbital specialists reviewed clinical photographs from baseline and three-month follow-up visits, with each photograph graded on the severity of conjunctival injection; chemosis; eyelid erythema; and eyelid edema on a scale from one to four. An inflammatory score was calculated as the sum of these four elements. Groups were compared using paired t tests.

Six patients showed a decrease in inflammatory score while on adalimumab, three showed an increase and one stayed the same. One patient experienced a significant complication (hospital admission for sepsis). Eight patients received concomitant tapering steroids during the first six weeks of therapy as the adalimumab reached maximum efficacy. When data from all 10 patients were analyzed together, there was no significant change in inflammatory index after three months of treatment with adalimumab. However, when the five patients with a high baseline inflammatory index (>4) were considered separately, there was a significant improvement (mean decrease of 5.2 ±2.7; p<0.01) after adalimumab treatment. Four of five patients also reported a subjective improvement in symptoms while on adalimumab.
Ophthal Plast Reconstr Surg 2014;30:415-419.
Ayabe R, Rootman D, Hwang C, Ben-Artzi A, Goldberg R.