Recent research at several insti-tutions in
The primary safety variables were the oc-currence of ocular and systemic adverse events throughout the course of the study. The primary efficacy variables were neovascular area (the area of the corneal vessels themselves); vessel caliber (the mean diameter of the corneal vessels); and invasion area) the fraction of the total corneal area covered by the vessels).
Results showed that the decreases in neovascular area and vessel caliber were statistically significant (p=0.001 and p<0.001, res-pectively). From baseline visit to the last follow-up visit, mean reductions were 47.1 percent (standard deviation: 36.7 percent) for neovascular area, 54.1 percent (SD: 28.1 percent) for vessel caliber and 12.2 percent (SD: 42 percent) for invasion area. Despite those results, changes in invasion area did not achieve statistical significance (p=0.19). Visual acuity and central corneal thickness showed no significant changes.
(Arch Ophthalmol 2009;127:381-9)
Dastjerdi MH, Al-Arfaj KM, Nallasamy N, et al
PPV Improves Visual Outcomes
Using pars plana vitrectomy to manage retained lens materials can help to improve overall visual outcomes, according to one study. A retrospective, noncomparative, consecutive case series was conducted to review the medical records of 166 patients with complicated cataract surgery who un-derwent PPV for retained lens material be-tween 2001 and 2007. Main outcome measures included final visual acuity, development of glaucoma, retinal detachments and cystoid macular edema.
The results showed that 120 patients (72.3 percent) had a visual outcome of 20/40 or better while 18 patients (10.8 percent) had a visual outcome of 20/200 or worse. Results were a little better for patients without any preoperative eye conditions, of which 82.6 percent achieved a final vision of 20/40 or better.
Multivariable analysis showed that predictors for visual outcomes of 20/40 or better were: better presenting vision (p=0.001); insertion of a posterior chamber lens (p=0.005); and absence of preoperative eye disease (p=0.001). As far as predicting visual outcomes of 20/200 or worse, indicators in-cluded were: the absence of an anterior vitrectomy at cataract surgery (p=0.005); absence of a sulcus lens (p=0.011); presence of preexisting eye disease (p=0.02); and development of glaucoma (p=0.001). Finally, performing a PPV within seven days of cataract surgery was associated with a lower risk of developing glaucoma (p=0.005).
The study authors recommend that cat-aract surgeons in this situation perform an anterior vitrectomy, place a posterior chamber lens if possible, and consult a retina specialist for a PPV within seven days to reduce the risk of developing secondary glaucoma.
(Am J Ophthalmol.2009;147(4):587-594)
Ho LY, Doft BH, Wang L, Bunker
Fuchs' Alleviated by DSAEK
The new triple-procedure Descemet's stripping automated endothelial keratoplasty combined with concurrent cataract surgery provides a rapid visual recovery for patients with Fuchs' dystrophy, according to a recent study. Three hundred fifteen eyes of 233 patients with Fuchs' corneal dystrophy were evaluated for the complications of dislocation and iatrogenic primary graft failure (IPGF) in a pro-spective, noncomparative, interventional case series. Two hundred and three eyes of 149 patients had six-month postoperative data available for other outcome analysis.
The authors performed a standardized technique of DSAEK with extensive use of cohesive viscoelastic in all 315 eyes with Fuchs' dystrophy, with 225 of those eyes having cataract sur-gery concurrently. Of the 203 eyes with six-month data, concurrent phacoemulsification with intraocular lens placement (triple procedure) was performed in 149 of those eyes. The outcome was based on six- and 12-month postoperative best spectacle-corrected visual acuity, refractive spherical equi-valent and central donor endothelial cell density, all of which were measured prospectively and then compared with preoperative values for the triple-procedure eyes.
There were four dislocations (4 percent) among the 90 straight DSAEK cases and four dislocations (1.8 percent) among the 225 triple-procedure cases (p=0.327). There was not a single case of IPGF in any of the 315 DSAEK cases. After the triple procedure, the BSCVA in eyes without com-orbidity (n=122) improved with 93 percent at 20/40 or better at six months and 97 percent at 20/40 or better at 12 months. Refractive SE at six months averaged 0.11 ±1.08 D, with 73 percent of eyes within 1 D of em-metropia and 95 percent within 2 D of emmetropia. The postoperative mean ECD was 1,955 cells/mm2 at six months (n=125) and 1,979 cells/mm2 at 12 months (n=89) and represented a 32 percent cell loss from that before surgery (p<0.001) for both postoperative time points.
(Ophthalmology 2009;116:631-9)
Terry MA, Shamie N, Chen ES, Phillips PM, et al.
Canaloplasty Yields Positive Results Two Years Postop
Canaloplasty remains both safe and effective for adults with open-angle glaucoma two years after the procedure, according a study by a host of
At 24 months, all 127 eyes had a mean IOP of 16 mmHg ±4.2 and mean medication use of 0.5 ±0.8 (baseline: 23.6 ±4.8 mmHg and 1.9 ±0.8 medications). Eyes with canaloplasty alone had a mean IOP of 16.3 ±3.7 mmHg and 0.6 ±0.8 medications (baseline: 23.2 ±4 mmHg and 2 ±0.8 medications). Mean-while, eyes with combined glaucoma-cataract surgery had a mean IOP of 13.4 ±4 mmHg and 0.2 ±0.4 medications (baseline: 23.1 ±5.5 mmHg and 1.7 ±1 medications).
The IOP and medication use results at all time points were statistically significant versus baseline (p<0.001). The late postoperative follow-up identified three patients with elevated IOP.
No serious ocular or nonocular complications were reported during the study.
(J Cataract Refract Surg. 2009; 35:814-24)
Lewis RA, von Wolff K, Tetz M, et al.
PDE5 Inhibitors Safer on the Eyes Than Once Thought
Phodiesterase type 5 (PDE5) inhibitors tadalafil and sildenafil that are prescribed for erectile dysfunction may not affect retinal function as once thought, suggests a recent study. The study tested tadalafil and sildenafil citrate to assess changes in electroret-inography and other retinal function parameters. Subjects were randomized to use of a placebo (n=82), 5 mg of tadalafil (n=85) or 50 mg of sildenafil (n=77) daily for six months.
Electroretinographs were recorded using the International Society for Clinical Electrophysiology of Vision (ISCEV) protocol and standardized ERG equipment at all 15 study sites. Other tests of ocular anatomy and visual function were performed at each assessment.
The outcome was measured by ob-serving average mean change for both eyes from baseline to endpoint in ERG b-wave amplitude using dark-adapted combined standard response to a bright ISCEV standard flash. The outcome was also measured by ob-serving other ERG parameter chang-es, visual acuity, number of errors in color discrimination testing, mean de-viation in automated visual field testing and intraocular pressure.
Results showed no significant differences between treatment/placebo groups for the primary outcome, most other ERG variables, visual function, IOP or anatomic assessments. The medications were well-tolerated over the prolonged time period.
(Arch Ophthalmol 2009;127:367-73)
Cordell WH, Maturi RK, Costigan TM, et al.
