After a 12-month intervention, German researchers concluded that a supplement containing a fixed combination of xanthophylls (lutein and zeaxanthin) and ω-3 long-chain polyunsaturated fatty acids (LC-PUFA) significantly improved plasma antioxidant capacity, circulating macular xanthophyll levels and the optical density of macular pigment in patients with nonexudative AMD.
A total of 145 individuals with nonexudative AMD were randomly divided as follows: placebo group; group 1 (a daily capsule containing lutein 10 mg, zeaxanthin 1 mg, docosahexaenoic acid 100 mg and eicosapentaenoic acid 30 mg); and group 2 (double the dose of substances used in group 1).

After a month of intervention, the concentrations of the administered carotenoids in plasma as well as the optical density of the macular pigment increased significantly in the groups randomized to receive supplementary macular xanthophylls and ω-3 LC-PUFAs; these concentrations remained stable though the end of the study. Use of the double dose of xanthophyll and LC-PUFA supplements in group 2 resulted in a beneficial alteration of the fatty acid profile in the plasma of patients with AMD in comparison with group 1. The lipophilic antioxidant capacity in plasma was also significantly elevated.
JAMA Ophthalmol 2013;131:564-572.
Arnold C, Winter L, Fröhlich K, Jentsch S, et al.

Visual Outcome of Cataract Surgery from the ERQOCRS

Fifteen European cataract surgery clinics participated in a database study to analyze visual outcomes after cataract surgery; the data supports excellent outcomes. A majority of patients (61.3 percent) achieved a corrected distance visual acuity of 1.0 (20/20) or better. While age and sex influenced outcomes, the greatest influences were short-term postoperative complications, ocular comorbidity, surgical complications and complex surgery.

Data were drawn from case series of cataract extractions reported to the European Registry of Quality Outcomes for Cataract and Refractive Surgery database; 368,256 cataract extractions were available for analysis. Case series data was entered into the database by surgeons, by transfer from existing national registries or by electronic medical record systems. The database contains individual anonymous data on preoperative, intraoperative and postoperative measures.

The best visual outcomes were achieved in age groups 40 to 74 years, with men showing a higher percentage of excellent vision (1.0 [20/20] or better). A corrected distance visual acuity of 0.5 (20/40) or better and of 1.0 (20/20) or better was achieved in 94.3 percent and 61.3 percent of cases. Ocular comorbidity and postoperative complications were the strongest influences on the visual outcomes, but surgical complications and ocular changes requiring complex surgery also had a negative influence. Deterioration of visual acuity after the surgery (n=6,112 [1.7 percent of cases]) was most common in patients with a good preoperative visual acuity. The researchers also note that a weakness of the study could be the self-reported nature of some data to the registry.
J Cataract Refract Surg 2013;39:673-679.
Lundström M, Barry P, Henry Y, Rosen P, et al.

Corneal Thickness as Predictor Of Corneal Transplant Outcome

A new report from the Cornea Donor Study shows that in the first five years after penetrating keratoplasty, corneal thickness can serve as a predictor of corneal graft survival. However, CT is not a substitute for cell density measurement because both measures are independently predictive of graft failure.

A total of 887 patients with a corneal transplant for a moderate-risk condition (principally Fuchs’ dystrophy or pseudophakic corneal edema) had postoperative CT measurements throughout a five-year follow-up time. Relationships between baseline (recipient, donor and operative) factors and CT were explored. Proportional hazards models were used to assess the association between CT and graft failure. Relationship between CT and cell density was assessed with a longitudinal repeated measures model and Spearman correlation estimates.

Higher longitudinal CT measurements were associated with the following: diagnosis of pseudophakic or aphakic corneal edema (p<0.001); intraocular pressure >25 mmHg during the first postoperative month (p=0.003); white (non-Hispanic) donor race (p=0.002); and respiratory causes of donor death (p<0.001). Among those without graft failure within the first postoperative year, the five-year cumulative incidence of graft failure (±95 percent CI) was 5 percent ±5 percent in those with a one-year CT ≤500 μm; 5 percent ±3 percent for CT 501 to 550 μm; and 20 percent ±11 percent for CT >600 μm. In a multivariate analysis, both one-year CT and cell density were associated with subsequent graft failure (p=0.002 and 0.009). CT increase was modestly associated with endothelial cell loss during follow-up (r= -0.29).
Cornea 2013;32:729-736.
Verdier D, Sugar A, Baratz K, Beck R, et al.

Patient Preferences Between Botox and Xeomin in BEB
According to doctors in Missouri, patients with benign essential blepharospasm treated with both onabotulinumtoxinA (Botox) and incobotulinumtoxinA (Xeomin) who prefer Xeomin over Botox had a statistically significant shorter treatment interval. In addition, those who preferred Xeomin thought it was more effective; patients who preferred Botox thought it had a longer duration of effect.

Fifty patients with BEB being treated with Botox were switched to Xeomin. At a scheduled follow up, patients decided to either continue with the Xeomin or switch back to Botox, and preferences regarding treatment were recorded. The preference groups were then analyzed using unpaired Student t test, with the statistical significance set at p<0.05.

The mean age of the 50 Xeomin patients was 64.9 years; 39 (78 percent) were women and 11 (22 percent) were men. In all, 26 (52 percent) preferred Xeomin and 24 (48 percent) preferred Botox. Those who preferred Xeomin believed that it was “more effective” (n=10; 29 percent), while those who preferred Botox concluded that it had a “longer duration” (n=11; 37 percent). The mean treatment interval was 13 weeks (SD=6.39) in those who preferred Botox, whereas it was 10.2 weeks (SD=2.15) in those who preferred Xeomin (p=0.017). There was no statistical difference when comparing mean disease duration, number of total treatments and number of units/treatment between the two preference groups.
Ophthal Plast Reconstr Surg 2013;29:205-207.
Chundury R, Couch S, Holds J.

Endothelial Graft Failure After Contralateral APK

Bascom Palmer Eye Institute and the Miami Veterans Affairs Hospital are the first to describe graft failure because of slow endothelial attenuation after contralateral autologous corneal transplantation (APK).

Five patients received a contralateral APK and a simultaneous allogeneic penetrating keratoplasty in the donor eye at the Bascom Palmer Eye Institute and the Miami Veterans Affairs Hospital. Median patient age at the time of surgery was 67 years (r: 58 to 88 years); four patients were male and one female; one patient was white and four were black. The surgeries were uneventful and no operative or immediate postoperative complications occurred in either eye. During follow-up (r: 18 to 54 months; mean: 35 months; median: 34 months), four autologous grafts failed because of endothelial attenuation. Identified risk factors for failure in the autologous eyes included the presence of a glaucoma tube (5/5), previous graft failure (4/5) and anterior synechiae (2/5).
Cornea 2013;32:745-750.
Martinez J, Galor A, Perez V, Karp C, et al.

Antibiotic-resistant Ocular Surface Flora After IVT Injection
Repeated use of topical moxifloxacin after intravitreal injection appears to increase antibiotic resistance in ocular surface flora. Because of this, researchers recommend that routine use of prophylactic antibiotics after IVT injection be discouraged.

Patients 65 years and older with newly diagnosed age-related macular degeneration were recruited by seven retinal specialists from July 1, 2010 through December 31, 2011. The study group (n=84) received topical moxifloxacin hydrochloride for three days after each monthly IVT injection, while the control group (n=94) received no topical antibiotics after injection. Researchers measured the resistance to moxifloxacin and ceftazidime in cultured isolates at baseline and monthly for three months in both groups, studying the changes in the minimal inhibitory concentration of culture isolates.

In the study group, the baseline adjusted MIC increased from 1.04 to 1.25 μg/mL (p=0.01), the MIC for 50 percent of isolates (MIC50) increased from 0.64 to 1.00 μg/mL and the MIC for 90 percent of isolates (MIC90) increased from 0.94 to 4 μg/mL. In both groups, the culture-positive rate did not change significantly when adjusted for baseline. No significant change was found in the MIC level, culture-positive rate, MIC50 level or MIC90 level in the control group. Subgroup analysis found diabetes mellitus to be noncontributory to both the MIC and culture-positive rate.
JAMA Ophthalmol 2013;131:456-461.
Published online February 21, 2013.

Yin V, Weisbrod D, Eng K, Schwartz C, et al.