Late vitreous hemorrhage may occur as a complication of a suture-fixated posterior chamber intraocular lens, says a team made up of researchers in San Francisco, Atlanta, Miami and Portland, Ore. They reviewed the records of six patients who experienced at least one late (at least three weeks post-procedure) vitreous hemorrhage after scleral fixation of a PCIOL. Patient age ranged from 39 to 84 years (median: 68 years).
After suture fixation of the PCIOL, the time until the initial vitreous hemorrhage ranged from three weeks to 68 months (median: four months). These hemorrhages, they report, may be caused by mechanical erosion of the haptic into vascularized uveal structures.
In three eyes, the hemorrhages spontaneously resolved, leading researchers to recommend that management of these cases include a reasonable period of observation. In the other three eyes, the patients underwent reoperation (between five and 17 months after the initial scleral fixation of the PCIOL). In two, the scleral-fixated PCIOL was removed and replaced with an anterior chamber IOL. In the third patient, the PCIOL was repositioned by resuturing the haptics in a meridian 45 degrees away from the original 3 o'clock and 9 o'clock position.
The median follow-up period was 17 months. All patients were noted at final visit to have attached retinas. Four eyes had final vision of 20/20 to 20/40, one eye had 20/70, and one eye had vision of hand motion only.
(Retina 2004; 24:193-198)
Fu A, McDonald HR, Jumper JM, Aaberg T, Smiddy W, Robertson J, Johnson R, Ai E.
Sunglasses and Photochromics See About the Same Use
Preference for sunglasses or photochromic lenses does not differ greatly among spectacle-wearers or contact lens wearers, reveals a survey conducted by New York researchers. Most survey participants wore sunglasses in the summer and to protect their eyes. Overall, gray was the preferred lens tint. The survey indicated that the potentially adverse effects of ultraviolet radiation exposure to the eye and the importance of proper UVR eye protection were not generally appreciated by the population who completed the anonymous questionnaire.
(Eye & Contact Lens 2004; 30(2):81-84)
Glavas I, Patel S, Donsoff I, Stenson S
Raised IOP in Chronic Uveitis
Raised intraocular pressure is more common in patients with uveitis but appears to be a more significant problem in patients with chronic uveitis of all types, say researchers in London. They reviewed consecutive case notes of 257 patients attending a specialist uveitis clinic during a three-month period; 216 patients were included in the study. Mean age of patients considered was 45 years; 51 percent were white and 53 percent were male.
The prevalence of raised IOP in the study eyes was 41.8 percent. Researchers found raised IOP in 26 percent of eyes with acute uveitis and in 46.1 percent of eyes with chronic uveitis (P=0.002). The prevalence of raised IOP requiring treatment in acute uveitis was 15.1 percent and in chronic uveitis, 33.8 percent (P=0.002). Active inflammation was significantly associated with raised IOP (P=0.031).
Steroid usage (P=0.008), increasing age (P=0.022), and number of years since diagnosis (P=0.006) were significantly correlated with raised IOP.
Glaucoma developed in 9.6 percent of the study eyes. The majority of these eyes (69.7 percent) received standard topical and/or oral treatment. The remaining 30.3 percent required medical and surgical management.
(J Glaucoma 2004;13:96-99)
Herbert H, Viswanathan A, Jackson H, Lightman S
Flap Inflammation May Not Be DLK
Researchers in Ohio and Minnesota investigated the natural course and treatment of the post-LASIK condition known variously as pressure-induced stromal keratitis (PISK) or pressure-induced interface keratitis (PIIK). PIIK is an interface inflammation that resembles DLK in appearance but presents late in the postop period. It is associated with increased IOP, and is exacerbated by steroid treatment.
The research team identified 10 eyes in six patients with late-onset interface inflammation and increased IOP. Half of the patients were male; age ranged from 28 to 55 years. Three patients underwent simultaneous bilateral LASIK and contributed six eyes to the study.
At presentation, all patients were presumed to have classic DLK and were treated initially with aggressive topical steroids. Eight of the 10 eyes were receiving topical steroids at the time of presentation.
The average time of presentation was 17 days after LASIK (range: seven to 34 d.). Elevated IOP was noted on average 28 days after presentation (range: eight to 69 d.). Topical steroids exacerbated lamellar inflammation. Investigators report that resolution of the interface inflammation didn't occur until they controlled the IOP. They suggest that postop assessment of IOP in essential in patients presenting with flap inflammation.
Nordlund M, Grimm S, Lane S, Holland E
Triamcinolone Use Worth Moderate Risks
Despite a significant adverse event profile, Australian researchers assert that intravitreal triamcinolone is generally well-tolerated by the eye as long as patients are carefully followed up by the surgeon and treated when necessary for adverse events.
In a double-masked, placebo-controlled randomized clinical trial, researchers assigned 75 eyes to study treatment and 76 to placebo. Participating patients had age-related macular degeneration with evidence of choroidal neovascularization, any part of which was classic. Average age was over 59 years; BCVA was 20/200 or better. Clinicians performed IOP and cataract grading every six months for three years.
Investigators noted no moderate or severe adverse event related to the surgical procedure in either the treatment group or the placebo group. Triamcinolone-treated eyes had a significantly increased risk of developing mild or moderate elevation of IOP, which was lowered to satisfactory levels with topical glaucoma medication. There was significant progression of cataract in treated eyes.
(Arch. Ophthalmol 2004;122:336-340)
Gillies M, Simpson J, Billson F, Luo W, Penfold P, Chua W, Mitchell P, Zhu M, Hunyor A