New research shows that younger patients with high myopia have a higher risk for a postoperative steroid response after uneventful cataract surgery and may require more frequent monitoring or alternative topical anti-inflammatory medications.

In a case-controlled study to evaluate the age and ocular axial length of topical steroid responders after uneventful cataract surgery, researchers in Los Altos, Calif., used a retrospective chart review that comprised consecutive patients from a singlesurgeon practice who had cataract surgery during a two-year period. All patients routinely received topical prednisolone acetate 1.0% postoperatively. In addition to axial length and patient age, the intraocular pressure was recorded preoperatively, one-day postoperatively, and at least one additional time in the first postoperative month while the patient was taking a topical corticosteroid agent. A steroid response was defined as an IOP increase greater than 25 percent while on topical prednisolone (minimum 28 mmHg) followed by a decrease of more than 25 percent after topical prednisolone was discontinued. The age and axial length were compared between steroid responders with nonresponders.

Of the 1,642 patients, 39 were diagnosed as steroid responders. Younger age and a longer axial length were associated With a higher risk for steroid response, particularly in patients younger than 65 years with an axial length of at least 29 mm. These patients had a 39- fold increased risk for an IOP higher than 28 mmHg and a 35-fold increased risk for an IOP higher than 35 mmHg than patients older than 65 years with a normal axial length.

J Cataract Refract Surg 2011;37:675-81.
Chang DF, Tan JJ, Tripodis Y.

IV Bevacizumab Before MMC Trab Reduces Hyphema
Intravitreal bevacizumab before mitomycin-C trabeculectomy (MMCT) reduces hyphema associated with MMCT for neovascular glaucoma, suggests a new study. Researchers at Kumamoto University in Japan used a retrospective, comparative, consecutive case series to evaluate a group consisting of 57 eyes from 50 patients with NVG who underwent a first MMCT. Thirty-three eyes were treated with MMCT alone between June 2005 and May 17, 2007 (control group); and, 24 eyes were treated with a combination of intravitreal bevacizumab and MMCT after May 18, 2007 (IVB group). Surgical complications, intraocular pressure and the probability of success were compared between the two groups. Surgical failure was defined as IOP .22 mmHg for two consecutive follow-up  visits, a deterioration of visual acuity to no light perception or additional glaucoma surgeries.

There were no significant differences in preoperative data between the groups. Hyphema associated with MMCT occurred significantly less often in the IVB Group (p=0.006). IOPs at seven and 10 days after MMCT were significantly lower in the IVB Group (p=0.01 and 0.02, respectively). However, Kaplan-Meier survivalcurve analysis showed the probability of success 120, 240 and 360 days after MMCT of 87.5 percent, 79.2 percent and 65.2 percent in the IVB Group, and 75 percent, 71.9 percent and 65.3 percent in the control group. No significant difference in survival times was found between the groups (p=0.76).

J Glaucoma 2011;20:196-201.
Takihara Y, Inatani M, Kawaji T, et al. 

Dry Eye Associated with Impaired Productivity

Results from a recent survey point to an association between dry-eye disease and impairment of daily activities. The cross-sectional, web-based survey was administered to 9,034 individuals who are part of the Harris Interactive Online dry-eye panel. Patients (.18 years of age) were included if they were currently employed, a U.S. resident, had a patient- reported, physician-diagnosed dry eye and scored 13 or higher on the Ocular Surface Disease Index. Work productivity and impairment in daily activity was measured using the validated Work Productivity and Activity Impairment Questionnaire. Comparisons were made across disease severity groups: mild, moderate, severe.

Reduced productivity while at work was reported by patients in all three severity groups. Patients with moderate (18 percent) and severe (35 percent) disease had significantly greater reductions in productivity than patients with mild (11 percent) disease (p<0.05). Impairment in ability to perform daily activities was significantly greater among respondents with severe disease (34 percent) than respondents with moderate (19 percent) or mild (12 percent) disease (p<0.05).

Curr Med Red Opin 2011;27:1041-8.
Patel VD, Watanabe JH, Strauss JA, Dubey AT.

Ptosis-assessment Spectacles As Accurate as Ruler Method
Ptosis-assessment spectacles work as well as the conventional ruler method while allow providing additional ease of use with pediatric patients, suggests a new study. Fifty-two children aged 2 to12 years were recruited in this study. Each child underwent two sets of measurements. The first was undertaken by an ophthalmologist in the conventional manner using a ruler, and the second set made with ptosis assessment spectacles. On each occasion the palpebral aperture, skin crease and levator function were recorded in millimeters. A verbal analog scale was used to assess parent satisfaction with each method.

Clinically acceptable reproducibility was shown with the ruler and the spectacles for all measurements: palpebral aperture, skin crease and levator function. Parents significantly preferred the glasses for measurement, as compared with the ruler (p<0.05).

Ophthal Plast Reconstr Surg 2011;27:111-3.

Khandwala M, Dey S, Harcourt C, Wood C, Jones CA.

Hyperopic LASIK Patients More Prone to Epithelial Ingrowth
Patients undergoing hyperopic LASIK have a greater incidence of epithelial ingrowth than those undergoing myopic treatment, shows a new study. The retrospective study analyzed 1,000 consecutive LASIK procedures performed by three surgeons from the Oregon Health Science University using identical surgical technique with a Hansatome microkeratome. Eyes that developed epithelial ingrowth were evaluated using the Machat grading system. Patients were subdivided into two groups (myopic or hyperopic) based on the preoperative refractive error.

The total incidence of epithelial ingrowth was 4.7 percent. The incidence after primary treatment was 3. 9 percent. The incidence after enhancement was 12.8 percent. The total incidence of epithelial ingrowth was 3 percent in the myopic group compared with 23 percent in the hyperopic group. After primary myopic treatment, there was a 3-percent incidence of epithelial ingrowth compared with 17 percent after primary hyperopic treatment. The incidence after enhancement was 7 percent in the myopic group and 43 percent in the hyperopic group.

Cornea 2011;30:550-2.
Mohamed TA, Hoffman RS, Fine IH, Packer M.

Anesthetic Abuse Keratopathy Persists in Laborers
New research suggests that ophthalmologists should be suspicious of topical anesthetic abuse keratopathy, particularly in young males in the welding and foundry business presenting with persistent epithelial defects, ring-shaped keratitis and accompanying severe ocular pain. In a study to evaluate the clinical course, treatment modality, factors affecting the epithelization period and visual outcome of patients with topical anesthetic abuse keratopathy, researchers in Turkey reviewed medical records of 19 patients with a confirmed diagnosis of abuse. Occupation, initiating event, biomicroscopic findings, treatment modality, epithelization period and best-corrected visual acuity were noted. The Wilcoxon signed rank test was used to compare BCVA before and after treatment; p values <0.05 were considered statistically significant.

In all, 26 eyes in 19 men aged 21 to 44 (mean age: 31 ±6) years were included. Initiating events included exposure to arc welding flash (eight patients), metallic foreign body injury (eight patients) and chemical injury (three patients). Upon admission to the hospital, 10 patients (52.6 percent) reported that they were using topical anesthetics. The remaining nine subjects were discovered to be using topical anesthetic drops during hospitalization. Twelve patients (63. 2 percent) were found to continue using these agents during their hospitalization. Oval corneal epithelial defect, stromal infiltrate, ringshaped keratitis and hypopyon were noted in 100 percent, 46.2 percent, 57. 7 percent, and 42.3 percent of the eyes, respectively. Topical antibiotics (fluoroquinolones or combined fortified cephalosporins and aminoglycosides), preservative-free lubricants/ autologous serum, and bandage contact lens/eye patches were used for treatment. Mean epithelization period was 19.96 ±11.16 days (range: six to 50 days). Mean pretreatment and posttreatment BCVA was 0.12 ±0.16 (range: 0.001 to 0.7) and 0.66 ±0.30 (range: 0.0 to one), respectively (p< 0. 001).

Cornea 2011;30:571-5.

Yagci A, Bozkurt B, Egrilmez S, et al