Researchers at several sites in Hong Kong and Shantou, China, conclude that acupuncture is a potentially useful complementary treatment modality that may provide sustainable adjunctive effect to refractive correction for anisometropic amblyopia in young children.
Their prospective, randomized, controlled, crossover trial included 83 children aged 3 to <7 years with untreated anisometropic amblyopia and baseline best-corrected visual acuity of 20/40 to 20/200 in the amblyopic eye.
Participants were randomized to receive spectacles alone (group 1; n=42) or spectacles plus acupuncture (group 2; n=41) for 15 weeks, and were then crossed over to receive the other regimen for another 15 weeks. The BCVA in both eyes was measured at baseline and every five (±1) weeks for the initial 45 weeks and at 60 (±1) weeks.
Main outcome measures were BCVA in the amblyopic eye at 15, 30 and 60 weeks.
The mean baseline BCVA in the amblyopic eye was 0.50 and 0.49 logMAR in groups 1 and 2, respectively. After 15 weeks of treatment, the BCVA had improved by a mean of 2.2 lines in group 1 and 2.9 lines in group 2. The mean difference in BCVA between groups was 0.77 lines (p=0.0020) with baseline adjustment. BCVA of ≤0.1 logMAR was achieved in 14.6 percent of the patients in group 1 and 57.5 percent in group 2 (p<0.00010). After the regimens were crossed over at 30 weeks, group 1 had a mean of 1.2 (p=2.0 × 10(-12)) lines additional improvement from the 15-week BCVA, whereas in group 2 the mean improvement was 0.4 (p=0.0010) lines.
The proportions of responders, resolution, and participants achieving a BCVA of ≤0.1 logMAR at 30 weeks were similar between groups. After completion of acupuncture, only one participant had >one line of VA decrease to 60 weeks. Acupuncture was well-tolerated by all children, and no severe adverse effect was encountered. The group concludes that further large-scale studies seem warranted.
Ophthalmology 2011 Aug; 118 (8):1501-11. Epub 2011 Apr 3.
Lam DS, Zhao J, Chen LJ, Wang Y, Zheng C, Lin Q, Rao SK, Fan DS, Zhang M, Leung PC, Ritch R.
Complications with Drainage Devices and Boston KPro
Surgeons at the U.C. Davis Health System Eye Center, University of California at Davis, retrospectively evaluated long-term complications related to glaucoma drainage devices in patients undergoing Boston type 1 keratoprosthesis surgery.
All patients who underwent Boston type 1 keratoprosthesis surgery at the institution between 2004 and 2010 were included. Preoperative and postoperative data were reviewed. Twenty-five eyes with glaucoma drainage devices were highlighted. Visual acuity and postoperative complications were tracked at postoperative month one, every three months through month 12 and at annual intervals thereafter.
Forty eyes of 35 patients were evaluated with an average follow-up of 33.6 months. Conjunctival breakdown occurred in association with 10 glaucoma drainage device implants in nine eyes. Eleven eyes had glaucoma drainage devices placed before keratoprosthesis surgery, three eyes underwent glaucoma drainage device placement at the time of surgery, and two eyes had a glaucoma drainage device placed after surgery. All but one of the eroded glaucoma drainage devices were placed before surgery.
Associated complications included endophthalmitis, hypotony and keratoprosthesis extrusion, with six glaucoma drainage devices requiring removal. Long-term BCVA was maintained better in eyes in which glaucoma drainage device erosions did not develop.
The group writes that one of the main challenges with keratoprosthesis surgery is treating concurrent glaucoma and although drainage devices have been advocated as a way to address this long-term complication, this series suggests that drainage device-related complications can cause significant vision loss.
Am J Ophthalmol 2011 Aug;152 (2):209-18. Epub 2011 Jun 2.
Li JY, Greiner MA, Brandt JD, Lim MC, Mannis MJ.
Pharmacologic Pupil Dilation to Predict IFIS Risk
Researchers at the University of Palermo, Italy, sught to evaluate the effect of α1-adrenergic receptor antagonists on pupil diameter and determine whether the diameter predicts intraoperative floppy-iris syndrome. α1-ARAs are accepted as first-line treatment of benign prostatic hyperplasia, but have been implicated in IFIS.
The study recruited three groups, 50 patients each, of male outpatients taking tamsulosin, α1-ARAs, or no α1-ARAs, all of them scheduled for phacoemulsification. Pupils were measured one month preoperatively, immediately preoperatively and postoperatively under mesopic low (0.4 lux) and high (4.0 lux) illumination after pharmacologic dilation. The IFIS severity was graded.
Pharmacologic dilation in both α1-ARA groups was statistically significantly less than in the no α1-ARA group one month preoperatively, immediately before surgery, and postoperatively (p=.001, p<.0005, and p<.0005, respectively). The IFIS incidence differed significantly between the tamsulosin and other α1-ARA groups and the no α1-ARA group (p<.0005 and p=.017, respectively) and between the tamsulosin group and the other α1-ARA group (p=.027).
On regression analysis, the hazard ratio for overall IFIS incidence was 3.8 in the other α1-ARA group (p=.012) and 10.1 in the tamsulosin group (p<.0005). Pupil size was inversely related to IFIS incidence and severity (p<.0005). A dilated pupil of 7 mm or smaller had 73 percent sensitivity and 95 percent specificity for predicting IFIS (p=.0001).
The group concludes that pupil dilation was inhibited by α1-ARAs, in particular tamsulosin. For a pupil 7 mm or smaller, the risk for IFIS existed regardless of α1-ARAs treatment, which surgeons should take into consideration.
J Cataract Refract Surg 2011;37:1447-54.
Casuccio A, Cillino G, Pavone C, Spitale E, Cillino S.
Examining FLEK Wound Geometry with OCT
A prospective, nonrandomized clinical and laboratory study at the Doheny Eye Institute and Department of Ophthalmology at the Keck School of Medicine of the University of Southern California, suggests that femtosecond laser-enabled keratoplasty, or FLEK, offers benefits of rapid wound healing and predictable wound geometry.
The study used optical coherence tomography to measure and analyze wound architecture in eight eyes of eight consecutive patients who underwent FLEK. Femtosecond laser lamellar cuts were performed on three eye-bank corneas, and the wound diameters were measured by OCT.
Sutures were completely removed on average at one month per decade of age after surgery. No cases of wound dehiscence were noted, and graft-host tissue apposition appeared excellent on OCT. The mean spectacle-corrected visual acuity one month after suture removal was 20/35, and mean astigmatism was 5 D by manifest refraction and 8.7 D by computerized topography. The measured graft diameter was smaller than the laser setting by 2.5 percent (p=0.007). The cut diameters of the eye bank corneas were also slightly smaller than the laser setting.
The measured wound geometry agreed well with laser setting other than a small systematic deviation that could be explained by the mechanics of corneal applanation during the laser cut. OCT is a useful tool to measure the actual graft diameter after FLEK.
Heur M, Tang M, Yiu S, Zhang X, Huang D.
Study Assesses Postop Blepharoplasty Experience
A prospective, observational study conducted by researchers at Orlando Eye and Oculoplastics, LLC, in Orlando, Fla., has shown that postoperative patient experience with blepharoplasty is based largely on anecdotal evidence.
The study looked at 51 consecutive patients undergoing bilateral upper eyelid blepharoplasty by a single surgeon between October 2008 and May 2009. Prior to surgery, patients were asked to rate, on a scale of 1 to 10, their expectations of pain, swelling, bruising, blurred vision, impairment of ability to function in daily activities and itching. Patients were then asked to rate these six elements at seven time points: 30 minutes, four hours, 24 hours, two days, three days, one week and two months. The number of pain pills utilized was also assessed. An analysis of the data was performed to determine our patients’ experience with blepharoplasty surgery. The paired t test was used to determine the statistical significance of patients’ expectations compared with their actual reported experience.
In this cohort of patients, researchers found the following: blurred vision and impairment in ability to function peaked in the immediate postoperative period, pain peaked at four hours, swelling and bruising peaked at 24 hours, and itching peaked at three days. The mean number of narcotic pain pills used by patients in the postoperative period was 2.45. Patients underestimated the degree of swelling, blurred vision, and impairment in ability to function experienced following surgery.
Ophthal Plast Reconstr Surg 2011;27:152-4.
Parbhu KC, Hawthorne KM, McGwin G Jr., et al.