A team of researchers from Ontario and Tennessee has published an assessment of the Bioceramic (aluminum oxide Al2O3), an alternative porous orbital implant (FCI, Issy-Les-Moulin-eaux, France).
Investigators reviewed a consecutive case series of 107 patients who received a Bioceramic orbital implant by two surgeons over a three-year period. They analyzed patient age, type of surgery, size of implant, peg system, follow-up duration, time of pegging, complications encountered and treatment.
Implant-related problems occurred in 11 patients. Discharge occurred in five patients, implant exposure in two, socket discomfort in one, troch-leitis in one and conjunctival thinning in two. Peg problems occurred in 11 (34.3 percent) of 32 pegged patients; discharge in four (12.5 percent), and in one patient (3.1 percent) each of: pyogenic granuloma, conjunctiva overgrowing the peg, implant exposure around the sleeve, clicking, accumulation of black material, and broken peg during insertion. Infection did not occur in any patient.
Investigators concluded that the Bioceramic orbital implant is biocompatible with orbital tissues, easy to manufacture, structurally strong, and less expensive than other commercially available porous orbital implants such as the Bio-Eye hydroxyapatite implant (Bio-Eye Integrated Orbital Implants, Inc., San Diego). The researchers say problems encountered with the Bioceramic product were similar to those seen with the Bio-Eye but occurred less often.
(Ophthal Plast Reconstr Surg. 2003;19:128-135)
Jordan D, Gilberg S, Mawn L
DLK Treatment Needs No Flap Lifting
An Oregon research team reports that treatment of severe diffuse lamellar keratitis with high-dose topical and oral corticosteroids produced excellent results without flap lifting or interface irrigation.
Researchers performed a retrospective analysis of 1,000 LASIK cases and identified 40 eyes in which DLK was diagnosed. It progressed to stage 3 in seven eyes (17 percent). Of those who developed the infection, the mean age was 37 years, and the mean preop spherical equivalent refraction was -3.44 D. Bi-lateral DLK presented in 15 of the 25 patients (60 percent). Eleven DLK eyes also had cor-neal abrasions, and three of these eyes progressed to stage-3 DLK. Sixteen of the 1,000 LASIK eyes had associated corneal abrasions that did not result in DLK.
Researchers treated eyes developing stage-3 DLK, or at risk for progressing to stage 3, with a combination of high-dose prednisolone ace-tate 1% and oral prednisone. No eye, regardless of stage or best-corrected vision, was treated with flap lifting or interface irrigation.
There were no instances of corneal scarring or permanent loss of best-corrected vision. The mean variation from the desired refractive outcome was 0.14 D.
(J Cataract Refract Surg 2003;29:451-456)
Hoffman RS, Fine IH, Packer M
Antivirals Worthwhile for Ocular Herpes Treatment
In a study of one Midwestern United States population, investigators from Rochester, Minn., determined that neurotrophic keratitis was less frequent among patients who re-ceived antiviral therapy.
Investigators identified all Olmstead County, Minn., residents diagnosed with acute herpes zoster ophthalmicus from 1976 to 1998. They compared the frequencies of complications within six months of disease onset between the untreated patients and those treated with antivirals. Complications were ocular sequelae due to the virus. Ad-verse outcomes included visual acuity of 20/200 or worse, trichiasis or eyelid malposition requiring surgical treatment.
The review revealed that 202 pa-tients had been treated with antivirals, 121 had not. Neurotrophic keratitis was the only complication found to be less likely in the treated group
(3.3 percent vs. zero percent). In treated patients, the development of a serious inflammatory complication was associated with a delay in therapy. Investigators believe these data support the early and routine use of systemic antiviral therapy for acute herpes zoster ophthalmicus.
(Arch Ophthalmol. 2003;121:386-390)
Severson E, Baratz K, Hodge D, Burke J
LASIK and Contrast Sensitivity
A study conducted in Taiwan confirmed decreased contrast sensitivity in post-LASIK patients. Re-searchers examined the effect of pupil size and amount of ablation on visual performance and perception of glare or halos following LASIK.
A random cross-section of 50 eyes of 32 post-LASIK patients with "uniform" topography and 51 eyes of 28 patients with normal corneas participated in this study. All LASIK procedures were performed by a single surgeon who used a 6.5-mm optical zone and an anticentral island pretreatment. LASIK patients completed surveys to rate symptoms of glare and halos. Researchers measured pupil diameter and best-corrected vision under photopic (250-300 lux) and scotopic (4-5 lux) conditions. They measured contrast sensitivity under three conditions: daytime, nighttime, and nighttime with night glare. Re-searchers calculated the potential corneal visual acuity (PCVA) after they changed the settings for the pupil size to the values measured under bright-light or dim-light conditions.
The research team found no significant difference between the post-LASIK and normal cornea groups in photopic or scotopic BSCVA.
In moderate myopia, (-3.5 to –7 D), the post-LASIK group had decreased PCVA under bright-light and dim-light conditions and decreased contrast sensitivity at all five spatial frequencies. In high myopia, (-7 to -10), the post-LASIK group had decreased contrast sensitivity at a spatial frequency of 1.5 cycles per degree under daytime conditions and at 3 cpd under nighttime conditions.
In moderate myopia, neither glare nor halos was significantly correlated with scotopic pupil size, attempted level of astigmatic correction, scotopic best-corrected acuity or PCVA, or nighttime contrast sensitivity with or without night glare. Researchers did find that the amount of attempted correction of the SE did correlate with halo symptoms. In high myopia, the amount of attempted astigmatism correction was correlated with the development of glare.
(J Cataract Refract Surg 2003; 29:769-777)
Lee Y-C, Hu F-R, Wang I-J