A comparison of clinical outcomes, functional vision and spectacle freedom in patients 70 years or younger with bilateral ReSTOR (Alcon) or ReZoom (Advanced Medical Optics) multifocal intraocular lenses shows both designs provided excellent uncorrected visual acuity. ReSTOR patients had better clinical and functional vision at near and comparable clinical and functional intermediate performance. Halos were more severe in the ReZoom group. Although the ReSTOR gave higher rates of spectacle freedom, patient satisfaction was high in both groups.

Thirty patients, age 70 or younger with operable bilateral cataracts and otherwise healthy eyes, had nonrandomized bilateral implantation of a ReZoom or ReSTOR in a private-practice setting. Outcome measures recorded six months postoperatively were uncorrected and distance-corrected (far, intermediate, near) visual acuities, contrast sensitivity (photopic, mesopic, mesopic with glare), pupil size and stereopsis. Patients completed a quality-of-life questionnaire and an interactive functional evaluation using real-life props.

The UCVA at all distances was excellent in both groups, with the ReSTOR IOL performing significantly better at 31 cm. This near superiority was also evident with distance correction or at the patient¡¯s preferred reading distance and correlated with subjective and functional vision testing results. Intermediate vision at 50 cm was comparable. The incidence of halos was similar; however, severity was higher in the ReZoom group, with two of 15 patients refusing a second IOL for this reason. Spectacle freedom was achieved by 50 percent in the ReZoom group and 72.7 percent in the ReSTOR group.

(J Cataract Refract Surg 2008;34:934-41)

Chang DF.

How the New IOLMaster Algorithm Measures Axial Length

A single-center study in a private practice in Arizona evaluated the ability of the new IOLMaster with Advanced Technology version 5 software (Carl Zeiss Meditec) to measure axial length in patients having preoperative cataract evaluation. The study recorded visual acuity, manifest refraction and LOCS III scores for 54 eyes (33 patients) and acquired 20 AL measurements per eye using the advanced software. AL measurements were analyzed and classified into four methods: standard, standard manipulated, composite-5, and composite-20.

AL measurements were successfully obtained in 55.6 percent of eyes with the standard method; 94.4 with standard manipulated; 92.6 percent with composite-5; and 96.3 percent with composite-20 methods. Axial length measurement availability (ability of the software to provide an AL measurement) was not statistically significantly affected by nuclear color, nuclear opalescence or cortical changes with any method. However, posterior subcapsular changes statistically significantly affected the standard and composite methods (p<.05) and marginally affected the standard manipulated method in measuring the AL (p= .0868). AL availability was significantly reduced in eyes with PSC of LOCS III grade 5.0 or higher.

The two composite methods performed as well as the more time-consuming, complicated standard manipulated method in measuring AL. More than 90 percent of eyes could be measured by the composite methods. Dense posterior subcapsular cataracts significantly reduced the ability of the composite and standard manipulated methods to successfully measure AL.

(J Cataract Refract Surg 2008; 34:920-4)

Hill W, Angeles R, Otani T.

Bevacizumab Shows Effect Against Non-AMD CNV

A group in New York City has reported the results of intravitreous bevacizumab treatment for choroidal neovascularization from causes other than age-related macular degeneration. Despite varying underlying etiologies, subfoveal CNV secondary to non-AMD causes treated with bevacizumab responded favorably and similarly. The retrospective analysis included eyes that received bevacizumab (Avastin), 1.25 mg, for subfoveal non-AMD CNV at a referral-based retinal practice. Repeat treatment occurred if there were signs of persistent or recurrent exudation. The main outcome measure was visual acuity.

The study included 39 eyes of 36 patients with subfoveal CNV secondary to multifocal choroiditis (n=12), angioid streaks (n=11), myopic degeneration (n=10), idiopathic disease (n=4) or other disease (n=2). The median baseline VA was 20/60 (logMAR, 0.48). The mean follow-up was 58.8 weeks, and the mean number of injections per eye was 3.4. After three-month follow-up, the median VA was 20/30 (logMAR, 0.18) (p=.004 vs baseline). At last follow-up, the median VA was 20/40 (logMAR, 0.30). This remained an improvement compared with baseline (p<.02) but was worse than three-month follow-up (p<.03). There was no correlation between underlying diagnosis and VA change during follow-up.

(Arch Ophthalmol 2008;126:941-5)

Chang LK, Spaide RF, Brue C, Freund KB, Klancnik JM Jr, Slakter JS.

 

Bevacizumab Studied for Effect on Retinoblastoma

Researchers in Seoul, Korea, report that bevacizumab suppressed the angiogenesis and tumor growth of retinoblastoma in vitro and in vivo, and  the drug is likely to be of benefit in the treatment of retinoblastoma. The group evaluated bevacizumab in a coculture of a Y-79 human retinoblastoma cell line and a human umbilical vein endothelial cell line by means of a cell proliferation assay kit and a VEGF enzyme-linked immunosorbent assay. Y-79 xenotransplanted mice were treated with bevacizumab intraperitoneally twice weekly for four weeks, with each tumor measured once a week. The mice were then euthanized, and the weight and microvessel density of each tumor were determined.

The mean increased human umbilical vein endothelial cell proliferation, when cocultured with Y-79, was suppressed 58 percent by the blockage of VEGF induced by bevacizumab. By causing a twofold reduction in microvessel density in the Y-79 xenograft model, bevacizumab induced a 75-percent reduction in the growth of the retinoblastomas without significant systemic toxicity.

(Arch Ophthalmol 2008;126:953-8)

Lee SY, Kim DK, Cho JH, Koh JY, Yoon YH.

 

Meta-analysis Looks at 24-hour IOP Studies

A meta-analysis of published articles evaluating patients with primary open-angle glaucoma, exfoliative glaucoma or ocular hypertension reveals similar efficacies in various ocular hypotensive agents during night and day hours.

PRN Pharmaceutical Research Network, of Dallas, collected articles describing randomized, prospective, single- or double-masked, comparative studies of ocular hypotensive therapies over 24 hours. All articles contained an untreated baseline, ¡Ýfour-week treatment period, ¡Ý20 patients per treatment arm, and ¡Ýsix time points not >five hours apart and used Goldmann applanation or Tonopen tonometry to measure intraocular pressure. The main outcome measure was 24-hour IOP efficacy. This yielded 864 separate 24-hour treatment curves from 386 patients in 28 treatment arms from 11 studies. A statistical difference in the mean diurnal pressure decrease existed between monotherapy treatments for POAG/OH patients, with bimatoprost (29 percent) and travoprost (27 percent) showing the greatest 24-hour reduction (p=0.026). Timolol 0.5% was less effective than latanoprost (24 vs. 19 percent reduction) but decreased the pressure at each night time point (p=0.0003). Dorzolamide showed a 19 percent 24-hour pressure reduction and brimonidine 0.2%, a 14 percent one.

In exfoliative glaucoma patients, latanoprost and travoprost showed higher baseline and treatment pressures, although the pressure reductions (29 percent and 31 percent, respectively) were greater generally than observed with POAG/OH. An evening-dosed latanoprost/timolol fixed combination reduced the pressure 33 percent, and the dorzolamide/timolol fixed combination (DTFC), 26 percent. However, the limited number of patients (20) in the DTFC group reduced the power to detect a difference for this specific comparison. A statistical difference between evening-dosed (24 percent) and morning-dosed (18 percent) latanoprost (p<0.0001) was noted, but not between evening (27 percent) and morning (26 percent) travoprost (p=0.074). The mean reduction of nighttime points was statistically lower than daytime for latanoprost (p=0.031), timolol (p=0.032), and brimonidine (p=0.050), but not for dorzolamide. Dorzolamide (p=0.60), travoprost (p=0.064) and bimatoprost (p=0.057) did not demonstrate nighttime pressures lower than daytime ones. The mean reduction of nighttime points was statistically lower than daytime for latanoprost (p=0.031), timolol (p=0.032) and brimonidine (p=0.050), but not for dorzolamide (p=0.60), bimatoprost (p=0.057) or travoprost (p=0.064). 

(Ophthalmology 2008;115:1117-1122)

Stewart WC, Konstas AG, Nelson LA, Kruft B.