Verteporfin ocular photodynamic therapy doesn't appear to lead to permanent and complete occlusion of choroidal neovascularization, says a research team from Cleveland, Atlanta, Ann Arbor and Stanford.

Investigators initiated a retrospective review of eight eyes of eight patients who underwent submacular surgery for CNV. Subjects had previously undergone Visudyne therapy for pathologies such as presumed ocular histoplasmosis, age-related macular degeneration, pathologic myopia, punctate inner choroiditis or idiopathic CNV. All cases had undergone ocular PDT with verteporfin using standard protocols.

Six of eight patients suffered a submacular hemorrhage after ocular photodynamic therapy, and two of eight patients refused further ocular PDT. All patients subsequently had submacular surgery with removal of the CNV. Date of removal ranged from three days after verteporfin ocular PDT to 152 days. There were signs of vascular damage with extravasated erythrocytes and fibrin, pigment clumping in cells, and inflammatory cells in all but the three-day specimen.

Based on this interventional case series, researchers conclude that treatments leading to permanent closure of the CNV without damage to the retinal pigment epithelium and sensory retina are still needed.
(Am J Ophthalmol 2003;135:343-350)
Moshfeghi D, Kaiser P, Grossniklaus H, Sternberg P, Sears J, Johnson M, Ratliff N, Branco A, Blumenkranz M, Lewis H

Fewer Red Eyes with Latanoprost
The pressure-controlling latanoprost (Xalatan, Pharmacia) may cause significantly less short-term conjunctival hyperemia on average in healthy subjects than its direct competitors—bimatoprost (Lumigan, Allergan) and travoprost (Travatan, Alcon).

Hyperemia Comparisons
• At hour 0, latanoprost had significantly less hyperemia than bimatoprost.
• At hour 0, latanoprost showed significantly less change than bimatoprost compared with the study baseline.
• At hour 1, latanoprost had significantly less hyperemia than travoprost.
• At hour 1, latanoprost demonstrated significantly less change from baseline in hyperemia than travoprost.
• At hour 1, latanoprost had less change in hyperemia than bimatoprost or travoprost between the study and the nonstudy eye.
• At hour 1, latanoprost showed significantly less change than bimatoprost and travoprost compared with hour 0.

In a prospective, randomized, double-masked crossover active controlled comparison, researchers from institutions in South Carolina and Missouri sought to evaluate conjunctival hyperemia after short-term use of latanoprost 0.005%, bimatoprost 0.03% and travoprost 0.004% in normal adults.
Researchers evaluated conjunctival hyperemia by a standard photographic measure at the slit lamp and by anterior segment photographs in healthy subjects after dosing forfive days with latanoprost, bimatoprost or travoprost. They evaluated conjunctival hyperemia at 24-hour trough (hour 0) and one hour after dosing. Each subject was crossed over between periods after a one-week washout interval. (See sidebar above for significant comparisons.)
Similar grades of hyperemia were observed by photographs with latanoprost demonstrating lowest levels.
(Am J Opthalmol 2003;1135:314-320)
Stewart W, Kolker A, Stewart J, Leech J, Jackson A

Ketorolac Alleviates Postop Pain
Researchers in North Carolina and Baltimore propose that Acular (ketorolac tromethamine, Allergan) is an ef-fective non-narcotic choice for postoperative pain control following vitreoretinal surgery.

This prospective, placebo-controlled clinical trial randomized 114 vitreoretinal surgical patients into two groups at one surgery center over a seven-month period. One group received a single intraoperative intravenous dose of Acular while others received a saline placebo. All patients underwent surgery with intravenous sedation and retrobulbar anesthetic injection and had access to a standard postop analgesic regimen. After periods of two and five hours, the investigators recorded eye pain, nausea, and sedation levels using a standard visual analog scale. They tabulated analgesic requirements. Investigators determined that patients given Acular were significantly less likely to have postop eye pain than were placebo-treated patients. Fewer Acular patients required postop analgesia than placebo patients did. Four Acular patients (7 percent) required a narcotic compared to 11 placebo patients (20 percent). Fewer treated patients experienced nausea and sedation than placebo patients did, but this difference wasn't statistically significant.

Researchers note that pain control is particularly important in this group of patients, whose compliance with postoperative procedures and positioning may significantly affect surgical outcomes. 
(Retina 2003;23:8-13)
Fekrat S, Marsh M, Elsing S, Raja S, DeJuan E, Campochiaro P, Haller J