Researchers have shown that four currently available topical nonsteroidal anti-inflammatory drugs (generic diclofenac, generic ketorolac, brand bromfenac and brand nepafenac) have similar anesthetic effects to branded diclofenac and branded ketorolac.
Baseline corneal sensitivity was measured on 10 healthy adult volunteers with a Cochet-Bonnet esthesiometer. One drop of the agent being studied was applied to the right eye every five minutes for a total of four drops. Corneal sensitivity was measured immediately after the last topical application and every 15 minutes for 60 minutes. After a one-week washout period, a different agent was studied until all four NSAIDs were evaluated.
Corneal sensitivity profiles over time were similar for all NSAIDs. Corneal sensitivity decreased significantly from baseline immediately after topical application, remaining flat from zero to 30 minutes and then rising from 45 to 60 minutes back toward baseline in all treatment groups (p<0.001). The maximal absolute drop in corneal sensitivity as measured by pressure thresholds was greatest for diclofenac (28.6 mm; 95 percent confidence interval, 19.8 to 37.4), followed by ketorolac (21.1 mm; 95 percent CI, 15.1 to 27.1), bromfenac (16.9 mm; 95 percent CI, 10.7 to 23.1) and nepafenac (16.4 mm; 95 percent CI, 12.7 to 20.1). Only diclofenac and nepafenac were statistically significant in maximal decrease in sensitivity.
Cornea 2015;34:541-543.
Singer D, Kennedy J, Wittpenn J.
Safety of 5-FU Injection After Eyelid Skin Grafting
A retrospective chart review of patients who underwent eyelid skin grafting for various etiologies with adjunctive postoperative 5-fluorouracil (50 mg/ml, with or without added kenalog 5 mg/ml) injections suggests that this procedure is safe, with good surgical results, minimal scarring and high patient and surgeon satisfaction.
In total, 19 patients from a multi-year period (2011 to 2013) were identified. Patient average age was 66, and a follow-up of 10 months was included in the chart review. Surgical indications for eyelid skin grafting included reconstruction of cancer excision defects, repair of lower eyelid ectropion or retraction, benign eyelid lesion excision and effacement of a canthal web. At each visit, patients were evaluated for redness, swelling, wound healing, scar formation, telangiectasis and pigmentary disturbances. Patient interpretation of outcome was determined subjectively by asking if they were satisfied and objectively by their separate responses to specific questions graded on a Likert-type scale.
On average, patients had a total of four separate 0.3 to 0.5 ml 5-FU (n=8) or 5-FU/kenalog (n=11) injections spaced two to three weeks apart. There were no cases of skin thinning, color/texture change, atrophy, telangiectasis or infection after injection, and all patients had uneventful healing of their grafts. In 95 percent of the cases, the surgeon was satisfied with the surgical result; 89 percent of the patients were satisfied with their outcome (graded 4.73/5) and the appearance of the skin graft.
Ophthal Plast Reconstr Surg 2015;31:122-126.
Yoo D, Azizzadeh B, Massry G.
Using Peripheral Lesions to Track Diabetic Retinopathy Progression
Boston researchers have determined that the peripheral diabetic retinopathy lesions identified on ultra-widefield imaging are associated with increased risk of diabetic retinopathy progression over four years, independent of baseline diabetic retinopathy severity or hemoglobin A1c levels. An increasing extent of predominantly peripheral lesions substantially increased the risk of diabetic retinopathy progression and progression to proliferative diabetic retinopathy, especially with less severe diabetic retinopathy at baseline.
Two hundred eyes of 100 participants previously enrolled in a comparative instrument validation study were enrolled in this study as a prospective, longitudinal cohort. Baseline mydriatic seven-standard field Early Treatment Diabetic Retinopathy Study photographs and ultra-widefield images were obtained. On ultra-widefield images, diabetic retinopathy lesions with a greater extent outside versus inside standard ETDRS fields were defined as predominantly peripheral lesions. Follow-up ETDRS photographs were obtained at 4.2 ±0.3 years after baseline measurements. Baseline and follow-up diabetic retinopathy severity were graded from ETDRS photographs. The main outcome measures were rates of two or more steps of progression and progression to proliferative diabetic retinopathy in eyes with PPLs compared to eyes without PPLs identified at ultra-widefield imaging at baseline.
In eyes without PDR (n=109) at baseline, 56 (51 percent) had at least one field with PPLs and 43 (39 percent) had diabetic retinopathy progression. Compared with eyes without PPLs, eyes with PPLs had a 3.2-fold increased risk of two-step or more diabetic retinopathy progression (six patients [11 percent] vs. 19 [34 percent]; p=0.005) and a 4.7-fold increased risk for progression to PDR (three patients [6 percent] vs. 14 [25 percent]; p=0.005). These findings remained statistically significant after adjusting for gender, diabetes type, diabetes duration, hemoglobin H1c levels and baseline diabetic retinopathy severity. Increasing extent of fields with PPLs increased the risk for two-step or more diabetic retinopathy progression (p=0.004) and progression to PDR (p=0.009).
Ophthalmology 2015;122:949-956.
Silva P, Cavallerano J, Haddad N, Kwak H, et al.
The Value of Preop Medical Testing for Vitreoretinal Surgery
A retrospective review of all vitreoretinal surgeries performed at Vanderbilt University from January 2002 until November 2011 indicates that preoperative testing does not measurably influence rates of postoperative systemic complications.
The medical charts of 2,215 patients were reviewed for baseline comorbidities, preoperative testing, type of anesthesia during surgery and systemic adverse events occurring within 30 days after surgery. Main outcome measures were the association of baseline characteristics and preoperative testing with postoperative systemic adverse events.
Approximately half of patients had electrolyte, renal function and electro-cardiogram evaluation. The most common comorbidities were hypertension (53 percent), diabetes mellitus (37 percent) and coronary artery disease (18 percent). The most common preoperative testing measure performed was blood glucose (58 percent). A total of 102 systemic adverse events occurred in 89 of 2,215 patients (4 percent) within the first 30 days after surgery, with the majority (72 percent) occurring within the first 24 hours. The most common adverse event was bradycardia (34 percent) followed by desaturation (25 percent). Patients with a history of coronary artery disease, asthma, chronic renal disease or receiving general anesthesia had 2.04 (p=0.91), 2.18 (p=0.03), 2.76 (p<0.001) and 3.72 (p<0.001) increased odds of developing postoperative systemic adverse events, respectively. Multivariate logistic regression analysis demonstrated no significant correlation between preoperative testing and postoperative adverse events.
Retina 2015;35:319-325.
Shalwala A, Hwang R, Tabing A, Sternberg P, et al.
Femto Cataract Outcomes the First Two Years After Adoption
The Singapore National Eye Center analyzed the outcomes of femtosecond laser cataract surgery cases in the first two years of use, determining that there was a low complication rate and that cases compared to controls had a statistically better unaided visual acuity (≤20/25) and manifest refraction spherical equivalence, although mean absolute error was not significant.
The outcomes and intraoperative events of all laser cataract surgeries (5.0 to 5.5-mm diameter laser capsulotomies and nuclear fragmentation) at the center from May 2012 to December 2013 were prospectively audited, with patient data matched to historical controls, a random sample of manual cases with similar age, axial length and preoperative cylinders. The six-weeks postoperative unaided visual acuities, mean absolute error, mean square error and manifest refraction spherical equivalent results of surgeons with >50 laser cases were compared with the control cases. Statistical analysis was performed with SPSS (p<0.05).
A total of 1,105 eyes (803 patients) underwent laser cataract surgery by 18 surgeons. The majority were female (56.9 percent) and Chinese (90.9 percent) with a mean age of 66.1 ±11 years. Intraoperative complications were subconjunctival hemorrhage (290, 26.2 percent), anterior capsule tear (nine eyes, 0.81 percent), posterior capsule rupture (three eyes, 0.27 percent), suction loss (five eyes, 0.45 percent), iris hemorrhage and endothelial incision (one eye each, 0.09 percent). There were no dropped nuclei. Visual outcomes of 794 laser surgeries were compared to 420 controls. The UAVA at 20/25 or better was higher in laser cases (68.6 percent vs. 56.3 percent; p<0.0001) but MAE (0.30 ±0.25 D vs. 0.33 ±0.25 D; p=0.062) and MSE (0.16 ± 0.27 D vs. 0.17 ±0.28 D; p=0.65) were not significant. MRSE comparison was significant (target plano, preoperative cylinder <1.5 D; -0.08 ±0.36 D vs. -0.13 ±0.40 D; p=0.034).
Am J Ophthalmol 2015;159:714-716.
Chee S, Yang Y, Ti S.
