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Purpose: Glaucoma is the second leading cause of blindness worldwide, affecting more than 64 million people aged 40–80. The best way to manage primary open?angle glaucoma (POAG) is by lowering the intraocular pressure (IOP). Netarsudil is a Rho kinase inhibitor, the only class of antiglaucoma medications that reorganizes the extracellular matrix to improve the aqueous outflow through the trabecular pathway. Methods: An open?label, real?world, multicentric, observation?based 3?month study was performed for assessing the safety and ocular hypotensive efficacy of netarsudil ophthalmic solution (0.02% w/v) in patients with elevated IOP. Patients were given netarsudil ophthalmic solution (0.02% w/v) as a first?line therapy. Diurnal IOP measurements, best?corrected visual acuity, and adverse event assessments were recorded at each of the five visits (Day?1: screening day and first dosing day; subsequent observations were taken at 2 weeks, 4 weeks, 6 weeks, and 3 months). Results: Four hundred and sixty?nine patients from 39 centers throughout India completed the study. The mean IOP at baseline of the affected eyes was 24.84 ± 6.39 mmHg (mean ± standard deviation). After the first dose, the IOP was measured after 2, 4, and 6 weeks, with the final measurement taken at 3 months. The percentage reduction in IOP in glaucoma patients after 3 months of once?daily netarsudil 0.02% w/v solution use was 33.34%. The adverse effects experienced by patients were not severe in the majority of cases. Some adverse effects observed were redness, irritation, itching, and others, but only a small number of patients experienced severe reactions, as reported in a decreasing order: redness > irritation > watering > itching > stinging > blurring. Conclusion: We found that netarsudil 0.02% w/v solution monotherapy when used as the first?line treatment in primary open?angle glaucoma and ocular hypertension was both safe and effective.
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Purpose: To determine the stabilization of refraction at 2 weeks following MSICS by comparing the difference in spherical, cylindrical component and also spherical equivalent of refraction of 2 weeks follow-up with that of 6 weeks following surgery. Methods: The difference of spherical, cylindrical component and also spherical equivalent of refraction at 2 weeks and 6 weeks follow-up of 194 eyes that underwent uncomplicated MSICS with implantation of PMMA IOL conducted by a single experienced surgeon were compared to find out the amount of change and its significance was statistically tested by Wilcoxon-Signed Rank Test. Results: The difference in spherical power (0.04 � 0.30), cylinder power (0.03 � 0.40), and spherical equivalent (0.06 � 0.34) were very small and not significant statistically (P-value ?0.05). Conclusion: Necessary spectacle correction can safely be prescribed after 2 weeks following MSICS as subjective refraction stabilizes by that time without undergoing significant change. However, our observation was applicable in patients who had an uneventful cataract surgery without any risk factor, which can delay wound healing or cause poor visual outcome.
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Purpose: To determine the effect of depth of scleral tunnel incision measured by anterior segment OCT on postoperative corneal astigmatism by comparing the change of magnitude of corneal astigmatism between superficial and deep sclerocorneal tunnel incision in manual small?incision cataract surgery (SICS). Methods: Depths of sclerocorneal incision of 72 eyes of patients undergoing uncomplicated manual SICS and attending regular follow?up schedule were assessed with anterior segment OCT at 6?week post?op follow?up. Results: The overall mean ± standard deviation (SD) change of astigmatism for superficial incision, that is, ?399 ?m, was 0.44 ± 0.30 and that for deeper, that is, ?400 ?m, was 0.13 ± 0.48 and the change was significantly higher in ?399 ?m group than in ?400 ?m group (P = 0.003). In both superior and temporal incision locations, the mean ± SD change of astigmatism for ?399 ?m incision was 0.48 ± 0.29 and 0.40 ± 0.30, respectively, and that for ?400 ?m was 0.03 ± 0.34 and 0.23 ± 0.57, respectively. The change of astigmatism was significantly higher in ?399 ?m incision group overall (P = 0.003) and also higher in both superior and temporal incision location groups (P = 0.001 and P = 0.479, respectively). Conclusion: The depth of sclerocorneal incision had a statistically significant effect on the change of astigmatism following manual SICS, with superficial incision (?399 ?m) causing a higher change than deeper incision (? 400 ?m).
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Purpose: To assess the comparability of ocular biometry measurements and refractive outcomes between ANTERION and IOL Master 700. Methods: This comparative prospective study was conducted from December 2020 to February 2021. A total of 225 patients who had cataracts were enrolled for the study and different parameters such as anterior keratometry (Steep K, Flat K) with axis, Sim K, central corneal thickness (CCT), aqueous depth (AQD), lens thickness (LT), and axial length (AL), white?to?white (WTW) were evaluated in IOL master 700 first and then with ANTERION. Finally, 203 patients completed the 6?week follow?up and the postoperative refraction was done at the 6th week. To assess the agreement between the devices, intraclass coefficient (ICC) and Bland–Altman analysis with 95% limits of agreement (LoA) were used. To analyze the agreement for postoperative residual refractive error between the two devices, Kappa statistics were used. Results: The mean difference for steep K, flat K, and Sim K between ANTERION and IOL Master 700 were ? 0.18 +/?0.26 D, ?0.13+/? 0.28D, ?0.15 +/?0.23, respectively. The CCT, ACD, and LT also showed excellent agreement (ICC > 0.9) but the similarity for the keratometry axis was not up to the mark (ICC = 0.794). For postoperative refractive outcomes, the Kappa value was 0.437, indicating moderate agreement. Conclusion: ANTERION showed a good agreement for the majority of parameters with IOLMaster 700 in measuring ocular biometry, except for the keratometry. The accuracy of the intraocular lens power calculations was clinically acceptable with both biometers though the IOL power given by ANTERION remained slightly on the hypermetropic side.
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Purpose: To compare the efficacy of topical nonsteroidal anti?inflammatory drugs (NSAIDs) and prednisolone acetate in controlling inflammation and preventing cystoid macular edema (CME) after uneventful phacoemulsification. Methods: All patients who underwent uneventful phacoemulsification from December 2020 to Feb 2021 were included in the study. These were randomly assigned to receive any one anti?inflammatory agent among topical nepafenac (0.1%) [96 eyes], bromfenac (0.07%) [93 eyes], preservative?free ketorolac (0.4%) [94 eyes], nepafenac (0.3%) [96 eyes], or prednisolone acetate (1%) [91 eyes]. The efficacy of the drugs was evaluated by comparing the grade of anterior chamber (AC) cells, conjunctival hyperemia, pain score, visual acuity, intraocular pressure (IOP), and central macular thickness (CMT) at 1 and 6 weeks after surgery. Results: At 1 and 6 weeks, there was no significant difference in pain score, conjunctival hyperemia, AC cells, change in IOP, and visual acuity between the prednisolone and the NSAIDs groups, though nepafenac 0.3% was most effective. At 6 weeks, there was no significant difference in the number of patients developing subclinical CME in the prednisolone versus NSAID group. The mean increase in CMT was significantly lower in nepafenac 0.3% than prednisolone at 1 and 6 weeks (P = 0.003 and 0.004, respectively). Conclusion: NSAIDs used in isolation are comparable to prednisolone in preventing inflammation and pain after uneventful phacoemulsification. However, nepafenac 0.3% is most comparable to prednisolone and more efficacious in reducing the incidence of CME. We recommend that nepafenac 0.3% can be used as a sole anti?inflammatory agent in patients with uneventful phacoemulsification.