Clinical outcomes of a beveled tip, ultra-high speed, 25-gauge pars plana vitrectomy system.

OBJECTIVE: To report the clinical outcomes of a 25-gauge, beveled-tip, 10,000 cuts-per-minute (cpm) microincisional vitrectomy surgery (MIVS) system. METHODS: Prospective case series of eyes undergoing primary pars plana vitrectomy (PPV) for common vitreoretinal indications. Main outcome measures were: rate of achieving surgical objectives, operative times, number of surgical steps, use of ancillary instruments, corrected distance visual acuity (CDVA), and adverse events (AE). RESULTS: The surgical objectives were achieved in all eyes. Mean total operative time (TOT), core, shave and total vitrectomy times were 1891 ± 890, 204 ± 120, 330 ± 320, 534 ± 389 s, respectively. Mean number of surgical steps was 4.3 ± 1.5. Mean number of ancillary instruments used was 4.5 ± 1.9. Mean CDVA improved by 0.53 ± 0.56 logMAR units (P < 0.001) 3 months postoperatively. AE included elevated IOP (8%), hypotony (6%), and re-detachment (2%). Majority (82%) had no postoperative discomfort. The number of surgical steps demonstrated a positive correlation with TOT (p < 0.05), number of ancillary instruments used (p < 0.05), and postoperative Day 1 IOP (p < 0.05). The number of times ancillary instrumentation was used demonstrated a positive correlation with TOT (p < 0.05). CONCLUSION: Beveled-tip, 10,000 cpm MIVS system effectively and safely performs common VR procedures of varying complexity and may reduce operative times and use of ancillary instrumentation.

Comparison of surgical parameters using different lens fragmentation patterns in eyes undergoing laser-assisted cataract surgery.

PURPOSE: To compare surgical parameters among eyes undergoing laser-assisted cataract surgery (LACS) using different lens fragmentation patterns (LFP). METHODS: Prospective, randomized, unmasked clinical trial. One-hundred eyes underwent LACS and were randomly assigned to 1 of 3 LFP treatment groups: (1) laser capsulotomy only; no lens fragmentation (NLF) (n = 34); (2) three-plane chop (TPC) (n = 33); and, (3) pie-cut pattern (PCP) fragmentation (n = 33). Prechop phacoemulsification (PHACO) was performed on all eyes using the same femtosecond (FS) laser and active-fluidics PHACO machine. MAIN OUTCOME MEASURES: FS laser dock time (s), PHACO time (s), PHACO power (%), cumulative dissipated energy (CDE) (%-s), irrigating fluid volume, and operative time. RESULTS: The 3 treatment groups were comparable in terms of patient age (P = 0.164) and nuclear density (P = 0.669). FS dock time was higher in the PCP group (184.18 ± 25.86) compared to the TPC (145.09 ± 14.15) group (P < 0.001). PHACO time was significantly shorter in the PCP (23.19 ± 17.20 s) compared to TPC (35.27 ± 17.70) and NLF (46.15 ± 23.72) groups (P < 0.001). PHACO power was lower in the PCP (11.81 ± 3.71) compared to the NLF (14.41 ± 1.88) and TPC (14.04 ± 2.46) groups (P < 0.001). CDE was lower in the PCP (2.85 ± 2.32) compared to NLF (6.55 ± 3.32) and TPC (6.55 ± 5.45) groups (P < 0.001). Fluid volumes and operative times were similar. CONCLUSION: LFP can influence PHACO surgical parameters. Extensive fragmentation patterns such as PCP appear to lower PHACO time, power, and CDE and may potentially reduce the risk of PHACO related complications.

Posterior Uveitis.

Posterior uveitis is a major cause of ocular morbidity worldwide. Systemic corticosteroids (CS) remain the primary method of treatment for noninfectious posterior uveitis; however, CS are associated with many side effects. Immunomodulatory therapy (IMT) is recommended when inflammatory control is not attained with a tolerable level of systemic CS (<10 mg/day of prednisone). IMT agents are associated with several toxicities and limited benefits in some patients. Locally administered therapies (e.g. intravitreal CS implants) offer the promise of providing therapeutic levels of anti-inflammatory agents while avoiding systemic complications. This chapter will briefly discuss common posterior uveitis entities that are amenable to retinal pharmacotherapy.

Stem cell therapy: a novel approach for vision restoration in retinitis pigmentosa.

Unfortunately, at present, degenerative retinal diseases such as retinitis pigmentosa remains untreatable. Patients with these conditions suffer progressive visual decline resulting from continuing loss of photoreceptor cells and outer nuclear layers. However, stem cell therapy is a promising approach to restore visual function in eyes with degenerative retinal diseases such as retinitis pigmentosa. Animal studies have established that pluripotent stem cells when placed in the mouse retinitis pigmentosa models have the potential not only to survive, but also to differentiate, organize into and function as photoreceptor cells. Furthermore, there is early evidence that these transplanted cells provide improved visual function. These groundbreaking studies provide proof of concept that stem cell therapy is a viable method of visual rehabilitation among eyes with retinitis pigmentosa. Further studies are required to optimize these techniques in human application. This review focuses on stem cell therapy as a new approach for vision restitution in retinitis pigmentosa.

Topical bevacizumab and ocular surface neovascularization in patients with stevens-johnson syndrome.

PURPOSE: To evaluate the efficacy and safety of topical bevacizumab on ocular surface neovascularization among patients with Stevens-Johnson syndrome. METHODS: This was a retrospective, interventional case report. Three eyes of 2 patients were examined. Bevacizumab (25 mg/mL) eyedrops were applied 4 times daily for a period of 3 months. Main outcome measures were improvement of symptoms, visual acuity, degree of ocular surface neovascularization, corneal opacification, conjunctival injection, and occurrence of adverse events. RESULTS: Both patients completed the 3-month observation period and reported that it significantly improved ocular comfort. At the end of the study period, visual acuity improved in all 3 eyes; all eyes were observed to have decreased ocular surface neovascularization, corneal opacification, and conjunctival injection. No serious adverse events were reported. CONCLUSIONS: Topical bevacizumab is well tolerated and may be effective in improving comfort and inducing regression of ocular surface neovascularization, conjunctival injection, and corneal opacification in patients with ocular surface disease caused by Stevens-Johnson syndrome. Further controlled and long-term studies are needed to fully evaluate the long-term effects of this novel treatment.

Pigment release and secondary glaucoma after implantation of single-piece acrylic intraocular lenses in the ciliary sulcus.

PURPOSE: To report the association of sulcus-fixated, single-piece hydrophobic acrylic intraocular lenses (HAIOL) with pigment release and secondary glaucoma. DESIGN: Interventional case series. METHODS: HAIOL was implanted in the ciliary sulcus of 20 eyes that developed posterior capsule rupture during phacoemulsification. We analyzed postoperative best-corrected visual acuity, manifest refraction, frequency of intraocular lens malpositioning, and postoperative complications. RESULTS: Postoperative best-corrected visual acuity was 20/40 or better in all eyes. The mean postoperative sphere was -0.5 +/- 0.7 diopters (range +1.25 to -2.00); the mean postoperative cylinder was -1.2 +/- 0.8 diopters (range 0 to -2.50). None of the HAIOLs was decentered or dislocated, and none required repositioning. Seven eyes (35%) developed pigment release; three eyes (15%) developed secondary glaucoma. CONCLUSIONS: Implantation of single-piece HAIOLs in the ciliary sulcus is associated with pigment release and secondary glaucoma. Alternative methods of aphakic correction should be considered.

Advances in the treatment of age-related macular degeneration: A review

Objective: To review the latest developments in the treatment of age-related macular degeneration (AMD). Method: Literature review Results: The treatment of AMD is rapidly evolving. New developments in the biophysical, biochemical and clinical sciences and greater understanding of the pathophysiology of AMD are being used to produce new treatment strategies Conclusion: While several promising novel treatment approaches are being developed for the treatment of AMD, treatment recommendations should be based on results of well-designed randomized clinical trials.