Prophylaxis against intraocular pressure spikes following uncomplicated phacoemulsification: a systematic-review and meta-analysis.

BACKGROUND: To investigate the effect of perioperative intraocular pressure (IOP) lowering medications on controlling postoperative IOP following uncomplicated phacoemulsification. METHODS: Ovid MEDLINE, EMBASE, and Cochrane CENTRAL databases were searched up until November 2022. Randomised controlled trials (RCTs) that assessed IOP change via applanation tonometry in medicated and control arms following uncomplicated cataract surgery in healthy eyes were included. The primary outcome was the weighted mean difference (WMD) of IOP at 2-8 h, 12-24 h, and 1-7 days postoperatively within each medication class or common fixed-combination formulations. Risk of bias was assessed using the revised risk of bias in randomised trials (RoB-2). Level of evidence was rated using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) RESULTS: From 702 screened articles, 30 RCTs involving 2986 eyes were included. There was a statistically significant reduction in IOP favouring treatment arms at 2-8 h (WMD = -3.87 mmHg; 95% CI [-4.75, -3.00]; p < 0.001) and 12-24 h (WMD = -2.69 mmHg; 95% CI [-3.36, -2.02]; p < 0.001), with the effect wearing off beyond 1 day (p = 0.18). Between medication classes, the largest effect at both 2-8 h and 12-24 h was observed with intracameral cholinergics or fixed-combination carbonic anhydrase inhibitor-beta-blocker (FCCB) formulations. Conversely, the smallest effect was observed with prostaglandin analogues, alpha-agonists, and topical carbonic anhydrase inhibitors (CAIs). CONCLUSION: Prophylaxis against acute IOP elevations following uncomplicated cataract surgery is effective. FCCB and intracameral cholinergics are the most effective ocular antihypertensive agents, while alpha-agonists, prostaglandin analogues, and topical CAIs were found to be the least effective. These findings may inform future surgical guidelines.

Early Experience With Full-scope Shared-care Teleglaucoma in Canada.

PRCIS: Large Canadian full-scope, shared-care teleglaucoma facilitates efficient management and diversion of medically stable patients away from overburdened subspecialty clinics while allowing patients the convenience of shorter travel, shorter wait time, and continuity with one provider. This report shares Care1 protocol, early patient characteristics, and quality data. PURPOSE: This paper describes early experience with Care1, a large full-scope, shared-care teleglaucoma program. Optometrists located in high-demand locations saw patients in-person, acquired clinical history, performed a physical examination, organized diagnostic testing, then uploaded data to a proprietary online platform where they were able to collaborate with participating ophthalmologists to make plans for patient care. MATERIALS AND METHODS: The Care1 database was queried for all patients with a diagnosis of glaucoma or glaucoma suspect seen between February 2016 and March 2017. Clinical characteristics like diagnosis, ocular medication history, best-corrected visual acuity, intraocular pressure, cup-to-disc ratios, optical coherence tomography imaging results, and central corneal thickness were collected. Quality metrics studied included rates of referral to an in-person ophthalmologist and consistency of cup-to-disc assessments between in-person optometrists and remote ophthalmologists. RESULTS: A total of 4070 patients received care at a Care1 teleophthalmology site in 2 provinces for glaucoma assessment from February 2016 to March 2017. The population was 55.1% female, and the average age was 57.8 years. Overall, 97.3% of patients had a best-corrected visual acuity between 20/20 and 20/40 and 3.3% had an intraocular pressure >26. An in-person consultation with an ophthalmologist was recommended for 1.9% of patients. CONCLUSION: Early experience with this full-scope, shared-care teleglaucoma program in Canada indicates it is a convenient, collaborative model of care for glaucoma suspects, and medically stable glaucoma patients.

Six-year prevalence and incidence of diabetic retinopathy and cost-effectiveness of tele-ophthalmology in Manitoba.

OBJECTIVE: The purpose of this study was to evaluate the diabetic retinopathy (DR) tele-ophthalmology screening program in Manitoba to determine prevalence and incidence of DR, as well as to estimate the program's cost-effectiveness. DESIGN: Retrospective chart review. PARTICIPANTS: A total of 4676 patients with type 2 diabetes examined 9334 times from 2007 to 2013. METHODS: Focused ophthalmic histories were recorded and examinations were performed by trained nurses, including visual acuities, intraocular pressure, and mydriatic 7 standard field stereoscopic fundus photography. Images were evaluated by retinal specialists according to the Early Treatment of Diabetic Retinopathy Study criteria. DR prevalence and incidence were then calculated during the study period. Cost-effectiveness was estimated by comparing the cost of running the tele-ophthalmology program compared with the cost of screening the same volume of patients in-office. RESULTS: The average prevalence of any DR in each year was 25.1%. The cumulative incidence of DR across 6 years was 17.1% (95% CI, 15.4%-18.7%). The average savings per tele-ophthalmology examination was $1007. CONCLUSIONS: DR is highly prevalent among the studied population. Tele-ophthalmology provides a cost-effective means of monitoring patients as well as identifying new or treatable disease.

Six-year prevalence and incidence of diabetic retinopathy and cost-effectiveness of tele-ophthalmology in Manitoba.

OBJECTIVE: The purpose of this study was to evaluate the diabetic retinopathy (DR) tele-ophthalmology screening program in Manitoba to determine prevalence and incidence of DR, as well as to estimate the program's cost-effectiveness. DESIGN: Retrospective chart review. PARTICIPANTS: A total of 4676 patients with type 2 diabetes examined 9334 times from 2007 to 2013. METHODS: Focused ophthalmic histories were recorded and examinations were performed by trained nurses, including visual acuities, intraocular pressure, and mydriatic 7 standard field stereoscopic fundus photography. Images were evaluated by retinal specialists according to the Early Treatment of Diabetic Retinopathy Study criteria. DR prevalence and incidence were then calculated during the study period. Cost-effectiveness was estimated by comparing the cost of running the tele-ophthalmology program compared with the cost of screening the same volume of patients in-office. RESULTS: The average prevalence of any DR in each year was 25.1%. The cumulative incidence of DR across 6 years was 17.1% (95% CI, 15.4%-18.7%). The average savings per tele-ophthalmology examination was $1007. CONCLUSIONS: DR is highly prevalent among the studied population. Tele-ophthalmology provides a cost-effective means of monitoring patients as well as identifying new or treatable disease.

Chronic postoperative endophthalmitis after cataract surgery secondary to vancomycin-resistant Ochrobactrum anthropi: case report and literature review.

BACKGROUND: The aim of this study was to report an unusual case of chronic postoperative endophthalmitis following cataract surgery, secondary to Ochrobactrum anthropi that was found to be resistant to vancomycin. FINDINGS: Anterior chamber paracentesis cultures grew gram negative bacilli Ochrobactrum anthropi. The patient was treated with a series of intracameral injections of moxifloxacin, with adjuvant oral moxifloxacin. Posterior sub-Tenon and oral corticosteroids were used to treat cystoid macular edema. Explantation of the intraocular lens (IOL)-capsular bag complex was avoided. CONCLUSIONS: Chronic postoperative endophthalmitis is a rare entity, often due to indolent pathogens that sequester in the capsular bag. Aggressive surgical intervention may be avoided with the use of adequate intraocular antibiotic, provided that the offending organism demonstrates appropriate antibiotic susceptibilities.

Delayed saccadic eye movements in glaucoma.

PURPOSE: To determine whether saccadic eye movements are altered in glaucoma patients. PATIENTS AND METHODS: Sixteen patients with glaucoma and 21 control subjects were prospectively studied. Patients participated in a pro-saccade step task. Saccades were recorded using a noninvasive infrared oculometric device with head-mounted target projection. Medians of saccade reaction time, duration, amplitude, and peak velocity; frequency of express saccades; and percentage of trials with direction error were recorded. t-tests were used to compare the glaucoma and age-matched control groups. A correlation analysis of saccade parameters with visual field loss was also performed. RESULTS: Median saccade reaction times were significantly prolonged in glaucoma patients compared with controls (220.9 ± 49.02 ms vs 192.1 ± 31.24 ms; t-test: P = 0.036). Median duration, median amplitude, and median peak velocity of saccades did not show significant differences between glaucoma and control groups (P > 0.05). Frequency of express saccades was significantly decreased in glaucoma patients compared with controls (1.75 ± 2.32 vs 7.0 ± 6.99; t-test: P = 0.007). Saccade parameters in glaucoma patients showed no significant correlation with visual field loss. CONCLUSION: Saccadic eye movements are significantly delayed in patients with early, moderate, or advanced glaucoma. Determination of median saccade reaction time may offer a novel functional test to quantify visual function in glaucoma patients. Further studies are needed to determine pathological processes implicated in delayed initiation of saccades, and to assess whether alteration of saccades affects daily activities in glaucoma patients.