The Use of Prostaglandin Analogues and Cystoid Macular Edema after Uneventful Cataract Surgery: A Systematic Review and Meta-Analysis.

PURPOSE: To evaluate whether using prostaglandin analogues (PGAs) perioperatively is associated with an increased rate of the development of clinical or subclinical cystoid macular edema (CME) after uneventful cataract surgery. METHODS: The PubMed, Scopus, and ScienceDirect databases were searched to June 2022 for this systematic review and meta-analysis. Two authors independently screened search results. Random-effects meta-analyses were performed to calculate the overall incidence rate and odds ratio (OR). Quality of studies was assessed using the modified Newcastle-Ottawa scale. The incidences of CME for continued vs discontinued use of PGAs perioperatively, continued use of PGAs, discontinued use of PGAs, and PGA users vs non-PGA antiglaucomatous users were main outcomes. RESULTS: Out of 544-articles, 9 studies that met the inclusion criteria were analyzed. The continued use of PGAs was not associated with an increased risk of the development of subclinical macular edema compared with discontinued use (OR = 1.32 [95% Confidence Interval (CI) = 0.49-3.51], p = .582). The overall incidence of CME was 34% (95% CI = 0.17-0.52) for continued use of PGAs and 7% (95% CI = 0.02-0.13) for discontinued use of PGAs. Using PGAs did not increase the risk of CME's development compared with non-PGA antiglaucomatous usage (OR = 2.29 [95% CI = 0.84-6.23], p = .103). CONCLUSIONS: Discontinuing treatment with PGAs during the perioperative period in eyes without any known risk factors for CME has no clinically significant effect on reducing the development of postoperative CME based on the existing studies. Further, well-designed randomized controlled trials need to be performed.

Evaluation of vessel density in healthy subjects with family history of glaucoma.

OBJECTIVES: To investigate whether any microvascular changes are present in optic disc, peripapillary or maculary regions in healthy subjects with a family history of glaucoma. METHODS: A total of 82 healthy subjects including 42 first-degree relatives of primary open-angle glaucoma (POAG) and 40 controls were enroled in this cross-sectional study. Global and sectoral vessel density (VD) measurements excluding large vessels, retina nerve fibre layer (RNFL) and macula ganglion cell (mGCC) thicknesses were obtained from a combined optical coherence tomography-angiography (OCT-A) and spectral-domain OCT system. Effect size (ES) was used for evaluating the magnitude of the statistically significant difference. Area under receiver operating characteristic curves (AUCs) were used to examine the ability of parameters to differentiate first-degree relatives to controls. RESULTS: There was no significant difference in RNFL and mGCC thicknesses between groups. Although lower VD measurements in optic disc, peripapillary region, and macula were observed in the first-degree relatives, statistically significant mean difference (3.13 ± 0.87, p = 0.001) and large ES (0.80) were in only lower nasal sector of peripapillary region. Inter-eye asymmetry of supero-nasal VD was also statistically higher (3.74 ± 2.55 vs 1.89 ± 1.64) with a large ES in the first-degree relatives (p < 0.001, ES = 0.86). AUC for differentiating first-degree relatives from controls was highest for inter-eye asymmetry of supero-nasal sector VD (0.74, p < 0.001), followed by lower nasal sector VD (0.72, p < 0.001). CONCLUSION: Compared to controls, first-degree relatives of patients with POAG were found to have significantly greater inter-eye asymmetry in supero-nasal peripapillary VD and less VD in the lower nasal peripapillary region.

Acute zonal occult outer retinopathy: optical coherence tomography angiography findings and treatment response.

Acute zonal occult outer retinopathy (AZOOR) is a rare condition primarily affecting the outer retina based on electrophysiologic studies. In addition to characteristic fundus appearance, spectral domain optical coherence tomography and fundus autofluorescence are unique in diagnosing AZOOR. There are a few reports on optical coherence tomography anjiography (OCTA) in AZOOR disease. In this report, we present a case using multimodal imaging including OCTA and treatment response to combined systemic antiviral, antiinflammatory, and immunosuppressive drugs. En-face OCTA outer retinal slab may provide useful tips for diagnosis and treatment response.

Remodeling of Cornea With Isotretinoin Treatment.

OBJECTIVES: To evaluate the change of corneal epithelial thickness (ET) in subjects using isotretinoin with spectral-domain optical coherence tomography and further to explore reflection of changes on corneal topography. METHODS: Forty eyes of 40 subjects with acne vulgaris scheduled for oral isotretinoin were included in this prospective study. Subjects were examined with RTVue-XR and Pentacam at baseline, 1th, 3rd, and 6th months of treatment, and 3rd month of isotretinoin cessation. RESULTS: A statistically significant increase was detected in each sector of ET map except inferonasal 7 to 9 mm between baseline and following visits (P<0.05, for all visits). The increase in superior (2-7 mm), inferior (2-7 mm), and maximum values in epithelium statistics and the decrease in superior (2-7 mm), inferior (2-7 mm), minimum, and maximum values in stroma statistics at follow-up visits were significant (P<0.05, for all visits). Central corneal thickness, maximum Ambrosio-relational thickness, average pachymetric-progression index at 1th, 3rd, and 6th months, and thinnest pachymetry, index of surface variance (ISV) at 3rd, and 6th months differed significantly (P<0.05, for specified visits). The regression in parameters was observed at 3rd month of isotretinoin cessation. CONCLUSIONS: Isotretinoin treatment induces epithelial thickening and stromal thinning. Remodeling of corneal layers causes statistical differences in ISV and pachymetry-related parameters of Pentacam. The pachymetry changes in cornea return to baseline at the 3rd month of discontinuation of treatment.

Application of autologous serum eye drops after pterygium surgery: a prospective study.

PURPOSE: The study aims to determine the effect of 50% autologous serum drops (ASD) on corneal healing and patient comfort following pterygium surgery. METHODS: Fifty eyes of 50 patients who underwent pterygium excision combined with autologous conjunctival graft were included in this prospective randomized study: in 25 eyes, 50% ASD. In the remaining 25 eyes, conventional artificial tears (CAT) were applied postoperatively until corneal epithelium had completely epithelialized. Corneal epithelium healing speed, visual analog scale (VAS) for postoperative pain assessment, conjunctival inflammation, and recurrences were evaluated. Patients were followed up for 6 months. RESULTS: Mean corneal epithelium closure time was 3.16 ± 0.37 days (range 3 and 4 days) in ASD group and 4.96 ± 0.84 days in CAT group (range 4 and 6 days), and the difference was statistically significant (p < 0.001). VAS scores were significantly lower in ASD group than CAT group in the first 5 days after surgery. In 9 of 50 eyes, moderate conjunctival inflammation continued 1 month: 4 (16%) in ASD group and 5 (20%) in CAT group (p = 0.713). In total, pterygium recurrence was seen in 5 (10%) eyes: 2 eyes (8%) in ASD group and 3 eyes (12%) in CAT group (p = 0.637). CONCLUSION: ASD accelerated corneal epithelial healing following pterygium surgery. ASD group had lesser pain that was seem to be related with accelerated corneal epithelial healing.

Assessment of Corneal Backward Light Scattering in Diabetic Patients.

OBJECTIVES: To analyze corneal backward light scattering differences in patients with type 2 diabetes mellitus. METHODS: We enrolled 43 eyes from 43 diabetic patients and 40 eyes from 40 healthy controls. Corneal backward light scattering was evaluated using densitometry measurements from different corneal layers and zones obtained using Scheimpflug tomography (PentacamHR). RESULTS: When densitometry values were divided by depth, anterior layer of diabetic corneas displayed significantly higher corneal backward light scattering values than controls (32.05, 95% confidence intervals [CI], 31.02-33.08 vs. 29.18, 95% CI, 27.60-30.76, P=0.024). Corneal densitometry measurements were also significantly higher in diabetic eyes compared with control eyes, when considered by concentric zones of total cornea in the 0 to 2 mm (21.65, 95% CI, 20.28-23.01 vs. 18.87 95% CI, 18.49-19.25, P=0.020), and anterior layer in the 0 to 2 mm (27.3, 95% CI, 25.04-29.56 vs. 22.31, 95% CI, 20.57-24.05, P<0.001), 2 to 6 mm (26.2, 95% CI, 24.99-27.41 vs. 22.4, 95% CI, 20.18-24.62, P<0.001) and 6 to 10 mm (32.19, 95% CI, 29.98-34.40 vs. 27.2, 95% CI, 25.39-29.01, P=0.022). There was excellent positive correlation between anterior total corneal densitometry measurements and duration of diabetes (r=0.802, P<0.001), although no significant correlation was observed with anterior total corneal densitometry measurements and hemoglobin A1c levels (r=0.080, P=0.621) in diabetic eyes. CONCLUSIONS: Backward light scattering values from the anterior layer of the cornea is greater in diabetic eyes than in controls. Anterior total corneal densitometry measurements show positive correlation with the duration of diabetes.

Evaluation of Visual Field Test Parameters after Artificial Tear Administration in Patients with Glaucoma and Dry Eye.

PURPOSE: To examine the effect of a single dose of artificial tear administration on automated visual field (VF) testing in patients with glaucoma and dry eye syndrome. MATERIAL AND METHODS: A total of 35 patients with primary open-angle glaucoma experienced in VF testing with symptoms of dry eye were enrolled in this study. At the first visit, standard VF testing was performed. At the second and third visits with an interval of one week, while the left eyes served as control, one drop of artificial tear was administered to each patient's right eye, and then VF testing was performed again. The reliability parameters, VF indices, number of depressed points at probability levels of pattern deviation plots, and test times were compared between visits. RESULTS: No significant difference was observed in any VF testing parameters of control eyes (P>0.05). In artificial tear administered eyes, significant improvement was observed in test duration, mean deviation, and the number of depressed points at probability levels (P˂0.5%, P˂1%, P˂2) of pattern deviation plots (P˂0.05). The post-hoc test revealed that artificial tear administration elicited an improvement in test duration, mean deviation, and the number of depressed points at probability levels (P˂0.5%, P˂1%, P˂2%) of pattern deviation plots from first visit to second and third visits (P˂0.01, for all comparisons). The intraclass correlation coefficient for the three VF test indices was found to be between 0.735 and 0.85 (P<0.001, for all). DISCUSSION: A single dose of artificial tear administration immediately before VF testing seems to improve test results and decrease test time.

Biocompatibility of Intraocular Lenses.

The performance of an intraocular lens is determined by several factors such as the surgical technique, surgical complications, intraocular lens biomaterial and design, and host reaction to the lens. The factor indicating the biocompatibility of an intraocular lens is the behavior of inflammatory and lens epithelial cells. Hence, the biocompatibility of intraocular lens materials is assessed in terms of uveal biocompatibility, based on the inflammatory foreign-body reaction of the eye against the implant, and in terms of capsular biocompatibility, determined by the relationship of the intraocular lens with residual lens epithelial cells within the capsular bag. Insufficient biocompatibility of intraocular lens materials may result in different clinical entities such as anterior capsule opacification, posterior capsule opacification, and lens epithelial cell ongrowth. Intraocular lenses are increasingly implanted much earlier in life in cases such as refractive lens exchange or pediatric intraocular lens implantation after congenital cataract surgery, and these lenses are expected to exhibit maximum performance for many decades. The materials used in intraocular lens manufacture should, therefore, ensure long-term uveal and capsular biocompatibility. In this article, we review the currently available materials used in the manufacture of intraocular lenses, especially with regard to their uveal and capsular biocompatibility, and discuss efforts to improve the biocompatibility of intraocular lenses.

Comparison of central corneal thickness with four noncontact devices: An agreement analysis of swept-source technology.

PURPOSE: The purpose of this study was to compare the central corneal thickness (CCT) measurements of four noncontact devices in healthy eyes. MATERIALS AND METHODS: In a sample of 45 healthy controls, CCT was measured using an optical biometer (IOLMaster 700) based on swept-source optical coherence tomography (SS-OCT), high-resolution rotating Scheimpflug camera system (Pentacam HR), spectral-domain OCT (SD-OCT) device with an anterior segment module (Spectralis), and noncontact pachymetry (NCP) device (Topcon TRK-2P). Agreement among the devices was analyzed using mean differences (i.e., bias) and Bland-Altman analysis with 95% limits of agreement (LoA). RESULTS: Mean CCT measurements were 537.5 ± 47.5 µm for SS-OCT optical biometer, 532.3 ± 43.8 µm for Scheimpflug system, 521.3 ± 44.7 µm for SD-OCT device, and 518.0 ± 43.1 µm for NCP (P < 0.001). The SD-OCT device and NCP showed the closest agreement, with a bias of 2.6 µm (95% LoA, -3.6-8.8 µm), whereas the SS-OCT optical biometer and NCP showed the least agreement, with a bias of 18.7 µm (95% LoA, -2.1-39.5 µm). Bias was 16.1 µm (95% LoA, -3.1-35.3 µm) for SS-OCT optical biometer and SD-OCT, 5.1 µm (95% LoA, -6.8-17.0 µm) for SS-OCT optical biometer and Scheimpflug system, 10.9 µm (95% LoA, -15.1-36.9 µm) for SD-OCT device and Scheimpflug system, and 13.6 µm (95% LoA, -5-32.2 µm) for Scheimpflug system and NCP. CONCLUSIONS: SS-OCT optical biometer overestimates CCT measurements compared to Scheimpflug system, SD-OCT device, and NCP. Given mean differences and range variations in CCT measurements between devices, SS-OCT optical biometer and Scheimpflug system are interchangeable as are SD-OCT and NCP.

Evaluating relaxed ciliary muscle tone in presbyopic eyes.

PURPOSE: Studies of age-related changes in ciliary muscle (CM) morphology and contractility have variously reported that CM weakens or strengthens with age. In response, the aim of this study was to evaluate relaxed CM tone in vivo in pre-presbyopic and presbyopic patients using a predictor value (PCM). METHODS: Two groups of eyes-40 eyes of 40 healthy volunteers with a mean age of 28.1 ± 5.8 years and 40 eyes of 40 healthy volunteers with a mean age of 56.6 ± 7.3 years-formed the sample for this prospective, observational cross-sectional study. Used to evaluate relaxed CM tone, PCM was calculated as the difference between the change in mean anterior chamber depth (ACD) and lens thickness (LT) before and after cycloplegia, as measured with swept-source optical biometry. RESULTS: The PCM for relaxed CM tone was 0.04 ± 0.04 mm in pre-presbyopic participants, 0.06 ± 0.03 mm in presbyopic ones, and significantly greater in presbyopic patients (p = .018). CONCLUSION: The statistical significance of PCM between pre-presbyopic and presbyopic eyes might not signify clinical significance, since the difference was close to the repeatability limits for swept-source optical biometry. When relaxed, CM tone does not diminish with presbyopia according to changes in anterior chamber parameters due to cycloplegia.

Changes in Ocular Parameters and Intraocular Lens Powers in Aging Cycloplegic Eyes.

PURPOSE: Age-related changes in lens elasticity and ciliary muscle contractility can affect how ocular parameters respond to cycloplegia, and therefore intraocular lens (IOL) power measurements calculated by formulas using anterior chamber depth (ACD), lens thickness (LT), or white-to-white (WtW) for effective lens position prediction can vary. In response, using swept-source optical biometry in prepresbyopic and presbyopic eyes, we investigated changes in ocular parameters and IOL power calculations attributable to cycloplegia. DESIGN: Cross-sectional study. METHODS: In 38 prepresbyopic and 42 presbyopic eyes, we measured pupil diameter, radius of corneal curvature values, central corneal thickness, WtW, ACD, LT, and axial length both before and after cycloplegia. We determined IOL power calculations with the Sanders-Retzlaff-Kraff/theoretical, Holladay 2, and Haigis formulas. To pinpoint the effect of cycloplegia, we recorded refractive predictions in pre- and postdilation conditions according to the same IOL power calculations, even if postdilation IOL power calculations had changed. RESULTS: With cycloplegia, pupil diameter changed significantly more in presbyopic eyes (P < .001). Central corneal thickness decreased in prepresbyopic eyes (P = .048), whereas WtW increased in presbyopic eyes (P = .02). In both groups, ACD and LT changed significantly (P < .001). IOL power calculations according to the Holladay 2 formula differed in prepresbyopic eyes (P = .042), and refractive predictions with the Holladay 2 and Haigis formulas differed significantly in prepresbyopic eyes (P = .043 and P = .022, respectively). CONCLUSION: Surgeons should consider the effect of cycloplegia on refractive prediction errors and IOL power calculations determined with Haigis and Holladay 2 formulas, especially in prepresbyopic ages.

Intraocular pressure dynamics with prostaglandin analogs: a clinical application of the water-drinking test.

AIM: To evaluate the clinical applicability of the water-drinking test in treatment-naive primary open-angle glaucoma patients. METHODS: Twenty newly diagnosed primary open-angle glaucoma patients and 20 healthy controls were enrolled in this prospective study. The water-drinking test was performed at baseline and 6 weeks and 3 months after prostaglandin analog treatment. Peak and fluctuation of intraocular pressure (IOP) measurements obtained with the water-drinking test during follow-up were analyzed. Analysis of variance for repeated measures and paired and unpaired t-tests were used for statistical analysis. RESULTS: The mean baseline IOP values in patients with primary open-angle glaucoma were 25.1±4.6 mmHg before prostaglandin analog treatment, 19.8±3.7 mmHg at week 6, and 17.9±2.2 mmHg at month 3 after treatment. The difference in mean baseline IOP of the water-drinking tests was statistically significant (P<0.001). At 6 weeks of prostaglandin analog treatment, two patients had high peak and fluctuation of IOP measurements despite a reduction in baseline IOP. After modifying treatment, patients had lower peak and fluctuation of IOP values at month 3 of the study. CONCLUSION: Peak and fluctuation of IOP in response to the water-drinking test were lower with prostaglandin analogs compared with before medication. The water-drinking test can represent an additional benefit in the management of glaucoma patients, especially by detecting higher peak and fluctuation of IOP values despite a reduced mean IOP. Therefore, it could be helpful as a supplementary method in monitoring IOP in the clinical practice.

Reproducibility of the water-drinking test in patients with exfoliation syndrome and exfoliative glaucoma.

PURPOSE: To evaluate the reproducibility of intraocular pressure (IOP) peaks and fluctuations detected during the water-drinking test (WDT) in patients with exfoliation syndrome (XFS) and exfoliative glaucoma (XFG). METHODS: This prospective study included 34 XFS and 30 XFG patients. Each patient was evaluated twice, with the two WDTs performed on a 30-day interval. We recorded IOP peak (highest IOP during the WDT) and IOP fluctuation (IOP peak minus IOP before the test). Bland-Altman analysis was applied to assess the agreement of IOP peaks and fluctuations between the two consecutive visits. We defined reproducible as within 4 mmHg for IOP peak and within 2 mmHg for IOP fluctuation. RESULTS: There were no significant differences in IOP values, IOP peaks and IOP fluctuations between the two visits for both XFS and XFG patients (p > 0.05, for all). The coefficient of repeatability for IOP peak was 2.5 mmHg and 3.5 mmHg in XFS and XFG patients respectively and for IOP fluctuation, it was 2.1 mmHg and 2.2 mmHg. None of the XFS or XFG patients had an IOP peak difference higher than 4 mmHg. Intraocular pressure (IOP) fluctuation differences above 2.0 mmHg were found in 8.8% of XFS patients and 16.6% of XFG patients. CONCLUSIONS: Intraocular pressure (IOP) peak and IOP fluctuation have a reproducibility, both in XFS and in XFG.

Agreement Between Swept-Source Optical Biometry and Scheimpflug-based Topography Measurements of Anterior Segment Parameters.

PURPOSE: To estimate the agreement of anterior segment parameters between a swept-source optical biometry (IOLMaster 700; Carl Zeiss Meditec AG, Jena, Germany) and a Scheimpflug-based topography with high resolution (Pentacam HR; OCULUS, Wetzlar, Germany). DESIGN: Interinstrument reliability analysis. METHODS: A total of 62 eyes from 62 young adults were included in the study. Average keratometry (AveK) and simulated keratometry (SimK) along 2.0-mm-ring measurements provided by Pentacam HR, keratometry readings provided by IOLMaster 700, and central corneal thickness (CCT) and anterior chamber depth (ACD) values obtained from both devices were recorded. J0 and J45 vectoral components of astigmatism were obtained using power vector analysis. Mean keratometry (Km) values of IOLMaster 700 were compared for each type of Km value from Pentacam HR, while other parameters were compared between devices. To assess the agreement between measurements of the devices, Bland-Altman analysis was performed. RESULTS: The Pentacam HR exhibited significantly lower Km and CCT measurements (P < .001, for all); however, no significant difference emerged in J0, J45, and ACD measurements (P = .057, P = .574, and P = .64, respectively). The mean difference between AveK, SimK 2.0 mm, and the IOLMaster 700 Km was -0.20 diopter (D) and -0.14 D, respectively, while the mean difference between J0, J45, CCT, and ACD measurements was 0.07 D, -0.016 D, -5.05 µm, and 0.004 mm, respectively. CONCLUSION: In clinical practice, Pentacam HR and IOLMaster 700 can be used interchangeably to measure J0 and J45 vectoral components of astigmatism for SimK 2.0 mm and IOLMaster keratometry values, as well as ACD and CCT measurements. However, SimK 2.0 mm and AveK values can be not interchangeable, as the devices have clinical and statistical differences in measurements.

Intra-ocular pressure fluctuation after cataract surgery in primary angle-closure glaucoma eyes medically controlled after laser iridotomy.

PURPOSE: To analyse the effect of cataract surgery on diurnal intra-ocular pressure (IOP) fluctuation in primary angle-closure glaucoma (PACG) eyes. METHODS: Thirty-nine eyes of 24 patients with PACG scheduled for cataract surgery were enrolled to this prospective study. A record was made which included mean IOP measurement, anterior chamber depth (ACD), anterior chamber angle (ACA), number of antiglaucomatous medications, visual field analysis (mean deviation - MD and pattern standard deviation - PSD) and responses to the Glaucoma Quality of Life-15 (GQL-15) questionnaires. The eyes were re-evaluated at 2 and 3 months of cataract surgery. RESULTS: IOP fluctuation was decreased from 4.58 ± 2.07 mmHg to 2.84 ± 1.5 mmHg (p < 0.001). The decrease in mean IOP, the number of glaucoma eye drops required (p < 0.001, p = 0.012, respectively) and the increase in mean ACD, ACA grading and SITA-standard MD (p < 0.001, p < 0.001, and p = 0.01, respectively) were statistically significant. The mean GQL-15 score was also improved (p < 0.001). The change in IOP fluctuation correlated positively with the preoperative IOP fluctuation (r = 0.56 p = 0.00), the change in ACD (r = 0.703, p < 0.001) and the change in ACA (r = 0.664, p < 0.001). In multivariate analysis, preoperative IOP fluctuation and postoperative increase in ACD were significantly associated with a reduction in IOP fluctuation of an average of 1.1 mmHg per unit change (p = 0.00 and p = 0.019, respectively). CONCLUSIONS: Cataract surgery in PACG provides the opportunity to address many pathologies with one intervention; improving vision, diminishing IOP, blunting IOP fluctuation, reducing need for medications, eliminating a narrow angle and improving GQL-15 scores.

External ophthalmomyiasis: a case series and review of ophthalmomyiasis in Turkey.

Ophthalmomyiasis externa is the infestation of the superficial external ocular structures by fly larvae. This is a particularly rare condition, which has nevertheless been reported in several countries worldwide. It is common in sheep-farming areas, especially in Mediterranean countries. The patients may present with classic conjunctivitis, pseudomembranous conjunctivitis, conjunctival hemorrhages, punctuate keratitis, keratouveitis, and eyelid edema with erythema. Herein, we present three cases of external ophthalmomyiasis caused by Oestrus ovis larvae and review ophthalmomyiasis cases reported from Turkey.

The Interaction of Nepafenac and Prostaglandin Analogs in Primary Open-angle Glaucoma Patients.

PURPOSE: To investigate the effect of nepafenac on intraocular pressure (IOP) in primary open-angle glaucoma (POAG) patients treated with prostaglandin (PG) analogs. MATERIALS AND METHODS: This prospective clinical study included 35 patients who had been receiving latanoprost (n=12), travoprost (n=12), or bimatoprost (n=11) for POAG. Nepafenac 0.1% and placebo drops were administered to the right and left eyes of patients, respectively, 3 times a day for 7 days. IOP measurements were taken at 9:00 AM, 12:00 PM, and 4:00 PM at baseline and all consecutive visits. The visits were scheduled on days 1 and 7 during treatment and 1 and 7 days after discontinuation of the treatment. RESULTS: The mean age of the patients was 60.28±7.51 years (range, 48 to 75 y). The baseline IOP was similar in the nepafenac and placebo groups (15.33±1.45 vs. 15.41±1.41, respectively, P>0.05). The decrease in the mean IOP was significant in the nepafenac group compared with the placebo group throughout the treatment period (P<0.001). After the discontinuation of nepafenac treatment, the mean IOP became similar with the placebo group from the first day (P>0.05). The change in mean IOP was not significant between the PG subgroups during treatment and discontinuation periods (P=0.712). CONCLUSIONS: Nepafenac potentiates the IOP-lowering effects of 3 different PG analogs in POAG patients.

The Efficacy of a Latanoprost/Timolol Fixed Combination Versus Latanoprost and Timolol Gel-forming Solution Unfixed Combination on Daytime Intraocular Pressure.

PURPOSE: To evaluate the effect of a latanoprost/timolol fixed combination (LTFC) versus a latanoprost and timolol gel-forming solution unfixed combination (LTuFC) on daytime intraocular pressure (IOP) levels and fluctuations. METHODS: This was an 8-week, randomized, parallel-group study. Ninety eyes of 90 patients diagnosed with primary open-angle glaucoma or ocular hypertension that were insufficiently controlled with latanoprost monotherapy were enrolled. Randomized patients received either a single evening dose of LTFC or unfixed combination of latanoprost administered once daily in the evening and timolol gel-forming solution administered once daily in the morning without a washout period. IOP measurements were taken at 8 AM, 11 AM, 2 PM, and 5 PM. The mean IOP, daytime IOP measurements, and fluctuation in IOP were assessed at weeks 4 and 8. RESULTS: The mean IOP reduction from baseline to each visit was significant in both groups (P<0.01). There was a significant difference in the mean IOP between groups at week 4 (P=0.0021). At week 8, the mean IOP reduction was 3.2 ± 2.1 and 5.7 ± 3.2 mm Hg in LTFC and LTuFC groups, respectively, and the difference was significant (P=0.001). A decrease in the daytime IOP fluctuation was observed in both groups over time, but the decrease in each group was not significant. At week 8, the mean IOP measurements at 8 AM, 11 AM, 2 PM, and 5 PM in LTuFC group were significantly lower than in the LTFC group (P=0.024, 0.0001, 0.0008, and 0.0011, respectively). CONCLUSIONS: The concomitant use of latanoprost and timolol gel-forming solution leads to a larger additional IOP reduction and lower daytime IOP levels as compared with the fixed combination.

Effect of four different intraocular lenses on posterior capsule opacification.

AIM: To evaluate the impact of 4 different intraocular lenses (IOLs) on posterior capsule opacification (PCO) by comparing the neodymium: yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy rates. METHODS: This retrospective study included 4970 eyes of 4013 cataract patients who underwent phacoemulsification and IOL implantation between January 2000 and January 2008 by the same surgeon at one clinic. Four different IOLs were assessed. The outcome parameter was the incidence of Nd:YAG laser posterior capsulotomies. RESULTS: An Nd:YAG laser posterior capsulotomy was performed in 153 (3.07%) of the 4970 eyes. The mean follow-up time was 84mo for all of the IOL groups. The percentage of eyes developing PCO was significantly greater for the acrylic hydrophilic IOLs than for the hydrophobic IOLs, although eyes with acrylic hydrophilic IOLs did not require Nd:YAG laser capsulotomy as soon as eyes with acrylic hydrophobic IOLs. There was no difference between the long-term PCO rates when 1- and 3-piece acrylic hydrophobic IOLs were compared or when IOLs made of the same material but with different haptic angles were compared. CONCLUSION: In this study, eyes with acrylic hydrophilic IOLs were more likely to develop PCO than those with acrylic hydrophobic IOLs. The lens design (1-piece versus 3-piece and varying haptic angles) did not affect the PCO rate.

Autofluorescence patterns as a predictive factor for neovascularization.

PURPOSE: To investigate fundus autofluorescence (FAF) patterns in patients with nonexudative age-related macular degeneration (AMD) and to test if FAF patterns affect the development of choroidal neovascularization (CNV). METHODS: One hundred one patients with early AMD underwent a detailed ophthalmological examination. Fundus autofluorescence imaging was performed with a confocal scanning laser ophthalmoscope following a standard protocol. The classification of the International Fundus Autofluorescence Classification Group was used for the description of the FAF patterns. RESULTS: One hundred seventy-eight eyes of 101 patients (59 women, 42 men) with a mean (±SD) age of 66.4 (±6.1) years were included. The mean (±SD) follow-up was 41.3 (±27) months. One hundred seventy-eight eyes presented various types of drusen with or without hyperpigmentation or hypopigmentation at initial examination. During follow-up, a total of 22 (12.3%) eyes developed CNV. The most frequent pattern for CNV development was the patchy pattern in 30.4%, followed by linear in 25%, and reticular pattern in 20.8% of eyes. CONCLUSIONS: Fundus autofluorescence imaging using a confocal scanning laser ophthalmoscope is a useful technique to identify FAF characteristics in patients with nonexudative AMD. Different patterns of FAF abnormalities can be obtained in these eyes. Our results indicate that patchy, linear, and reticular patterns are the specific patterns associated with CNV development in nonexudative AMD.