In a small pilot study with limited follow-up, early application of micropulse laser trabeculoplasty (MLT) using a specific diode laser (IQ810, Iridex Corp.) appeared promising. Use of this multifunctional laser may have practical advantages in a clinical setting. Further study of the technology is needed to determine the role of MLT in the treatment of glaucoma.
A phase 1 trial of rapamycin (Sirolimus, MacuSight) indicated that the drug is safe and has biologic activity in patients with diabetic macular edema when injected intravitreally and subconjunctivally.
JPE1375 (Jerini Ophthalmic), a peptidomimetic inhibitor of the complement factor 5a receptor, blocks the mechanism that draws inflammatory cells into the disease process of age-related macular degeneration. When blocked, the numbers of neutrophils and macrophages decrease substantially and in turn the choroidal neovascularization also decreases.
The Micro-Surgical Safety Task Force analyzed potential complications associated with sutureless vitrectomy and disseminated guidelines to reduce the rate of endophthalmitis associated with 25-gauge vitrectomy.
The FDA approved a multifocal IOL (Tecnis, Advanced Medical Optics) for implantation in patients with cataract and presbyopia.
Retinal specialists seemed to hold their collective breaths in 2008 in anticipation of the results of a number of ongoing trials of drugs for various retinal pathologies. Medical retina and the anti-vascular endothelial growth factor therapies were center stage again this year. Some of the highlights include bevacizumab (Avastin, Genentech) for retinopathy of prematurity, sustained-release ciliary neurotropic factor for dry age-related macular degeneration, anti-complement drugs, and the results of the Diabetic Retinopathy Clinical Research study.
Collagen cross-linking, the newest advancement in the refractive arena, possibly will stabilize keratoconic and ectatic corneas. LASIK, an area that always is improving, has seen changes in flap sizes and lasers. Knowledge of corneal biomechanics also is progressing to provide more information than ever before with new instrumentation. The phakic IOL market has expanded considerably, catering to those with high myopia. IOL options for pseudophakia also are expanding, and refractive lens exchange remains popular for hyperopia. In addition, questions of patient satisfaction postLASIK are being answered by an FDA task force.
A prismatic IOL (P-Flex, Rayner) is giving hope to patients with advanced age-related macular degeneration because of its novel design. A Fresnel prism in the IOL reflects images onto healthy retinas in patients with small macular lesions. No scotoma or diplopia has resulted from implantation of this IOL in two patients.
Adjuvant use of bromfenac ophthalmic solution 0.09% (Xibrom, ISTA Pharmaceuticals) with ranibizumab (Lucentis, Genentech) reduced the reduced the number of ranibizumab injections needed to control choroidal neovascularization secondary to age-related macular degeneration. Use of the two drugs together resulted in better visual acuity outcomes than those achieved with ranibizumab alone.
Micropulse laser trabeculoplasty (MLT) using a specific diode laser seems to be a safe and effective approach to performing trabeculoplasty.