Cheryl Guttman

A phacoemulsification software upgrade further enhances safety, efficiency, and control for surgeons performing torsional ultrasound with proprietary handpiece and phaco system.

An in vitro kill kinetics study evaluated eradication of 18 human ocular Staphylococcus isolates by commercial formulations of gatifloxacin 0.3% (Zymar, Allergan) and moxifloxacin 0.5% (Vigamox, Alcon Laboratories). Gatifloxacin demonstrated superior activity, which may be attributed to the presence of benzalkonium chloride 0.005% in its formulation.

Sulcus placement of a proprietary three-piece multifocal IOL (ReZoom, Abbott Medical Optics) is a viable option in eyes in which capsular bag support is not adequate to ensure good lens stability. Then, if the lens decenters in the sulcus, scleral suturing is a safe and effective option for recentering the IOL and restoring good vision.

The introduction of a new fourth-generation fluoroquinolone for ophthalmic use may prompt an assessment of the pros and cons of the available agents. James P. McCulley, MD, explains his continued preference for moxifloxacin 0.5% (Vigamox, Alcon).

A retrospective study analyzed outcomes of 345 consecutive eyes with the proprietary glaucoma minishunt (Ex-PRESS, Optonol) implanted, including 114 eyes having combined cataract surgery. During a mean follow-up of about 2 years, the implant provided effective IOP control whether used alone or in a combination procedure and was associated with few complications.

Results of a survey of 124 ophthalmologists show interest in preservative-free formulations of IOP-lowering medications to preserve ocular surface health. Preservative-free timolol maleate (Timoptic in Ocudose, Aton Pharma) can be a good choice for appropriately selected patients, according to one ophthalmologist.

Endocyclophotocoagulation (ECP) can be performed easily in patients with medically controlled glaucoma who are undergoing cataract surgery, to provide additional IOP lowering and reduce medication use. Misunderstanding that ECP is a completely different procedure than transscleral cyclodestruction contributes to under-use of this very safe procedure, according to one ophthalmologist.

The efficacy and tolerability of continuing latanoprost 0.005% (Xalatan, Pfizer) after 6 weeks of latanoprost monotherapy versus switching to bimatoprost 0.03% (Lumigan, Allergan) was investigated in an investigator-masked, randomized, parallel-group trial. The results showed good efficacy and tolerability in patients whose therapy was switched to bimatoprost and suggest that bimatoprost may be tolerated better after latanoprost pre-treatment.

The first microincisional IOL (Akreos MICS IOL, Bausch & Lomb) has been introduced in the U.S. market. The lens is a single-piece hydrophilic acrylic IOL designed for delivery through a 1.8-mm incision. Its material and design offer several advantages, according to three surgeons who have used it.

A meta-analysis based on data from 12-month trials including patients treated with brimonidine 0.1% with a preservative (Alphagan P 0.1% with Purite, Allergan) and patients using brimonidine 0.15% (Alphagan P 0.15%, Allergan) showed better systemic safety and tolerability with the lower-concentration product.

One surgeon's preference for an ophthalmic surgical device (OVD) of 1.6% sodium hyaluronate (Amvisc Plus, Bausch & Lomb) was reinforced by a study that found it superior to another OVD during phaco and OVD removal.

A new phaco tip (Fine OZil Tip, MicroSurgical Technology) for use with a proprietary handpiece (OZil, Alcon Laboratories) improves the safety and efficiency of phacoemulsification using torsional ultrasound with a biaxial microincisional technique. Modification of the phaco parameters improves chopping and segment removal.

An ophthalmic viscosurgical device of 2.3% sodium hyaluronate (Healon 5, Abbott Medical Optics) makes one ophthalmologist's prechopping-assisted phacoemulsification technique safer and easier, he says.

Surgeons discuss their preferences and techniques for using various ophthalmic viscosurgical devices in eyes with intraoperative floppy iris syndrome.

The most recent results from the 2008 American Society of Cataract and Refractive Surgery/European Society of Cataract and Refractive Surgeons survey on foldable IOLs requiring removal or other secondary intervention highlight changes over time in the complications associated with various lens types.

The current version of a proprietary phaco system (WhiteStar Signature, Abbott Medical Optics) features fluidics control software that allows automatic switching from longitudinal ultrasound to transversal (Ellips) on recognition of occlusion and back again to longitudinal on occlusion break. Results of a prospective study show the benefits of this technology for optimizing the efficiency of cataract removal.

Ketorolac tromethamine 0.45% (Acuvail, Allergan) is a preservative-free ophthalmic NSAID recently approved for twice-daily use in treating pain and inflammation after cataract surgery. Its novel formulation is designed to promote drug delivery and tolerability.

Recent surveys of patients and eye care specialists were undertaken to obtain information about the prevalence and management of blepharitis. Survey results together with clinical trial data highlight use of topical azithromycin.

A prospective study including 51 patients who underwent bilateral wavefront-guided LASIK for low to moderate myopia assessed visual symptoms at follow-up visits through 12 months after surgery. There was no evidence that large preoperative pupil size correlated with increased risk of unwanted postLASIK symptoms.

Cataract surgeons confronted by capsular rupture with vitreous prolapse usually favor performing limbal vitrectomy over using a pars plana approach.

A new formulation of lubricant eye drop (Systane Ultra, Alcon Laboratories) contains polymer network and demulcent ingredients that have been proven in multiple studies to provide benefits in patients with dry eye disease, according to one ophthalmologist. The drop, however, reformulates these agents in a system designed to further enhance ocular surface comfort, protection, and symptomatic relief. Initial patient impressions are very positive, he said.

A compromised lipid layer plays a key role in the development and perpetuation of dry eye disease because it allows increased aqueous evaporation and fails to protect against friction between the blinking lid and the ocular surface. A proprietary brand of emollient eye drops (Soothe XP. Bausch & Lomb) was created to re-establish the tear film lipid layer and restore moisture, and it is an effective choice for providing symptomatic relief in patients with dry eye disease, says one optometrist.

A review of the world literature shows that about one-third of patients who are undergoing LASIK already suffer from dry eye, and the proportion affected after surgery is similar. In most cases, however, dry eye does not appear to affect postoperative vision and satisfaction outcomes adversely. Identification of patients at risk and pre-treating may reduce the postoperative incidence of dry eye.

Recognizing and treating dry eye disease before LASIK is an important strategy for mitigating patient unhappiness after surgery.

In a small retrospective study, eyes receiving intravitreal bevacizumab (Avastin, Genentech) within 3 months of a central retinal vein occlusion showed rapid improvement in anatomic abnormalities and subsequent improvement in vision. The benefits were maintained with repeated injections after a mean follow-up of 1 year.

Oral fenretinide (Sirion Therapeutics) is being investigated in a phase II study as a treatment for advanced geographic atrophy associated with age-related macular degeneration. It is hypothesized that this agent may limit disease progression by preventing delivery of circulating retinol to the eye, thereby reducing the accumulation of retinol-derived metabolites that are toxic to the retinal pigment epithelium and photoreceptor cells.

Although 2008 was not a year of major advances in glaucoma, it still was a time of progress. Structural imaging devices continue to improve; more data are emerging on surgical alternatives to trabeculectomy; and some novel medical therapies appear interesting, even though they are just in very early stages of clinical investigation. Perspectives on recent developments and current controversies are discussed.

Cataract surgery is a modern success story because of the advances in techniques and technology that have been made over the years. Excellent outcomes are becoming routine, and the field only continues to progress, thanks to a steady stream of innovations. Three cataract surgeons share their thoughts on some of the most noteworthy innovations and trends of 2008 and beyond.

1-year results from the HORIZON open-label extension study of ranibizumab (Lucentis, Genentech) for the treatment of exudative age-related macular degeneration show that treatment beyond 2 years relatively is safe and well tolerated, but previously treated patients who received ranibizumab monthly for 2 years may be susceptible to loss of vision with less-frequent dosing during the third year of treatment.

In a dose-ranging phase IIb study, microplasmin 125 micrograms (ThromboGenics) was safe and demonstrated significant efficacy compared with placebo for inducing posterior vitreous detachment in eyes with macular holes or macular edema related to vitreomacular traction. Pivotal phase III trials are being planned.