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Embryonic stem cell transplantation represents an attractive method for restoring vision to patients with degenerative retinal diseases. Researchers in this field face many challenges in obtaining perfect stem cells and inducing the transplanted cells to differentiate into synaptically connected photoreceptors. Lessons from the embryo may yield answers to some of those issues.

The phenotypic analysis of patients with age-related macular degeneration indicates that peripheral reticular pigmentary change is the only phenotypic feature that correlates significantly with the CFH Y402H variant.

Intravitreal triamcinolone does not benefit patients with presumed macular edema resulting from parafoveal telangiectasia type 2A. This treatment has been associated with a high incidence of ocular complications.

Pharmacologic testing can help target subsequent imaging for Horner's syndrome, but can it delay a full evaluation? Two ophthalmologists engage in a friendly debate.

Computed tomography and magnetic resonance imaging are extremely important imaging modalities with different capabilities that the ophthalmic surgeon should understand to use to the best advantage, according to Neil R. Miller, MD.

Managing patients with diabetic macular edema means focusing on a number of details to obtain a good clinical picture of each patient's status. These details include the location of the edema in the fovea, the nature of the evolution (acute, chronic, or progressive), status of the blood retinal barrier, signs of retinal pigment epithelial dysfunction, presence of retinal tissue damage, ischemia, vitreoretinal traction, status of metabolic control, and blood pressure.

The instillation of bromfenac 0.09% (Xibrom, ISTA Pharmaceuticals) results in less severe and less frequent patient discomfort compared with ketorolac tromethamine 0.4% (Acular LS, Allergan). However, the anesthetic effect of either commercially available nonsteroidal anti-inflammatory drug was statistically equivalent.

Treatment with topical azithromycin 1% ophthalmic solution (AzaSite, InSite Vision) using a frequent dosing regimen was effective in reducing colony counts of azithromycin-resistant Pseudomonas aeruginosa in an animal model of keratitis.

In a double-masked, randomized comparison of three leading ocular nonsteroidal anti-inflammatory agents, nepafenac 0.1% (Nevanac, Alcon Laboratories) had significantly greater ocular bioavailability than either ketorolac 0.4% (Acular LS, Allergan) or bromfenac 0.09% (Xibrom, ISTA Pharmaceuticals).

The efficacy of gatifloxacin and moxifloxacin for preventing methicillin-resistant Staphylococcus aureus (MRSA) keratitis was investigated in a rabbit model. Animals were pretreated with one of the two fourth-generation fluoroquinolones or BSS, received a midstromal injection with an inoculum of MRSA, and then study treatment continued for up to 96 hours postinjection. Gatifloxacin-treated eyes demonstrated less inflammation and infection, and lower numbers of recovered MRSA than moxifloxacin-and BSS-treated animals.

A retrospective review suggests that administration of intracameral moxifloxacin 0.5% (Vigamox, Alcon Laboratories) is safe for endophthalmitis prophylaxis during cataract surgery.

In vitro susceptibility patterns do not differentiate among the newer fluoroquinolones, (levofloxacin, moxifloxacin, and gatifloxacin). All have equal effectiveness against methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S aureus (MSSA). With the exception of trimethoprim, a dihydrofolate reductase inhibitor, MRSA was highly resistant to all antibiotics tested by the TRUST (Tracking Resistance in the U.S. Today) Study. MSSA was highly susceptible to all antibiotics except polymyxin B, a polypeptide; penicillin, a ,b-lactam; and azithromycin, a macrolide. When treating patients with MRSA infections, the potential for failure of the antibiotics must be considered.

Analysis of the time course of visual acuity outcomes during the first year of the ANCHOR study indicates that the mean visual acuity benefit of ranibizumab (Lucentis, Genentech) compared with photodynamic therapy (PDT) with verteporfin (Visudyne, Novartis) for the treatment of exudative age-related macular degeneration (AMD) was observed after the first month of treatment, and this benefit continued with increased vision that was maintained over the 2 years of the study.

The European Society of Cataract and Refractive Surgeons' annual meeting will be Sept 8 to 12 in Stockholm, Sweden. Among the events will be symposia, exhibits, live surgery demonstrations, a didactic course on refractive surgery, a workshop on visual optics, courses, and free papers.

Outcomes after implantation of an accommodating IOL (crystalens, eyeonics) were probed with a simple questionnaire designed to characterize spectacle wear and patient satisfaction. The results based on these critical metrics were favorable.

Sutureless vitrectomy using 25-gauge instrumentation reduces surgical time and results in faster visual recovery relative to 20-gauge vitrectomy. The risk of wound leak, however, is increased after the sutureless procedure, and that may lead to other complications. James T. Handa, MD, discusses these and other issues relating to the technique.

Interim results of a study of pegaptanib sodium as maintenance therapy for age-related macular degeneration show that patients previously treated successfully with other agents maintain visual and anatomic stability.

A modified latex bead rat model has proven to be valid for measuring retinal ganglion cell loss in high-pressure glaucoma.

Intravitreal injection of up to 4 mg of a fusion protein that is an anti-vascular endothelial growth factor agent (VEGF Trap-Eye, Regeneron Pharmaceuticals Inc.) is well tolerated and yields no evidence of ocular inflammation. The agent appears to produce rapid and durable clinical increases in best-corrected visual acuity, along with improvements in anatomic features, in patients with neovascular (wet) age-related macular degeneration.

The 6-month interim results from the Verteporfin Intravitreal Triamcinolone Acetonide Study indicate that the combination of photodynamic therapy with verteporfin and either pegaptanib (Macugen, OSI/Eyetech and Pfizer Ophthalmics) or triamcinolone acetonide (Kenalog, Bristol-Myers Squibb) in two different doses resulted in no differences among the groups on several key measures.

Selective VEGF inhibition appeared to produce improvements in vision and macular edema in patients with central retinal vein occlusion in a recent study. In this multicenter, randomized trial, patients with macular edema secondary to CRVO received five intravitreal injections of pegaptanib sodium over a 24-week period.

A new signaling pathway in the trabecular meshwork is involved in glaucomatous ocular hypertension, believes the research team that discovered it. Altered Wnt signaling may be responsible for pathogenic elevated IOP.

A novel retinal imaging tool combining confocal scanning laser ophthalmoscopy (cSLO) with high-resolution spectral-domain optical coherence tomography (SD-OCT) allows for the first time simultaneous imaging with cSLO (including angiography and autofluorescence) and SD-OCT.

Bevacizumab rescue therapy administered following treatment with pegaptanib (Macugen, OSI/Eyetech and Pfizer Ophthalmics) resulted in minimal improvement, said William R. Freeman, MD, at the Association for Research in Vision and Ophthalmology annual meeting. While primary bevacizumab (Avastin, Genentech) therapy for choroidal neovascularization (CNV) in age-related macular degeneration (AMD) resulted in 2 to 3 ETDRS lines of improvement, which is similar to the improvement seen with ranibizumab (Lucentis, Genentech).

This year, the Association for Research in Vision and Ophthalmology annual meeting focused on the aging eye. With reference to new treatment possibilities, researchers presented information about novel therapies for age-related macular degeneration, glaucoma, and other age-associated ocular conditions, as well as investigations of current treatments.

The rehabilitation of the contracted anophthalmic socket may be challenging for the surgeon. In order to retain and support an ocular prosthesis, there must be adequate orbital volume, mucosal lining of the fornices and the fundus of the socket, a properly sized prosthesis, and adequate support from the upper and lower eyelids. David E. Holck, MD, reviews the pathophysiology of the contracted socket and possible surgical options that can be undertaken in collaboration with an ocularist.

Results of a large study of women with cardiovascular disease or risk factors show that long-term daily supplementation with folic acid and B vitamins reduces the risk of age-related macular degeneration.

A new offset system (Torsion Error Detection, Nidek) for alignment control measures the distance between the line of sight and the visual axis as well as the difference between photopic and mesopic fixation images. The amount of translation needed to match these images can be an indicator of poor fixation. The offset system allows detection and definition of line of sight and visual axis positions.

The American Society of Cataract and Refractive Surgery's Refractive Surgery Survey reached the 10-year mark in 2006. The results show an increase in epi-LASIK, advanced surface ablation, and wavefront-guided procedures and continued surprises regarding some standard-of-care issues.

Mixing and matching multifocal IOLs appears to be a safe and effective approach, according to a study of two lenses from the same manufacturer (Tecnis and ReZoom, Advanced Medical Optics). The surgeon who conducted the research provides pearls for using this technique.