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Recent studies suggest that the rate of endophthalmitis after cataract surgery has been increasing. Antisepsis with povidone-iodine remains the standard of care, and surrogate evidence exists to support the use of a topical antibiotic. Prospective, randomized clinical trial data demonstrated a benefit for intracameral cefuroxime, but the role of intracameral antibiotics is a subject of ongoing debate.

The rate of methicillin-resistant Staphylococcus aureus (MRSA) is increasing in both systemic and ocular infections, according to an analysis of nationwide surveillance data. Increasing rates of resistance and lowered rates of susceptibility could soon reduce the number of drugs that can be successfully used to treat ocular infections.

Retrospective analyses comparing clinical results achieved with wavefront-guided and conventional LASIK and surface ablation procedures convincingly demonstrate the superiority of a customized approach, said Capt. Steven C. Schallhorn, MD, who is affiliated with ClearView Eye and Laser Medical Center, San Diego.

Ophthalmologists who use botulinum toxin type A to help patients improve their appearance should add the use of hyaluronic acid (HA) fillers to their procedures because they have many ideal characteristics, recommends one oculoplastics specialist. HA fillers are made of natural substances; no toxic effects are known. They can be used alone or in combination with permanent procedures such as fat transplantation; they have a combined effect with botulinum toxin; and they can be eliminated, if needed, through the use of hyaluronidase. HA fillers also have a low incidence of side effects, are easily stored, do not need to be refrigerated, and come in preloaded syringes with small needles.

Collagen crosslinking with riboflavin (C3-R) was used to treat six eyes with progressive hyperopia after RK that had experienced further progression after intervention using laser vision correction. Retrospective analyses based on a mean follow-up of 215 days after the C3-R procedure suggests keratometric stabilization.

With periorbital soft-tissue infections on the increase due to methicillin-resistant Staphylococcus aureus (MRSA), physicians must be suspicious of MRSA and aware of local resistance profiles in order to treat these infections effectively.

Although millions of patients worldwide have undergone LASIK to treat myopia, the complication rate is very low. The problems that do arise postoperatively, however, can be serious and include endophthalmitis, retinal tears, retinal detachments, retinal hemorrhages, macular holes, and choroidal neovascularization.

A newer-generation IOL reduces higher-order, spherical, and trefoil aberrations when compared with the previous-generation lens. This reduction in higher-order aberrations may result in better outcomes for patients, specifically, improved contrast sensitivity, reduction in night vision disturbances, and improved visual performance compared with conventional spherical IOLs.

A combination of a refractive and a diffractive multifocal IOL for correction of presbyopia virtually eliminates complaints about intermediate vision that are frequent among patients who undergo bilateral implantation of diffractive lenses.

A multifocal silicone IOL seems to provide better overall vision to patients compared with other lenses available to correct presbyopia.

Multicenter studies are under way in Europe and the United States investigating an angle-supported phakic IOL for the treatment of high myopia.

A toric IOL enables patients with corneal astigmatism undergoing lens surgery to achieve the same clear uncorrected vision on day 1 as patients with minimal astigmatism.

Subjective and objective accommodation in patients with a dual-optic accommodating IOL implanted bilaterally were measured in a pilot study. Accommodation was adequate in subjective testing and significantly greater than in controls with an acrylic foldable monofocal IOL. Objective evaluations demonstrated movement of the anterior optic.

Blue light-filtering IOLs may provide protection against potential blue light toxicity without significantly affecting clinical functioning of recipients, according to one ophthalmologist. Another cataract surgeon, however, contends that blue light filtering is not clinically important for preventing age-related macular degeneration and that further study is needed regarding the potential adverse effect of blue light-filtering implants on melanopsin production and scotopic vision.

A violet light-filtering IOL seems to protect eyes from phototoxicity caused by ultraviolet light without decreasing nighttime vision or compromising color vision compared with blue light-filtering lenses.

A newer-generation IOL reduces higher-order, spherical, and trefoil aberrations when compared with the previous-generation lens. This reduction in higher-order aberrations may result in better outcomes for patients, specifically, improved contrast sensitivity, reduction in night vision disturbances, and improved visual performance compared with conventional spherical IOLs.

Implantation of a toric implantable contact lens for compound myopic astigmatism seems to be very effective, highly predictable, and relatively safe. A widely dilated pupil is very important, especially in the implantation of a toric lens, to align the axes properly. In the case of improper alignment of axes, repositioning of the lens is easy and safe.

A second-generation refractive multifocal IOL provides excellent distance and intermediate vision, with distance, intermediate, and near vision improving over time, according to preliminary results of an ongoing multicenter study.

A prospective study of 20 eyes in 20 patients found that implantation of an apodized diffractive IOL in patients with presbyopia and unilateral cataract and a healthy fellow eye resulted in improved distance and near vision, reduced spectacle dependency, and enhanced binocular function, with quality vision in most cases.

A new accommodating lens seems to be a safe option for properly selected patients, in whom excellent refractive results can be achieved.

An accommodating IOL provides excellent visual results in patients with hyperopia or myopia.

An aberration-free aspheric silicone IOL, performed better in eliminating spherical aberrations than two other silicone IOLs, one a conventional spherical IOL and the other an aspheric IOL with a prolate anterior surface and a spherical posterior surface.

Although expressing different levels of enthusiasm for accommodative IOLs, clinicians debating the merits of this technology agreed that the devices have promise and said they look forward to improvements and new designs.

Persons who have unilateral nonarteritic anterior ischemic optic neuropathy (NAION) that either is spontaneous or developed after cataract surgery should be cautioned that they are at increased risk for NAION after cataract surgery in the fellow eye.

Howard V. Gimbel, MD, MPH, has used intracameral injection of vancomycin to prevent endophthalmitis after cataract surgery since 1990. In an analysis of more than 35,000 eyes operated on over 15 years, the incidence of presumed endopthalmitis was only 0.01% and there was no evidence of complications associated with the antibiotic injection.

Horizontal eyelid tightening alone results in secondary improvement in the ptosis associated with floppy eyelid syndrome, according to the results of a case series in 24 eyelids of 18 patients.

Accommodation is the result of changes in the optical power of the crystalline lens that results from change in the lens anterior and posterior surface curvatures and thickness. The ciliary muscle is the engine that drives the accommodative process, and the lens capsule and the lens are important components of accommodation, according to Adrian Glasser, MD, from the College of Optometry, University of Houston, Houston.

The short-term clinical experience with intravitreal bevacizumab (Avastin, Genentech) supports growing perception that treatment is safe and effective for neovascular age-related macular degeneration.

Patients who complain of poor visual function after LASIK may have unstable tear film, which affects the smoothness of the ocular surface and disturbs vision. With the help of the functional visual acuity meter, clinicians can assess functional vision over 60 seconds and then address any instability of the tear film if necessary.

Researchers at Wilmer Eye Institute and Genentech collaborated to study retrospectively the incidence of myocardial infarction and strokes in persons with neovascular AMD. The initial results showed the rates increased with increasing levels of comorbidity.