• Journal Highlights

    American Journal of Ophthalmology

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    Iris-Sutured Posterior Chamber IOLs in Children

    January 2016

    Shah et al. reported the long-term outcomes and complications of iris-sutured posterior chamber intraocular lenses (PCIOLs) in a pediatric population. Iris-sutured IOLs have been used as an alternative to transsclerally sutured IOLs to correct aphakia in children. Because dislocation of these IOLs occurs frequently, however, the procedure should be considered with caution in this group.

    This retrospective interventional case series involved 12 consecutive patients (17 eyes) who received a foldable iris-sutured PCIOL between September 2004 and September 2007. Of the 17 eyes, 6 (35%) had hereditary or idiopathic ectopia lentis, 5 (29%) had Marfan syndrome, 2 (12%) were aphakic after pars plana vitrectomy, and 4 (24%) were aphakic after trauma. Mean age at surgery was 7.2 years, and average follow-up was 4.7 years.

    Dislocation of the PCIOL occurred in 7 eyes at an average of 12.1 months after surgery, and 2 patients had a second dislocation. The rate of dislocation was higher in patients with a history of ectopia lentis due to Marfan syndrome, idiopathic causes, or hereditary causes than in patients with other causes of aphakia (71% vs. 29%). The authors commented that although this difference was not statistically significant, it was clinically significant. Mean visual acuity improved in 12 of 17 patients (71%). One eye of a Marfan patient sustained a retinal detachment 8 months after dislocation of the PCIOL, and 1 patient experienced iris capture of the PCIOL after surgery.

    The authors concluded that although this technique improves VA in the majority of patients, ophthalmologists should be aware that the dislocation rate is 50% in eyes followed for more than 1 year.

    Geo-Epidemiology of AMD

    January 2016

    Reibaldi et al. studied the demographic, geographic, and race-related factors that account for variability in prevalence rates of age-related macular degeneration (AMD) using a systematic review, meta-regression, and decision-tree analysis. The strongest correlations they identified were with race and sun exposure.

    A systematic literature review identified population-based studies on the prevalence of AMD published before May 2014. The researchers included only those studies that took place in a spatially explicit geographic area that could be geolocalized and that used retinal photographs and standardized grading classifications. Information on latitude and longitude data (geolocalization) and the mean annual exposure to sunlight (insolation) were obtained for each of the areas surveyed. Age-standardized prevalence rates across studies were estimated using the direct standardization method. Correlations between the prevalence of AMD and longitude and latitude were obtained by regression analysis. The researchers further investigated other relevant factors and potential associations through Bayesian meta-regression and conditional-inference decision trees.

    After multiple analyses, the researchers observed significant correlations between insolation, latitude, longitude, age, and race and the prevalence rates of early and late AMD. Proximity to the equator and insolation were inversely correlated with prevalence of AMD. Decision-tree analysis identified that the most important predictive variable was race for early AMD and insolation for late AMD. In terms of race, people of European ancestry had higher rates of early AMD than Asians; they also had higher rates of both early and late AMD than people of African ancestry.

    Photodynamic Therapy for Choroidal Metastasis

    January 2016

    In a retrospective interventional case series, Ghodasra and Demirci assessed the effectiveness of photodynamic therapy (PDT) in the management of choroidal metastasis. They concluded that PDT might be an effective therapeutic option in selected cases.

    Patients with choroidal metastasis treated with PDT at a single institution were reviewed. PDT was applied with verteporfin at a dose of 6 mg/m2 body surface area and a 689-nm diode laser for 83 seconds. Twenty-one tumors in 13 eyes of 10 patients were included. Eight tumors were treated with a single session of PDT, 11 tumors received 2 sessions, 1 tumor received 3 sessions, and 1 tumor received 5 sessions.

    At the end of a mean follow-up of 12 months, 9 eyes (69%) had stable or improved visual acuity, while 4 eyes (31%) had decreased visual acuity. Mean logMAR change in visual acuity was –0.09. Seventeen of 21 tumors (81%) were flat at last follow-up. The mean decrease in ultrasound-measured thickness was 0.83 mm, while the decrease in thickness, as measured by enhanced depth imaging optical coherence tomography, was 400 μm. Eighteen tumors (86%) had complete resolution of subretinal fluid. There were no PDT-related complications.

    Trifocal IOL Implantation

    January 2016

    Kohnen et al. evaluated the visual and refractive outcomes after implantation of a trifocal intraocular lens (IOL), using a prospective nonrandomized, noncomparative case series design. Their evaluation showed good visual acuity (VA) at far, intermediate, and near distance; high patient satisfaction despite some optical phenomena such as halo and glare; and high spectacle independence 3 months postoperatively.

    Twenty-seven patients (54 eyes) who had bilateral implantation of the AT LISA trifocal IOL (Carl Zeiss Meditec; not available in the United States) were enrolled. Exclusion criteria were previous ocular surgeries apart from cataract surgery and refractive lens exchange, irregular corneal astigmatism of more than 1.5 D, and ocular pathologies or corneal abnormalities. Outcome measures at 3 months after implantation included postoperative monocular and binocular uncorrected VA (UCVA) and distance-corrected VA at 4 m, 80 cm, and 40 cm; defocus curve; contrast sensitivity; and quality-of-vision questionnaire results.

    Mean spherical equivalent was 0.05 ± 0.32 D at 3 months postoperatively. Binocular UCVA at distance, intermediate, and near was –0.1 ± 0.1 logMAR, 0.0 ± 0.1 logMAR, and 0.0 ± 0.1 logMAR, respectively. Despite some optical phenomena, 92% of patients would choose the same IOL again.

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    American Journal of Ophthalmology summaries are edited by Thomas J. Liesegang, MD.

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