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Effects of Dry Eye Therapies on Ocular Surface Disease
July AJO
Moore et al. evaluated the effectiveness of artificial tears and corticosteroids for mitigating the ocular surface response to low-humidity environments. They found that corticosteroid eyedrops did indeed diminish the adverse effects of low humidity, likely due to the suppression of stress-activated inflammatory pathways.
The researchers enrolled 20 patients with aqueous-deficient dry eye. These patients were first exposed to a 90-minute low-humidity environment and then directed to use artificial tears for 2 weeks prior to a second low-humidity exposure. Next, they used 0.1% dexamethasone for 2 additional weeks before they were exposed a third and final time. Digital polymerase chain reaction was performed to measure HLA-DR RNA transcripts in conjunctival cells taken by impression cytology at each visit.
The researchers found significantly less corneal and conjunctival epitheliopathy as well as decreased HLA-DR transcripts after use of dexamethasone compared with artificial tears. Patients also reported significantly less eye irritation during the low-humidity exposure following dexamethasone.
The researchers cautioned that extended use of corticosteroids is not indicated and that other anti-inflammatory therapies with activity against stress-activated pathways may also prove to be effective.
Endophthalmitis After Intravitreal Injections
July AJO
Dossarps et al. reported the incidence and characteristics of endophthalmitis following intravitreal injections of anti-VEGF agents and corticosteroids. They found that although the incidence of presumed endophthalmitis following injections was low, the overall prognosis was poor.
For this retrospective, multicenter case series, the researchers investigated a total of 316,576 intravitreal injections from 25 French ophthalmic centers. For each center, the number of intravitreal injections was determined using billing codes, and the injection protocol was recorded.
During the study period, the researchers found 65 cases of presumed endophthalmitis, giving an overall incidence of 0.021%. The median number of days from injection to presentation was 4 days, and the most common symptom was vision loss. Bacterial identification was achieved in 43% of patients, and the most frequent pathogens were gram-positive bacteria (91%), including coagulase-negative Staphylococcus in 78%. A majority of patients had worse visual acuity after 3 months of follow-up compared with acuity prior to endophthalmitis.
Influence of Age on Corneal Astigmatism Following Cataract Surgery
July AJO
Hayashi et al. investigated the relationship between long-term changes in corneal astigmatism following cataract surgery and age at the time of the procedure. They found that astigmatic changes did not differ significantly due to age and were comparable to changes in eyes that did not undergo surgery.
In this retrospective cohort study, a total of 437 eyes underwent phacoemulsification with a 4.1-mm horizontal corneoscleral incision. For controls, 600 eyes without surgery were divided into 4 age groups: 60 years of age or younger, 61 to 65 years, 66 to 70 years, and 71 years or older. The researchers then compared the corneal astigmatic change between 1) baseline and 5 years, 2) 5 and 10 years, and 3) baseline and 10 years among the different age groups and between eyes with and without surgery.
Corneal astigmatic change, expressed as x and y coordinates, showed an against-the-rule shift of 0.2 to 0.4 D during the 10-year span in all age groups of both the surgery and control eyes. The researchers also found that the mean x and y coordinates did not differ significantly among the age groups in either surgery or control eyes.
They concluded that further studies are necessary to determine corneal astigmatic change more than 10 years following cataract surgery.
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American Journal of Ophthalmology summaries are written by Thomas J. Liesegang, MD.
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