• Journal Highlights

    American Journal of Ophthalmology

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    Ocular Surface Squamous Neoplasia Treatment

    August AJO

    Li et al. reported a retrospective interventional case series that evaluated the recurrence rate of ocular surface squamous neoplasia (OSSN) after excision and cryotherapy and determined factors associated with recurrence.

    This study reviewed all cases of OSSN from 1998 through 2013 that were treated with excisional biopsy and adjunctive cryotherapy in a New Jersey health care system. All recurrences of OSSN after excision and cryotherapy were noted and categorized in relation to clinical characteristics, pathologic grade, and margin involvement. A total of 43 cases of OSSN from 42 patients were analyzed with a median follow-up of 29 months; of these, 33% had dysplasia, and 67% had squamous cell carcinoma.

    Among the 43 cases of OSSN, there were 3 recurrences, for a recurrence rate of 7.1% after wide excision with cryotherapy. This figure remained the same at 1, 2, and 5 years. All 3 cases that recurred had been incompletely excised. However, the majority of incompletely excised OSSN (25/28) experienced no recurrence, suggesting that minimal recurrence can be achieved with excision and cryotherapy applied to the margins.

    Acupuncture as Treatment for Glaucoma

    August AJO

    Law et al. used a prospective double-masked randomized crossover study to evaluate acupuncture as treatment for glaucoma. They found that acupuncture therapy for glaucoma did not show any overall effect on diurnal IOP reduction or on visual acuity. One eye per patient with primary open-angle glaucoma and stable IOP was randomized to receive 1 acupuncture series consisting of 12 sessions with either eye-related acupoints (eye-points) or non-eye-related acupoints (non-eye-points). Patients then crossed over to receive a series of the other acupoint treatment. Measures evaluated included IOP, blood pressure (BP), heart rate (HR), best-corrected visual acuity (BCVA), visual field (VF), optic disc and peripapillary retinal nerve fiber layer (RNFL) measurements, compliance, and adverse reactions.

    Twenty-two patients volunteered and 11 (50%) completed the study; 8 (36%) did not complete treatment owing to changes of health, moving away, lack of transportation, or family crisis; and 3 (14%) were withdrawn because of needle sensitivity or IOP elevation (8 mm Hg) in the contralateral eye.

    After an acupuncture session, the researchers found a small, temporary mean IOP increase after using either eye-points (from 12.9 to 13.6 mm Hg) or non-eye-points (from 13.0 to 13.5 mm Hg). HR, diurnal IOP, and BCVA showed no statistically significant changes after 12 sessions of either series. Systolic and diastolic BP were reduced after 12 sessions of the noneye-points series. Optic disc, RNFL, and VF showed no statistically significant changes.

    Punctal Plug Retention Rates in Treatment of Dry Eye

    August AJO

    Brissette et al. conducted an interventional randomized double-masked controlled trial to compare retention rates of SuperFlex versus Parasol punctal plugs. The study demonstrated a higher rate of retention at 6 months of the Parasol punctal plug compared with the SuperFlex plug.

    The study evaluated 50 eyes from patients with moderate to severe dry eye. Each eye from eligible patients was separately randomized to receive SuperFlex or Parasol punctal plugs. The main outcome measure was plug retention at 6 months. Secondary outcome measures included objective tests of Schirmer I, tear meniscus height, tear breakup time, inferior fluorescein corneal staining, and average lissamine green conjunctival staining.

    Punctal plug retention was significantly different between the 2 types at 6 months: 68% of Parasol plugs were retained, compared with 32% of SuperFlex plugs. Mean retention time was 4.7 and 3.4 months for the Parasol and SuperFlex plugs, respectively. Additionally, eyes with Parasol plugs required less frequent artificial tear use at 6 months. There were no additional significant differences between groups, and no complications were reported.

    This study also demonstrated the effectiveness of punctal occlusion for the treatment of moderate to severe dry eye. With both types of plugs, there was a statistically significant improvement in all secondary outcome measures at 6 months, except for conjunctival staining.

    Strabismus Surgery Reoperation With Adjustable vs. Conventional Sutures

    August AJO

    In a retrospective cross-sectional study, Leffler et al. evaluated the association of strabismus surgery reoperation rates with adjustable or conventional sutures. They used an insurance database to analyze reoperations following strabismus surgery with adjustable or conventional sutures in 6,178 patients.

    Adults aged 18 to 89 who had strabismus surgery between 2007 and 2011 were included. Overall, 526 of 6,178 surgical patients (8.5%) had a reoperation. Overall, there was no association of reoperation rate with suture type. Reoperations were performed after 8.1% of adjustable suture surgeries and after 8.6% of conventional suture surgeries.

    However, when the researchers considered horizontal and vertical types of surgery separately, differences emerged. Adjustable sutures were associated with a significantly lower reoperation rate following horizontal muscle surgery. Of the 4,357 horizontal muscle surgeries, reoperations were performed after 5.8% of adjustable suture surgeries and after 7.8% of conventional suture surgeries. Of the 1,072 vertical muscle surgeries, reoperations were performed after 15.2% of adjustable suture surgeries and after 10.4% of conventional suture surgeries; however, this difference was not significant after adjustment for patient age.

    Younger age (18-39 years) was associated with a lower reoperation rate. The significant multivariable factors in predicting the rate of reoperation for horizontal surgery were adjustable sutures, monocular deviation, complex surgery, and unilateral surgery on 2 horizontal muscles. No significant association was found for adjustable sutures in vertical muscle surgery.

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

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