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One-Year Clinical Experience With CyPass Micro-Stent
Journal of Glaucoma
Published online Oct. 9, 2014
Hoeh et al. evaluated the safety and clinical outcomes of the CyPass Micro-Stent and found that the minimally invasive device, which is implanted into the supraciliary space in conjunction with cataract surgery, was effective in reducing intraocular pressure (IOP) and use of IOP-lowering medications. In addition, they noted a low rate of complications.
For this one-year study, 142 patients (167 eyes) with open-angle glaucoma were implanted with the CyPass. At the 12-month mark, 111 eyes were available for evaluation.
No serious adverse events were noted in the postoperative period; complications included transient hypotony and blood reflux. Eyes with an IOP of 21 mmHg or greater at baseline showed a 35 percent decrease in mean IOP and a 49 percent reduction in mean medication use, while eyes with an IOP of less than 21 mmHg at baseline experienced a 75 percent reduction in medication use while maintaining a mean IOP of less than 21 mmHg.
The researchers acknowledged that the lack of a control group limits these findings. They also stated that a more definitive study would have included a medication washout period before implantation, with another at 12 months. Nonetheless, they concluded that the safety profile and clinical outcomes at one year are encouraging and indicate that the CyPass is a promising option.
Toric IOLs for Astigmatism After Keratoplasty
Journal of Cataract and Refractive Surgery
2014;40(12):2044-2049
Lockington et al. assessed the effectiveness of toric intraocular lenses (IOLs) in the management of the astigmatism that can follow corneal transplants and found that the IOLs are indeed safe and effective in significantly reducing corneal astigmatism and improving visual acuity (VA).
This retrospective case series involved 26 patients, all of whom had undergone cataract extraction with in-the-bag implantation of an IOL. Most had undergone penetrating keratoplasty (n = 22); the remainder had undergone deep anterior lamellar keratoplasty. For all patients, graft sutures were removed and the refraction was stable before cataract surgery.
Three different toric IOLs were used. After implantation, no eyes had intraoperative or postoperative complications, no IOL required postoperative realignment, and no graft had rejection episodes. The overall decrease in refractive astigmatism was 52 percent, and patients experienced improvements in both uncorrected and corrected distance VA, with 61.5 percent of eyes having a postoperative uncorrected distance VA of 20/40 or better and 92.3 percent having a postoperative corrected distance VA of 20/40 or better.
Toric Multifocal IOLs to Correct Moderate Astigmatism
Journal of Cataract and Refractive Surgery
2014;40(10):1625-1632
What’s the best option for a cataract patient with astigmatism—a nontoric multifocal intraocular lens (IOL) with a peripheral corneal relaxing incision (PCRI) or a toric multifocal IOL? Gangwani et al. compared the outcomes of these two approaches in a small group of patients with astigmatism. They found that, while refractive astigmatism decreased regardless of the approach, the multifocal toric IOL was more predictable with good rotational stability.
This randomized trial included 29 patients with visually significant cataract in both eyes who desired spectacle independence and had corneal astigmatism of between 1.00 and 2.50 D. All patients underwent multifocal toric IOL implantation in one eye and nontoric multifocal IOL combined with PCRI in the contralateral eye. Outcome measures were visual acuity, astigmatic vector reduction, digital toric IOL axis determination, spectacle need, and patient satisfaction.
Three months after surgery, the mean residual refractive astigmatism was 0.45 ± 0.49 D in the toric IOL group and 0.72 ± 0.61 D in the IOL-PCRI group. No significant difference between uncorrected distance visual acuity emerged between the two groups. Rotational stability of the toric IOL was good—slightly better than in other studies of the same IOL—and no regression effects were noted.
Cone Cell Loss and Retinal Detachment Repair
British Journal of Ophthalmology
2014;98(10):1343-1348
In this study, Saleh et al. used an adaptive optics camera to investigate cone loss ratio in patients who underwent repair of a retinal detachment (RD) and correlated these findings with clinical outcomes. They found a decrease in the patients’ cone density after RD repair and a corresponding decrease in visual acuity.
Twenty-one patients (42 eyes) who underwent surgery for primary RD were imaged six weeks after surgery. At that time, imaging revealed decreased cone density compared with fellow eyes in all of the operated eyes except one; the mean decrease reached 31 percent. Imaging also detected an increase in cone spacing. Postoperative best-corrected visual acuity was strongly correlated with cone density and inversely
correlated with cone spacing.
The researchers concluded that, although adaptive optics may be a useful prognostic tool, further studies are needed to define potential applications in a clinical setting.
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Roundup of Other Journals is written by Jean Shaw and edited by Deepak P. Edward, MD.
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