Novel Treatment for Severe Plateau Iris Syndrome
Journal of Glaucoma
Published online March 18, 2015
Francis et al. explored the effects of lens extraction plus endoscopic cycloplasty (ECPL) for severe plateau iris syndrome. They found that the combined treatment appears to open the anterior chamber angle and shrink and flatten the ciliary processes, effectively reversing the anatomic cause of angle closure that is observed in the syndrome.
For this prospective case series, the researchers evaluated six patients (12 eyes) who had plateau iris syndrome that was refractory to other treatment, including laser iridotomy and iridoplasty. All eyes were treated with standard cataract surgery and intraocular lens insertion. ECPL was then performed in the superior, nasal, and inferior quadrants; the untreated temporal quadrants served as controls. Ultrasound biomicroscopy (UBM) measurements were taken in all four quadrants before and after surgery.
Following treatment, the anterior chamber depth, iridocorneal angle, and angle opening distance UBM measurements all increased. In addition, measurements of the ciliary processes and iris contact all decreased, which is to be expected with a procedure that shrinks the ciliary processes, the researchers said. The control quadrants did not exhibit the same changes as those treated with laser.
Although intraocular pressure did not change significantly after treatment compared with baseline readings, the number of glaucoma medications was reduced. The researchers noted several possible factors in this outcome, including effects of the ciliary laser procedure, increase in aqueous flow due to angle opening, and phacoemulsification. However, they could not determine which of these contributed most strongly to the results.
No Topical Antibiotics for Intravitreal Injections
Are topical antibiotics an essential component of the protocol for intravitreal injection? In a retrospective review, Bhavsar and Sandler assessed the incidence of endophthalmitis and other complications after a consecutive series of intravitreal injections in which no antibiotics were used. They found an exceptionally low risk of endophthalmitis, suggesting that topical antibiotics are not necessary for this procedure.
Over a 15-year period, the lead author administered a total of 18,839 injections to 3,457 patients in an outpatient setting. The patients’ mean age was 81 years (range, 16-108 years), and the mean number of injections per patient was 5.5. Injections were administered with a regimen of topical povidone-iodine, proparacaine, and tetracaine; a sterile eyelid speculum; and clean nonsterile gloves. No antibiotics were used before, during, or after the procedure.
Because most of the patients were being treated for age-related macular degeneration, bevacizumab and ranibizumab accounted for 82.16 percent and 8.86 percent of injections, respectively. Other reasons for treatment were diabetic macular edema (DME), cystoid macular edema due to retinal vein occlusion, cytomegalovirus retinitis, and severe uveitis; drugs used included triamcinolone, pegaptanib, and dexamethasone.
There was one case of endophthalmitis, for an incidence rate per injection of 0.0053 percent. The affected patient, who had received bevacizumab for DME, later underwent a pars plana vitrectomy. The authors noted a possible contributing cause to endophthalmitis in this patient: He had inserted an extended-wear contact lens into the affected eye immediately after the injection without informing the surgeon that he was doing so.
AMD Lesion Activity and Treatment Outcomes
British Journal of Ophthalmology
Barthelmes et al. set out to determine whether lesion activity, as assessed by the treating physician, had an effect on visual acuity (VA) outcomes in patients who received intravitreal injections for neovascular age-related macular degeneration (AMD). They found that, contrary to common belief, it did not.
This cohort study included 655 eyes from the Fight Retinal Blindness observational study. “Activity” was defined as intraretinal or subretinal fluid attributable to leakage from choroidal neovascularization or fresh hemorrhage. Lesion activity was classified as low, moderate, high, or persistent, based on the proportion of study visits in which it was seen. The primary outcome measure was change in VA 12 months after the index visit.
A total of 5,305 injections of ranibizumab were administered during the study. At the 12-month mark, the mean index VA was similar for the four cohorts. In addition, eyes in all four groups received similar numbers of injections during the study period. Nine adverse events were reported, including four cases of endophthalmitis, two of which were infectious.
Roundup of Other Journals is written by Jean Shaw and edited by Deepak P. Edward, MD.
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