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Optic Neuropathy Linked to Antidepressants
Eye
Published online July 3, 2015
In a reminder that systemic medications can have serious ophthalmic consequences, Lochhead reported 5 cases of optic neuropathy (ON) in patients who had taken selective serotonin reuptake inhibitors (SSRIs). This group of medications is commonly prescribed for depression and includes the drugs Paxil, Prozac, and Zoloft.
The cases were identified in the Isle of Wight population during a 2-year period by means of a retrospective analysis of case notes. Each case was assessed using the Naranjo algorithm to indicate the likelihood of an adverse drug reaction.
The 5 affected patients were relatively young (in their 40s and 50s), and their duration of SSRI use ranged from 6 months to 14 years. Of the 5 patients, 4 presented with posterior ischemic ON, and the fifth presented with bilateral anterior ischemic ON. Only 1 of the 5 achieved full visual recovery, while 1 achieved partial recovery, and the remaining 3 experienced no recovery. Smoking and diabetes were identified as potentially synergistic risk factors in 4 of the 5 cases. Until more is understood about the mechanisms of this potentially blinding side effect, the authors advised caution in prescribing SSRIs to patients with known ocular vascular disease or systemic vascular risk factors.
Refractive Outcomes With Triple DMEK
Journal of Cataract and Refractive Surgery
2015;41(6):1182-1189
Schoenberg et al. reported on the refractive outcomes of triple Descemet membrane endothelial keratoplasty (DMEK)—that is, DMEK combined with phacoemulsification and IOL implantation. They found that the procedure consistently achieved excellent corrected distance visual acuity (DVA).
For this retrospective case series, the researchers reviewed the records of 108 sequential triple DMEK procedures performed by 2 surgeons at a single center. In all study patients, Fuchs endothelial dystrophy was the indication for DMEK. Eyes with prior refractive surgery, concurrent keratoconus, amblyopia, or preexisting macular pathology were excluded.
With a mean follow-up of 11.9 months, the median corrected DVA was 20/20 (range, 20/15-20/40), and the median uncorrected DVA was 20/40 (range, 20/20-20/200). All told, 45% of patients gained 3 or more lines of corrected DVA. Because DMEK is known to produce a hyperopic shift, the researchers recommend selecting an IOL power to target a postoperative refraction of –0.75 D to –1.0 D to achieve the best range of functional vision. The researchers noted that aspheric IOLs (n = 91) did not significantly change refractive astigmatism, but that toric IOLs (n = 9) did.
Photovoltaic Restoration of Sight
Nature Medicine
2015;21(5):476-482
Lorach et al. described their research on a new type of retinal prosthetic device in a study of rats with retinal degeneration. They reported encouraging results with regard to ease of implantation and visual acuity results.
Unlike the 2 types of retinal prostheses now used in humans, the photovoltaic implants in this study are completely wireless. They contain subretinal pixels that convert pulsed light, both in the visible and near-infrared spectrum, into electric current. The implants were evaluated in retinal ganglion cells (RGCs) in vitro (to examine the spatial resolution of the retinal response) and in vivo (to assess visual acuity).
The researchers demonstrated that the implants 1) provided highly localized stimulation of retinal neurons and 2) elicited retinal responses with a spatial resolution corresponding to half of the normal visual acuity in healthy rats. At the highest settings used in the study, electrical stimulation of RGCs for many hours at a time in vitro and in vivo did not decrease responsiveness or produce any signs of tissue damage.
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Roundup of Other Journals is written by Jean Shaw and edited by Deepak P. Edward, MD.
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