Effectiveness of 190 µg Fluocinolone Acetonide and 700 µg Dexamethasone Intravitreal Implants in Diabetic Macular Edema Using the Area-Under-the-Curve Method: The CONSTANT Analysis.

PURPOSE: Calculations of area-under-the-curve (AUC) provide the average letters gained across the entire treatment period, which may be a better estimate of long-term effectiveness than single time-point outcomes, particularly when it comes to sustained-release therapies. MATERIALS AND METHODS: The AUC method was used to compare the efficacy of the 0.2 µg/day fluocinolone acetonide (total dose of 0.19 mg; FAc) and dexamethasone (DEX) 700 µg implants based on published data from their respective Phase 3 FAME (Fluocinolone Acetonide for Macular Edema) and MEAD pivotal clinical trials in diabetic macular edema (DME). Best-corrected visual acuity (BCVA) letter scores were collated from the FAME trial and compared with those reported in MEAD. The trapezoidal rule was then used to calculate AUC, based on BCVA letter score, from baseline to Month 36 (FAME)/Month 39 (MEAD) and presented as an overall mean visual acuity change per day. RESULTS: Treatment with either the FAc or DEX implant resulted in an improved BCVA over the treatment period compared with sham. This effect was statistically greater (p=0.029) for the FAc implant than the DEX implant (5.2 vs 3.5 letters/day, respectively) and even greater in the recurrent DME subgroup (p<0.001; 6.9 vs 3.5 letters/day, respectively). CONCLUSION: Although direct comparisons between trial cohorts cannot be performed, this analysis indicated that, in their respective pivotal clinical trial cohorts, treatment with the FAc implant provides better long-term visual acuity outcomes and a lower treatment burden than achieved with the DEX implant.

Treatment of Refractory Acute Retinal Necrosis with Intravenous Foscarnet or Cidofovir.

PURPOSE: To report use of intravenous foscarnet or cidofovir for the treatment of refractory acute retinal necrosis (ARN). METHODS: Retrospective chart review. RESULTS: Four immunocompetent men aged 45-90 years presented with ARN from 2008-2014. One patient with two prior episodes of herpes simplex virus (HSV) ARN developed ARN after 6 years of antiviral prophylaxis. His condition worsened on acyclovir followed by intravenous foscarnet but responded to intravenous cidofovir (final VA in involved eye 20/20). Another patient with HSV ARN had received prolonged acyclovir prophylaxis for HSV keratitis; ARN improved after switching from acyclovir to intravenous foscarnet (final VA 20/125). Two patients with varicella zoster virus (VZV) ARN initially responded to acyclovir but developed fellow eye involvement 2-8 weeks later that worsened on acyclovir but responded to intravenous foscarnet (fellow eye final VA 20/20, 20/40). CONCLUSIONS: Cases of HSV or VZV ARN that worsen despite intravenous acyclovir treatment may respond to intravenous foscarnet or cidofovir.

Combined optical and atropine treatment of children with residual amblyopia after atropine penalization.

The authors studied 5 cases in which combined optical and atropine treatment (COAT) was instituted in children with residual amblyopia after atropine penalization. All 5 amblyopic eyes improved without lasting decrease in the visual acuity of the dominant eyes. Appropriately administered, COAT may rescue atropine failures.

The use of argon laser punctal stenosis in patients with contact lens-induced dry eyes.

OBJECTIVE: To determine the efficacy of argon laser punctal stenosis inpatients with contact lens-induced dry eyes. METHODS: A retrospective review of 25 eyes of 13 patients who underwent argon laser punctal stenosis to improve their contact lens intolerance was performed. The mean age was 31 (range, 21-52) years and 11 patients (85%) were women. The mean Schirmer I test was 15.2 (range, 3-35). RESULTS: All patients tolerated the procedure well. In 19 eyes, the treatment involved only the lower punctum, whereas in six eyes, it involved both the upper and lower puncta. Eight patients required more than one treatment session (range, 2-6). At follow-up after 6 months, 10 of the 13 (77%) patients reported a substantial improvement in their symptoms and contact lens wear time. CONCLUSIONS: Argon laser punctual stenosis provides a useful and titratable treatment of contact lens intolerance due to dry eyes.