Topical Difluprednate for Early Corneal Graft Rejection After Penetrating Keratoplasty.

PURPOSE: To evaluate the safety and efficacy of topical difluprednate ophthalmic emulsion use for prophylaxis of corneal graft rejection in patients undergoing penetrating keratoplasty. METHODS: This study reviewed the charts of patients undergoing penetrating keratoplasty who were treated with difluprednate (DP) ophthalmic emulsion postoperatively. At each follow-up visit, patients were followed for signs of graft rejection, cataract development, and intraocular pressure rise in addition to routine ocular examination. RESULTS: The charts of 36 patients (38 eyes) who underwent penetrating keratoplasty (PKP) (27 eyes) and PKP triple (11 eyes) were reviewed. All eyes were followed up for at least 8 months postoperatively. Five grafts developed rejection and three grafts subsequently failed. Six eyes had an increase of IOP that required use of antiglaucoma drops. Three eyes were switched from difluprednate to prednisolone acetate (PA) after persistent rise of IOP failed to respond to antiglaucoma drops. None of these cases needed glaucoma surgery. Two patients developed cataract during the follow-up period (out of 12 phakic eyes). CONCLUSION: Topical difluprednate is potentially effective and safe in preventing graft rejection after penetrating keratoplasty. Larger prospective clinical trials are warranted.

Safety of Trypan Blue Capsule Staining to Corneal Endothelium in Patients with Diabetic Retinopathy.

PURPOSE: To study the potential corneal endothelial cell toxicity of trypan blue (TB) when used for phacoemulsification to stain the anterior capsule in patients with diabetic retinopathy. METHODS: This was a single-center, prospective, randomized, individual cohort study. One eye in each patient with diabetic retinopathy underwent phacoemulsification without trypan blue capsule staining (control eye), while the other eye underwent phacoemulsification with trypan blue capsule staining (study eye). Both eyes underwent intraocular lens implantation. Preoperative and four-week postoperative quantitative and qualitative morphometric endothelial cell analyses of the cornea were performed using noncontact specular microscopy. RESULTS: There were no significant differences in endothelial cell density (mean ± SD for the study group: 2506.74 ± 413.99 cells/mm2; mean ± SD for the control eyes: 2466.34 ± 369.12 cells/mm2; P=0.316) or endothelial cell density (CD) loss% (mean CD loss% was 7.23 ± 13.31 for the study eyes and 9.94 ± 9.36 for the control eyes; P=0.157) four weeks after the operation. Additionally, no significant differences were seen in the percentage of hexagonal cells, coefficient of variation, or corneal thickness between the two groups preoperatively and 4 weeks postoperatively. CONCLUSIONS: Direct administration of trypan blue into the anterior chamber for staining of the anterior capsule during cataract surgery did not result in any significant corneal endothelial changes on specular microscopy in patients with severe nonproliferative diabetic retinopathy or high-risk proliferative diabetic retinopathy at 4 weeks postoperatively. This trial is registered with NCT03755752.

OUTCOMES OF AN INTRAVITREAL INJECTION CLINIC.

PURPOSE: To examine the safety outcomes of an intravitreal injection-only clinic where patients needing long-term anti-vascular endothelial growth factor therapy are treated with injections at a predetermined interval for a set number of injections without an accompanying clinic visit. METHODS: This is a retrospective chart review of all patients with exudative macular degeneration treated in an intravitreal injection clinic over a 4-year period. Data on the outcome measures of interest were gathered from electronic medical records. RESULTS: There were 556 patients who received 4,386 injections in the injection-only clinic in a total of 1,524 injection cycles. One hundred six cycles were interrupted. The most common causes for interruption were decreased vision in the injected eye (32), decreased vision in the fellow eye (23), flashing lights (6), pain (5), and irritation in the noninjected eye (2). Of patients who had interruption of the cycle, 32 had a new diagnosis (6 corneal abrasions, 6 exudative age-related macular degeneration in fellow eye). There were six instances of conversion to exudative age-related macular degeneration found in the other eye at a routine follow-up visit following the injection clinic. CONCLUSION: An injection-only clinic may provide a reasonable approach to streamline retina practices to ensure that patients receive timely injections.

EVALUATION OF MULTIPLE DEXAMETHASONE INTRAVITREAL IMPLANTS IN PATIENTS WITH MACULAR EDEMA ASSOCIATED WITH RETINAL VEIN OCCLUSION.

BACKGROUND: Limited data have evaluated multiple injections of the dexamethasone 700 µg implant (DEX) (Ozurdex; Allergan, Inc.) for cystoid macular edema (CME) secondary to retinal vein occlusion (RVO) over an extended regimen. METHODS: This retrospective study evaluated patients treated with DEX for CME associated with RVO. Each patient had ophthalmologic evaluation, optical coherence tomography (OCT), and 4 weeks to 6 weeks follow-up intervals. Retreatment criterion was fluid on OCT. Outcome measures included best-corrected visual acuity, intraocular pressure (IOP), central macular thickness on OCT, fluid resolution on OCT, and required treatment for elevated IOP and cataract. RESULTS: Thirty-one patients had 82 DEX injections, with 19 patients having ≥2, 12 having ≥3, 10 having ≥4, 6 having ≥5, and 4 having ≥6 DEX injections. All patients were followed at least 12 weeks and had a mean follow-up period of 344.94 days. Fourteen patients (45%) developed ocular hypertension (≥22 mmHg), and 40% of phakic patients required cataract surgery. Mean interval of OCT fluid resolution was 52 days (range, 28-245; SD, ±8), and mean retreatment interval was 119 days (range, 42-309; SD, ±9). No patients required glaucoma surgery or developed endophthalmitis. CONCLUSION: This study suggests that repeated, as needed, DEX injections for CME associated with RVO may be performed. Patients should be monitored and treated for ocular hypertension and cataract progression.

Genetics of diabetic retinopathy.

Multiple studies have shown that genetic factors may play an important role in determining an individual's risk for the development of diabetic retinopathy (DR) and progression to proliferative DR. However, consistent and definitive genetic associations with DR across broad populations have been not been established. Numerous genes have been studied for their association with DR and the results of these investigations have most specifically pointed to three specific genes that are likely involved in DR development and progression. The gene coding for vascular endothelial growth factor, aldose reductase, and the receptor for advanced glycation end products have been extensively evaluated, and specific polymorphisms of these genes have been suggested to potentially increase the risk of DR development. In this paper, we have reviewed the published literature on the genetics of DR and the potential implications for DR development and progression.

Evolution of vitreomacular traction following the use of the dexamethasone intravitreal implant (Ozurdex) in the treatment of macular edema secondary to central retinal vein occlusion.

PURPOSE: To report a case of worsening of vitreomacular traction (VMT) after the dexamethasone intravitreal implant (Ozurdex; Allergan, Inc., Irvine, CA) for the treatment of macular edema secondary to central retinal vein occlusion (CRVO). CASE: A 71-year-old man who presented with macular edema secondary to CRVO was treated by intravitreal injections of bevacizumab followed by Ozurdex. RESULTS: VMT developed during the course of treatment and became more evident when macular edema resolved after treatment with Ozurdex. CONCLUSION: VMT may become apparent and worsen after resolution of macular edema treated with intravitreal Ozurdex.