Factors associated with spontaneous release of vitreomacular traction.

PURPOSE: To analyze the factors that may predict the release of vitreomacular traction (VMT) and vitreomacular adhesion. METHODS: Retrospective case-control study of sixty-one patients with VMT imaged by optical coherence tomography over at least 3 months. Records from all patients seen at the University of Iowa from January 2012 to September 2013 were screened for the ICD9 code for VMT, vitreomacular adhesion, and epiretinal membrane (379.27 and 362.56). Release of VMT (R-VMT) was defined by resolution of patients' symptoms or traction by optical coherence tomography without surgical intervention or ocriplasmin injection. Individual factors or characteristics were evaluated by chi-square test. Using a binary logistic regression model, the potentially prognostic factors were evaluated for contribution to R-VMT. RESULTS: Of the 61 patients that met entry criteria, 21 (35%) developed R-VMT during optical coherence tomography follow-up, and 40 (65%) did not. Isolated inner retinal distortion without outer retinal involvement was significantly associated with R-VMT (P = 0.01). Vitreous injections were also associated with R-VMT (P = 0.02). CONCLUSION: Eyes with VMT and isolated inner retinal distortion and those receiving vitreous injections are more likely to develop VMT release without the need for surgical intervention or ocriplasmin treatment.

10-Year Framingham risk in patients with retinal vein occlusion: a systematic review and meta-analysis.

OBJECTIVE: Cardiovascular risk factors predispose individuals to retinal vein occlusions (RVOs). Yet, the future risk for development of cardiovascular disease in persons with RVOs is uncertain. We performed a literature review and meta-analysis of studies to determine the 10-year Framingham risk for individuals with RVO. METHODS: A literature search was performed in MEDLINE and EMBASE. Studies were eligible if they included subjects with RVO and presented data on age, sex, smoking status, systolic blood pressure, total cholesterol, and high-density lipoprotein. The 10-year Framingham risk was calculated. Sensitivity analysis was performed and hypothesis testing was carried out using the upper tail z test with α = 0.05 to compare the estimated Framingham risk in RVO patients with the risk in the general Canadian population. Subgroup meta-analysis was carried out by Cochrane Collaboration Review Manager 4.5 software (Cochrane IMS, Copenhagen, Denmark). RESULTS: A final list of 6 articles was included. The estimated 10-year Framingham risk score in subjects with RVO was 10.1% (95% CI 9.9-10.2). Sensitivity analysis found Framingham risk score to be greatest in male smokers. The Framingham risk in subjects with RVO was significantly greater than the general Canadian population. In a subgroup analysis, the 10-year risk was significantly greater in subjects with RVO compared with control subjects. CONCLUSIONS: Patients with RVO have an increased 10-year risk for cardiovascular disease. This risk is greatest for male smokers (high risk). These patients may benefit from therapy aimed at controlling their risk factors. All individuals with an increased Framingham risk should be warned about vision loss as a potential complication of systemic atherosclerotic disease.

Prophylactic nepafenac and ketorolac versus placebo in preventing postoperative macular edema after uneventful phacoemulsification.

PURPOSE: To evaluate the efficacy of prophylactic ketorolac 0.5% versus nepafenac 0.1% versus placebo on macular volume 1 month after uneventful phacoemulsification and evaluate the health-related quality-of-life (HRQOL) of topical nonsteroidal antiinflammatory drugs (NSAIDs) in the context of cataract surgery. SETTING: Hotel Dieu Hospital, Kingston, Ontario, Canada. DESIGN: Prospective placebo-controlled parallel-assignment double-masked randomized clinical trial. METHODS: In this study, patients 18 years or older scheduled for routine phacoemulsification were randomized to a placebo, ketorolac 0.5%, or nepafenac 0.1% and dosed 4 times a day starting 1 day before surgery and continuing for 4 weeks. Spectral-domain macular cube ocular coherence tomography scans measuring central subfield thickness, macular cube volume, and average macular cube thickness were performed at baseline and 1 month postoperatively. The HRQOL metrics were determined with the Comparison of Ophthalmic Medications for Tolerability (COMTOL) questionnaire. RESULTS: Each study group comprised 54 patients. One month postoperatively, although a trend toward significance occurred for nepafenac and ketorolac, analysis of the means of differences showed no statistically significant differences between the 3 study groups (P=.2901). The COMTOL analysis found no difference in tolerability, compliance, side-effect frequency and bother, and effects on HRQOL between ketorolac and nepafenac compared with the placebo. CONCLUSIONS: One month after uneventful phacoemulsification, there was no difference in macular volume between the placebo, ketorolac, and nepafenac. Ketorolac and nepafenac were well tolerated with minimal side-effect profiles. Thus, for patients without risk factors having routine surgery, prophylactic topical NSAIDs are not recommended.