Pterygium Surgery Utilizing Limbal Conjunctival Autograft and Subconjunctival Amniotic Membrane Graft in High-Risk Populations.

OBJECTIVE: To measure the outcomes of primary pterygium excision with a limbal conjunctival autograft when combined with the adjunctive use of a prophylactic subconjunctival graft of amniotic membrane to decrease the recurrence rate after surgery in an ethnically diverse population with a statistically higher risk for recurrence (African American, Asian, Caribbean, Asian, Latin). DESIGN: This is a retrospective, non-comparative study of post-operative outcomes. PARTICIPANTS: A total of 355 patients, totaling 493 eyes, with clinically significant, primary pterygia. PATIENTS AND METHODS: Patients were enrolled into the study based on the need for pterygium surgery and if they underwent primary pterygium excision with conjunctival autograft with subconjunctival amniotic membrane placement. Patients with recurrent pterygium or those with pseudopterygium were excluded from this study. All surgeries took place at the Florida Eye Microsurgical Institute (Boynton Beach, FL) between June 2006 and October 2013 by a single surgeon (BAS). Patients were seen on post-operative day 1, 7, 30, 90, 180 and 365 to evaluate for pterygium recurrence. Pterygium recurrence is defined in this study as growth greater than 1 mm past the corneal limbus at or after 6 months. RESULTS: There were six cases of recurrent pterygium for a recurrence rate of 1.22% ± 0.97% (n=493, p=0.05). Follow-up ranged from 6 months to 6 years (mean 28 months). CONCLUSION: Primary pterygium excision with a limbal conjunctival autograft and placement of a subconjunctival amniotic membrane graft has a low recurrence rate consistent with previously published data.

Use of topical bromfenac for treating ocular pain and inflammation beyond cataract surgery: a review of published studies.

Topical ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat postoperative inflammation and pain following cataract surgery and for treatment and prophylaxis of pseudophakic cystoid macular edema (CME). Bromfenac is a brominated NSAID with strong in vitro anti-inflammatory potency. Like other ophthalmic NSAIDs, bromfenac is often used outside of the cataract surgery setting. This paper provides an overview of bromfenac's preclinical ocular pharmacology and pharmacokinetics, followed by a review of 23 published clinical studies in which various marketed bromfenac formulations were used for conditions other than cataract surgery or pseudophakic CME. These include: post-refractive eye surgery; macular edema associated with diabetes, uveitis, or retinal vein occlusion; inflammation associated with age-related macular degeneration; pain related to intravitreal injections; and other ocular anterior segment and surface disorders with an inflammatory component. The published evidence reviewed supports the safety and effectiveness of bromfenac in these additional ophthalmic indications. Bromfenac was well tolerated when given alone or in combination with intravitreal anti-vascular endothelial growth factor agents, topical corticosteroids, or topical mast-cell stabilizers. The most common adverse event reported was ocular irritation. No serious adverse events (ie, corneal epithelial disorders) were reported, although the majority of studies did not systematically evaluate potential side effects. Corneal complications, such as melts reported with diclofenac and ketorolac, were not observed with bromfenac in the studies. In summary, published study data support the clinical utility of bromfenac in various ocular disorders beyond post-cataract surgery. Additional studies are warranted to further define the potential role of bromfenac ophthalmic solution in clinical practice.

Endothelial survival after Descemet-stripping automated endothelial keratoplasty in eyes with retained anterior chamber intraocular lenses: two-year follow-up.

PURPOSE: To evaluate endothelial cell survival 2 years after Descemet-stripping automated endothelial keratoplasty (DSAEK) for the treatment of endothelial dysfunction in the presence of an anterior chamber intraocular lens (AC IOL). SETTING: LSU Eye Center, New Orleans, Louisiana, and Florida Eye Microsurgical Institute, Boynton Beach, Florida, USA. DESIGN: Case series. METHODS: This study comprised eyes with endothelial failure that had DSAEK in the presence of an AC IOL. Donor central endothelial cell density (ECD) was recorded 6 months, 1 year, and 2 years postoperatively and compared with preoperative ECD eye-bank values. RESULTS: The study evaluated 25 eyes; data from 20 eyes were available up to 2 years postoperatively. The mean preoperative ECD was 2606 cells/mm(2). At 1 year, the mean ECD was 1943 cells/mm(2) ± 266 (SD), representing a mean cell loss from preoperative measurements of 24% ± 12%. At 2 years, the mean ECD was 1831 ± 291 cells/mm(2), representing a 28% ± 13% cell loss from preoperative values. The additional cell loss between the first and second postoperative years was not statistically significant (P=.265). CONCLUSIONS: Descemet-stripping automated endothelial keratoplasty grafts in the presence of a well-centered AC IOL with an AC IOL-to-endothelial depth greater than 3.0 mm had a mean postoperative donor endothelial cell loss of 24% at 1 year and 28% at 2 years. There was no significant difference in cell loss in this series compared with ECD loss in DSAEK surgeries in the presence of a posterior chamber IOL. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Efficacy of topical cyclosporine for the treatment of ocular rosacea.

INTRODUCTION: This study was designed to compare the efficacy of cyclosporine ophthalmic emulsion 0.05% with an artificial tear solution for the treatment of rosacea-associated eyelid and corneal pathology. METHODS: Double-masked, randomized, 3-month clinical trial of 37 patients with rosacea-associated eyelid and corneal changes (defined as lid margin telangiectasia, meibomian gland inspissation, and/or fullness of the lid margin). All findings were standardized and compared to photographs for grading. RESULTS: There was a statistically significant increase in Schirmer (with anesthesia) scores of 2.7+/-2.2 mm after 3 months of treatment in the topical cyclosporine group (P<0.001), compared with a mean decrease of -1.4+/-4.6 mm (P=0.271) in the artificial tears group. The mean tear break-up time score significantly improved in the topical cyclosporine group (mean increase of 3.56+/-1.5 seconds, P<0.001), but worsened in the control group, although this change was not significantly significant (mean decrease of -0.04+/-1.6 seconds, P=0.929). The topical cyclosporine group exhibited a significantly greater mean reduction in corneal staining scores (-1.3+/-0.53) compared with the control group (-0.2+/-0.83; between groups P<0.001). The topical cyclosporine group had a greater improvement in Ocular Surface Disease Index scores than those using artificial tears (P=0.022). Limitations of the study included an older, predominantly Caucasian patient population and short trial length. CONCLUSIONS: Topical cyclosporine 0.05% is more effective than artificial tears for the treatment of rosacea-associated lid and corneal changes.

Ketorolac tromethamine 0.4% as a treatment for allergic conjuctivitis.

BACKGROUND: Acular LS (ketorolac tromethamine 0.4%) ophthalmic solution, a reformulation of the original Acular (ketorolac tromethamine 0.5%), is indicated for the reduction of ocular pain and burning/stinging following corneal refractive surgery. OBJECTIVE: This manuscript will review the off-label application of this topical NSAID medication as a treatment for allergic conjunctivitis. METHODS: An extensive MedLine search was undertaken to evaluate data on the use of ketorolac for allergic conjunctivitis. Data on both human and animal data were reviewed. RESULTS/CONCLUSIONS: Studies have demonstrated that ketorolac 0.4% has equivalent efficacy to ketorolac 0.5%. Several studies have demonstrated that ketorolac effectively treats allergic conjunctivitis. Ketorolac 0.4% is effective when used as either monotherapy or as adjunct therapy to steroids.

Long-term follow-up of conjunctival and corneal intraepithelial neoplasia treated with topical interferon alfa-2b.

OBJECTIVE: To evaluate the long-term recurrence rate (>1 year) of conjunctival and corneal intraepithelial neoplasia (CIN) treated with topical interferon alfa-2b. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Twenty-eight eyes of 26 patients from 2 institutions, treated between April 1997 and June 2005, with CIN lesions utilized topical interferon alfa-2b drops 4 times daily until clinical resolution was achieved. METHODS: Patients' charts and clinical photographs were reviewed, and data were analyzed. MAIN OUTCOME MEASURES: All eyes were monitored for the possibility of recurrence with a minimum of 1-year follow-up from the time of documented clinical resolution. RESULTS: Complete clinical resolution of the CIN lesions was achieved in 27 of the 28 eyes treated (96.4%). One of the 28 eyes treated (3.6%) had only a partial response to treatment. For the 27 eyes with complete response, resolution occurred after a median of 2.0 months (range, 10 days-15 months). Eyes were treated for a median of 3.2 months (range, 1-15). Median follow-up after clinical resolution (tumor-free period) was 42.4 months (range, 14-89). One eye of the 27 analyzed (3.7%) experienced a recurrence. Side effects of treatment were limited to mild conjunctival hyperemia and follicular conjunctivitis in 3 patients (12%). In all cases, there was total resolution of the side effects within 1 month after cessation of the medication. CONCLUSIONS: In this group of patients with CIN lesions observed for >1 year, topical interferon alfa-2b was effective in treating lesions with minimal self-limited side effects.

Treatment of conjunctival papillomata with topical interferon Alfa-2b.

PURPOSE: Two patients with biopsy-proven conjunctival papillomata exhibited complete resolution after treatment with topical Interferon Alfa-2b (IFNalpha2b). DESIGN: Interventional case reports. METHODS: Two patients with monocular biopsy-confirmed conjunctival papillomata were treated with IFNalpha2b, 1 million units/cc, one drop four times daily until clinical resolution was achieved. RESULTS: (Patient 1) The lesion's size was significantly reduced at 1 month. Complete resolution was noted at the 3-month visit. No recurrences were seen 40 months post-treatment. (Patient 2) The lesion completely resolved after 6 weeks of treatment. No recurrence has occurred 18 months post-treatment. No systemic or local side effect of treatment was noted. CONCLUSIONS: Two sizable conjunctival papillomata resolved using topical IFNalpha2b alone. Interferon is usually not considered effective for large solid tumors without surgical debulking. We realize that this is a limited case series, but these cases may serve as a basis for further investigation.

Regression of presumed primary conjunctival and corneal intraepithelial neoplasia with topical interferon alpha-2b.

PURPOSE: To evaluate topical interferon alpha-2b (IFNalpha2b) as a lone therapy in the treatment of primary conjunctival and corneal intraepithelial neoplasia (CIN). METHODS: Noncomparative, prospective, interventional case series. Seven patients from three institutions, treated between February and October 1999, with presumed primary CIN lesions (clinically diagnosed by corneal specialists) were given topical IFNalpha2b drops (1 million units/mL) four to six times daily. Follow-up was performed biweekly until there was complete clinical resolution of the presumed CIN lesions. Patients were to continue topical IFNalpha2b drops for 1 month after clinical resolution. Patient charts and clinical photographs were reviewed, and data were analyzed. RESULTS: All seven eyes had complete resolution of the presumed CIN lesions after an average of 77.0 +/- 59.2 days (range, 28-188 days). Average posttreatment follow up was 12.4 +/- 2.5 months (range, 9-16 months). No patients were lost to follow-up. No recurrences have yet been seen. Side effects of treatment were limited to mild conjunctival hyperemia and follicular conjunctivitis in four (57.1%) eyes. In all cases, there was total resolution of conjunctival hyperemia and follicular changes within 1 month after cessation of the medication, without additional treatment. CONCLUSIONS: Topical IFNalpha2b alone may be an effective treatment of primary CIN. It appears to be a safe alternative to radiation, intralesional IFNalpha2b injection, and surgical excision with cryotherapy. Larger population studies with longer follow-up are recommended to better assess the risk of recurrence and other possible adverse effects.