Retinal vein occlusion in patients with primary angle closure: a prospective case-control study.

OBJECTIVE: To compare the prevalence of angle closure in eyes with retinal vein occlusion (RVO) with control eyes and assess the possible association between angle-closure and RVO. PATIENTS AND METHODS: This prospective, blinded case-control study included patients with a history of RVO (cases) and control individuals matched for age and refractive error. Clinical characteristics and angle-based structures derived from anterior-segment optical coherence tomography (AS-OCT) were analyzed. RESULTS: Eighty-eight patients (44 per group) were included. The average age of the RVO and control groups was 59.8 ± 11.6 years and 60.8 ± 9.0 years, respectively (p = 0.667). There were no significant differences in terms of clinical characteristics between the 2 groups, including intraocular pressure (p = 0.837) and Shaffer gonioscopy grading (p = 0.620). None of the AS-OCT-derived angle characteristics were significantly different between the 2 groups. The number of angle-closure diagnoses between the RVO group (1 primary angle closure and 7 primary angle-closure suspects) and the control group (6 primary angle-closure suspects) did not differ significantly (p = 0.560). Anterior-chamber depth (ACD) was shallower in RVO eyes (2.72 ± 0.31 mm) than in the contralateral non-RVO eyes (2.76 ± 0.31 mm; p = 0.014). CONCLUSIONS: This prospective, blinded, matched case-control study did not evidence any significant differences in clinical and AS-OCT-derived structural measures between RVO and control eyes. However, RVO eyes, compared with their contralateral non-RVO eyes, had a slightly shallower ACD. These findings collectively suggest that an association between primary angle-closure mechanisms and RVO is unlikely. However, the shallower ACD in RVO eyes could potentially put them at higher risk for intermittent or permanent pupillary block.

Effect of Topical Corticosteroids on Early Postoperative Intraocular Pressure Following Combined Cataract and Trabecular Microbypass Surgery.

Purpose: To evaluate the early postoperative outcomes of trabecular micro-bypass stents and concomitant cataract surgery (TMS-CS) with and without postoperative corticosteroid therapy. Methods: Prospective, interventional matched, consecutive case series comparing outcomes of open-angle glaucoma patients who underwent TMS-CS with and without postoperative corticosteroid therapy. Primary outcome was intraocular pressure (IOP) changes up to 6 months postoperatively and the secondary outcomes included number of postoperative medications, IOP spikes, peripheral anterior synechia (PAS), and best-corrected visual acuity improvements. Results: The clinical outcomes of 97 eyes-49 in the steroid group age- and IOP-matched with 48 in the nonsteroid group-were analyzed. Baseline IOP in steroid and nonsteroid groups were 16.22 ± 3.98 and 16.04 ± 3.99 (P = 0.822), respectively. Both IOP and number of antiglaucoma medications significantly decreased postoperatively (P < 0.001), however, there were no group differences at different time points (P = 0.653 and P = 0.168, respectively). At 1 week postoperatively, the steroid group had higher number of IOP spikes (n = 9) compared with nonsteroid group (n = 2, P = 0.022). There was no significant difference in postoperative PAS between the steroid group (n = 6) and nonsteroid group (n = 6, P = 0.970). Vision improved significantly postoperatively (P < 0.001) with no group differences at different time points (P = 0.322). Conclusions: TMS-CS decreased IOP and number of antiglaucoma medications while improving visual acuity both with and without the use of postoperative steroids. Limiting the use of postoperative steroids in combined microbypass stents and cataract surgery appears to be a safe surgical option and may help minimize acute elevations in IOP in the early postoperative period.

Intravenous fluorescein angiography-associated adverse reactions.

OBJECTIVES: To assess (i) the adverse reactions (ARs) associated with intravenous fluorescein angiography (IVFA); (ii) the relationship between a known history of IVFA-associated AR and ARs on the subsequent IVFA test; and (iii) the dose-response relationship between intravenous sodium fluorescein (NaFl) injection and ARs associated with IVFA. DESIGN: Retrospective chart review. PARTICIPANTS: A total of 2247 patients with 3381 consecutive IVFAs between May 2013 and April 2014. METHODS: Fisher's exact tests or χ2 tests were used to compare the percentage difference of IVFA-associated ARs for different categorical variables. Logistic regressions were used to assess the relationship between a known history of IVFA-associated AR and any AR(s) on a subsequent IVFA test. RESULTS: The overall percentage for IVFA-associated ARs was 3.3%. Adjusted for age and sex, patients who had a previous IVFA-associated AR(s) were 6.2 times more likely (adjusted odds ratio 95% CI 3.4-11.2, p < 0.0001) to have an AR compared to those who did not. Among 17 patients who had 2 repeated IVFA tests and an AR on the first IVFA test, the rate of AR on the second test was lower in patients who received a reduced dosage of NaFl (n = 14) compared to those with the standard dosage (n = 3) (35.7% vs 66.7%); however, this finding was not statistically significant (p = 0.5368). CONCLUSIONS: The rate of IVFA-associated ARs in this study was low. Patients who had a known IVFA-associated AR were more likely to re-experience an AR on a subsequent test compared to those who did not. In addition, a reduced NaFl dose did not significantly reduce the chance of experiencing an AR on a subsequent test, which is likely because of the insufficient power of this comparison.

Drug-prescribing patterns among optometrists and nonophthalmologist physicians at a tertiary care centre in Kingston, Ontario.

OBJECTIVE: To report on patterns of optometry prescribing and adherence to prescribing regulations at a tertiary care ophthalmology centre. DESIGN: Prospective cohort study. PARTICIPANTS: All new referrals from optometrists and other health care professionals to the emergency eye care service (n = 1965) between July 2011 and June 2012, as well as optometry referrals to 2 subspecialty services (glaucoma [n = 71] and cornea [n = 212]). METHODS: In our primary analysis, the frequency of prescribing and classes of medications prescribed were reported and compared amongst various referral sources to the emergency eye care service. As a secondary analysis, we reported frequency of prescribing in optometry referrals to 2 subspecialty clinics. Adherence to prescribing guidelines was reported for all optometry referrals. RESULTS: Of 296 referrals from optometrists to the emergency eye care service, 20 (6.8%) had received a prescription medication; this was significantly less compared to emergency and family physicians (p < 0.001). Topical antibiotics were the most frequently prescribed medication class. The frequency of prescribing by optometrists was 5.2% (11/212) and 4.2% (3/71) for patients referred to the cornea and glaucoma services, respectively. Among those patients referred after being given a prescription for a glaucoma medication by an optometrist, 89% cases (8/9) did not adhere to prescribing regulations. CONCLUSIONS: After the introduction of prescribing privileges, optometrists prescribe a variety of medications in their practices. Current prescribing guidelines are not always followed in practice, suggesting that continued study and collaboration is necessary to create an optimal model of interdisciplinary care that provides access to the highest quality of care.

Peripapillary RNFL thickness in nonexudative versus chronically treated exudative age-related macular degeneration.

OBJECTIVE: To compare the peripapillary retinal nerve fibre layer (RNFL) thickness in nonexudative versus exudative age-related macular degeneration (wet AMD) eyes treated chronically with intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF). DESIGN: Cross-sectional study. PARTICIPANTS: Twenty-nine patients with unilateral wet AMD with at least 12 prior intravitreal anti-VEGF injections and 2 years of therapy were analyzed. The fellow eye with nonexudative (dry) AMD with no prior treatment served as the control group. METHODS: All patients were prospectively enrolled from a single academic subspecialist practice. Bilateral spectral-domain optical coherence tomography (Cirrus SD-OCT; Carl Zeiss Meditec, Dublin, Calif.) of the peripapillary RNFL was performed on all pairs of eyes. Optic nerve head (ONH) parameters were also computed. The primary outcome was mean difference in peripapillary RNFL thickness compared between the treated and the nontreated eyes. RESULTS: Mean RNFL in the chronically treated eyes (95.0 [95% CI 89.8-100.2] µm) was significantly greater than the nontreated fellow eyes (89.9 [95% CI 85.5-94.3] µm) (p = 0.01). Quadrantic optic nerve analysis revealed the temporal RNFL to be greater in the treated group (p = 0.02), whereas all other locations were similar. No significant differences were found between the 2 groups in any ONH parameters. CONCLUSIONS: This study demonstrated no deleterious optic nerve RNFL thinning in a series of wet AMD eyes with long-term repetitive exposure to intravitreal anti-VEGF injections. Furthermore, we observed that those with wet AMD have a relatively thickened temporal peripapillary RNFL layer, which is an important association for all observers of optic nerve disease.