Postoperative safety outcomes in patients undergoing routine Phacoemulsification Cataract Surgery with Intraoperative Intracameral Injection of Preservative-Free Moxifloxacin versus Levofloxacin

Purpose@#This study compared the safety outcomes of two intracameral fluoroquinolone antibiotics, moxifloxacin and levofloxacin, as prophylaxis treatment in eyes that underwent uncomplicated cataract surgery. @*Methods@#This is a prospective, double-masked, randomized, interventional, single-center clinical trial. Eyes with visually-significant cataracts underwent phacoemulsification and received preservative-free intracameral 0.5% moxifloxacin [58 eyes (M group)] or 0.5% levofloxacin [56 eyes (L group)] at the end of the surgery as antibiotic prophylaxis. The following safety parameters were evaluated postoperatively at Day 1, Week 1 and Month 1: central retinal thickness (CRT), macular volume (MV), central corneal thickness (CCT), and endothelial cell density (ECD). In-between group comparison was made at each of the 4 study visits using Student’s t-test. @*Results@#Both M and L groups had similar baseline characteristics. There were no significant differences in CRT, MV, CCT and ECD between the 2 groups at each time point in the study. There were no significant differences in the mean changes in CRT, MV, CCT and ECD from baseline to final visit between the 2 groups. No study-related adverse events were observed during the study period. @*Conclusion@#Intracameral application of preservative-free 0.5% moxifloxacin and 0.5% levofloxacin appear to have similar safety outcomes when used as antibacterial prophylaxis among eyes undergoing cataract surgery. Based on the results, both fluoroquinolone agents are potentially suitable options for endophthalmitis chemoprophylaxis.

Refractive errors in Filipino eyes in a single-center study population

Objective@#We determined the frequency of refractive errors among Filipino patients undergoing refractive or cataract screening at an ambulatory eye-care center, correlated them with demographic and ophthalmic variables, and compared refractive and keratometric astigmatism.@*Methods@#Clinical records of 666 consecutive patients who had optical interferometry were reviewed and the demographic and clinical parameters obtained were subjected to statistical analyses.

Refractive errors in Filipino eyes in a single-center study population

Objective We determined the frequency of refractive errors among Filipino patients undergoing refractive or cataract screening at an ambulatory eye-care center, correlated them with demographic and ophthalmic variables, and compared refractive and keratometric astigmatism. Methods Clinical records of 666 consecutive patients who had optical interferometry were reviewed and the demographic and clinical parameters obtained were subjected to statistical analyses. Results The mean axial length (AL) was 24.43 ± 1.56 mm, significantly shorter among females (p < 0.001). Axial length (AL) was also inversely correlated with age (r = –0.50). Mean sphere was –1.3 ± 3.4D, and correlated with age (r = 0.57); younger age groups had higher negative values. Myopia was the major refractive-error type (90 to 100%) in the 17- to 30-year-old age bracket. Hyperopia was the predominant refractive error (50 to 75%) among the elderly. The mean keratometry reading was 44 ± 1.5D. Females had steeper K readings than males (p = 0.000). Refractive astigmatism was observed in 47.88% and keratometric astigmatism in 71.7%. Against-the-rule (ATR) was the prevalent type (46.1%) in refractive astigmatism and with-the-rule (WTR) (59.1%) in keratometric astigmatism. Conclusion In the older population, AL was shorter and hyperopia was more prevalent; in the younger population, myopia was more prevalent. Astigmatism did not differ between gender groups but differed among age groups. WTR astigmatism was more prevalent in the younger age group and ATR in the elderly.

Rapid visual recovery after inadvertent embolization of retinal arterioles with triamcinolone acetonide

@#Objective To describe a case of acute visual loss due to retinal arteriolar embolization caused by transeptal triamcinolone-acetonide injection, with rapid visual recovery following immediate intervention. Methods This is a case report. Results A 39-year-old female developed loss of vision (no light perception) after transeptal triamcinolone-acetonide injection. Examination revealed yellowish, particulate emboli within the retinal arterioles. Strategies to relieve the obstructed vessel (anterior-chamber paracentesis, intraocular-pressurelowering medications, and ocular massage) were immediately performed. Full recovery of vision occurred within 24 hours. Conclusion Retinal vascular embolization should be suspected when there is loss of vision after corticosteroid injection. Immediate ocular decompression may lead to rapid improvement and favorable visual outcomes.

Pegaptanib sodium for macular edema due to retinal-vein occlusion among patients intolerant to intravitreal triamcinolone acetonide

Objective@#To report the efficacy and safety of intravitreal pegaptanib sodium (IVP) on macular edema (ME) due to branch retinal-vein occlusion (BRVO) among patients intolerant to intravitreal triamcinolone acetonide (IVTA). @*Methods@#Four eyes with ME due to BRVO were included in this interventional case series. The main outcome measures were best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP), and adverse effects.@*Results@#There was a significant decrease in mean CMT from 524.50 ± 141.12 to 293.75 ± 130.75 microns (p = 0.009) after IVP injection. BCVA improved in all 4 eyes after IVP. Mean IOP after IVP was 13.60 ± 3.21. No ocular or systemic complications were observed.@*Conclusion@#IVP appears to be safe and effective in decreasing retinal thickness and improving VA in eyes with ME due to BRVO. IVP is a potential treatment for eyes that are intolerant to IVTA.

Intravitreal bevacizumab for neovascular age-related macular degeneration

Objectives@#Anti-vascular endothelial growth factor (anti-VEGF) drugs delivered intravitreally have been proven effective and safe for the treatment of patients diagnosed with neovascular age-related macular degeneration (ARMD). This study evaluated the short-term biologic efficacy and safety of multiple intravitreal injections of bevacizumab in patients with neovascular ARMD.@*Methods@#A prospective, interventional, placebo-controlled, randomized clinical trial was done involving patients with active subfoveal neovascular ARMD. Excluded were patients with significant media opacity, concomitant retinal/ocular diseases, previous intravitreal injections, recent laser treatment or intraocular surgery, and contraindications to the drug. Demographic data were taken and a complete ocular examination, fluorescein angiogram (FA), and optical coherence tomogram (OCT) were performed. Patients received either 3 monthly intravitreal injections of 1.25mg bevacizumab or sham injections. Best-corrected visual acuity (BCVA) and central macular thickness were recorded at baseline, 2, 4, 8, and 12 weeks follow-up. Ocular/Periocular or systemic drug-related side effects or toxicities and iatrogenic complications were noted.@*Results@#Thirty eyes (15 per group) were included in the final analysis. Both treatment and control groups were comparable in baseline characteristics. There was a significant increase in the mean visual acuity (p < 0.001) in eyes treated with bevacizumab across all time periods. The average gain at the end of the study was 11.6 letters. This paralleled a similar significant decrease in central macular thickness for the treatment group (p < 0.02). No major ocular adverse events were noted.@*Conclusion@#This study supported the growing body of evidence that intravitreal injections of bevacizumab 1.25 mg result in short-term anatomical as well as functional improvement with minimal adverse events in patients with neovascular ARMD.

Subconjunctival injection of bevacizumab for treatment of pterygium

@#Objectives This study determined the biologic effect and safety of subconjunctival administration of bevacizumab in patients with primary and recurrent pterygium. Methods We conducted an off-label, multiple-dosing, interventional case series involving 15 patients with primary and recurrent pterygium. They received subconjunctival bevacizumab (1.25 mg) every 2 weeks for 10 weeks. Pterygium vascularity and thickness were graded (1 for atrophic, 2 for intermediate, and 3 for fleshy) by 3 masked observers. The size of the pterygium (measured by surface area in cm2) was recorded from baseline to 16 weeks postinjection. Treatment-related complications and adverse events were reported. The main outcome measures were changes in pterygium size, vascularity, thickness, and treatment safety. Results There was no statistically significant difference in the mean surface area of the pterygia at different intervals (p > 0.05). The mean surface area was 1.22 ± 0.19 cm2 at baseline, 1.22 ± 0.18 cm2 and 1.22 ± 0.17 cm2 at 10 and 16 weeks postinjection respectively. There was a significant difference in the mean pteygium grading by the 3 masked observers at different intervals (p < 0.01). At baseline, there were 11 patients (73.3%) with grade 2 pterygium and 4 (26.7%) with grade 3. At 1.5 months postinjection, there were 5 (33.3%) with grade 1 pterygium, 7 (46.7%) with grade 2, and 3 (20%) with grade 3. The 5 patients with grade 1 pterygium at the end of the study period had a baseline pterygium grading of 2. Snellen visual acuity, refraction, intraocular pressure, and blood pressure remained stable. No serious ocular or systemic side effects were observed. Conclusion Subconjunctival injection of 1.25 mg of bevacizumab given every 2 weeks for 10 weeks resulted in no significant change in size of the pterygium. However, local application of bevacizumab showed promise in inducing regression in pterygium vascularity and thickness. Further evaluation of bevacizumab for the treatment of pterygia is warranted.