Kahook Dual Blade versus Trabectome (KVT): Comparing Outcomes in Combination with Cataract Surgery.

Purpose: To compare the safety and efficacy of Kahook Dual Blade (KDB) versus Trabectome with cataract surgery in reducing intraocular pressure (IOP) and medications used by patients with glaucoma. Methods: Retrospective chart review comparing eyes after KDB or Trabectome with cataract surgery at 2 academic centers. Surgical success was defined as IOP <21 mmHg with ≥20% IOP reduction at post-operative month 12 (POM12). Changes in IOP, number of glaucoma medications, and adverse events were assessed. Results: Ninety eyes in the KDB group and 125 eyes in the Trabectome group were included. Mean changes in IOP at POM12 were -1.9 ± 4.9 mmHg (11.2%, P = 0.002) in the KDB group and -3.5 ± 5.5 mmHg (19.1%, P < 0.001) in the Trabectome group, without a significant difference between the groups (P = 0.20). Mean change in glaucoma medications at POM12 was -0.8 ± 1.5 in the KDB group (58%, P < 0.001) and -0.3 ± 1.3 (38%, P = 0.003) in the Trabectome group, with KDB having a greater decrease in medications (P = 0.02). The percentage of eyes achieving success was 30% for the KDB group and 54% for the Trabectome group (P = 0.01). Hyphema was the most common complication, with an incidence of 3% for the KDB group and 14% for the Trabectome group (P = 0.01). Conclusion: KDB or Trabectome with cataract surgery is safe and effective at lowering IOP and medication burden, with KDB resulting in a greater reduction in medications and Trabectome more frequently achieving success with an increased incidence of hyphema. Considering the study's limitations, the outcomes were similar.

Trends in treatment strategies for suspected bacterial endophthalmitis.

PURPOSE: To describe how vitreoretinal specialists have incorporated the Endophthalmitis Vitrectomy Study (EVS) findings into current practice, to highlight divergences from the EVS recommendations, and address the role of microbial culture in guiding additional treatments. METHODS: This is a cross-sectional survey of vitreoretinal specialists regarding indications used for performing a pars plana vitrectomy (PPV), selection of antibiotics for treatment, utilization of cultures, and treatment strategies for treatment-refractory patients with bacterial endophthalmitis. RESULTS: Of 681 physicians contacted, 149 (21.9%) responded. For patients with visual acuity of light perception or less, 75% of respondents utilized PPV. Intravitreal vancomycin and ceftazidime were used by 100% and 96% of participants respectively. Vitreal cultures were obtained more than 50% of the time by 86.5% of participants, and were used to influence retreatment less than 50% of the time by 77.8% of respondents. For patients with worsening clinical signs 48 hours after initial treatment, 69.8% of participants performed PPV with intravitreal antibiotics. CONCLUSIONS: Although most respondents followed the EVS guidelines, a minority deviated, and the majority generalized their strategy to other forms of endophthalmitis. There is significant variation in retreatment strategies, and while cultures are frequently obtained to help guide these treatments, they are utilized infrequently.

Neovascular Age-Related Macular Degeneration Disease Quiescence with Visual Acuity Stability in a Subgroup of Patients Following PRN Treatment.

PURPOSE: This study evaluates long-term visual acuity (VA) outcomes in patients with prolonged clinically quiescent neovascular age-related macular degeneration (AMD) after treatment with a pro re nata (PRN) regimen of anti-vascular endothelial growth factor agents (bevacizumab, ranibizumab, and/or aflibercept). METHODS: This retrospective study analyzes VA changes in 105 eyes from 72 patients with a period of AMD disease quiescence (determined by retinal examination) not requiring treatment for at least 180 days. All patients were seen at Colorado Retina Associates between October 31, 2005 and December 31, 2015. VA was measured at the time of first treatment, last treatment, and final clinic visit showing changes in VA during the treatment and quiescent periods. The sample was stratified to compare those with VA gain throughout the study to those with VA loss. RESULTS: The aggregate group showed VA stability during the treatment period (20/117 to 20/116) with a significant decline during the quiescent period (to 20/235; P < 0.001). The VA gainers had a significant increase in VA during the treatment period (20/187 to 20/88; P < 0.001) and VA stability during the quiescent period (to 20/93). VA losers had a significant decline in VA during both the treatment and quiescent periods (P < 0.001). CONCLUSION: Overall, PRN treatment resulted in a decline in VA during a period of apparent disease quiescence. There is a group of patients that does not lose VA during this period, and if patients like these can be identified, their treatment could be optimized to include a period of clinically justified nontreatment.