Comparative analysis of the safety and efficacy of intracameral cefuroxime, moxifloxacin and vancomycin at the end of cataract surgery: a meta-analysis.

BACKGROUND: Current practice methods are unclear as to the most safe and effective prophylactic pharmacotherapy and method of delivery to reduce postoperative endophthalmitis occurrence. METHODS: A systematic review and meta-analysis using Meta-analysis of Observational Studies in Epidemiology guidelines was performed to compare the efficacy of intracameral cefuroxime, moxifloxacin and vancomycin in preventing postphacoemulsification cataract surgery endophthalmitis. A safety analysis of intracameral antibiotics was concurrently performed. DATA SOURCES: BIOSIS Previews, CINAHL, ClinicalTrials.gov, Cochrane Library, Dissertations & Theses, EMBASE, PubMed, ScienceDirect and Scopus were searched from inception to January 2017. Data were pooled using a random effects model. All articles were individually reviewed and data were extracted by two independent reviewers. Funnel plot, risk of bias and quality of evidence analyses were performed. RESULTS: Seventeen studies with over 900 000 eyes were included, which favoured the use of intracameral antibiotics at the end of cataract surgery (OR 0.20; 95% CI 0.13 to 0.32; P<0.00001). The average weighted postoperative endophthalmitis incidence rates with intracameral cefuroxime, moxifloxacin and vancomycin were 0.0332%, 0.0153% and 0.0106%, respectively. Secondary analyses showed no difference in efficacy between intracameral plus topical antibiotics versus intracameral alone (P>0.3). Most studies had low to moderate risk of bias. The safety analysis showed minimal toxicity for moxifloxacin. Dosing errors led to the majority of toxicities with cefuroxime. Although rare, vancomycin was associated with toxic retinal events. CONCLUSION: Intracameral cefuroxime and moxifloxacin reduced endophthalmitis rates compared with controls with minimal or no toxicity events at standard doses. Additionally, intracameral antibiotics alone may be as effective as intracameral plus topical antibiotics.

Retinal Findings on OCT in Systemic Conditions.

PURPOSE: Imaging technology has advanced by leaps and bounds in the recent past and has resulted in a much greater understanding of ocular diseases. The aim of this review article is to summarize optical coherence tomography (OCT) findings of various systemic conditions. METHOD: A systematic literature search of the Medline/PubMed database was performed. English articles up to April 2015 were included. Terms used for search included: Alzheimer's Disease; Multiple Sclerosis; Parkinson's Disease; Behçet's Disease; Schizophrenia; Migraine; Obstructive Sleep Apnea Syndrome; Neurofibromatosis; Sickle Cell Disease; Renal diseases; Lupus Retinopathy; Valsalva Retinopathy; Whiplash Retinopathy; Shaken-Baby Syndrome; Choroidal metastases; Intracranial Hypertension; Drug toxicity; Deferoxamine; Sildenafil; Tamoxifen; Hydroxychloroquine; Chloroquine; Ethambutol; Lead; Sickle Cell Disease; and Thalassemia along with OCT. RESULTS: Studies have shown that inner retinal thinning could be the earliest sign of neurological diseases and may help to differentiate individuals with abnormalities. Outer retinal damage was noted in cancer-related retinopathy and secondary to drug toxicity as a diagnostic sign. This review article summarizes the OCT findings and their importance in early diagnosis, treatment, and follow-up in a varying spectrum of systemic diseases including neurological diseases, hematological diseases, cancer-related retinopathies, and systemic drug toxicity. CONCLUSION: OCT findings are useful to predict the probability of a disease, to diagnose it early, to differentiate between healthy and unhealthy tissue, and to assess the effect of therapeutic interventions in many systemic diseases.

Targeted Intraceptor Nanoparticle for Neovascular Macular Degeneration: Preclinical Dose Optimization and Toxicology Assessment.

Neovascular age-related macular degeneration (AMD) is treated with anti-VEGF intravitreal injections, which can cause geographic atrophy, infection, and retinal fibrosis. To minimize these toxicities, we developed a nanoparticle delivery system for recombinant Flt23k intraceptor plasmid (RGD.Flt23k.NP) to suppress VEGF intracellularly within choroidal neovascular (CNV) lesions in a laser-induced CNV mouse model through intravenous administration. In the current study, we examined the efficacy and safety of RGD.Flt23k.NP in mice. The effect of various doses was determined using fluorescein angiography and optical coherence tomography to evaluate CNV leakage and volume. Efficacy was determined by the rate of inhibition of CNV volume at 2 weeks post-treatment. RGD.Flt23k.NP had peak efficacy at a dose range of 30-60 µg pFlt23k/mouse. Using the lower dose (30 µg pFlt23k/mouse), RGD.Flt23k.NP safety was determined both in single-dose groups and in repeat-dose (three times) groups by measuring body weight, organ weight, hemoglobin levels, complement C3 levels, and histological changes in vital organs. Neither toxicity nor inflammation from RGD.Flt23k.NP was detected. No side effect was detected on visual function. Thus, systemic RGD.Flt23k.NP may be an alternative to standard intravitreal anti-VEGF therapy for the treatment of neovascular AMD.

Intraocular foreign body removal: a novel technique using intraoperative imaging.

We describe a case illustrating a new technique of using intraoperative optical coherence tomography (IOCT) for foreign body removal from the limbus and cornea. In this case, fragments of a fish hook in the temporal limbus and cornea were identified on the OCT. The residual pieces were then removed, assisted by high-resolution, real-time cross-sectional imaging, IOCT. While this technique involves steep learning curve, we believe that it is safe for the patient and helps surgeon with instant decision making and reduce orbital manipulation.

Minimally Invasive Pterygium Surgery: Sutureless Excision with Amniotic Membrane and Hydrogel Sealant.

PURPOSE: To describe a novel technique for sutureless pterygium surgery using ReSure(®) tissue sealant. METHODS: In this retrospective observational case series, we describe a modified procedure for pterygium excision followed by amniotic membrane transplant (AMT) adhered to the corneal and conjunctival defects using ReSure tissue sealant. RESULTS: Nine eyes of seven patients (age range: 28-80 years, 4 females and 3 males) underwent pterygium removal with AMT followed by adherence of tissue to the conjunctival edges with ReSure. No issues with transplant dislocation or failure and no intra- or postoperative complications were noted. No recurrences were noted during the follow-up period. CONCLUSION: ReSure may be considered as a potential sealant to adhere AMT to defective corneal and conjunctival tissues in sutureless pterygium surgery.

Antivascular Endothelial Growth Factor Monotherapy for Choroidal Neovascularization Associated With Retinochoroidal Coloboma: Case Series.

PURPOSE: This study aimed to report the outcomes of antivascular endothelial growth factor (anti-VEGF) monotherapy for choroidal neovascularization (CNVM) associated with retinochoroidal coloboma (RCC). DESIGN: A retrospective case series. METHODS: This was a case series of 3 eyes with CNVM associated with RCC that presented to the LV Prasad Eye Institute, Hyderabad, India, between January 2006 and January 2014. Reported data included demographics, preoperative details (symptoms, duration of symptoms, and visual acuity), treatment methods, and postoperative details (visual acuity, follow-up, and recurrence). These data were compared with 9 other cases previously reported in the literature. RESULTS: Three eyes of 3 patients (2 females and 1 male) were included, with a mean age of 18.3 years (range, 2-32 years). The preoperative best corrected visual acuity ranged from 20/540 to 20/100. All 3 eyes were treated with intravitreal bevacizumab injections. The mean number of injections was 2.0 (range, 1-3) and mean duration of follow-up was 12 months (range, 4-24 months) with no recurrence. The best corrected visual acuity at the last follow-up was improved, ranging from 20/310 to 20/60. CONCLUSIONS: In view of good treatment outcomes with no recurrence and a lesser number of injections, anti-VEGF monotherapy could be considered as treatment for coloboma-associated CNVM.

The Characteristics and Short-term Refractive Error Outcomes of Cystoid Macular Edema in Premature Neonates as Detected by Spectral-Domain Optical Coherence Tomography.

BACKGROUND AND OBJECTIVE: To explore characteristics associated with cystoid macular edema (CME) in neonates screened for retinopathy of prematurity (ROP). PATIENTS AND METHODS: In this institutional review board-approved, prospective, observational study, premature neonates underwent imaging with handheld spectral-domain optical coherence tomography. RESULTS: Of 73 included infants (median gestational age [GA]: 28 weeks, range 23-33 weeks; birth weight: 966 g, range 506 g-1695 g), 28 (38%) had CME and 17/28 (61%) had ROP. CME was associated with ROP (P=.03) and younger GA (P=.04), but not associated with sex, race, birth weight, postmenstrual age at imaging, ROP severity, or myopia at median 6 months corrected age. CME resolved in three cases after bevacizumab treatment for type 1 ROP and in five cases without treatment. CME appeared in two cases several weeks following injections. CONCLUSION: CME was associated with ROP and younger GA, but not with myopia. Intravitreal bevacizumab for type 1 ROP has inconclusive effects on CME.

Role of macular hole angle in macular hole closure.

AIM: To evaluate correlation of various spectral-domain optical coherence tomography (SD-OCT) parameters including macular hole angle as well as various indices with anatomical and visual outcomes after idiopathic macular hole repair surgery. METHODS: Retrospective study of 137 eyes of 137 patients who underwent idiopathic macular hole repair surgery between January 2008 and January 2014 was performed. Various qualitative parameters such as presence of vitreomacular traction, epiretinal membrane and cystic edges at the macular hole as well as quantitative parameters such as maximum diameter on the apex of the hole, minimum diameter between edges, nasal and temporal vertical height, longest base diameter and macular hole angle between the retinal edge and the retinal pigment epithelium were noted. Indices including hole form factor, Macular Hole Index (MHI), Diameter Hole Index and Tractional Hole Index (THI) were calculated. Univariate and multivariate regression analysis was performed separately for final visual acuity (VA) and type of closure as dependent variable in relation to SD-OCT parameters as independent variables. RESULTS: On multivariate regression only minimum diameter between edges (p≤0.01) and longest base diameter (p≤0.03) were correlated significantly with both, type 1 closure and final VA. Among the indices, significant correlation of MHI (p=0.009) was noted with type of closure and that of THI with final VA (p=0.017). CONCLUSIONS: Our study shows no significant correlation between macular hole angle and hole closure. Minimum diameter between the edges and longest diameter of the hole are best predictors of hole closure and postoperative VA.

Retrospective hospital-based analysis of age-related macular degeneration patterns in India: 5-year follow-up.

PURPOSE: To provide a detailed analysis of age-related macular degeneration (AMD) with a 5-year follow-up at a Tertiary Eye Care Center in India. METHODS: In this retrospective institutional study, 408 eyes of 204 subjects (100 males) with a diagnosis of AMD with minimum 5-year follow-up were included. Data collected included demographics, details of the ocular exam, special investigations performed, treatment offered, complications, and systemic diseases, if any. RESULTS: The median age was 74.24 ± 8.23 years. Median follow-up was 5.77 years. The visual acuity (VA) at baseline and last visit was 0.74 ± 0.12 (Snellen's equivalent 20/100) and 0.54 ± 0.12 logarithm of the minimum angle of resolution (Snellen's equivalent 20/50; P = 0.032) in patients with choroidal neovascular membrane (CNVM). The most common complaint was decreased vision (94.5%). AMD (any stage) was found to be bilateral in 93% of patients at baseline and 197 patients (96.56%) at 5 years. Seventeen eyes had active CNVM (12 of these were occult) at presentation. At baseline, 43 eyes had a disciform scar. Three hundred twenty-one eyes had dry AMD at baseline (geographic atrophy - 12 [3.7%] eyes). Five-year conversion rate into wet AMD and geographic atrophy was 2.87% and 3.12%. Median number of anti-vascular endothelial growth factor injections administered per patient was 2.8 ± 1.2. CNVM bilaterality was low (7.5%). CONCLUSION: Patients with AMD in India presented later in the course of the disease. Bilateral advanced AMD and geographic atrophy were uncommon. Five-year conversion rate into wet AMD and geographic atrophy was 2.87% and 3.12%.

External drainage for exudative retinal detachment secondary to central serous chorioretinopathy.

BACKGROUND: To report the outcomes of external drainage of subretinal fluid (SRF) in exudative retinal detachment secondary to central serous chorioretinopathy (CSCR). METHODS: Retrospective observational analysis of six eyes with exudative retinal detachment secondary to CSCR who underwent external drainage of SRF between 2004 and 2014 was performed. Collected data included demographics, steroid usage, surgical details, and visual acuity preoperatively and postoperative visual acuity and clinical examination data were collected. RESULTS: Six eyes of six subjects were included with mean age of 45 years (range, 32 to 61 years). All subjects were male. Mean duration of symptoms was 4.6 months (range, 3 to 8 months). The pre-operative best-corrected visual acuity (BCVA) ranged from perception of light to 20/60. Four eyes were treated with conventional external drainage and two underwent Chandelier-assisted external drainage. Three cases had laser treatment before drainage and one case underwent photodynamic therapy (PDT) after drainage. The BCVA at last follow-up ranged from 20/2,000 (counting fingers at 2 feet) to 20/20. No recurrences were noted in any of the cases till the last follow-up. Mean duration of follow-up was 38 months. CONCLUSIONS: Our study demonstrates successful management of exudative retinal detachment secondary to CSCR with external SRF drainage without any complications.

Sub-tenon triamcinolone acetonide injections for topical medication intolerance in chronic blepharokeratoconjunctivitis.

PURPOSE: To report the efficacy of sub-Tenon triamcinolone acetonide (TA) injections for chronic blepharokeratoconjunctivitis (BKC) in 2 patients who were intolerant to topical therapies. METHODS: In this retrospective observational case series, the records of 2 patients with chronic BKC who received sub-Tenon TA injections were reviewed. RESULTS: Both patients, a 4-year-old girl and a 21-year-old developmentally delayed man, were managed successfully with sub-Tenon TA injections. The treatment resulted in resolution of symptoms, diminished corneal haze, reduced conjunctival injection, and improved visual acuity without complications. CONCLUSIONS: This case series illustrates the potential benefit of using sub-Tenon TA injections for chronic BKC in patients who are intolerant to topical corticosteroid therapy. Therefore, sub-Tenon TA injections may be considered for patients with vision-threatening BKC and nonadherence to topical therapies.