Anterior chamber maintainer versus viscoelastic material for intraocular lens implantation: case-control study.

PURPOSE: To compare best corrected visual acuity (BCVA) and intraocular pressure (IOP) in eyes that had a foldable intraocular lens (IOL) implanted with the use of an anterior chamber maintainer (ACM) in 1 eye and hyaluronate 3.0% (Vitrax) viscoelastic material in the other eye. SETTING: Private practice in a large urban center. METHODS: Sixty-six eyes of 33 patients had consecutive bilateral cataract extraction by the same surgeon using an identical temporal approach, clear corneal phacoemulsification, and implantation of an Allergan SI-40NB or SA-40NB IOL through an injection delivery system. The first operative eye was arbitrarily assigned to the ACM or Vitrax group, while the fellow eye received the opposite technique. Patients with coexisting ocular pathology that could influence the measured outcomes (eg, glaucoma, age-related macular degeneration) were excluded. Patients were evaluated preoperatively and 1 day and 3 to 6 weeks postoperatively. RESULTS: No serious intraoperative or postoperative complications were reported. The only statistical difference in BCVA or IOP was on the first postoperative day, when the mean IOP was approximately 2 mm Hg lower in the ACM group than in the Vitrax group. CONCLUSION: The use of an ACM for implantation of an injected 3-piece silicone IOL may lower IOP on the first postoperative day.

The birth of ocular pharmacology in the 20th century.

Nineteenth century ophthalmology, characterized by significant gains in diagnostic techniques, provided the basis for great advancements in treatment during the 20th century. Drug therapy at the turn of the century was empiric, palliative, and often toxic. The development of ocular pharmacology during the 20th century provided the basis for a rational therapeutic approach to ocular disease. Foremost among the therapeutic developments were antibiotics, due to their potential to cure conditions that frequently resulted in blindness. Second, other therapeutic classes provided palliative therapy for chronic diseases, and thus decreased morbidity. For example, drugs specifically targeting many different aspects of glaucoma have had remarkable success controlling intraocular pressure and forestalling development of blindness. In addition, other new approaches provided palliative therapy for nonblinding conditions and effective adjuncts to surgical procedures. Antiallergy and anti-inflammatory drugs greatly increased patient comfort and facilitated treatment of allergic and inflammatory reactions. Local anesthetics and analgesia reduced patient discomfort during surgery. Other adjunct drugs improved surgical outcomes by reducing inflammation and infectious complications. The 21st century will undoubtedly provide novel approaches to address many of today's therapeutic dilemmas. Photodynamic therapy, growth factors, antisense technology, and genetic-based therapies all show great promise. Many of the conditions that are only treated palliatively today will be curable in the next century using many of these pharmacological advances.