Incidence of hypotony and sympathetic ophthalmia following trans-scleral cyclophotocoagulation for glaucoma and a report of risk factors.

OBJECTIVE: To report the incidence and risk factors for hypotony and estimate the risk of sympathetic ophthalmia following diode laser trans-scleral cyclophotocoagulation (TSCPC). DESIGN: Retrospective study using data from a private tertiary glaucoma clinic and review of the literature. PARTICIPANTS: Seventy eyes of 70 patients with refractory glaucoma who received TSCPC treatment. METHODS: Review of the records of consecutive patients who underwent TSCPC by a single ophthalmic surgeon and review of the literature. MAIN OUTCOME MEASURES: Hypotony (including phthisis bulbi), sympathetic ophthalmia. RESULTS: Seven eyes (10%; CI 5-19%) developed hypotony and included 4 eyes that developed phthisis. Higher total energy delivered during TSCPC treatment was associated with an increased risk of hypotony: eyes that developed hypotony received a mean total energy of 192.5 ± 73.2 joules, compared to a mean of 152.9 ± 83.2 joules in hypotony-free cases. The risk of sympathetic ophthalmia estimated from a review of the published literature and current series was one in 1512, or 0.07% (CI 0.03%-0.17%). CONCLUSIONS: Total laser energy is one of several risk factors that act in a sufficient component cause-model to produce hypotony in an individual patient. The small sample size precluded inference for other individual putative risk factors but titrating laser energy may help decrease the occurrence of hypotony. The risk of sympathetic ophthalmia calculated from the literature is likely an overestimate caused by publication bias.

Diabetic Macular Oedema Guidelines: An Australian Perspective.

The number of people living with diabetes is expected to rise to 578 million by 2030 and to 700 million by 2045, exacting a severe socioeconomic burden on healthcare systems around the globe. This is also reflected in the increasing numbers of people with ocular complications of diabetes (namely, diabetic macular oedema (DMO) and diabetic retinopathy (DR)). In one study examining the global prevalence of DR, 35% of people with diabetes had some form of DR, 7% had PDR, 7% had DMO, and 10% were affected by these vision-threatening stages. In many regions of the world (Australia included), DR is one of the top three leading causes of vision loss amongst working age adults (20-74 years). In the management of DMO, the landmark ETDRS study demonstrated that moderate visual loss, defined as doubling of the visual angle, can be reduced by 50% or more by focal/grid laser photocoagulation. However, over the last 20 years, antivascular endothelial growth factor (VEGF) and corticosteroid therapies have emerged as alternative options for the management of DMO and provided patients with choices that have higher chances of improving vision than laser alone. In Australia, since the 2008 NHMRC guidelines, there have been significant developments in both the treatment options and treatment schedules for DMO. This working group was therefore assembled to review and address the current management options available in Australia.

Orbital apex anatomy: relationship between the optic foramen and anterior face of sphenoid sinus - a radiological study.

BACKGROUND/OBJECTIVES: This study aims to identify radiologically the position of the optic foramen in relation to the anterior face of the sphenoid sinus, to aid surgeons in their planning for orbital decompression. METHODS: CT scans of 100 orbits from 50 adult patients without any abnormality were assessed. Primary outcome measures included: position and measurement of the distance from the optic foramen to the anterior face of the sphenoid sinus. Secondary outcomes included: medial orbital wall length, distance from the optic foramen and the anterior face of the sphenoid sinus to the carotid prominence in the sphenoid sinus, and the thickness of bone anterior to the optic foramen. RESULTS: The mean location of the optic foramen was just posterior to the position of the anterior face of sphenoid sinus, with an average distance of +0.4 +/- 3.5 mm. In 54% of orbits the optic foramen was positioned posterior to the anterior face of the sphenoid sinus. The finding was symmetrical in 80% of patients. CONCLUSIONS: Our study identifies that the optic foramen lies posterior to the anterior face of sphenoid sinus in approximately half of cases. The position may be asymmetric in 20% of individuals.

Cataract Surgery in Eyes with Low Corneal Astigmatism: Implantation of the Acrysof IQ Toric SN6AT2 Intraocular Lens.

PURPOSE: To assess the refractive and visual outcomes following cataract surgery and implantation of the AcrySof IQ Toric SN6AT2 intraolcular lens (IOL) (Alcon Laboratories, Inc., Fort Worth, TX, USA) in patients with low corneal astigmatism. METHODS: This study is a retrospective, consecutive, single surgeon series of 98 eyes of 88 patients (with low preoperative corneal astigmatism) undergoing cataract surgery and implantation of the AcrySof IQ Toric SN6AT2 IOL. Postoperative measurements were obtained 1-month postsurgery. Main outcome measures were monocular distance visual acuity and residual refractive astigmatism. RESULTS: Mean preoperative corneal astigmatic power vector (APV) was 0.38±0.09 D. Following surgery and implantation of the toric IOL, mean postoperative refractive APV was 0.13±0.10 D. Mean postoperative distance uncorrected visual acuity was 0.08±0.09 logMAR. Postoperative spherical equivalent refraction (SER) resulted in a mean of -0.23±0.22 D, with 96% of eyes falling within 0.50 D of the target SER. CONCLUSION: The AcrySof IQ Toric SN6AT2 IOL is a safe and effective option for eyes undergoing cataract surgery with low levels of preoperative corneal astigmatism.

Replacing ranibizumab with bevacizumab on the Pharmaceutical Benefits Scheme: where does the current evidence leave us?

The battle between two anti-vascular endothelial growth factor (VEGF) treatment options (ranibizumab and bevacizumab) for neovascular macular degeneration is a topic of particular significance to eye health professionals with an interest in cost-effective treatment. Being the first of its kind directly comparing the two anti-VEGF, a recent large multicentre clinical trial has shown that bevacizumab is not inferior when compared with ranibizumab in regards to efficacy of visual acuity outcomes; the evidence at this stage is inconclusive for safety outcomes. Before bevacizumab can be considered a justifiable replacement for the much more expensive ranibizumab on the Pharmaceutical Benefits Scheme (PBS), its safety in treatment needs further supporting evidence.