Year : 2016 | Volume
: 28 | Issue : 3 | Page : 215--216
Ophthalmology, Little Flower Hospital and Research Centre, Angamaly, Kerala, India
Ophthalmology, Little Flower Hospital and Research Centre, Angamaly, Kerala
|How to cite this article:|
Remya R. Journal Review.Kerala J Ophthalmol 2016;28:215-216
|How to cite this URL:|
Remya R. Journal Review. Kerala J Ophthalmol [serial online] 2016 [cited 2021 Jun 13 ];28:215-216
Available from: http://www.kjophthal.com/text.asp?2016/28/3/215/205430
Effect of Postoperative Administration of Nonsteroidal Anti-Inflammatory Drugs and Steroids on the Conformational Changes in Wound Healing After Cataract Surgery
Choi EY, Kang HG, Kim TI, Kim EK, Lee HK. Journal of Cataract and Refractive Surgeries. 2016 Dec; 42:1804-12.
The integrity of clear corneal incision widely used in phacoemulsification cataract surgery has been questioned recently. A physically unstable incision leaks while eye rubbing or forceful blinking and can also predispose to intraocular infections, epithelial ingrowth, and surgically induced astigmatism. To suppress postoperative inflammation and to facilitate wound healing topical steroids and nonsteroidal, anti-inflammatory agents are considered standard. However, no comparative reports of cataract wound changes caused by nonsteroidal anti-inflammatory drugs (NSAIDs) and steroid treatment exists.
The aim of this study was to evaluate the periodic conformational changes in clear corneal incision with the administration of topical Bromfenac sodium 0.1% (Bronuck) or prednisolone acetate 1.0% (Pred Forte) after uneventful surgery assessed using anterior segment optical coherence tomography (ASOCT).
It was a prospective, randomized comparative study. A total of 59 eyes of 34 patients who underwent uneventful phacoemulsification cataract surgery and intraocular lens (IOL) implantation by same surgeon were studied. They randomly gave a NSAID or a steroid. Using ASOCT structural changes of clear corneal, incision were examined on day 1, 1 week, 3.5 week, and 23 weeks postoperatively. The incidence and size of 5 wound architecture abnormalities (endothelial gap, descemet membrane detachment, epithelial detachment or defect, posterior misalignment, and loss of coaptation) were analyzed and scored. Wound instability was defined as the mean value of these five architectural abnormality scores. The correlation between wound instability and surgically induced astigmatism was also evaluated.
During the 6 months follow-up, the changes in wound stability were comparable for both groups. Most structural abnormality of the incision resolved within 3.5–23 weeks postoperatively. Only epithelial detachment appeared more frequently and had a significantly greater average size in the NSAID treatment group; however, all these resolved in 1 month. The wound instability was positively correlated with preoperative cataract grading and postoperative surgically induced astigmatism.
No significant difference in the conformational changes of cataract wound observed between NSAIDs and steroids administered postoperatively. Considering the increased risk of infections, ocular hypertension with steroids, NSAIDs can be substituted for steroids to control postoperative inflammation after an uneventful cataract surgery.
A Lower Dose of Intravitreal Bevacizumab Effectively Treats Retinopathy of Prematurity
Khodabande A, Niyousha MR, Roohipoor R. Journal of AAPOS. 2016 Dec; 20:490-2.
Retinopathy of prematurity (ROP) is the condition where incomplete retinal vascularization due to prematurity results in the release of angiogenic factors like vascular endothelial growth factor (VEGF) from the hypoxic peripheral retina. This leads to retinal neovascularization and even retinal detachment in advanced cases. Recent studies suggest the successful use of anti-VEGFs like Bevacizumab in ROP treatment. However, Bevacizumab enters systemic circulation and alter the normal VEGF concentration in the body which is required for the normal development of kidney, lung, and brain development. Hence, it is important that the lowest possible dose of intravitreal Bevacizumab is given. Until now, studies have assessed 0.625 mg/0.025 ml to treat ROP.
The aim of this study was to determine whether a low dose (0.25 mg/0.01 ml) of intravitreal Bevacizumab is effective in the treatment of type 1 ROP. This was a prospective interventional study including 49 eyes of 25 consecutive premature infants with type 1 ROP, defined according to Early Treatment for Retinopathy of Prematurity guidelines as zone 1 any stage with plus disease, zone 1 stage 3 without plus disease, zone 2 stage 2, or 3 with plus disease. All were given intravitreal injections of 0.25 mg/0.01 ml of Bevacizumab and followed up until 90 weeks postmenstrual age.
In all the eyes, plus disease was regressed at 1 week follow-up. Extraretinal neovascularization regressed in 2–3 weeks. There were no treatment failures or recurrences in the follow-up period. No patients had ocular or systemic complications or side effects. However, 38% had a small avascular area in zone 3.
Validation of Guidelines for Undercorrection of Intraocular Lens Power in Children
Sachdeva V, Katukuri S, Kekunnaya R, Fernandes M, Ali MH. American Journal of Ophthalmology. 2017 Feb; 174:17-21.
After a pediatric cataract surgery, the control of long-term refractive outcome is a great challenge. Initial under correction of IOL is a common practice in view of the myopic shift associated with the growth of eyeball. However, the long-term refractive status of these children is largely unknown.
The aim of the study was to analyze the long-term refractive status of these children.
It was a retrospective observational study including records of children <7 years age who underwent lens aspiration with primary posterior capsulotomy with anterior vitrectomy and primary posterior chamber IOL implantation for congenital or developmental cataract. The IOL power was calculated using Sanders-Retzlaff-Kraff II formula and power was chosen as suggested by Enyedi et al. Data were collected regarding age at surgery, sex, etiology of cataract, technique of biometry, IOL power calculation formula used, method and amount of under correction done, and site of IOL placement, and IOL refraction was performed at various follow-up visits till 7 years of age.
The main outcome measured was prediction error (difference of refractive error from emmetropia) at 7 years of age. They considered 84 eyes of 56 children divided into 3 groups based on their age at surgery. About 8.3% of children achieved emmetropia while an equal proportion was myopic (45%) or hypermetropic (46%). Most children had a median refractive error ranging from −1.0D myopia to −1.5D hypermetropia. Prediction error was not significantly different in any group. The maximum myopic shift was observed in children <2 years of age. Multivariate analysis showed age at surgery as the only significant factor that influenced prediction error.
Hence these guidelines under correction may be safely used to select pediatric IOL power.
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Conflicts of interest
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