EW Weekly, September 30, 2016

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September 30, 2016
Volume 21 , Number 35

Tecnis Toric Calculator with PCA approved

The Tecnis Toric Calculator with posterior corneal astigmatism (PCA) compensation has received Food and Drug Administration approval, marketer Abbott Medical Optics (Abbott Park, Illinois) said. The PCA compensation "eliminates the need for look-up tables and improves the predictability of residual astigmatism," the company added.

Study: Lubricin a promising alternative to sodium hyaluronate for DED

Recombinant human lubricin demonstrated significant improvement in both signs and symptoms of dry eye disease (DED) compared to sodium hyaluronate (HA) in a recent study, developer Lubris BioPharma (Boston) said in a press release. According to the study authors, lubricin reduced the symptoms of dry eye by more than 70% and demonstrated statistically significant improvements against HA in the following symptoms: foreign body sensation ( p<.013), sticky feeling ( p<.0432), blurred vision ( p<.0013), and photophobia ( p<.011) in at least one eye. Lubricin demonstrated statistically significant improvements against HA in the following objective signs of dry eye: corneal fluorescein staining (OD/OS: 43.8%, 50.0%, vs. 26.5%, 23.3%, p<.0398, p<.0232, respectively), tear film break-up time ( p<.010), eyelid erythema ( p<0.004), conjunctival erythema ( p<.0013), and daily mean instillations ( p<0.04).

Study: iStent delivers sustained IOP/medication use reductions

A recently published study "showed that a consistent cohort of 107 open-angle glaucoma (OAG) eyes receiving the iStent Trabecular Micro-Bypass Stent in combination with cataract surgery achieved a 22% reduction in mean intraocular pressure (IOP) to 15.17 mm Hg and a 56% reduction in mean ocular hypotension medications to 0.61 two years following surgery," developer Glaukos (San Clemente, California) said in a press release. John Berdahl, MD, retrospectively evaluated 350 eyes of his own patients who underwent iStent implantation with concomitant cataract surgery between October 2012 and December 2015. In this study, OAG subjects were defined as patients with primary OAG, normal tension glaucoma and ocular hypertension, with no cases excluded. To date, this cohort represents the largest sample size to evaluate iStent and cataract surgery combined procedures.

Study: D-EYE detection may be better than ophthalmoscope

A recent study in the Journal of Hypertension found a smartphone-based retinal imaging system was better at detecting an abnormal fundus than a traditional ophthalmoscope in 41 patients who presented in an emergency department, D-EYE (Padua, Italy) said in a press release. All patients underwent both screening methods by an emergency room physician. No abnormalities were detected by traditional ophthalmoscopy, yet a significant number of abnormal fundus findings were detected by the use of D-EYE in 17 and 19 patients by the emergency physician and an ophthalmologist, respectively. The Kappa Coefficient ranged from good concordance for the assessment of hemorrhages and exudates, and from optimal concordance for the evaluation of presence and severity of papilledema.

RESEARCH BRIEFS

  • EX-PRESS Glaucoma Filtration Device (Alcon, Fort Worth, Texas) implantation combined with phacoemulsification cataract extraction is safe and effective for reducing intraocular pressure (IOP) and anti-glaucoma medications in primary angle-closure glaucoma (PACG) patients with cataract, according to B. Liu and colleagues. They evaluated 24 eyes (24 patients) with unregulated PACG who underwent the combined procedure. The EX-PRESS (R-50) was inserted into the anterior chamber under a scleral flap. The mean follow-up was 16.4±2.5 months (range 14-21 months), and the mean age of the patients was 64.7±6.8 years (range 56-78 years). The mean IOP was 20.4±5.4mm Hg preoperatively and decreased to 10.2±2.8, 13.1±2.7, 14.9±4.1, 14.3±3.9, and 14.0±3.6mm Hg on day 7 and at 1, 3, 6, and 12 months after surgery, respectively (all P<0.005). At 12 months, the mean BCVA was 0.62±0.33, and the number of medications was 0.3±0.6. The study is published in Medicine (Baltimore).
  • Conversion from manual phacoemulsification to femtosecond laser-assisted cataract surgery resulted in a statistically significant decrease in vitreous loss complication rates, according to W. Scott and colleagues. In their retrospective, single-center case series, the group audited cataract surgeries performed by four surgeons between 2010 and 2014 to analyze rates of vitreous loss with and without exclusions. Of the total 7,155 cases from 2010 to 2014, 3,784 were consecutively performed using manual phacoemulsification from 2010 to 2012, and 3,371 were performed using femtosecond laser-assisted cataract surgery from 2013 to 2014. The rate of vitreous loss with exclusions was 1.17% in the manual phacoemulsification group and 0.65% in the femtosecond laser-assisted group; without exclusions, the rate was 1.40% versus 0.77%. In absolute terms, the rate decreased for every surgeon in the study. Odds ratio analysis with exclusions versus without exclusions indicated that surgeries performed from 2010 to 2012 using manual phacoemulsification were 1.6 times and 1.8 times, respectively, more likely to have vitreous loss than surgeries performed from 2013 to 2014 using the femtosecond laser-assisted cataract surgery technique. The study is published in the Journal of Cataract & Refractive Surgery.
  • Selected cases of severely subluxated cataracts may be managed using femtosecond laser technology to perform the capsulotomy and nuclear fragmentation, with successful preservation of the capsular bag in 90% of eligible cases especially in eyes with soft cataracts, according to Soon Phaik Chee and colleagues. In this retrospective, interventional case series, all eyes with subluxated cataract (N=72) seen between July 2012 and June 2015 were assessed for suitability for femtosecond laser-assisted cataract surgery, with the use of capsular tension devices; 47 eyes (47 patients) were eligible. Participants with subluxated cataracts of at least 6 clock hours of zonular weakness were included in the study. The main outcome measure was the retention of the capsular bag. Almost two-thirds (30 eyes) had more than 9 clock hours of zonular weakness; 70% of cataracts (n=33) were nuclear sclerosis grade 3 and above. The capsular bag was preserved in 43 eyes (91.5%). The IOL was stable and centered at the last follow-up in all of the 43 eyes. An anterior capsule tear occurred in six eyes, all of which had cataracts of nuclear sclerosis grade 3 and above, with posterior extension occurring in three eyes. Primary posterior capsule rupture occurred in one eye. At 1 month, 37 eyes (80.4%) had a BCVA of 20/40 or better. There was significant improvement in BCVA at 1 month, which was maintained at 1 year. The study is published in the American Journal of Ophthalmology.

NEW PRODUCT BRIEFS

  • Keeler (Broomall, Pennsylvania) introduced the new Z Series slit lamp, noting it's the "only slit lamp currently available with a 1 mm square aperture and 14 mm variable slit width." Slit width can be manually adjusted from 0-14 mm. Preset apertures include 0.2, 2, 3, 5, and 9 mm, 14 mm circle, 1 mm square, specifically designed for assessment of uveitis, and space reserved for additional preset apertures. Slit angle can be continually adjusted 360 degrees. Blue, red-free, clear, and neutral density filters are included, and a flip-up diffuser provides a good visual of the whole eye at low magnification. A yellow barrier filter is included to detect subtle corneal staining.
  • Avedro (Waltham, Massachusetts) is now shipping Photrexa Viscous and Photrexa, the drugs used in corneal crosslinking procedures with the KXL System. The system is used in corneal collagen crosslinking for the treatment of progressive keratoconus and for the treatment of corneal ectasia following refractive surgery.
  • Bausch + Lomb (Bridgewater, New Jersey) launched an enhanced version of its Pinnacle 360 line of single-use instruments that now include a redesigned piston to provide smooth, consistent actuation. The line includes a strong, thinner internal limiting membrane forceps that provides surgeons with excellent visualization, allowing them to see down to the tissue as they engage it.

EYEWORLD WEEK Online is edited by Stacy Majewicz and Michelle Dalton.

EyeWorld Week Online (ISSN 1089-0319), a digital publication of the American Society of Cataract and Refractive Surgery and the American Society of Ophthalmic Administrators, is published every Friday, distributed by email, and posted live on Friday.

Medical Editors: Eric Donnenfeld, MD, chief medical editor; Rosa Braga-Mele, MD, cataract editor; Clara Chan, MD, cornea editor; Nathan Radcliffe, MD, glaucoma editor; and Vance Thompson, MD, refractive editor.

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