EyeWorld Weekly Update, June 30, 2017

June 30, 2017
Volume 23 , Number 23

Study: Increased risk for cataracts associated with statin use

A recently published meta-analysis of observational studies found an increased risk for the development of cataracts associated with statins, according to C. Alves and co-researchers. They acknowledged that their results contrasted other recently published research that analyzed randomized controlled trials and observational studies and found a 19% decrease in the risk of cataracts associated with statin use. In the study from Alves and co-researchers, 20 observational studies (10 cohort studies, seven case control studies, and three cross-sectional studies) were identified after a broad literature search. There was an increased risk for cataracts with statin use (OR 1.11 [95% CI 1.02-1.21]; P=0.03), but that risk became significant in studies from the year 2016. Because of the wide use of statins, researchers recommended further analysis of confounding variables to assess the consistency of the study's results. The work is published in Clinical Therapeutics.

NDA for drug that treats cataract surgery inflammation accepted by the FDA

The New Drug Application (NDA) for IBI-10090 (Dexycu, Icon Bioscience, Sunnyvale, California) has been accepted by the U.S. Food and Drug Administration (FDA), according to a company press release. The FDA has established a user fee goal date of Feb. 12, 2018, under the Prescription Drug User Fee Act. This indicates that the FDA has determined the NDA is sufficiently complete to permit a substantive review by the FDA; the drug could be potentially approved in early 2018. Dexycu uses Icon's Verisome technology to administer a sustained-release and biodegradable formulation of dexamethasone into the anterior chamber through a single injection given by the physician.


  • In a retrospective case-control study, cardiovascular disease was a risk factor for faster progression of glaucoma, according to Thomas Chun Wai Chan and co-researchers. This was a risk factor irrespective of IOP control. The study included 48 rapidly progressing eyes and 486 non-rapidly progressing eyes from five ophthalmology clinics. Eligible patients had a glaucoma diagnosis and had five or more Humphrey visual fields. Researchers collected clinical and demographic data, including age, sex, central corneal thickness, IOP, refraction, and medications. Those with the most rapid progression of glaucoma were older and had significantly lower central corneal thickness and baseline IOPs. They also were more likely to have pseudoexfoliation and ocular medication changes, among other factors. Subjects with cardiovascular disease were 2.33 times more likely to develop rapidly progressing glaucoma even if they had lower mean and baseline IOPs. The study is published in the American Journal of Ophthalmology.
  • The absence of laser suture lysis was associated with a low IOP after trabeculectomy, reported Victoria Tseng, MD, and co-researchers. Their retrospective case-control study focused on risk factors for low IOP after trabeculectomy and its long-term outcomes. Low IOP was defined as any patient with an IOP of 5 mm Hg or lower on three or more consecutive visits 3 months or later after trabeculectomy. Control patients who did not have low IOP were randomly selected. A variety of factors were considered when analyzing why patients had low IOP. Main outcome measures were low IOP after trabeculectomy, reoperation, vision loss, and surgical failure. Of 3,659 total trabeculectomies, 64 eyes had low IOP (1.7%) compared with 130 control eyes. The trabeculectomies were performed by five surgeons between 1990 and 2013. Laser suture lysis was negatively correlated with low IOP (odds ratio, 0.33; 95% confidence interval, 0.13-0.87). Individual surgeons were positively correlated with low IOP (OR, 5.32, 95% CI, 1.53-18.52). Factors that were not significant included time to reoperation, vision loss, and surgical failure. The research is published in Ophthalmology.
  • In emmetropic eyes, the astigmatic axis had a small but significant effect on uncorrected distance visual acuity (UDVA) in a retrospective study of eyes that had laser refractive surgery, according to M. Mimouni and co-researchers. Their study included 17,416 consecutive eyes of patients who had LASIK or PRK between January 2000 and December 2015. There were three groups in the study according to steep astigmatic axis: with-the-rule (WTR; 60 to 120), oblique (31 to 59 or 121 to 149), and against-the-rule (ATR; 0 to 30 or 150 to 180). The oblique group was additionally divided into oblique ATR and oblique WTR. The WTR eyes had better UDVA than the oblique ATR group, but the UDVA of the oblique and ATR groups was similar. When correcting astigmatism, it may be better to err toward WTR astigmatism, the authors concluded. The study is in the European Journal of Ophthalmology.
  • Phenylephrine and ketorolac injection 1.0%/0.3% (Omidria, Omeros, Seattle) was safe and efficacious for maintaining mydriasis and reducing ocular pain after surgery, according to Eric Donnenfeld, MD, and co-researchers. Their randomized clinical trial compared the study drug with a balanced salt solution (vehicle), ketorolac, and phenylephrine on pupil diameter during cataract surgery. The study's 223 patients were randomized to receive the vehicle, phenylephrine, ketorolac, or the study drug administered intracamerally during surgery, and pupil diameter was measured each minute by video. Researchers also evaluated postop ocular pain for up to 12 hours. The study drug was better than both the vehicle and ketorolac in maintaining mydriasis. Ocular pain was significantly lower with the study drug compared with the vehicle or phenylephrine. Both ketorolac and phenylephrine had therapeutic effects, and the combination of the two was superior to either agent alone in helping to maintain an intraoperative pupil diameter of 6.0 mm or larger. The study appears in the Journal of Cataract & Refractive Surgery.

    • At this week's World Glaucoma Congress in Helsinki, Finland, Quantel Medical (Clermont-Ferrand, France) launched the SubCyclo laser procedure, used to treat primary open-angle glaucoma and angle-closure glaucoma. SubCyclo is a non-thermal glaucoma treatment based on the transscleral cyclophotocoagulation principle, according to a company press release. It lowers IOP by stimulating the ciliary body and the uveoscleral pathway.

    This issue of EyeWorld Weekly Update was edited by Amy Goldenberg and Vanessa Caceres.

    EyeWorld Weekly Update (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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