July 2018


In the Journal of Cataract & Refractive Surgery July 2018

Randomized controlled European multicenter trial on the prevention of cystoid macular edema after cataract surgery in diabetics: ESCRS PREMED study report

Laura Wielders, MD, Jan Schouten, MD, Bjorn Winkens, PhD, Frank van den Biggelaar, PhD, Claudette Veldhuizen, MD, Joaquim Murta, MD, Willem Goslings, MD, Thomas Kohnen, MD, Marie-José Tassignon, MD, Maurits Joosse, MD, Ype Henry, MD, Zoltán Nagy, MD, Alexander Rulo, MD, Oliver Findl, MD, Michael Amon, MD, Rudy Nuijts, MD
In this clinical trial, the aim was to compare prophylactic strategies for reducing CME in diabetic patients after uncomplicated cataract surgery. The 213 patients in the study all received topical bromfenac 0.09% and dexamethasone 0.1% and were randomized to receive either a 40 mg subconjunctival triamcinolone acetonide injection, a 1.25 mg intravitreal injection of bevacizumab, a combination of both, or no additional treatment. Investigators determined that for those who received the subconjunctival triamcinolone acetonide injection the mean macular thickness at 6 weeks was 12.3 microns less and at 12 weeks was 9.7 microns less than those who did not receive this medication. Also, no CME occurred among those who received the triamcinolone. Macular thickness, however, was not significantly affected by the intravitreal bevacizumab. The conclusion reached was that triamcinolone was associated with lower macular thickness and macular volume in diabetic patients at 6 to 12 weeks than those who received the bevacizumab or who were given no additional treatment. The bevacizumab had no significant effect.

Long-term results of mechanical epithelial removal versus transepithelial phototherapeutic keratectomy followed by accelerated corneal crosslinking for pediatric keratoconus

Ozge Sarac, MD, Pinar Kosekahya, MD, Mehtap Caglayan, MD, Burak Tanriverdi, MD, Ayse Güzin Taslipinar Uzel, MD, Nurullah Cagil, MD
This retrospective case series examined 36-month outcomes of accelerated corneal crosslinking for pediatric keratoconus when done with mechanical epithelial removal versus using a transepithelial phototherapeutic keratectomy (PTK) approach. All of the 35 keratoconus patients treated were under 18 years of age. Mechanical epithelial removal followed by accelerated crosslinking was performed in 15 eyes. Another 20 eyes were evaluated after transepithelial PTK was performed followed by the accelerated crosslinking procedure. At the 36-month mark, investigators found that there was a significant decrease in maximum keratometry, as well as in thinnest corneal thickness. The uncorrected distance visual acuity had significantly improved. While at 12 months postoperatively those who underwent transepithelial PTK prior to crosslinking had greater improvements in maximum K, topographic astigmatism, and spherical aberration, after this period outcomes were similar throughout the rest of follow up. Investigators concluded that in pediatric keratoconus patients, while the initial topographic and visual results were better with the transepithelial PTK approach before accelerated crosslinking, in the long term outcomes were equivalent.

Reproducibility of laser in situ keratomileusis flap thickness using a new multifunctional femtosecond laser platform and correlation with clinical preoperative measurements

Marcello Colombo-Barboza, MD, Guilherme Colombo-Barboza, MD, Luiz Roberto
Colombo-Barboza, MD, Mateus Matuoka, MD, Adamo Lui Neto, MD, Denise de
Freitas, MD

How reproducible is LASIK flap thickness when using the multifunctional LenSx femtosecond laser (Alcon, Fort Worth, Texas)? Investigators in this prospective case series involving 63 eyes set out to determine this. Patients included had acuity between –1.25 and –6 D with allowance for astigmatism up to –4 D. Under high resolution, the cornea of each eye was examined in four sections: 45- to 225-degree, 90- to 270-degree, 135- to 315-degree, and 0- to 180-degree meridians. In two out of 20 measurements, a significant difference from the flap thickness target was found. Overall, however, there was an actual difference of 2.2 microns. No correlation was found between preoperative clinical factors and reproducibility of the LASIK flap. Using the multifunctional femtosecond laser, this reproducibility was determined to be good.

In the Journal of Cataract & Refractive Surgery July 2018 In the Journal of Cataract & Refractive Surgery July 2018
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