February 2019


News in brief

First no-baseline concussion test approved

The U.S. Food and Drug Administration (FDA) approved marketing of EyeBOX (Oculogica, New York), the first noninvasive, baseline-free test to help diagnose concussion. The manufacturer plans to market the device for use in patients 5 years old to 67 years old. It will start with a pilot launch for select, qualified sites. EyeBOX uses eye tracking to provide objective information that helps clinicians assess patients who have a suspected concussion. It uses a simple, 4-minute test that does not require a baseline test. EyeBOX uses a unique eye-tracking algorithm to enable it to perform without a baseline. EyeBOX was evaluated in a clinical trial known as DETECT, which enrolled 282 patients at six U.S. clinical sites. They compared the EyeBOX results to a clinical reference standard for concussion in patients presenting to emergency departments and sports medicine clinics with suspected head injury. The study showed that the EyeBOX has high sensitivity to the presence of concussion and that a negative EyeBOX result is consistent with a lack of concussion, the company said.

Few eye patients infected without systemic antibiotics

Among 608 consecutive patients who underwent orbital surgery without prophylactic systemic antibiotics, five were diagnosed with postop surgical site infections (SSIs), according to new research. The single-center retrospective descriptive case series was published in the British Journal of Ophthalmology. The authors studied the notes of 639 consecutive patients who had undergone orbital surgery in one hospital from 2009 through 2013. Among the patients, 226 were categorized as “clean orbital surgery,” 290 were “clean orbital surgery with implant,” and 92 were “clean-contaminated surgery.” Among the five patients diagnosed with SSI, one was in the “clean” group, three were in the “clean with implant” group, and one was in the “clean-contaminated” group. All five patients with SSI were effectively treated with antibiotics. Due to the low infection rate and the effective treatment with systemic antibiotics of those infected, the authors suggested restricting the use of systemic antibiotic prophylaxis in orbital surgery.


1. de Keizer ROB, et al. Retrospective study in 608 cases on the rate of surgical site infections after orbital surgery without prophylactic systemic antibiotics. Br J Ophthalmol. 2018. Epub ahead of print.

Better visual outcomes in bacterial keratitis with high- dose steroid treatment

A high-dose steroid treatment was significantly associated with better visual outcomes in patients with culture-positive bacterial keratitis, according to a case series published in the journal Cornea. The single-center retrospective review of patients with culture-positive bacterial keratitis treated between 1999 and 2015 identified them through a database and gathered clinical information through a subsequent medical record review. High-dose steroid treatment was classified as six or more drops of a steroid a day started within 7 days of corneal scraping. The outcome of a patient’s episode of keratitis was classified as good if their final visual acuity was 6/12 or better and poor if it was 6/60 or worse or required a corneal transplant. Otherwise, it was classified as average. Among the 328 patients reviewed, 164 were treated with steroids. Factors significantly associated with outcomes in the multivariate model were high-dose steroid treatment, visual acuity on presentation, age group, cause of keratitis, infiltrate size, and location. The odds ratio of better outcomes with high-dose steroids was 5.49.


1. Green M, et al. High-dose steroid treatment of bacterial keratitis. Cornea. 2019;38:135–140.

Preop natural lens tilt predicts postop IOL tilt

Preop crystalline lens tilt could be used to predict the postop IOL tilt, according to a study in the Journal of Cataract and Refractive Surgery. Researchers evaluated crystalline lens and IOL tilt using a swept-source optical coherence tomography (SS-OCT) biometer (IOLMaster 700, Carl Zeiss Meditec, Jena, Germany). In the retrospective case series of 333 patients, the authors found excellent repeatability of crystalline lens tilt measurements using the SS-OCT biometer. There was mirror symmetry between the right eyes and left eyes. The lens tilt magnitude was greater in short eyes and in eyes with a larger angle.


1. Wang L, et al. Evaluation of crystalline lens and intraocular lens tilt using a swept-source optical coherence tomography biometer. J Cataract Refract Surg. 2019;45:35–40

DMEK provides improved graft survival post-PK failure

Treatment of failed penetrating keratoplasty (PK) with Descemet membrane endothelial keratoplasty (DMEK) produced similar 4-year survival rates (76%) and better visual outcomes than previously reported with Descemet stripping endothelial keratoplasty (DSEK) or an initial PK regraft, according to research. The study in the journal Cornea prospectively reviewed 93 DMEK procedures performed in 84 eyes of 77 patients with failed PK. Median Snellen corrected distance visual acuity improved from 20/100 preop to 20/30 at 6 months postop. Rebubbling rates were 53% when the diameter of the DMEK graft was oversized, 27% when same sized, and 33% when undersized relative to that of the previous PK graft. Previous glaucoma surgery was the only significant risk factor for failure.


1. Pasari A, et al. Descemet membrane endothelial keratoplasty for failed penetrating keratoplasty: visual outcomes and graft survival. Cornea. 2019;38:151–156.

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