Bonnie An Henderson

Clinical pseudophakic cystoid macular edema: Risk factors for development and duration after treatment

PURPOSE: To characterize the incidence, duration, and risk factors for and outcome of cystoid macular edema (CME) after cataract surgery and investigate the effects of treatment regimens on visual outcome and duration. SETTING: University‐based comprehensive ophthalmology practice. METHODS: This study included 1659 consecutive cataract surgeries performed by residents between 2001 and 2006. Cases were classified according to the presence of CME. Subset analysis excluded patients with diabetes mellitus (DM). The CME groups were analyzed according to type of treatment to compare duration of CME and final best corrected visual acuity. RESULTS: The incidence of postoperative CME was 2.35% (39/1659), and history of retinal vein occlusion (RVO) was predictive of postoperative CME (odds ratio [OR], 47.12; P<.001). When patients with DM were excluded, the incidence of CME was 2.14% (29/1357) and history of RVO (OR, 31.75; P<.001), epiretinal membrane (ERM) (OR, 4.93; P<.03), and preoperative prostaglandin use (OR, 12.45; P<.04) were predictive of postoperative CME. Patients with DM and/or intraoperative complications did not have an increased risk for CME when treated with prophylactic postoperative nonsteroidal antiinflammatory drugs (NSAIDs) for 3 months. Groups treated with NSAIDs plus a steroid had significantly shorter resolution times than the untreated group (P = .004). CONCLUSIONS: A history of RVO, ERM, and preoperative prostaglandin use were associated with an increased risk for pseudophakic CME. Treatment with NSAIDs plus steroids was associated with faster resolution of CME than no treatment. Treating high‐risk patients with NSAIDs after cataract surgery decreases the incidence of postoperative CME to that of patients who are not at high risk.

Antibiotic prophylaxis of postoperative endophthalmitis after cataract surgery: Results of the 2014 ASCRS member survey

&NA; A 2014 online survey of the American Society of Cataract and Refractive Surgery members indicated increasing use of intracameral antibiotic injection prophylaxis compared with a comparable survey from 2007. Forty‐seven percent of respondents already used or planned to adopt this measure. One half of all surgeons not using intracameral prophylaxis expressed concern about the risks of noncommercially prepared antibiotic preparations. Overall, the large majority (75%) said they believe it is important to have a commercially available antibiotic approved for intracameral injection. Assuming reasonable cost, the survey indicates that commercial availability of Aprokam (cefuroxime) would increase the overall percentage of surgeons using intracameral antibiotic injection prophylaxis to nearly 84%. Although the majority used topical perioperative antibiotic prophylaxis, and gatifloxacin and moxifloxacin were still the most popular agents, there was a trend toward declining use of fourth‐generation fluoroquinolones (60%, down from 81% in 2007) and greater use of topical ofloxacin and ciprofloxacin (21%, up from 9% in 2007).

Multifocal intraocular lenses: relative indications and contraindications for implantation.

UNLABELLED This article presents an extensive overview of best clinical practice pertaining to selection and use of multifocal intraocular lenses (IOLs) currently available in the United States. Relevant preoperative diagnostic evaluations, patient selection criteria, counseling, and managing expectations are reviewed, as well as how to approach patients with underlying ocular intricacies or challenges and best practices for intraoperative challenges during planned implantation of a multifocal IOL. Managing the unhappy multifocal IOL patient if implantation has been performed is also addressed. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.

Stepwise approach to establishing an ophthalmology wet laboratory

Wet laboratories (wet labs) play an increasingly important role in ophthalmology surgical residency training. We summarize the necessary components in establishing and maintaining a well-functioning wet lab and offer a stepwise guide for educators to improve the quality of the wet lab experience. We present 6 key factors in creating an ophthalmology wet lab; that is, setting up the physical space, establishing appropriate faculty and curriculum, obtaining the practice eye, stabilizing the eye, preparing the eye, and funding the wet lab.

Safety and Efficacy of Bromfenac Ophthalmic Solution ( Bromday ) Dosed Once Daily for Postoperative Ocular Inflammation and Pain

PURPOSE To evaluate the efficacy and ocular safety of bromfenac ophthalmic solution (bromfenac) 0.09% dosed once daily for the treatment of ocular inflammation and pain after cataract surgery with posterior chamber intraocular lens implantation. DESIGN Randomized, double-masked, vehicle-controlled or active-controlled, multicenter, clinical trials. PARTICIPANTS AND CONTROLS A total of 872 subjects (872 study eyes: bromfenac in 584, placebo in 288). METHODS Four randomized, double-masked, vehicle or active-controlled, clinical trials were conducted at 134 ophthalmology clinics in the United States. Subjects aged ≥ 18 years were randomized to receive either bromfenac 0.09% or placebo dosed once daily beginning 1 day before cataract surgery (day -1), continuing on the day of surgery (day 0), and continuing for an additional postoperative 14 days. Subjects were evaluated for efficacy and safety on days 1, 3, 8, 15, and 22. The primary efficacy end point was cleared ocular inflammation, measured by the summed ocular inflammation score (SOIS; anterior chamber cells and flare) by day 15. The secondary efficacy end point was the number of subjects who were pain-free at day 1. The data from the 4 trials were pooled for analyses. MAIN OUTCOME MEASURES The SOIS and ocular pain. RESULTS The proportion of subjects who had cleared ocular inflammation by day 15 was significantly higher in the bromfenac 0.09% group than in the placebo group (P < 0.0001). The mean SOIS in the bromfenac 0.09% group was significantly lower than in the placebo group at days 3, 8, 15, and 22 (P < 0.0001). The proportion of subjects who were pain-free at days 1, 3, 8, and 15 was significantly higher in the bromfenac 0.09% group than in the placebo group (P < 0.0001). The incidence of adverse events reported in the bromfenac 0.09% group was significantly lower than in the placebo group (P < 0.0001). On day 15, 84.0% of the bromfenac subjects had ≥ 1-line improvement in visual acuity compared with 66.1% of placebo subjects (P < 0.0001). CONCLUSIONS Bromfenac 0.09% dosed once daily was clinically safe and effective for reducing and treating ocular inflammation and pain associated with cataract surgery. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.

Radiotherapy and cataract formation.

In the past five decades, the treatment options for intraocular tumors have expanded from one surgical option of enucleation to numerous regimens including radiotherapy. Radiotherapy has proven to be as efficacious in controlling the malignant lesion; however, normal ocular structures can also be affected. The lens is radio-sensitive and therefore the development of post radiation cataract commonly impairs vision and the ability to monitor tumor recurrence. Prevalence, severity, onset, and prognosis of radiation-induced cataract depend highly on the dose and rate of radiation. Recently, additional studies have given insight into this important relationship and the efficacy of treatment options.

Incidence of intraoperative complications in cataract surgery performed by left-handed residents.

PURPOSE: To compare the incidence of intraoperative complications during cataract surgery performed by left‐handed and right‐handed residents and to find predictor variables for complications in resident‐performed surgery. SETTING: Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. METHODS: This retrospective chart review comprised cataract extractions performed by postgraduate fourth‐year residents from July 1, 2001, to June 30, 2006. The incidence of posterior capsule tear and vitreous loss were the main outcomes. Univariate and multivariate logistic analyses incorporated the variables of patient age and sex; laterality of surgical eye; presence of diabetes mellitus, glaucoma, or age‐related macular degeneration; history of vitrectomy; axial length; pseudoexfoliation; small pupils; white cataract; posterior polar cataract; handedness of resident; and academic quarter during which surgery occurred. RESULTS: Left‐handed residents performed 170 (9.8%) of the 1730 surgeries. The incidence of posterior capsule tear and vitreous loss was significantly lower in surgeries performed by left‐handed residents than in those performed by right‐handed residents (P = .03 and P<.001, respectively). Multivariate logistic analysis showed that resident right‐handedness and older patient age were predictive of an increased incidence of posterior capsule tear and vitreous loss. A small pupil was predictive of an increased incidence of vitreous loss. CONCLUSIONS: The incidence of posterior capsule tear and vitreous loss was significantly lower in cataract surgeries performed by left‐handed residents. Handedness and patient age were significant predictor variables for these complications.

Incidence and causes of ocular surgery cancellations in an ambulatory surgical center

PURPOSE: To report the incidence and analyze potentially preventable causes of ocular surgery cancellations. SETTING: Ambulatory Care Surgical Center of the Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. METHODS: A retrospective review of the ambulatory surgical center cancellation records and patient medical records from December 2001 to December 2003 was conducted. The primary statistical analysis was conditional logistic regression. RESULTS: Three hundred seventy‐nine of 7153 (5.3%) ambulatory ophthalmic surgeries were cancelled within 24 hours of the scheduled start time. Cancellation rates varied by patient age, with the rate among children being highest (8.7%) and that among older patients (age 60+) lowest (4.9%; P = .08). Surgeons who performed at least 4 surgeries per month on average had the lowest cancellation rate (P = .08). Cancellations occurred less frequently in warmer months (June, 3.3%; August, 4.2%) than during the rest of the seasons (P<.001). The highest incidence of cancellations occurred in February (7.8%) and the lowest in June (3.3%). Of the total causes, 41% were considered “preventable,” 45% “unpreventable,” and 14% “no reason given.” Cancellations deemed preventable were lower in general anesthesia cases (1.0%) than in local anesthesia cases (2.0%; P = .02). Preventable cancellation rates also varied by procedure and were statistically significant. CONCLUSIONS: Among ambulatory ophthalmic surgeries, there was a higher incidence of late cancellations in pediatric cases. Late cancellation rates were highest in cases scheduled in the winter, especially in February. Of the reasons documented for cancellations, 41% were considered “preventable” with proper preoperative counseling and instructions. The costs of late cancellations to the particular institution are estimated to be at least

Same-day Cataract Surgery Should Not Be the Standard of Care for Patients With Bilateral Visually Significant Cataract

100 000 per year, or nearly 1 month of scheduled surgeries in a 2‐year period.

Perioperative prophylaxis for postcataract extraction endophthalmitis.

Benefits of sequential surgery include assessment of the outcome of the first surgery to tailor the surgical technique, intraocular lens (IOL) power, and choice of IOL for the second surgery. Additionally, recovery may be prolonged from corneal edema, anterior chamber inflammation, or cystoid macular edema. Allowing the patient to maintain visual function in one eye during the recovery of the other eye can be important. Therefore, the few benefits of simultaneous surgery are greatly outweighed by risks of bilateral complications, inability to foresee refractive outcome, inability to alter IOL choice, potential loss of physician reimbursement, and possible increased legal ramifications.