Guillermina Villanueva

A Randomized Double-Masked Trial Comparing Ketorolac Tromethamine 0.5%, Diclofenac Sodium 0.1%, and Prednisolone Acetate 1% in Reducing Post-Phacoemulsification Flare and Cells

BACKGROUND AND OBJECTIVE To compare the efficacy of ketorolac tromethamine 0.5%, diclofenac sodium 0.1%, and prednisolone acetate 1% in reducing flare and cells following cataract surgery. PATIENTS AND METHODS Fifty-eight patients undergoing phacoemulsification with posterior chamber intraocular lens implantation were randomly selected to receive either ketorolac tromethamine 0.5%, diclofenac sodium 0.1%, or prednisolone acetate 1% following surgery. The treatment regimen was 1 drop 4 times a day for 1 week, then twice a day for the next 3 weeks. Flare, cells, and intraocular pressures (IOPs) were measured preoperatively and on postoperative days 1, 7, and 28. RESULTS No statistically significant differences in either actual flare or cell counts or in change in flare or cell counts from baseline were detected among the three groups. No statistically significant differences in IOP or in change of IOP from preoperative measurements were detected. No medication-related complications were noted at any time. CONCLUSION Ketorolac tromethamine 0.5% and diclofenac sodium 0.1% may be as effective and as safe as prednisolone acetate 1% in controlling inflammation following cataract extraction.

Valve membrane adhesion as a cause of Ahmed glaucoma valve failure.

PurposeThe purpose of this study was to describe a possible mechanism of failure of the Ahmed glaucoma valve (AGV; New World Medical, Rancho Cucamonga, CA). MethodTwo AGVS that failed to control intraocular pressure (IOP) were examined. In vivo examination consisted of unroofing the capsule surrounding the implant and injecting fluorescein-stained balanced salt solution into the tube. In one case the entire implant was removed and examined in vitro, and in the other case only the valve portion was removed. ResultNo flow in either case extended beyond the valve. In both cases, the membrane valve system was found to be fused and could not be pulled apart. ConclusionFailure of the AGV may occur due to adhesion of the valve membranes.

Reproducibility of the Laser Flare Meter and Laser Cell Counter in Assessing Anterior Chamber Inflammation Following Cataract Surgery

BACKGROUND AND OBJECTIVES To determine the interobserver and intraobserver reproducibility of the laser flare meter and laser cell counter in assessing anterior chamber inflammation following cataract surgery. PATIENTS AND METHODS Thirty-nine eyes with varied degrees of inflammation and 9 normal eyes were included in the study. Anterior chamber flare and cells were evaluated with the slit lamp and graded on a scale of 0 to 4+. The flare and cells were then measured three times each using the flare meter and cell counter by two different, experienced observers. The intraobserver reproducibilities were computed to evaluate repeatability of the instruments operated by the same observer. The first measurement taken by each observer was used to assess reproducibility between the two observers. RESULTS The intraobserver reproducibility for overall flare was 0.995 for both observers. The intraobserver reproducibility for overall cells was 0.996 for observer 1 and 0.991 for observer 2. The overall interobserver reproducibility was 0.994 for flare and 0.988 for cells. The correlation between measurements and slit-lamp ratings was 0.78 for flare and 0.56 for cells. CONCLUSIONS The intraobserver and interobserver reproducibilities were excellent, with good correlation to slit-lamp measurements. Reproducible results can be obtained using the laser flare meter and the laser cell counter. It is not known whether these results are applicable to other inflammatory processes with higher grades of flare and cells and with different protein and cell types.

Quantitative assessment of aqueous flare: The effect of age and pupillary dilation

OBJECTIVE To assess the effect of age and pupillary dilation on aqueous flare. METHODS In this study, 100 eyes of 100 patients ranging in ages from 23 to 84 years were examined. Anterior chamber flare was measured before and after pupillary dilation using the Kowa laser flare meter (FM-500). Predilation and postdilation flare counts were compared by paired t-test. Stepwise regression analysis was then used to determine the effect of demographic variables on pre- and postdilation flare as well as the difference between pre-and postdilation flare counts. RESULTS The predilation and postdilation flare counts correlated with age (P < 0.0001 for both pre-and postdilation flare counts). Correlation coefficient between age and flare measurements was R2 = 0.58 predilation and 0.63 postdilation. Flare intensity significantly decreased after pupillary dilation (P < 0.001). CONCLUSIONS Anterior chamber flare increases with age. It might be related to blood-aqueous barrier instability. Pupillary dilation significantly decreases flare counts suggesting that aqueous protein concentration is dependent on aqueous flow rates.

Efficacy of preoperative versus postoperative ketorolac tromethamine 0.5% in reducing inflammation after cataract surgery

Purpose: To compare the efficacy of 30 minute preoperative versus 1 day postoperative administration of ketorolac tromethamine 0.5% ophthalmic solution (Acular®) in reducing anterior chamber inflammation after cataract surgery. Setting: The Hermann Eye Center, The University of Texas Health Science Center–Houston, Texas, USA. Methods: Fifty eyes of 48 consecutive patients scheduled for phacoemulsification with intraocular lens implantation were included. Before surgery, patients were randomly assigned to start the study drug 30 minutes preoperatively or 1 day postoperatively. No other antiinflammatory agents were used intraoperatively or postoperatively. Main outcome measures were flare and cell counts. Results: Preoperative and postoperative flare and cell counts did not differ significantly between the 2 treatment groups at any time. Both groups showed significant increases in flare (P = .0001) and cells (P = .0001) 1 day postoperatively. Flare and cells returned to baseline levels by day 28 in both groups. There was no significant difference at any time between the 2 groups in the change from the preoperative level of inflammation. Conclusion: There was no difference between administering ketorolac 30 minutes preoperatively versus 1 day postoperatively in reducing inflammation.

Consensual inflammation following ocular surgery.

PURPOSE To determine whether a consensual inflammatory response occurs following unilateral phacoemulsification or trabeculectomy in humans. METHODS Sixty patients undergoing phacoemulsification or primary trabeculectomy were included in the study. Some patients were randomly assigned to have a shield placed on the non-operated eye during surgery. The Kowa laser flare meter (FM-500) and laser cell counter (LC-500) (Kowa Electronics and Optics, Tokyo, Japan) were used to assess the inflammatory response in both eyes. Measurements were taken preoperatively and on postoperative days 1, 7 and 28. The regression analysis with random model effect was used to identify factors which may affect the change of flare and cells in the non-operated eye after surgery. Correlation was evaluated between the inflammatory responses of the paired eyes. A P<0.05 was considered statistically significant for all analyses. RESULTS The flare and cells in the non-operated eye showed a small, but significant, increase on day 1 (mean flare increased 2.68 photons/ms from preoperative level with P<0.001 and mean cells increased 2.49 cells/0.5 mm3 from preoperative level with P<0.0001). At day 7 the amount of inflammation was still elevated (mean flare increased 0.41 photons/ms from preoperative level with P<0.001 and mean cells increased 0.63 cells/0.5 mm3 from preoperative level with P<0.001). By day 28, the amount of inflammation in the nonoperated eyes returned to preoperative levels. CONCLUSIONS Subclinical inflammation occurs in the non-operated eye following phacoemulsification and trabeculectomy. The etiology of this finding has yet to be elucidated.

Low-dose postoperative transconjunctival application of mitomycin C in rabbit trabeculectomy.

PURPOSE Mitomycin C (MMC) is commonly administered during filtering surgery to enhance the success of the procedure. Unfortunately, the increased success rate is associated with complications, including late bleb leaks, endophthalmitis, and ciliary epithelial toxicity. The purpose of this study was to investigate a safe and effective dose regimen for MMC to reduce incidence of those complications. METHODS Trabeculectomy was performed in 36 rabbits. MMC was applied only during surgery, only one day after surgery, or once daily after surgery for 3 days at lower concentrations. Balanced salt solution (BSS) was administered during surgery to one group as a placebo. The time to bleb failure was determined and the eyes were evaluated histopathologically. Success and toxicity were compared for the different treatment groups. RESULTS The mean time until trabeculectomy failure was 2.83 days for the placebo group, 6.33 days with administration of MMC 0.5 mg/mL during surgery, 7.83 days with administration of MMC 0.5 mg/mL once after surgery, and 11, 9, and 4.83 days with administration of MMC 0.1 mg/mL, 0.05 mg/mL, or 0.025 mg/mL, respectively, once a day for 3 consecutive days. On electron microscopic examination of the ciliary epithelium, toxic effects were greatest with MMC concentrations of 0.5 mg/mL and were less with lower concentrations. CONCLUSION The effect of MMC on trabeculectomy survival was dependent on both the concentration and the method of administration. Lower concentrations with multiple postoperative administrations were as effective as but caused less ciliary body toxicity than intraoperative administration of higher concentrations.