Vol: 43 Issue: 11 Month: November 2017
CME risk factors
Pseudophakic cystoid macular oedema is a common cause of reduced visual acuity gain after cataract surgery in patients with diabetes. A new study found unreported clinical characteristics that predispose diabetic patients to a high risk for this complication. The study evaluated 93 patients with type 1 or type 2 diabetes, comparing preoperative and postoperative spectral-domain optical coherence tomography imaging. The level of retinopathy was identified as a risk factor for central retinal thickness increase. This was also greater in patients with T1D than in patients with T2D, and the increase was greater in T2D patients who were insulin dependent than in T2D patients who were not using insulin. Not previously described, poor glycaemic control, which was determined by the high serum HbA1c level, was a predisposing risk factor.
P Ylinen et al., JCRS, “Poor glycaemic control as a risk factor for pseudophakic cystoid macular oedema in patients with diabetes”, Volume 43, Issue 11, 1376–1382.
Reducing infectious endophthalmitis
The beneficial effects of intracameral injection of antibiotics are supported by relatively strong evidence, whereas the beneficial effects of other prophylaxes against endophthalmitis have not been clearly established. A large-scale Japanese study evaluated the potential of the behind-the-lens technique to wash and clear the capsular bag for OVD removal for reducing the risk of infectious endophthalmitis. The prospective study looked at 9,720 eyes undergoing cataract surgery at 93 centres in Japan. Patients underwent phacoemulsification and implantation of a single-piece hydrophobic acrylic foldable intraocular lens and were followed for two months. All three cases of endophthalmitis that did occur had not received the behind-the-lens cleaning technique. The difference was statistically significant (P = .050, and the incidence of infectious endophthalmitis did not correlate with any other patient-related and surgery-related factors.
T Oshika et al., JCRS, “Endophthalmitis after cataract surgery: Effect of behind-the-lens washout”, Volume 43, Issue 11, 1399–1405.
Epithelial remodelling with corneal inlays
The corneas of emmetropic eyes that undergo implantation of a corneal shape-changing inlay undergo central thinning that tapers approximately to the 2.0mm radial zone. A study conducted in Mexico looked at 34 hyperopic patients and 29 myopic patients who had implantation of a Raindrop Near Vision Inlay in the non-dominant eye immediately after LASIK. The researchers concluded that the corneas of eyes undergoing corneal inlay implantation concurrently with myopic or hyperopic LASIK experience had similar amounts of epithelial remodelling to that seen in emmetropic eyes, with a minimal difference in profiles between the two procedures.
RF Steinert et al., JCRS, “Corneal remodelling after implantation of a shape-changing inlay concurrent with myopic or hyperopic laser in situ keratomileusis”, Volume 43, Issue 11, 1443–1449.