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• Various doses of a new topical nonsteroidal anti-inflammatory agent, diclofenac sodium, were tested against prednisolone sodium phosphate in a randomized double-masked study to determine comparative efficacy and safety regarding the reduction of postsurgical ocular inflammation. Inflammation was assessed by measuring fluorescein leakage into the anterior chamber using f luorophotometry techniques. Increased leakage in each patient's operated-on eye compared with the unoperated-on control eye was attributed to a breakdown in the blood-aqueous barrier caused by the cataract surgery. Elimination or significant reduction of fluorescein leakage within a treatment group constituted increased efficacy in controlling inflammation. A total of 124 cases were analyzed. There were no preoperative differences among groups in fluorescein leakage. At 1 week after surgery, all three diclofenac groups had significantly less fluorescein leakage compared with the prednisolone group. Mean percent increases were 56% to 118% in diclofenac groups vs 324% in the prednisolone group. No differences among diclofenac concentrations were detected. The differences between prednisolone and diclofenac were also present, although of lesser magnitude, at 3 weeks. This demonstration of increased efficacy of the nonsteroidal anti-inflammatory agent vs prednisolone is promising given the known side effects of ocular steroids.

• Neodymium-YAG capsulotomy for secondary cataracts can induce acute intraocular pressure rises, possibly by a blocking of the trabecular meshwork by debris. To test a hypothesis that bag-fixated intraocular lenses may act as a barrier to debris, thus reducing pressure rises after YAG capsulotomy, we conducted a study comparing pressures (at 1, 2, 3, 6, and 24 hours after YAG capsulotomy) between bag-fixated and sulcus-fixated cases. There were substantial and statistically significant intraocular pressure rises in the sulcus-fixated group starting at 1 and 2 hours after YAG capsulotomy, and peaking at 3 hours (mean rise, 7.83 mm Hg). There were no such peaks of intraocular pressure rise among bag-fixated cases (mean change, −0.32 mm Hg at 3 hours). There was a weak but significant (r = −.18) correlation between the change 1 hour after YAG capsulotomy in intraocular pressure and percent of enclosure of the intraocular lens optic among bag-fixated cases. Higher proportions (fourfold to fivefold) of cases with sulcus-fixated lenses had significant flare and particulate matter in the anterior chamber, compared with bag-fixated cases.

OBJECTIVE: To evaluate the long-term stability of the refractive outcome after metal-blade radial keratotomy procedures. DESIGN: A cohort of 146 patients who underwent 225 consecutive metal-blade radial keratotomy procedures that were performed under a uniform protocol between November 1979 and August 1981 was monitored prospectively, with 64% of the patients followed up for at least 5 years. MAIN OUTCOME MEASURES: Changes in spherical equivalent and changes in average keratometry were evaluated within the following periods: 3 months to 1 year; 1 to 2 years; 2 to between 3 and 4 years (mean, 3.7 years); between 3 and 4 (mean, 3.7 years) to between 5 and 12 years (mean, 8.5 years); and 1 to between 5 and 12 years (mean, 8.5 years). RESULTS: Total mean change in refraction between 1 year and the average of 8.5 years of follow-up was 1.01 diopters (D) (SD, 1.13 D). At 1 year, 31% of the cases were at least 1 D hyperopic, whereas at an average of 8.5 years, 48% were at least 1 D hyperopic. Fifty-four percent of the cases had shifted in the hyperopic direction by 1 D or more. Stepwise regression analysis failed to identify significant predictive factors for the hyperopic shifts. CONCLUSIONS: The trend toward progressive hyperopic shifts within this cohort has continued with time. Other long-term studies have documented similar, although somewhat smaller, hyperopic shifts among both patients treated with metal-blade and patients treated with diamond-blade procedures. Causative factors for the hyperopic shift have not been identified. It remains to be seen if eyes undergoing current, more cautious surgical approaches to radial keratotomy will also experience this phenomenon.