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The article reports that choosing prophylactic regimens for the prevention of infection and endophthalmitis after cataract surgery depends on physician preference. Povidone-iodine is noted to be the most commonly used antiseptic by cataract surgeons due to its broad-spectrum of activity and absence of microbial resistance while gatifloxacin and moxifloxacin are the most frequent topical prophylactic antibiotics used by the members of the American Society of Cataract and Refractive Surgery.

The article discusses the importance of endoscope to retina surgeon. Topics mentioned include the us of the instrument as a vehicle backup camera during the routine surgery, the advice on how to use B-scan ultrasonography in identfying the abnormalities, and the providing of wide-angle views that are similar to overhead lighting and like the flaslight beam.

PURPOSE: To assess pupil diameter before and after femtosecond laser-assisted cataract surgery (FLACS) pretreatment and compare the outcomes of three laser platforms. METHODS: This prospective observational case series included consecutive patients scheduled to undergo cataract extraction using FLACS between August 2013 and February 2015. All eyes received FLACS pretreatment using three laser platforms: LenSx (Alcon Laboratories, Inc., Fort Worth, TX), Catalys (Abbott Medical Optics Inc., Santa Ana, CA), and Victus (Bausch & Lomb, Inc., Rochester, NY). The same protocol for preoperative medical mydriasis was used for all patients, and pupil diameter was assessed immediately before and 3 minutes after FLACS using a surgical ruler. RESULTS: A total of 198 eyes of 161 patients were included in the study. Mean pupillary miosis was 1.42 ± 1.26 mm for the LenSx, 0.66 ± 0.89 mm for the Catalys, and 0.14 ± 0.34 mm for the Victus groups. Furthermore, 8 of the 198 eyes (4.0%) demonstrated a pupil diameter of less than 5 mm after FLACS and 48 eyes (24.24%) demonstrated a pupil diameter of 6 mm or less. There was a statistically significant decrease in pupil diameter for all groups individually (P < .05). There was also a statistically significant difference among the three groups (P < .05), with LenSx inducing the highest degree of miosis, followed by Catalys, and finally Victus. A correlation between the pupil diameter before FLACS and degree of FLACS-induced miosis was demonstrated (P < .05), with larger pupil diameter before FLACS associated with greater miosis. CONCLUSIONS: FLACS pretreatment seems to induce significant pupillary miosis with all laser platforms assessed in this study. The decrease in pupil diameter after FLACS reached clinical significance for cataract extraction (< 5 mm) in 4.0% of cases, whereas 20.2% of eyes demonstrated small pupil diameter (= 6 mm) after FLACS pretreatment. [ABSTRACT FROM AUTHOR]

Purpose To compare corneal graft survival rate after primary Descemet's stripping endothelial keratoplasty (DSEK) and primary penetrating keratoplasty (PK) in patients with prior trabeculectomy or medically managed glaucoma. Methods A retrospective chart review was conducted on consecutive patients who underwent DSEK or PK. Inclusion criteria consisted of eyes with a diagnosis of glaucoma prior to corneal transplantation and ≥6 months of follow-up. Graft failure was defined as an oedematous cornea with failure to maintain deturgescence lasting beyond a period of 1 month of intense steroid therapy or vascularisation and scarring resulting in irreversible loss of central graft clarity. Corneal graft survival was calculated using Kaplan-Meier survival analysis. Patients were divided into four groups: trabeculectomy-DSEK, trabeculectomy-PK, medical-DSEK or medical-PK. Results Fifty eyes (30 DSEK, 20 PK) of 50 patients (mean age 77±10 years) met the enrolment criteria. Mean follow-up was 17.4±14.2 months. A significantly higher proportion of the DSEK grafts (50%) compared with PK grafts (10%) failed at last follow-up (p=0.005). Kaplan-Meier analysis identified a significant difference between the groups with respect to time to graft failure (p=0.006). Patients with trabeculectomy who underwent DSEK had earlier graft failures than all other groups (p≤0.035), but there were no differences between the medical-DSEK, medical-PK and trabeculectomy-PK groups (all p>0.35). Conclusions Eyes with prior glaucoma showed higher rates of DSEK graft failure compared with PK. Patients with prior trabeculectomy demonstrated higher and earlier corneal graft failure rates with DSEK than with PK. [ABSTRACT FROM AUTHOR]

The article focuses on the management of mooren's ulcer with descemetocele through amniotic membrane transplantation using fibrin glue and sutures, intra-conjunctival corticosteroid injection and conjunctival recession. Topics discussed include involvement of peripheral cornea with limbal in mooren's ulcer; administration of intraconjunctival injection of Kenalog; and presence of a descemetocele with a peripheral corneal ulceration warranting surgical intervention.

The article focuses on a panel discussion on the detection, prevention and treatment of various diseases led by Dr. Terry Kim at Ocular Surgery News (OSN) New York 2014. Topics covered include information on adenovirus, toxic anterior segment syndrome (TASS), endophthalmitis and methicillin-resistant Staphylococcus aureus (MRSA), experts involved including Dr. Jodi Luchs and Dr. Penny A. Asbell and the use of povidone-iodine antiseptic to address infectious keratoconjunctivitis.

The article offers information on the 46th Annual Scientific Congress from November 23-16, 2014.

The article reports on the impact of investigations into drug contamination cases on compounding pharmacies. A fungal meningitis outbreak was traced to contaminated steroids produced at a compounding pharmacy in Massachusetts in 2012. According to data from the U.S. Centers for Disease Control and Prevention, 745 cases were reported and 58 had already died.

The article reports on the high expectations of young patients with presbyopia, a dysfunctional syndrome of the eye lens, with regard to their options for vision correction treatment. It discusses the demand for a solution that will avoid the use of eyeglasses and maintain a youthful appearance. It examines the depression caused by the loss of near vision and the misunderstanding on the development of cataracts.

The article discusses the developments in the field of ophthalmology as of August 2013. It claims that ophthalmologists are well-positioned to conduct cosmetic ocuplastics like blepharoplasty as the eye is the centerpiece of the face. According to the journal's Doctor Mark R. Levine, good experience and background are very important in the performance of aesthetic surgery.

The article discusses the expanded role played by micro-stents in the management of glaucoma. It explains how micro-stents have helped fill a safety gap between medications and lasers and more traditional surgical procedures. It describes some safer procedures for management of glaucoma which are predicted to allow earlier interventions in patients noncompliant with medical therapy.

The article reports on a study on the effects of nutritional supplements on age-related macular degeneration (AMD) progression. It states that adding omega-3 fatty acids, with or without lutein and zeaxanthin, had minimal impact on AMD progression beyond the preventive impact of the original age-related eye disease study (AREDS) formulation. However, a positive impact on slowing AMD progression reportedly resulted in a combination of lutein/zeaxanthin.

The article reports that surgeons in the U.S. are attempting to discuss with their European colleagues corneal collagen cross-linking research. Researchers who are delving on the combination of ultraviolet light and riboflavin in the cornea to reinforce collagen bonds cite promising outcomes in individuals presenting with keratoconus and ectasia as reasons for pushing with clinical trials. The U.S. approval of the procedure is not expected for at least two years.

The article reports on the instrument-based pediatric vision screening for preschool children endorsed by the American Academy of Pediatrics, the American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus, and the American Association of Certified Orthoptists. Ophhalmologist David G. Hunter explains the importance of early detection and treatment of amblyopia. Updates to the instrument-based pediatric vision screening guidelines are discussed.

The article discusses physicians' adoption of optical coherence tomography (OCT) and other imaging technologies over visual field assessments of glaucoma patients. Some reasons why OCT has not yet been proven to detect glaucoma progression are provided. Advancements in glaucoma management through OCT imaging include faster processors and three-dimensional (3D) scans. OSN Glaucoma board member Joel S. Schuman points out the potential of OCT in assessing glaucoma progression.

Purpose: To compare in vitro susceptibility of amphotericin B (AMB) and amphotericin B methyl ester (AME) (a more soluble and less toxic formulation of AMB) against Candida albicans isolates recovered from human cases of endophthalmitis. Methods: The in vitro susceptibility of AMB and AME was determined for C. albicans isolates recovered from endophthalmitis ( N=10) and for C. albicans ATCC reference strain 90028 using the Clinical and Laboratory Standards Institute M27-A2 (NCCLS/CLSI) broth dilution method. All isolates were obtained from samples of vitreous humor of patients with suspected endophthalmitis within the last 5 years at the Bascom Palmer Eye Institute, University of Miami Miller School of Medicine (Miami, FL). Results: The minimal inhibitory concentrations (MICs) of AME were equal to or lower than values for AMB in 7 of the 10 isolates; range: AME (0.125-1 μg/mL) versus (0.5-1 μg/mL) for AMB. The MIC90 value of both drugs was equal (1 μg/mL). Compared with AMB, the minimal fungicidal concentrations (MFCs) of AME were equal to or lower in 8 of 10 isolates; range: AME (0.125-2 μg/mL) versus AMB (0.25-4 μg/mL). MFC90 values of AME (1 μg/mL) was slightly superior to AMB (2 μg/mL). The MIC of the quality control strain (ATCC® 90028) was within an acceptable range. Conclusions: AME was equivalent to AMB in vitro against C. albicans. This formula may offer a slightly more efficient and less toxic formulation for the treatment of Candida endophthalmitis. [ABSTRACT FROM AUTHOR]

Acute bacterial conjunctivitis, the most common cause of conjunctivitis, is responsible for approximately 1% of all primary-care consultations. Of the topical ophthalmic antibiotics used to treat acute bacterial conjunctivitis, fluoroquinolones are especially useful because they possess a broad antibacterial spectrum, are bactericidal in action, are generally well tolerated, and have been less prone to development of bacterial resistance. Besifloxacin, the latest advanced fluoroquinolone approved for treating bacterial conjunctivitis, is the first fluoroquinolone developed specifically for topical ophthalmic use. It has a C-8 chlorine substituent and is known as a chloro-fluoroquinolone. Besifloxacin possesses relatively balanced dual-targeting activity against bacterial topoisomerase IV and DNA gyrase (topoisomerse II), two essential enzymes involved in bacterial DNA replication, leading to increased potency and decreased likelihood of bacterial resistance developing to besifloxacin. Microbiological data suggest a relatively high potency and rapid bactericidal activity for besifloxacin against common ocular pathogens, including bacteria resistant to other fluoroquinolones, especially resistant staphylococcal species. Randomized, double-masked, controlled clinical studies demonstrated the clinical efficacy of besifloxacin ophthalmic suspension 0.6% administered three-times daily for 5 days to be superior to the vehicle alone and similar to moxifloxacin ophthalmic solution 0.5% for bacterial conjunctivitis. In addition, besifloxacin ophthalmic suspension 0.6% administered two-times daily for 3 days was clinically more effective than the vehicle alone for bacterial conjunctivitis. Besifloxacin has also been shown in preclinical animal studies to be potentially effective for the 'off-label' treatment of infections following ocular surgery, prophylaxis of endophthalmitis, and the treatment of bacterial keratitis. Taken together, clinical and preclinical animal studies indicate that besifloxacin is an important new option for the treatment of ocular infections. [ABSTRACT FROM AUTHOR]

The article offers information on diagnosis and treatment for inflammatory dry eye. It states that inflammatory dry eye can develop into epithelial damage and loss of vision if left untreated. It cites the standard definition of meibomian gland dysfunction (MGD) as an important step in matching new diagnosis and treatment methods for inflammatory dry eye. It attributes inflammation in aqueous-deficient dry eye as mediated by T-cell infiltration.

The article reports on the increasing practice of microincision glaucoma surgery. Surgeons are utilizing microincision techniques for implanting a wide variety of devices designed to facilitate aqueous outflow and lessen intraocular pressure. Of the current crop of microincision techniques that have surfaced, the U.S. Food and Drug Administration has approved trabeculectomy ab interno by NeoMedix and the more involved ab externo procedure canaloplasty.

An interview with several eye specialists is presented. According to the experts, maintaining ocular surface health is important in glaucoma management. Malik Y. Kahook states that a healthy ocular surface should have a balance between tear film layers and the epithelial cell layers, while Mark B. Sherwood explains that it can also be based on the physiological condition of the tear film and the corneal epithelium. They add that decreased vision is the most common complaints from patients. INSETS: Classifying Disorders of Ocular Health;Ocular Surface Disease.

The author offers step-by-step instructions for performing canaloplasty for the treatment of glaucoma.

The article discusses the potential impact of advances in refractive vision correction options on ophthalmic surgeons and patients. It describes the differing views of these surgeons regarding surgical trends such as laser-assisted in situ keratomileusis (LASIK) and surface ablation. Surgeon Richard W. Yee supports the renewed popularity of surface ablation unlike fellow surgeon Eric D. Donnenfeld who asserts that the cost of LASIK is comparable to the cost of photorefractive keratectomy (PRK).

The author talks about innovation and education in ophthalmology and the duty of a physician. He views the duty of the ophthalmologist as defining the problems and unmet needs in daily practice that might help preserve, restore and enhance vision. He discusses the presence of conflicts of interest in every ophthalmologist's practice including personal interest conflicts. He calls for support to innovation so as to preserve, restore and enhance vision for the benefit of patients worldwide.

The article focuses on the debate regarding the use of bevacizumab and ranibizumab that was spurred by the analysis of Johns Hopkins Medicare and the Comparison of Age-Related Macular Degeneration (AMD) Treatment Trials (CATT) of the National Eye Institute. It mentions that ranibizumab is approved by the Food and Drug Administration (FDA) while bevacizumab is not. It also notes that 1,185 patients in the CATT study were given intraviteral injections of bevacizumab and ranibizumab.

The article presents the challenges of accountable care organizations (ACO), made up of primary care physicians and hospitals, that participate in the Medicare Shared Savings Program starting in January 2012. An ACO shares in the savings of the program provided standards and reduced health care spending are met but may repay Medicare for losses above the benchmark. Ophthalmologists may gain from getting referrals of new patients from ACO doctors but lose over the health care dollar rationing.

The article discusses the increased interest in research on epithelium-on cross-linking even as epithelium-off methods are not yet approved by the U.S. Food and Drug Administration (FDA). In the U.S., both modalities are used under regulatory investigational exemptions. Clinical trials on epithelium-on procedures are being conducted to test its promise of efficacy in reducing pain, faster healing and quicker improvement in visual activity. INSET: POINT/COUNTER.

The article discusses small firm innovation and projects that are deemed to have the potential to change how retinal medicine is practiced in the U.S. It cites the introduction of optical coherence tomography which allowed an improved visualization medium for clinical and research purposes. The Argus II retinal prosthesis by Second Sight Medical Products Inc. is cited as an example of innovative technology entering the retinal market after small firm development. Also noted is Vitrasert, the first drug delivery implant introduced to the U.S. market.

The article reports that some medical experts in the U.S. see the lack of testing for generic ophthalmic drugs to be problematic. It mentions that they are disturbed by the implications of the Drug Price Competition and Patent Term Restoration Act which allowed the licensure of drugs based on bioequivalence demonstration. According to the author, they are concern about the negative effects of the lack of requirement for clinical testing on the efficiency and safety of generic drugs.

The article explores the challenges of successful pediatric cataract surgery. It notes that cataract surgery is more complex in children, with the presurgical process more involved, and a long term follow-up that involves patching, drops and monitoring changes in eye growth among others. Some of the major issues include compliance, risk of subsequent glaucoma and use of anesthesia, while treatment approach reportedly varies depending on patient age and cataract morphology.

The article discusses the risk factors and prevention of postoperative endophthalmitis. Endophthalmitis is an inflammation of the internal coats of the eye that can lead to complete loss of vision. It states that critical care must be taken to address all risk factors for endophthalmitis in the operative stages of treatment.

The article focuses on eye disorder keratoconus which includes information on the approval of corneal collagen cross-linking to treat keratoconus and corneal ectasia by U S Food and Drug Administration (FDA).

The article focuses on role of the collagen cross-linking towards slow progression of keratoconus. It mentions that collagen cross-linking was first used for keratoconus management by using ultraviolet A (UVA) light irradiation that was combined with corneal riboflavin (vitamin B2) application. It also mentions approval of the cross-linking procedure of Avedro by the U.S. Food and Drug Administration (FDA).