This Issue At A Glance

Abstract

The Risk of Microbial Keratitis in Contact Lens WearersFindings from a 2-year prospective case-control study by Dart et al (p. 1647) suggest that contact lens (CL)/ocular surface interactions may be more important in the development of corneal infection than oxygen levels and CL case contamination. The study involved 367 CL wearers with presumed microbial keratitis (MK) seen at one hospital, 1069 hospital control CL wearers with disorders unrelated to CL, and 639 control CL wearers randomly selected from the local area. Compared with planned replacement soft lenses, the relative risks of MK was significantly increased with daily disposable (DD) contact lenses (and different between brands of DD lenses), was reduced for rigid lenses, and no different for silicone hydrogel lenses. Although the risk of MK was higher overall in DD lens wearers, the risk of vision loss was less than for planned replacement soft CL users. The authors conclude that different brands of CL may be associated with significantly different MK risks, a finding that should lead to the development of safer soft contact lenses.Study Reviews Management of Dislocated Intraocular LensesA large retrospective study by Kim et al (p. 1699) characterizing the management of dislocated intraocular lenses (IOLs) indicates that IOL dislocation most commonly involves foldable IOLs, with the frequency of in-the-bag dislocations increasing. Effective treatment techniques include IOL repositioning with or without scleral suture fixation or IOL exchange. The investigators reviewed 284 eyes of 277 patients who underwent surgery for dislocated IOLs. Three month follow-up data was gathered from 184 eyes. Dislocated lenses included polymethyl methacrylate IOLs, silicone plate IOLs, 3-piece silicone IOLs, and acrylic IOLs. “In-the-bag” dislocations were associated with pseudoexofoliation and ocular trauma. Cystoid macular edema was the most common complication of a dislocated IOL. In 11 eyes, retinal detachment occurred after management of the dislocated IOL. The authors caution that management approaches depend upon surgeon preferences and specialty (this study was performed by vitreoretinal specialists), yet the wide range of treatment options allows surgeons to customize the optimal treatment approach for each patient.Black Diaphragm Intraocular Lens for AniridiaAlthough individuals with aniridia have significant higher order optical aberrations associated with an increased pupillary aperture to focal length ratio, they often experience further aberrations following cataract surgery. In 1994, Sundmacher et al developed the black diaphragm intraocular (BDI) lens to counter these optical effects, and this study by Aslam et al (p. 1705) evaluates the biometry accuracy, visual outcomes, and long-term changes in 40 eyes of 35 patients with congenital and traumatic aniridia implanted with the BDI lens. Results showed that the mean biometry prediction error was the equivalent to 80% of target eyes being within 2 diopters of predicted refraction. The main complication was glaucoma, which occurred immediately after surgery–suggesting a possible direct mechanical effect of the large BDI lens. Visual outcomes were better when using the BDI lens for traumatic aniridia compared with congenital aniridia. The authors urge caution when using the BDI lens in congenital anirida due to glaucoma management challenges; delaying cataract surgery is suggested with these patients.Decreased Visual Acuity in Urban Preschool ChildrenA cross-sectional study by Friedman et al (p. 1786) of children aged 30 months through 71 months in Baltimore, Maryland, found that bilateral decreased visual acuity (VA) in white and African American children was infrequent, with uncorrected ametropia the most common cause. This decreased VA was not consistently associated with age, race, or sex. The researchers included 1714 of 2546 children (67%) in the 30 months to 71 months age group of the Baltimore Pediatric Eye Disease Study, conducting an in-home interview and comprehensive eye examination. Decreased visual acuity was initially detected in 1.2% among white children and 1.8% among African American children. After retesting within 60 days of the initial exam and with children wearing the best refractive correction, the rate of decreased VA in both eyes was 0.5% among whites and 1.1% among African Americans. Limitations of the study included a 62% overall examination response rate, and the fact that 42.7% of the children were untestable using the Amblyopia Treatment Study VA testing protocol.Three Antimetabolite Drugs Compared for Noninfectious Ocular InflammationIn a retrospective study comparing the relative effectiveness and side effects of 3 commonly used antimetabolite agents to treat ocular inflammation—methotrexate, azathioprine, and mycophenolate—Galor et al (p. 1826) found that mycophenolate controls ocular inflammation faster than methotrexate, with azathioprine demonstrating the highest rate of treatment-related side effects compared with the other 2 agents. The majority of the 257 patients involved in the study were diagnosed with uveitis or scleritis. Ninety were treated with methotrexate, 38 with azathioprine, and 129 with mycophenolate. The median time to treatment success was 4.0 months for the mycophenolate, 4.8 months for the azathioprine, and 6.5 months for the methotrexate treatment groups. The incidence of side effects was higher in the azathioprine group compared with the other 2 drugs. In addition to these findings, other factors should be taken into consideration when deciding on an appropriate corticosteroid-sparing therapy including costs, dosing, pill size, availability of an injectable form, and long-term experience in children. The Risk of Microbial Keratitis in Contact Lens WearersFindings from a 2-year prospective case-control study by Dart et al (p. 1647) suggest that contact lens (CL)/ocular surface interactions may be more important in the development of corneal infection than oxygen levels and CL case contamination. The study involved 367 CL wearers with presumed microbial keratitis (MK) seen at one hospital, 1069 hospital control CL wearers with disorders unrelated to CL, and 639 control CL wearers randomly selected from the local area. Compared with planned replacement soft lenses, the relative risks of MK was significantly increased with daily disposable (DD) contact lenses (and different between brands of DD lenses), was reduced for rigid lenses, and no different for silicone hydrogel lenses. Although the risk of MK was higher overall in DD lens wearers, the risk of vision loss was less than for planned replacement soft CL users. The authors conclude that different brands of CL may be associated with significantly different MK risks, a finding that should lead to the development of safer soft contact lenses. Findings from a 2-year prospective case-control study by Dart et al (p. 1647) suggest that contact lens (CL)/ocular surface interactions may be more important in the development of corneal infection than oxygen levels and CL case contamination. The study involved 367 CL wearers with presumed microbial keratitis (MK) seen at one hospital, 1069 hospital control CL wearers with disorders unrelated to CL, and 639 control CL wearers randomly selected from the local area. Compared with planned replacement soft lenses, the relative risks of MK was significantly increased with daily disposable (DD) contact lenses (and different between brands of DD lenses), was reduced for rigid lenses, and no different for silicone hydrogel lenses. Although the risk of MK was higher overall in DD lens wearers, the risk of vision loss was less than for planned replacement soft CL users. The authors conclude that different brands of CL may be associated with significantly different MK risks, a finding that should lead to the development of safer soft contact lenses. Study Reviews Management of Dislocated Intraocular LensesA large retrospective study by Kim et al (p. 1699) characterizing the management of dislocated intraocular lenses (IOLs) indicates that IOL dislocation most commonly involves foldable IOLs, with the frequency of in-the-bag dislocations increasing. Effective treatment techniques include IOL repositioning with or without scleral suture fixation or IOL exchange. The investigators reviewed 284 eyes of 277 patients who underwent surgery for dislocated IOLs. Three month follow-up data was gathered from 184 eyes. Dislocated lenses included polymethyl methacrylate IOLs, silicone plate IOLs, 3-piece silicone IOLs, and acrylic IOLs. “In-the-bag” dislocations were associated with pseudoexofoliation and ocular trauma. Cystoid macular edema was the most common complication of a dislocated IOL. In 11 eyes, retinal detachment occurred after management of the dislocated IOL. The authors caution that management approaches depend upon surgeon preferences and specialty (this study was performed by vitreoretinal specialists), yet the wide range of treatment options allows surgeons to customize the optimal treatment approach for each patient. A large retrospective study by Kim et al (p. 1699) characterizing the management of dislocated intraocular lenses (IOLs) indicates that IOL dislocation most commonly involves foldable IOLs, with the frequency of in-the-bag dislocations increasing. Effective treatment techniques include IOL repositioning with or without scleral suture fixation or IOL exchange. The investigators reviewed 284 eyes of 277 patients who underwent surgery for dislocated IOLs. Three month follow-up data was gathered from 184 eyes. Dislocated lenses included polymethyl methacrylate IOLs, silicone plate IOLs, 3-piece silicone IOLs, and acrylic IOLs. “In-the-bag” dislocations were associated with pseudoexofoliation and ocular trauma. Cystoid macular edema was the most common complication of a dislocated IOL. In 11 eyes, retinal detachment occurred after management of the dislocated IOL. The authors caution that management approaches depend upon surgeon preferences and specialty (this study was performed by vitreoretinal specialists), yet the wide range of treatment options allows surgeons to customize the optimal treatment approach for each patient. Black Diaphragm Intraocular Lens for AniridiaAlthough individuals with aniridia have significant higher order optical aberrations associated with an increased pupillary aperture to focal length ratio, they often experience further aberrations following cataract surgery. In 1994, Sundmacher et al developed the black diaphragm intraocular (BDI) lens to counter these optical effects, and this study by Aslam et al (p. 1705) evaluates the biometry accuracy, visual outcomes, and long-term changes in 40 eyes of 35 patients with congenital and traumatic aniridia implanted with the BDI lens. Results showed that the mean biometry prediction error was the equivalent to 80% of target eyes being within 2 diopters of predicted refraction. The main complication was glaucoma, which occurred immediately after surgery–suggesting a possible direct mechanical effect of the large BDI lens. Visual outcomes were better when using the BDI lens for traumatic aniridia compared with congenital aniridia. The authors urge caution when using the BDI lens in congenital anirida due to glaucoma management challenges; delaying cataract surgery is suggested with these patients. Although individuals with aniridia have significant higher order optical aberrations associated with an increased pupillary aperture to focal length ratio, they often experience further aberrations following cataract surgery. In 1994, Sundmacher et al developed the black diaphragm intraocular (BDI) lens to counter these optical effects, and this study by Aslam et al (p. 1705) evaluates the biometry accuracy, visual outcomes, and long-term changes in 40 eyes of 35 patients with congenital and traumatic aniridia implanted with the BDI lens. Results showed that the mean biometry prediction error was the equivalent to 80% of target eyes being within 2 diopters of predicted refraction. The main complication was glaucoma, which occurred immediately after surgery–suggesting a possible direct mechanical effect of the large BDI lens. Visual outcomes were better when using the BDI lens for traumatic aniridia compared with congenital aniridia. The authors urge caution when using the BDI lens in congenital anirida due to glaucoma management challenges; delaying cataract surgery is suggested with these patients. Decreased Visual Acuity in Urban Preschool ChildrenA cross-sectional study by Friedman et al (p. 1786) of children aged 30 months through 71 months in Baltimore, Maryland, found that bilateral decreased visual acuity (VA) in white and African American children was infrequent, with uncorrected ametropia the most common cause. This decreased VA was not consistently associated with age, race, or sex. The researchers included 1714 of 2546 children (67%) in the 30 months to 71 months age group of the Baltimore Pediatric Eye Disease Study, conducting an in-home interview and comprehensive eye examination. Decreased visual acuity was initially detected in 1.2% among white children and 1.8% among African American children. After retesting within 60 days of the initial exam and with children wearing the best refractive correction, the rate of decreased VA in both eyes was 0.5% among whites and 1.1% among African Americans. Limitations of the study included a 62% overall examination response rate, and the fact that 42.7% of the children were untestable using the Amblyopia Treatment Study VA testing protocol. A cross-sectional study by Friedman et al (p. 1786) of children aged 30 months through 71 months in Baltimore, Maryland, found that bilateral decreased visual acuity (VA) in white and African American children was infrequent, with uncorrected ametropia the most common cause. This decreased VA was not consistently associated with age, race, or sex. The researchers included 1714 of 2546 children (67%) in the 30 months to 71 months age group of the Baltimore Pediatric Eye Disease Study, conducting an in-home interview and comprehensive eye examination. Decreased visual acuity was initially detected in 1.2% among white children and 1.8% among African American children. After retesting within 60 days of the initial exam and with children wearing the best refractive correction, the rate of decreased VA in both eyes was 0.5% among whites and 1.1% among African Americans. Limitations of the study included a 62% overall examination response rate, and the fact that 42.7% of the children were untestable using the Amblyopia Treatment Study VA testing protocol. Three Antimetabolite Drugs Compared for Noninfectious Ocular InflammationIn a retrospective study comparing the relative effectiveness and side effects of 3 commonly used antimetabolite agents to treat ocular inflammation—methotrexate, azathioprine, and mycophenolate—Galor et al (p. 1826) found that mycophenolate controls ocular inflammation faster than methotrexate, with azathioprine demonstrating the highest rate of treatment-related side effects compared with the other 2 agents. The majority of the 257 patients involved in the study were diagnosed with uveitis or scleritis. Ninety were treated with methotrexate, 38 with azathioprine, and 129 with mycophenolate. The median time to treatment success was 4.0 months for the mycophenolate, 4.8 months for the azathioprine, and 6.5 months for the methotrexate treatment groups. The incidence of side effects was higher in the azathioprine group compared with the other 2 drugs. In addition to these findings, other factors should be taken into consideration when deciding on an appropriate corticosteroid-sparing therapy including costs, dosing, pill size, availability of an injectable form, and long-term experience in children. In a retrospective study comparing the relative effectiveness and side effects of 3 commonly used antimetabolite agents to treat ocular inflammation—methotrexate, azathioprine, and mycophenolate—Galor et al (p. 1826) found that mycophenolate controls ocular inflammation faster than methotrexate, with azathioprine demonstrating the highest rate of treatment-related side effects compared with the other 2 agents. The majority of the 257 patients involved in the study were diagnosed with uveitis or scleritis. Ninety were treated with methotrexate, 38 with azathioprine, and 129 with mycophenolate. The median time to treatment success was 4.0 months for the mycophenolate, 4.8 months for the azathioprine, and 6.5 months for the methotrexate treatment groups. The incidence of side effects was higher in the azathioprine group compared with the other 2 drugs. In addition to these findings, other factors should be taken into consideration when deciding on an appropriate corticosteroid-sparing therapy including costs, dosing, pill size, availability of an injectable form, and long-term experience in children.