Anterior Segment Inflammation Research Articles

Nepafenac Dosing Frequency for Ocular Pain and Inflammation Associated with Cataract Surgery

Nepafenac ophthalmic suspension 0.1% was dosed topically once (QD), twice (BID), or three-times (TID) daily to assess the resolution of ocular pain and anterior-segment inflammation following cataract surgery. This was a prospective, multicenter, double-masked, randomized, placebo-controlled study of 212 adults. Patients received nepafenac 0.1% or placebo, 1 drop QD, BID, or TID beginning 1 day before cataract surgery, continuing on the day of surgery, and for 14 days thereafter. One (1) additional drop was administered 30-120 min prior to surgery. The primary efficacy endpoint was percent of treatment failures (>or=16 aqueous cells, aqueous flare = severe, or ocular pain score = moderately severe or severe) through postoperative day 14. On days 7 and 14, the QD, BID, and TID all nepafenac posologies significantly reduced the percent of treatment failures, compared to placebo ( p <or= 0.0029). Compared with placebo, the TID posology achieved statistical significance beginning on day 3 ( p <or= 0.0080). Nepafenac treatment significantly increased the proportion of patients with resolved ocular inflammation, compared to placebo, beginning on day 1 for TID dosing ( p <or= 0.0208) and beginning on day 3 for QD dosing ( p <or= 0.0483). A significantly greater percentage of nepafenac-treated patients were pain free, compared to placebo, beginning on postoperative day 1 with BID and TID dosing ( p <or= 0.0150) and beginning on day 3 for QD dosing (p <or= 0.0220). No serious ocular adverse events were reported, and fewer patients experienced adverse events in the nepafenac groups than in the placebo group. Nepafenac ophthalmic suspension 0.1% was well tolerated and effectively resolved ocular inflammation and increased the incidence of ocular pain-free patients following cataract surgery when dosed QD, BID, or TID. By postoperative day 14, all nepafenac posologies significantly reduced the incidence of treatment failures and the incidence of patients presenting with ocular inflammation, and significantly increased the incidence of ocular pain-free patients relative to placebo.

Clinical review of Nd:YAG laser in treatment of the anterior fibrinous membrane of intraocular lens

目的 评价Nd:YAG激光治疗白内障术后人工晶状体前膜的疗效.方法 回顾性总结Nd:YAG激光治疗白内障术后人工晶状体前膜42例(45眼).激光参数:单次脉冲能量0.6～3.8 mJ,击发次数平均42次(16～150次).结果 所有患眼应用Nd:YAG激光均成功切除人工晶状体前膜.其中32例(33眼)术后视力有不同程度的提高,5眼无变化.并发症包括虹膜出血、晶状体表而细小损伤、短暂性眼压升高、前房炎性反应,对术后视力无影响.结论 应用Nd:YAG激光可有效、安全的切除人工晶状体前膜。

Effect of room temperature and cooled intraocular irrigating solution on the cornea and anterior segment inflammation after phacoemulsification: a randomized clinical trial

To compare the effects of cooled and room temperature BSS Plus solution on the central corneal thickness (CCT), anterior segment inflammation, and corneal endothelium in patients undergoing phacoemulsification. In this prospective, randomized study, 70 consecutive patients undergoing phacoemulsification were assigned to one of two groups: Group 1 (controls) (n=35) received BSS Plus at a room temperature of 23 degrees C and Group 2 (cases; n=35) received BSS Plus cooled at 10 degrees C. In both the groups, the percentage of difference for CCT, absolute change in endothelial cell density, and coefficient of variation (CV) from preoperative to postoperative periods was analysed. The presence of anterior chamber flare and cells were compared postoperatively between the two groups. There was no significant difference in percentage change for CCT from preoperative to postoperative days 1, 7, and 30 between the two groups (P=0.30, P=0.56, and P=0.52). There was no statistically significant difference in the ECD loss (P=0.19) and CV (P=0.88) at 1 month between the two groups. The influence of the solutions on anterior chamber flare and cells was not statistically significant between the two groups on the first postoperative day (P=0.17, P=0.11). The temperature of the BSS Plus solution did not affect any parameter of the study. The use of moderately cooled BSS had no detectable effect and benefit on the outcome of the surgery.

Associations of Seroreactivity against Crystallin Proteins with Disease Activity and Cataract in Patients with Uveitis

betaB1-crystallin is a putative target of an autoantibody observed in a subset of patients with uveitis. The purpose of this study was to determine whether seroreactivity against betaB1 or other specific purified crystallin proteins is observed in patients with uveitis and whether this reactivity is associated with either cataract or active intraocular inflammation. Sera from patients with uveitis were tested for IgG antibodies with reactivity against alphaA-, alphaB-, betaB1-, or betaB2-crystallin proteins using a modified slot-blot protocol. Ophthalmic evaluations included analysis of the degree of intraocular inflammation and assessment of lens opacity by the Lens Opacities Classification System (LOCS) III. Positive anti-crystallin reactivity was defined as greater than the mean + 2 SD of the reactivity of a commercially available control serum panel. Statistical analysis was performed with the Fisher exact test, Kruskal-Wallis test, and Student's t-test. IgG antibodies against alphaA-, alphaB-, or betaB1-crystallin were identified in 70% of 39 subjects; in contrast, only 30% of the control sera exhibited reactivity against one or more of these crystallin proteins (P <or= 0.01). Seroreactivity against alphaA-, alphaB-, or betaB1-, but not betaB2-crystallin was related to active anterior segment inflammation. Seroreactivity against alphaB and betaB1 was significantly related to cortical cataract (P <or= 0.05). Serum antibodies against specific crystallin proteins are present in most patients with uveitis. The relationship between the presence of specific anti-crystallin antibodies and active inflammation may indicate a role for these autoantibodies in uveitis pathogenesis.

Topical ophthalmic NSAIDs: a discussion with focus on nepafenac ophthalmic suspension

The removal of diclofenac sodium ophthalmic solution as a viable pharmaceutical entity in September 1999 from the US market spurred considerable interest in the general safety and effectiveness of topical ophthalmic NSAIDs for treatment of anterior segment inflammation. In late 1999 the use of topical ocular NSAIDs declined in the US as a result of incidents involving corneal melts and toxicity surrounding use of generic diclofenac. However, since the removal of diclofenac sodium ophthalmic solution from the marketplace, ophthalmic NSAIDs have regained use as viable pharmacotherapeutic entities. Moreover, several new ophthalmic NSAID products have recently been introduced for commercial use in the US including the novel chemical entity nepafenac. The purpose of this report is to revisit the use of topical ophthalmic NSAIDs for the treatment of surgically induced anterior segment inflammation with a particular focus on nepafenac. Nepafenac is unique among ophthalmic NSAIDs in that it is a prodrug deaminated to amfenac, a highly effective non-selective cyclooxygenase inhibitor. In the case of topical ophthalmic NSAIDs, practitioners should carefully weigh the cost-benefit of implementing "highly potent" new drug products because perturbations in pharmacodynamic response due to the inherent novelty in terms of chemical designs may outweigh the demonstrated replicative pharmacologic action of all topical ophthalmic NSAIDs.

Rapidly Progressive Cataract and Iris Atrophy during Treatment of Acanthamoeba Keratitis

To identify characteristics associated with cataract occurring during the course of Acanthamoeba keratitis. Retrospective observational case series. Eighty-one laboratory-confirmed patients with Acanthamoeba keratitis. Review of clinical records. Development of cataract during management of Acanthamoeba keratitis. Rapidly progressive crystalline lens opacification occurred in 9 eyes within 4 to 15 weeks after diagnosis of Acanthamoeba keratitis. Three were associated with inflammatory complications, including anterior scleritis (2 eyes) and iridocyclitis (1 eye). Six others had the abrupt onset of a dense cataract, including 5 with iris atrophy, that occurred during the initial 6 months of therapy with chlorhexidine, a diamidine, and adjunctive corticosteroid. Extracapsular cataract extraction was performed with or after penetrating keratoplasty. Secondary glaucoma developed in 6 of 9 eyes subsequent to iris atrophy (4 eyes) or a cyclitic membrane (2 eyes), and 3 eyes underwent trabeculectomy. Cataract may occur and progress during the management of Acanthamoeba keratitis in association with anterior segment inflammation, iris atrophy, and secondary glaucoma.

Posterior capsulorhexis combined with optic buttonholing: an alternative to standard in-the-bag implantation of sharp-edged intraocular lenses? A critical analysis of 1000 consecutive cases

BackgroundCurrent after-cataract prevention relies on optimizing the natural barrier effect of the optic rim against lens epithelial cell (LEC) migration. However, deficiencies in circumferential capsular bag closure caused by the intraocular lens (IOL) haptic or delayed secondary re-division of the fused capsules by Soemmering´s ring formation lead to primary or secondary barrier failure. Consequently, surprisingly high posterior laser capsulotomy rates have been reported long-term, even with optimal capsular surgery and the most widespread hydrophobic acrylic IOLs, considered to be the most advanced. Intraoperative removal of the central posterior capsule has been shown to be effective in further reducing LEC immigration. However, efficacy has turned out to be limited because of the propensity of LECs to use the posterior optic surface as an alternative scaffold.Material and methodsTechnique: in pediatric cataract surgery, buttoning-in of the optic into an adequately-centered posterior capsulorhexis opening has been described previously. This technique was further elaborated and applied as the standard technique in a large series of adult eyes. In general, the diameter aimed at was 5–6 mm for the anterior, and 4–5 mm for the posterior capsulorhexis. Between September 2004 and June 2007, 1000 consecutive cases have thus been performed and systematically evaluated. One hundred and fifty eyes additionally underwent extensive anterior LEC abrasion. Another sub-series investigated the option of further reducing capsular fibrosis by creating an anterior capsulorhexis larger than the optic.Evaluation: special scrutiny was applied to detect postoperative vitreous entrapment. Regeneratory and fibrotic after-cataract formation were both meticulously followed-up. Postoperative pressure course, anterior segment inflammation, macular thickness and morphology, as well as axial optic stability and optic centration, were evaluated in intraindividual comparison studies.ResultsA low rate of vitreous complications was found, which can be avoided by appropriate surgery. Vitreous entanglement occurred in six eyes, and vitreous herniation after PPCCC over-sizing in two. In three, anterior vitrectomy was performed. There was only one single case of retinal detachment—supposedly unrelated to the technique itself—and no case of cystoid macular edema. Retro-optical regenerate formation was completely abolished, while fibrosis was drastically reduced by the posterior capsule sandwiched in between the anterior LEC layer on the backside of the anterior capsule and the anterior optic surface, thereby blocking contact-mediated myofibroblastic LEC transdifferentiation. Additional capsular polishing further reduced residual fibrosis emerging from the anterior capsule contacting the optic adjacent to the haptic junction, as well as regeneratory LEC re-proliferation on the posterior capsule overlying the optic. Postoperative pressure course was almost identical to that found after standard in-the-bag implantation of the IOL, as was flare, and macular thickness and morphology. As opposed to bag-fixated IOLs, no axial movement of the optic was detected. IOL optics always perfectly centered even when the capsular opening was not optimally centered. Due to the exquisite stretchability and elasticity of the posterior capsule, the 6-mm IOL optic could safely be buttoned-in in a posterior capsulorhexis of 4 mm and smaller.ConclusionsPosterior optic buttonholing (POBH) is a safe and effective technique which not only excludes retro-optical opacification, but also withholds capsular fibrosis by obviating direct contact between the anterior capsular leaf and the optic surface. Anterior LEC abrasion significantly reduced both the residual fibrosis and regeneratory LEC proliferation. Apart from pediatric cataract, POBH is currently recommended for eyes with pseudoexfoliation syndrome, high axial myopia, peripheral retinal disease, and multifocal IOL implantation. Toric IOLs and magnet-driven accommodative IOL systems are other potential applications. Generally, POBH holds promise for becoming a routine alternative to standard in-the-bag IOL implantation in the future.

The Anti-inflammatory Effects ofCurcuma longaandBerberis aristatain Endotoxin-Induced Uveitis in Rabbits

To investigate the anti-inflammatory effect of topical application of Curcuma longa (C. longa) and Berberis aristata (B. aristata) aqueous extracts on experimental uveitis in the rabbit. Anterior uveitis was induced in rabbits by intravitreal injection of lipopolysaccharide from Escherichia coli after pretreatment with C. longa and B. aristata aqueous extracts. Subsequently, the anti-inflammatory activity of C. longa and B. aristata was evaluated by grading the clinical signs and histopathologic changes and estimating the inflammatory cell count, protein, and TNF-alpha levels in the aqueous humor. The anterior segment inflammation in the control group was significantly higher than in both the extract-treated groups, as observed by clinical and histopathologic grading. The inflammatory cell count in the control group was 30.75 +/- 7.33 x 10(5) cells/mL, whereas it was 2.39 +/- 0.59 x 10(5) (P < 0.001 vs. control) and 11.56 +/- 2.44 x 10(5) (P = 0.001 vs. control) cells/mL in the C. longa- and B. aristata-treated groups, respectively. The protein content of the aqueous humor was 18.14 +/- 4.98, 3.16 +/- 0.55 (P < 0.001 vs. control), and 8.24 +/- 1.42 (P < 0.01 vs. control) mg/mL in the control, C. longa-, and B. aristata-treated groups, respectively. The aqueous TNF-alpha level in the control group was 976.29 +/- 66.38 pg/mL and was 311.96 +/- 28.50 (P < 0.0001 vs. control) and 654.09 +/- 47.66 (P < 0.001vs. control) pg/mL in the C. longa- and B. aristata-treated groups, respectively. Topical instillation of aqueous extracts of C. longa and B. aristata showed potent anti-inflammatory activity against endotoxin-induced uveitis in rabbits.

Bromfenac ophthalmic solution 0.09%: ocular role and systemic safety profile

Nonsteroidal anti-inflammatory drugs are widely used for systemic control of acute or chronic pain and inflammation. Topical ophthalmic NSAIDs are used to treat ocular surface and anterior segment inflammation as well as postoperative management of pain and inflammation. Bromfenac ophthalmic solution 0.09% is rapidly becoming a widely prescribed topical ophthalmic within its class. Bromfenac has an extensive global safety record as an anti-inflammatory drug, as well as in the management of ocular pain and inflammation following cataract and refractive surgery and corneal abrasions. Bromfenac’s unique chemical structure makes it both a potent anti-inflammatory drug and a lipophilic molecule that penetrates ocular tissues, ensuring sustained drug levels in all ocular tissues for over 24 h.

Multistate outbreak of toxic anterior segment syndrome, 2005

To present the findings of an outbreak of toxic anterior segment syndrome (TASS). Six states, 7 ophthalmology surgical centers, United States. Cases were identified through electronic communication networks and via reports to a national TASS referral center. Information on the procedure, details of instrument reprocessing, and products used during cataract surgery were also collected. Medications used during the procedures were tested for endotoxin using a kinetic assay. The search identified 112 case patients (median age 74 years) from 7 centers from July 19, 2005, through November 28, 2005. Common presenting clinical features included blurred vision (60%), anterior segment inflammation (49%), and cell deposition (56%). Of the patients, 100 (89%) had been exposed to a single brand of balanced salt solution manufactured by Cytosol Laboratories and distributed by Advanced Medical Optics as AMO Endosol. Two patients continued to have residual symptoms. There were no reports of significant breaches in sterile technique or instrument reprocessing. Of 14 balanced salt solution lots, 5 (35%) had levels exceeding the endotoxin limit (0.5 EU/mL). Based on these findings, the balanced salt solution product was withdrawn, resulting in a termination of the outbreak. This is the first known report of an outbreak of TASS caused by intrinsic contamination of a product with endotoxin. Ophthalmologists and epidemiologists should be aware of TASS and its common causes. To facilitate investigations of adverse outcomes such as TASS, those performing cataract surgeries should document the type and lot numbers of products used intraoperatively.

Pharmacology, clinical efficacy and safety of bromfenac ophthalmic solution

NSAIDs are widely used not only for systemic control of acute or chronic pain and inflammation, but also for ocular surface and anterior segment inflammation as a topical instillation. Bromfenac sodium is a NSAID approved for the treatment of postoperative inflammation and ocular inflammatory disorder (blepharitis, conjunctivitis and scleritis/episcleritis). Bromfenac ophthalmic solution has been demonstrated to be very effective for ocular inflammation with twice-daily instillation, resulting from preclinical and pharmacokinetic features. Bromfenac ophthalmic solution is well tolerated, and the incidence of serious adverse events is very low. These results demonstrate that bromfenac ophthalmic solution is clinically useful and a convenient ophthalmic NSAID.

Posterior sympathetic ophthalmia: a single centre long-term study of 40 patients from North India

To report 'posterior sympathetic ophthalmia' in North Indian population as an early manifestation of sympathetic ophthalmia. Forty consecutive patients with a diagnosis of sympathetic ophthalmia seen between 1989 and 2004 at our centre were studied for their clinical presentation and disease course. All received systemic corticosteroids and 12 patients, in addition, also received immunosuppressive agents. There were 28 male and 12 female patients with a median age of 29.4 years. In 22 of the 40 sympathizing eyes, the only presenting sign was the fundus lesions without any associated anterior segment inflammation. Only four eyes showed classically described granulomatous anterior uveitis at presentation. The fundus lesions predominately included exudative retinal detachment (29 eyes), yellowish-white mid-peripheral lesions (10 eyes), optic disc oedema (15 eyes), vasculitis (three eyes), and peripapillary choroidal neovascular membrane (two eyes). Over a median follow-up of 5.2 years, recurrences were seen in 12 of 40 (30%) eyes and were mainly in the anterior segment. Over a median follow-up of 5.2 years, a final visual acuity of 20/40 or better could be achieved in 29/36 (80.5%) eyes. In the early stage, sympathetic ophthalmia may present only in the posterior segment without any associated anterior segment inflammation and carries a good visual prognosis. Anterior segment inflammation, however, maybe seen during recurrences.

Ocular involvement in children with localised scleroderma: a multi-centre study

Background:Most of the available documentation in the literature on ocular involvement in localised scleroderma (LS) are descriptions of single cases in adult patients. This article reports the frequency and specific...

Preclinical Safety Evaluation of Intravitreal Injection of Full-Length Humanized Vascular Endothelial Growth Factor Antibody in Rabbit Eyes

To evaluate the preclinical safety of intravitreal bevacizumab, which is a full-length humanized monoclonal antibody against the vascular endothelial growth factor (VEGF), in rabbit eyes over a short-term period. Twenty-four rabbits were divided into two groups, each with two subgroups. The first group (groups 1 and 2) received 1.25 mg (0.05 mL) intravitreal bevacizumab, and the second group (groups 3 and 4) received 3.00 mg (0.12 mL) intravitreal bevacizumab. The right eyes were designated as the study eyes, and the left eyes served as a control and received the same volume of saline intravitreally. Groups 1 and 3 were labeled as early groups and scheduled to be terminated at 14 days. Groups 2 and 4, labeled as late groups, were scheduled to be terminated at 28 days. Besides electroretinography (ERG) and visually evoked potentials (VEP), central corneal thickness, intraocular pressure, fundus photography, and anterior segment imaging were performed at baseline and scheduled time points. Enucleated eyes were preserved for light and electron microscopic investigation. No anterior segment inflammation was observed, except in one eye in group 1 which showed a uveitic reaction. No evidence of retinal toxicity was seen with intravitreal bevacizumab at doses of 1.25 and 3.00 mg, by either ERG or light microscopy. Electron microscopic assessment revealed mitochondrial damage in the inner segments of photoreceptors. Immunohistochemical staining with bax and caspase-3 and -9 showed intensive apoptotic protein expression in all study sections and minimal expression in the control eyes. Although electrophysiologic investigation and light microscopy showed normal retinal function and structure, mitochondrial disruption in the inner segments of photoreceptors was detected by electron microscopy, and apoptotic expression was detected after the injection of intravitreal bevacizumab.

Conjunctival nodules associated with Vogt-Koyanagi-Harada disease

To report on conjunctival nodules as an unusual manifestation of Vogt-Koyanagi-Harada disease. A 24-year-old woman presented with a two-month history of bilateral conjunctival injection and gradually decreased vision. Ophthalmological examinations revealed bilateral granulomatous uveitis and bulbar conjunctival nodules, and a biopsy of the conjunctival nodules was performed. The biopsy specimens showed noncaseating granulomas. The major components of the infiltrating lymphocytes were CD8-positive T cells. Topical corticosteroid therapy reduced the anterior segment inflammation, and the conjunctival nodules disappeared within a week. Afterwards, the patient demonstrated bilateral retinal detachments, sunset glow fundus and alopecia, and, therefore, was diagnosed to have Vogt-Koyanagi-Harada disease four months after the first symptoms. Conjunctival nodules may represent the primary manifestation of Vogt-Koyanagi-Harada disease.

Update on toxic anterior segment syndrome

To review, summarize and update our present understanding of toxic anterior segment syndrome. Toxic anterior segment syndrome has emerged within the last 2 years as a complication of increasing frequency following uneventful cataract surgery. Over 100 North American clinics reported toxic anterior segment syndrome cases to a specially constituted task force over a 4-month period in 2006. Toxic anterior segment syndrome is now recognized as a specific, noninfectious condition presenting as anterior segment inflammation that occurs within days of surgery and is responsive to topical steroids. Specific causes have been identified such as endotoxin contamination of balanced salt solutions and antibiotic ointment accessing the anterior chamber, although most cases appear to result from inadequate instrument sterilization and preparation. Outcomes are usually excellent, but delayed treatment and severe cases may result in glaucoma and persisting corneal edema requiring penetrating keratoplasty. Toxic anterior segment syndrome has become a significant complication of cataract surgery. Rapidly increasing knowledge made possible by ophthalmic organizations and the prompt dissemination of research findings, however, appear to have provided the information necessary to help prevent and resolve this condition.

Updates in Acanthamoeba Keratitis

Acanthamoeba keratitis is a potentially blinding microbial disease that has been increasing in incidence during the past two decades. Prognosis of this serious disease had been dismal, but improvement in diagnosis, a better understanding of the natural course of the disease, and recent introduction of multiple and effective therapeutic agents have resulted in improvement of visual outcomes. A review of literature pertaining to Acanthamoeba keratitis. Contact lens wear and exposure to contaminated water sources remain the most important risk factors; however, in vivo confocal microscopy and improved biomicroscopic screening have proven instrumental in accurate early diagnosis. Complications of Acanthamoeba keratitis include dacryoadenitis, corneal melting and scarring, severe secondary glaucoma, cataract, and chronic anterior segment inflammation that can rarely lead to reactive blinding retinal ischemia. Combination chemotherapeutic agents have been shown to be more effective than monotherapy, whereas rehabilitative surgery such as penetrating keratoplasty is best performed on a quiet eye free of ocular inflammation and with no residual amoebae. Increased suspicion by clinicians for Acanthamoeba and confocal microscopy have allowed more rapid and accurate diagnosis; treatment with multiple antiamoeba drugs is essential to disease resolution. Provided there are no residual amoebae after treatment, penetrating keratoplasty has been successful in visual rehabilitation. Secondary glaucoma occurs frequently and may require drainage procedures for control of intraocular pressure. Posterior complications are rare but may lead to ischemic retinitis.

Corneal Melt Associated With Idiopathic Dacryoadenitis

A 15-year-old boy presented with left-sided ptosis, upper eyelid swelling, proptosis, conjunctivitis, and a central corneal epithelial defect with thinning. MRI demonstrated an enhancing orbital mass associated with the lacrimal gland. Biopsy findings were consistent with orbital inflammatory syndrome. Topical cyclosporine and 1% methylprednisolone eliminated the anterior segment inflammation; subsequent treatment with systemic prednisone reduced the ptosis and edema. To our knowledge, this is the only reported case of orbital inflammatory syndrome associated with a corneal epithelial defect and thinning.

Retained Nuclear Fragments in the Anterior Chamber after Phacoemulsification with an Intact Posterior Capsule

To review the clinical features and treatment of patients with retained nuclear fragments in the anterior chamber (AC). Single-center, retrospective, noncomparative, consecutive case series. Sixteen patients with a diagnosis of retained nuclear fragments in the AC. Retrospective review of the medical records at Bascom Palmer Eye Institute in Miami, Florida, to identify all patients with a diagnosis of retained nuclear fragments in the AC after phacoemulsification surgery without rupture of the posterior capsule. Charts were reviewed and patient characteristics, ocular history, clinical findings, treatment (medical and surgical), and visual outcomes were recorded. Visual outcome and visual acuity at last follow-up visit. Most patients presented with corneal edema and anterior segment inflammation. All patients proved refractory to medical management, and surgical extraction of the retained lens fragment was required. Ten patients were myopic or had long axial lengths and/or steep keratometry readings. Three patients underwent penetrating keratoplasty for intractable corneal edema. One patient required a second surgery for fragment removal after a previous unsuccessful attempt at removal. Visual outcomes for the patients without macular disease who had lens fragment removal alone ranged from 20/20 to 20/40. Of the 2 patients without macular disease who underwent penetrating keratoplasty, the visual outcomes were 20/50 and 20/30. Retention of nuclear fragments in the AC may occur after phacoemulsification. This complication was associated with myopia in a majority of patients in this series, and we hypothesize that small fragments may hide in the posterior chamber in these larger eyes. Surgical removal was associated with a good visual outcome in patients without macular disease.

Intravitreal steroids in the management of macular oedema

The use of intravitreal corticosteroids in the management of macular oedema has recently gained widespread acceptance. New long-acting steroid preparations and methods of delivery have facilitated the use of these new modalities. This review describes the various types of macular oedema for which this therapeutic option is used and the results.