Magnetically Integrated Microporous Implant

Incidence of increased intraocular pressure after subtenon injection of triamcinolone acetonide

PURPOSE

To determine the incidence of eyes that have an increase in the intraocular pressure (IOP) after subtenon injections of triamcinolone acetonide (TA).

METHODS

The medical records of 147 patients treated with single or multiple subtenon injections of TA (10 mg) were reviewed. The incidence of an IOP elevation (ΔIOP) ≥5 mmHg or an IOP of >21 mmHg was determined. The peak ΔIOP, defined as the difference in the IOP at the peak to the baseline IOP, was also evaluated. Multivariate analyses were used to evaluate the relation between the IOP elevation and the age, gender, refractive error, and lens status.

RESULTS

A ΔIOP ≥5 mmHg was found in 75 eyes (46%), and an IOP >21 mmHg was found in 48 eyes (30%) after a single injection of TA. The IOP increased within 3 months in 39 eyes (81%) and after 4 months in 9 eyes (19%). The IOP began to increase significantly from 2 weeks up to 5 months (P<0.05) and returned to the baseline IOP in 10 months. The incidence of ΔIOP ≥5 mmHg or an IOP of >21 mmHg after multiple subtenon injections of TA was significantly higher than after a single injection (62%; P=0.027, 47%; P=0.013, respectively). The incidence of IOP >21 mmHg and the peak ΔIOP were significantly related with younger age (P=0.002, P=0.021, Forward stepwise regression analysis). A weak but significant negative correlation was found between the peak ΔIOP and the age (r=-0.216, P=0.006, Pearson's correlation coefficient test), and the peak ΔIOP and the refractive error (r=-0.198; P=0.018).

CONCLUSION

Repeated injections of TAs and injection of younger patients or myopic eyes increase the incidence of an IOP elevation.

Motility assessment and clinical outcomes of a magnetically integrated microporous implant

The purpose of this study was to evaluate the surgical technique, morbidity, and motility of a novel microporous, high-density, polyethylene implant with magnetic coupling of the prosthesis and implant. Four adult patients requiring enucleation underwent implantation of a microporous, high-density, polyethylene implant with an integrated stainless steel, titanium-coated post. The motility of a magnetically embedded prosthesis was assessed by measuring lateral prosthetic excursion using digital photography. Clinical grading documented increased motility with a magnetically integrated prosthesis versus a nonmagnetically integrated prosthesis. The magnetically integrated microporous high-density implant appears to be an effective approach.

Intravitreal Triamcinolone Acetonide for Diabetic Macular Edema: A Prospective, Randomized Study

PURPOSE

The aim of this study was to examine the visual outcome of patients receiving an intravitreal injection of triamcinolone acetonide (TA) as treatment of diffuse diabetic macular edema (DDME).

METHODS

This prospective, placebo-controlled, randomized, clinical interventional study included 40 eyes (38 patients) with DDME, with 28 (70%) eyes randomized to treatment and 12 (30%) eyes randomized to receive a placebo injection. Thirty-six (36) (90%) eyes completed the 3-month study visit, and 32 (80%) eyes completed the 6-month study visit. The treatment group received an intravitreal injection of approximately 20 mg of TA.

RESULTS

Visual acuity increased significantly (P < 0.001) in the study group by 3.4 +/- 2.5 Snellen lines. In the control group, visual acuity did not change significantly (P = 0.07) during follow-up. Difference in change of best visual acuity was significant (P < 0.001) between both groups. At 3 months after baseline, 11 (11/26; 42%) eyes and 10 (10/26; 39%) eyes, respectively, improved by at least 2 and 3 lines, respectively, in the study group, versus 2 (2/10; 20%) eyes and 1 (1/10; 10%) eye in the control group. At 6 months after baseline, 11 (11/23; 48%) eyes and 9 (9/23; 39%) eyes, respectively, improved by at least 2 and 3 lines, respectively, in the study group, versus 0 (0%) eyes and 0 (0%) eyes in the control group. The difference was significant for the 2-line improvement (P = 0.01) and 3-line improvement (P = 0.03).

CONCLUSIONS

Using a dosage of approximately 20 mg of intravitreal TA, visual acuity temporarily increases for 6 months after injection.

Postoperative endophthalmitis

Postoperative endophthalmitis remains a serious clinical problem in ophthalmology, with an incidence of approximately 0.5%. Prognosis is largely determined by the virulence of the offending organism. The Endophthalmitis Vitrectomy Study (EVS) was a prospective, randomized trial comparing various diagnostic and treatment modalities in cases of endophthalmitis that followed cataract surgery. The EVS found that vitrectomy was only beneficial for patients presenting with very poor visual acuity and that intravenous antibiotic treatments had no additional benefit, compared with intravitreal antibiotic therapy alone. However, weaknesses of the EVS leave these conclusions open to modification in the future. Preoperative application of povidone-iodine preparation to the skin and conjunctiva is the only proven endophthalmitis prophylaxis. Endophthalmitis may be chronic and may follow glaucoma surgery and intravitreal injection of gas and drugs. The EVS did not study these issues, although they are associated with specific features that may require alterations in patient management.