Intraoperative complications and visual outcomes of cataract surgery in neovascular age-related macular degeneration

PURPOSE

To compare the rate of intraoperative complications and visual outcomes in patients with neovascular age-related macular degeneration (NvAMD) and control eyes without NvAMD undergoing phacoemulsification.

SETTING

Multicenter study.

DESIGN

Retrospective, nonrandomized comparative study.

METHODS

Eyes were classified based on the presence or absence of an NvAMD diagnosis. The main outcomes were (1) the rate of intraoperative complications, (2) the logMAR visual acuity (VA) at 4 to 12 weeks postoperatively in both groups, and (3) the reinjection rate of intravitreal antivascular endothelial growth factor after phacoemulsification.

RESULTS

Preoperative VA was worse in the NvAMD group (0.9 ± 0.5) compared with the reference group (0.6 ± 0.5). We observed no difference in the rate of posterior capsule rupture (PCR) (2.90% vs 2.77%; P = .889), dropped lens fragments (0.46% vs 0.29%; P = .618), or zonular dialysis (0.46% vs 0.58%, P = .749) between the 2 groups. Receiving ≥10 intravitreal injections before cataract surgery predicted the likelihood of PCR with an odds ratio of 2.86 (P = .027). Proportions of eyes achieving a visual gain of ≥0.3 logMAR (∼3 Snellen lines equivalent) was lower in NvAMD eyes (39.2% vs 63.7%; P < .0001). We observed 203 eyes (73%) in the active treatment group and 139 eyes (36%) in the inactive treatment group received >1 intravitreal injection after phacoemulsification (P < .0001).

CONCLUSIONS

The risk for PCR was higher for eyes receiving ≥10 intravitreal injections before phacoemulsification. Only 39% of eyes with NvAMD had visual improvement by ≥3 Snellen lines.

Impact of axial length on visual outcomes and complications in phacoemulsification surgery: a multicenter database study

PURPOSE

To analyze the impact of axial length (AL) on the visual outcome and rate of perioperative complications in phacoemulsification surgery.

DESIGN

Retrospective clinical database study.

METHODS

Cataract surgery data of 217,556 eyes was extracted from the electronic medical records of 8 ophthalmic centers in the United Kingdom from July 2003 to March 2015. A total of 88,774 eyes without ocular co-pathologies were grouped eyes according to AL (mm): short AL (< 22), average AL (22-26; reference group), and long AL (> 26).

MAIN OUTCOMES AND MEASURES

We analyzed visual acuity (VA) outcomes at 4 weeks, 4-12 weeks, and 12-24 weeks postoperatively, as well as the incidence of posterior capsular rupture (PCR), torn iris (TI), cystoid macular edema (CME), and retinal detachment (RD).

RESULTS

Mean pre-operative VA (logMAR) was the worst in eyes with long AL compared to average and short AL eyes (VA 0.59 vs. 0.58 and 0.56; p < 0.001). However, post-operative VA at 4-12 weeks was slightly better in the long AL group (0.14 in short and average AL; 0.12 in long AL, p < 0.001). We observed an increased odds of TI in the short AL group (OR 2.09, 95% CI 1.60-2.75). There was increased risk of RD in long AL eyes (p < 0.001). However, PCR and CME rates were not different.

CONCLUSION

In the absence of any coexisting ocular pathology, AL alone did not have an impact on VA improvement or the risk of encountering PCR or CME. The risk of TI was greater in the short AL group, and the risk of RD was higher in the long AL group.

Visual outcomes and postoperative complications of eyes with dropped lens fragments during cataract surgery: multicenter database study

PURPOSE

To analyze the visual outcomes and postoperative complications of phacoemulsification cataract surgery in eyes with posterior capsule rupture (PCR) and dropped lens fragments (DLFs) in comparison with a reference group with uneventful surgery.

SETTING

8 UK National Health Service departments.

DESIGN

Retrospective comparative nonrandomized study.

METHODS

Demographic, medical history, and ocular examination data were automatically extracted from the electronic records. The main outcome variables were postoperative visual acuity (VA), and the development of postoperative cystoid macular edema (CME) as well as rhegmatogenous retinal detachment (RRD) and epiretinal membrane (ERM) requiring surgery.

RESULTS

The analysis included 175 589 eyes in the reference group, 2751 eyes in the PCR group, and 519 eyes in the DLF group. During all postoperative intervals, the mean VA in the DLF and PCR groups was significantly worse than the reference group ( P < .001). On multivariate analysis, the odds of having a VA ≤0.3 logMAR at 4 to 12 weeks postoperatively among eyes with DLF and PCR were 88% and 73% lower than the reference group ( P < .001). More eyes developed CME in the DLF and PCR groups ( P < .001). The odds of requiring RRD and ERM surgery were 3.6 and 2.1 times higher in the DLF group, and 1.8 and 1.3 times higher in the PCR group, respectively, as compared with the reference group.

CONCLUSIONS

Eyes undergoing phacoemulsification complicated by PCR, and more so with DLF, have worse visual outcomes and higher chances of CME, ERM, and RRD when compared with uneventful surgery.

Risk of Pseudophakic Cystoid Macular Edema in Fellow-Eye Cataract Surgeries: A Multicenter Database Study

OBJECTIVES

To quantify the risk of pseudophakic cystoid macular edema (pCME) in fellow-eye cataract surgery, and to determine risk factors, including prior first-eye pCME.

DESIGN

Retrospective clinical database study PARTICIPANTS: Patients undergoing bilateral non-simultaneous cataract surgeries in eight United Kingdom National Health Service clinical centers between July 2003 and March 2015.

METHODS

We excluded patients with history of diabetic macular edema and perioperative topical non-steroidal anti-inflammatory drug use in either eye. We calculated the overall risk of pCME and used multiple log-binomial regression to calculate adjusted relative risks of pCME in the fellow eye for potential risk factors.

MAIN OUTCOME MEASURE

The risk of postoperative clinical pCME in the fellow eye RESULTS: A total of 54,209 patients were included. The mean age was 74.6 ± 10.4 years and 38.8% were males. The fellow-eye developed pCME in 544 (1%) patients. The risk of fellow-eye pCME among patients without first-eye pCME was 0.9%. However, the risk among those with first-eye pCME was 10.7%. In the fully adjusted model, we found that the risk factors for the development of fellow-eye pCME were first-eye pCME (RR = 8.55, 95% confidence interval [CI] = 6.19 - 11.8), epiretinal membrane (RR = 4.1, CI = 2.63- 6.19), history of retinal vein occlusion (RR = 2.94, CI = 1.75 - 4.93), diabetes without history of DME (RR = 2.08, CI = 1.73 - 2.5), advanced cataract (RR = 1.75, CI = 1.16 - 2.65), prostaglandin analogue use preoperatively (RR = 1.49, CI = 1.13 - 1.97), and male sex (RR = 1.19, CI = 1.0 - 1.41).

CONCLUSIONS

History of pCME in one eye is the strongest independent risk factor for development of pCME in the fellow eye. Our findings may guide clinicians in counselling patients on the risk of pCME prior to performing in cataract surgery in the fellow eye and help in identifying high-risk patients who may benefit from prophylactic therapy.

Visual outcomes and complications of combined vs sequential cataract surgery and pars plana vitrectomy: multicenter database study

PURPOSE

To compare the visual outcomes and rates of intraoperative complications in eyes that underwent combined cataract extraction (CE) and pars plana vitrectomy (combined group) with those that underwent sequential surgery (sequential group).

SETTING

Multicenter study.

DESIGN

Retrospective chart review.

METHODS

CE data set pooled from 8 UK sites between 2000 and 2015. The main outcome measures were the mean postoperative visual acuity (VA) and the rate of intraoperative complications in both groups.

RESULTS

2236 eyes in the combined group and 2270 eyes in the sequential group were included in this study. Mean preoperative VA was 1.0 logMAR in both groups. The mean logMAR postoperative VA was worse in the combined group than in the sequential group ( P < .0001) at all timepoints, however, the differences in visual improvement between both groups decreased with longer follow-up time: 1.0 ± 0.7 vs 0.6 ± 0.6, 0.7 ± 0.6 vs 0.4 ± 0.5, and 0.7 ± 0.6 vs 0.5 ± 0.5 at 0 to 4 weeks, 4 to 12 weeks, and 12 to 24 weeks, respectively. Proportions of eyes that gained >3 logMAR units were 49% in the combined group and 66.2% in the sequential group ( P < .0001). Logistic regression analysis showed that sequential surgery (odds ratio, 2.1) was a predictor for reaching 20/40 vision by 6 months. In the combined group, there was a statistically significantly higher rate of posterior capsular rupture.

CONCLUSIONS

Postoperative visual gain was less in the combined group with a higher rate of posterior capsular rupture as compared with sequential phacovitrectomy. However, small differences in visual improvements between both groups by 6 months were observed.

Visual outcomes of primary versus secondary epiretinal membrane following vitrectomy and cataract surgery

PURPOSE

To compare visual outcomes, incidence of cystoid macular edema (CME), and rate of repeat epiretinal membrane (ERM) surgery following phacovitrectomy for primary and secondary ERM.

METHODS

Retrospective review of 178,856 cataract surgeries from 2003 to 2015. Eyes that underwent cataract surgery combined with ERM peel were included (n = 708). Eyes were divided into primary (n = 538) and secondary (n = 170) ERM groups. Patient demographics, visual acuity (VA), and postoperative CME were recorded.

RESULTS

Patients with secondary ERM had worse preoperative VA, 0.9 ± 0.6 logMAR (20/160 Snellen equivalent) as compared to patients with primary ERM, 0.6 ± 0.3 (20/80), respectively (p < 0.0001). There was no difference between the secondary and primary ERM groups in postoperative vision (0.5 ± 0.4 logMAR vs. 0.5 ± 0.3; p = 0.9962) or proportion with VA ≥ 20/40 (46.4% vs. 43.1%; p = 0.6744) at 12-24 weeks. Postoperative CME was twice as likely in the secondary ERM group (16.5%) compared to the primary ERM group (7.8%) (p = 0.0018). There was no difference in the rate of repeat ERM surgery between the secondary ERM group (1.8%) and the primary ERM group (1.5%) (p = 0.7308).

CONCLUSION

Eyes with secondary ERM had significant postoperative improvement in VA. They had worse preoperative VA and had a twofold increase in postoperative CME than primary ERM.

Intraoperative Complications and Visual Outcomes of Cataract Surgery in Diabetes Mellitus: A Multicenter Database Study

PURPOSE

To compare the visual outcome and the rate of intraoperative complications in eyes of diabetic and nondiabetic patients undergoing phacoemulsification over 15 years.

DESIGN

Retrospective clinical cohort study.

METHODS

Data of 179,159 eyes that underwent phacoemulsification at 8 centers were classified based on the presence or absence of diabetes mellitus. Visual acuity (VA) was defined as the best value of uncorrected or corrected distance measure available. For the VA analysis, eyes with co-pathologies or combined surgical procedures were further excluded, leaving a subset of 90,729 eyes. Main outcome measures were logarithm of the minimum angle of resolution (logMAR) VA at 4-12 weeks postoperatively, and rate of intraoperative complications.

RESULTS

Cataract surgery in eyes of diabetic patients was associated with an improvement in mean VA of 0.48 logMAR (5 Snellen lines). Mean postoperative VA was slightly worse in diabetic compared to nondiabetic group (logMAR 0.23 vs 0.13; Snellen 20/30 vs 20/25; P < .0001) and the proportions of eyes achieving a visual gain of ≥3 Snellen lines (≥0.3 logMAR) was lower in the diabetic group (56.6% vs 63.5%; P < .0001). There was a linear relationship between diabetic retinopathy severity and worse postoperative visual acuity (β coefficient 0.098 to 0.288; P < .0001). We observed higher rates of posterior capsule rupture (2.3% vs 1.6%; P < .001) and dropped nuclear fragments (0.3% vs 0.2%; P < .001) in the diabetic group.

CONCLUSIONS

Postoperative VA negatively correlated with diabetes and diabetic retinopathy severity. Eyes of diabetic subjects had higher risks of posterior capsule rupture.

Survey of the use of laser protective eyewear among international retina specialists: a European vitreoretinal society study

Objective

To report the trends for the use of eye protection methods during retinal laser in clinic and operating room.

Methods and analysis

Retrospective analysis of a 14-item survey questionnaire submitted to the European Vitreoretinal Society members.

Results

Responses from 630 members were analysed. Most of the respondents practised in Europe (52.7%), followed by North America (21.0%). The majority of respondents had laser filters in the microscope for the operating surgeon (92.1%), or used protective goggles (6.8%). Only 38.9% of respondents indicated that auxiliary staff in the operative room used protective goggles during laser treatment. Three-dimensional retina viewing system was used by only 22.5% of respondents, of those, 34.5% reported use of laser protection goggles by the operating surgeon. Rates of laser protection by auxiliary staff were 62.9% for indirect laser and 60.8% for slit lamp laser. We found a higher rate for use of laser protection by auxiliary staff in North America-based practices for endolaser (p<0.00001), laser indirect ophthalmoscope (p<0.00001) and slit lamp laser (p=0.00033) compared with the rest of the world.

Conclusion

The use of laser protection methods is routinely adopted by the physicians in the operating room and clinic, but less so by their assisting or auxiliary staff.

Outcome of Intravitreal Dexamethasone Implant Use in Uveitic Eyes Undergoing Pars Plana Vitrectomy Surgery

Purpose: To report the outcomes in eyes with noninfectious uveitis receiving dexamethasone implant at the time of pars plana vitrectomy (PPV).Methods: Retrospective analysis of visual acuity (VA), intraocular pressure (IOP), vitreous haze score (VHS), and central subfield thickness (CST) at baseline and follow-up visits.Results: Fourteen eyes received dexamethasone implant at the time of PPV. The CST was improved from 469 ± 182 µm at baseline to 320 ± 60 at 6 months (p = .0112) and 295 ± 46 at 12 months (p = .0728). Vitritis only recurred in 2 eyes at 6 months (18.2%) and 1 eye at 12 months (14.3%). The probability of VA improvement of ≥0.3 logMAR was 57% at 6 months and 66% at 12 months. Therapy for IOP rise was initiated in 6 eyes (42.9%).Conclusions: Local delivery of dexamethasone implant with PPV is a feasible method to counteract postoperative inflammation and macular thickening.

Cataract Surgery Outcomes in Eyes With Primary Epiretinal Membrane

Importance

Primary epiretinal membrane (ERM) is a common retinal disorder with a prevalence of 4% to 18.5%. Although ERM and cataracts commonly occur together, to our knowledge, no studies have investigated the outcome of cataract surgery alone in this setting.

Objective

To analyze the visual outcome and cystoid macular edema risk with cataract surgery in eyes with primary ERM.

Design, Setting, and Participants

In this retrospective clinical database study, data were collected from July 2003 to March 2015 from 8 locations in the United Kingdom. Cataract surgery data of 217 557 eyes were extracted from the electronic medical record of the UK National Health Service. After exclusion of 57 561 eyes with combined surgery, prior vitrectomy, copathology, and complications, 812 eyes with primary ERM and 159 184 reference eyes were analyzed.

Main Outcomes and Measures

We report on visual acuity (VA), the incidence of cystoid macular edema, and the need for ERM surgery.

Results

The mean (SD) age of patients in the ERM group was 73.7 (9.23) years, and 395 of 812 were men (46.8%). The mean (SD) age of patients in the reference group was 74.4 (12.19) years, and 65 265 of 159 184 were men (41%). Epiretinal membrane eyes assessed at 4 to 12 weeks postoperatively gained 0.27 (0.32) logMAR (approximately 3 Snellen lines), with 200 of 448 (44.6%) improving by 0.30 logMAR or more (≥3 Snellen lines) and 32 of 448 (7.1%) worsening by 0.30 logMAR or more. Reference eyes gained a mean (SD) of 0.44 (0.26) logMAR (approximately 4 Snellen lines), with 48 583 of 77 408 (62.8%) improving by 0.30 logMAR or more and 2125 of 77 408 (2.7%) worsening by 0.30 logMAR or more. Although all eyes with preoperative VA of 20/40 or less improved, only reference eyes with preoperative VA of more than 20/40 showed improvement. Cystoid macular edema developed in 57 of 663 ERM eyes (8.6%) (95% CI, 6.69-10.98) and 1731 of 125 435 reference eyes (1.38%) (95% CI, 1.32-1.45) (P < .001). Epiretinal membrane surgery was performed in 43 of 663 (6.5%) ERM eyes.

Conclusions and Relevance

On average, VA improved 0.27 logMAR (approximately 3 Snellen lines) in eyes with ERM. Eyes with ERM and VA of 20/40 or less showed more benefit after cataract surgery than those with better preoperative vision. However, compared with eyes without ERM, higher rates of cystoid macular edema and a lower postoperative VA gain were noted.

Diurnal variation of choriocapillaris vessel flow density in normal subjects measured using optical coherence tomography angiography

Background

Vessel flow density (VFD) may provide important information regarding perfusion status. Diurnal variation in VFD of choriocapillaris has not been reported in literature. In the index study, optical coherence tomography angiography (OCTA) was used to assess the diurnal variation of the VFD in the choriocapillaris of subjects with no known ocular disease.

Methods

Fifty eyes with no known ocular disease (25 subjects) were included. OCTA images were acquired using AngioVue (Optovue, Fremont, CA, USA) at two different time points on a single day: 9:00 AM and 6:00 PM. Macular cube scan protocol (3 × 3 mm) centered on the fovea was used. Automatic segmentation of the retinal layers and choriocapillaris was performed using ReVue software, which was also used to measure the choriocapillaris VFD. Horizontal line scan passing through fovea was obtained by the device at both time points to measure the subfoveal choroidal thickness (CT). Linear measurement tool of software was used to measure subfoveal CT according to a standardized reproducible method. Wilcoxon signed-rank test was used to assess the differences in choriocapillaris VFD and subfoveal CT at the two time points. Correlation between change in choriocapillaris VFD and subfoveal CT at the two time points was assessed using the Pearson correlation coefficient (r).

Results

The mean age of the subjects was 31.96 ± 11.23 years. Choriocapillaris VFD was significantly higher at 9:00 AM compared to 6:00 PM (P < 0.0001) with mean choriocapillaris VFD of 68.74 ± 4.80% at 9:00 AM and 67.57 ± 5.41% at 6:00 PM, with a mean diurnal amplitude of 1.17%. Mean subfoveal CT was 287.74 ± 61.51 µm at 9:00 AM and 270.06 ± 60.73 µm at 6:00 PM. Subfoveal CT was also significantly higher at 9:00 AM compared to 6:00 PM (P < 0.0001) with a mean diurnal amplitude of 17.68 µm. Change in choriocapillaris VFD correlated with change in subfoveal CT (r = 0.87, P < 0.001).

Conclusion

OCTA demonstrated significant diurnal change in choriocapillaris VFD in subjects without any ocular disease with VFD being higher in the morning and lower in the evening. Decrease in choriocapillaris VFD in the evening correlated with a reduction in subfoveal CT.

Evaluation of macular and peripapillary vessel flow density in eyes with no known pathology using optical coherence tomography angiography

Purpose

To assess normal vessel flow density (VFD) in macular and peripapillary regions of eyes with no known ocular pathology using optical coherence tomography angiography (OCTA).

Methods

AngioVue (Optovue, Fremont, CA, USA) was used to capture OCTA images. A 3 × 3 mm grid and a 4.5 × 4.5 mm grid was used to scan parafoveal and peripapillary regions, respectively. ReVue software was utilized to measure VFD in five sectors within the inner two circles of ETDRS grid in macular region and correlated to retinal thickness of same sectors. At optic disc, VFD was calculated in six sectors based on Garway-Heath map. Area and morphology of foveal avascular zone (FAZ) was correlated with VFD in central 1 mm. The influence of myopia on mean VFD was also assessed.

Results

Twenty-four eyes (mean age: 30 years) were analyzed. Mean VFD in macular sectors was 43.5 (±4.5) and 45.8 (±5.0) % in superficial and deep retinal plexuses, respectively. Mean VFD was significantly higher in deep retinal plexus compared to superficial retinal plexus in all sectors except central 1 mm (p < 0.05). Mean VFD in central 1 mm increases with an increase in central retinal thickness in both superficial and deep retinal plexuses (p < 0.001). Mean parafoveal VFD at level of both superficial and deep retinal plexuses decrease with an increase in spherical equivalent in myopics (p < 0.05). Mean VFD in myopics was found to be significantly lower in parafoveal region of deep retinal plexus (p < 0.05). Mean area of FAZ was 0.33 (±0.15) and 0.47 mm² (±0.15) in superficial and deep retinal plexuses, respectively. Area of FAZ decreases with an increase in central 1 mm thickness and foveal VFD (p < 0.001).

Conclusions

OCTA may be used to measure VFD in macular and peripapillary regions. Vessels in the parafoveal region are more densely packed in the deep retinal plexus leading to higher VFD compared to superficial plexus. Thicker retina in fovea translates into higher foveal VFD due to more compact arrangement of retinal layers and continuity of inner nuclear layer (INL). Myopia is associated with lower VFD in parafoveal region at level of deep retinal plexuses which may explain thinning of INL in myopics.

Therapies in Development for Non-Infectious Uveitis

Uveitis represents a spectrum of diseases characterized by ocular inflammation that leads to significant visual loss if left untreated. Adequate, long-term control of inflammation with minimal systemic and local adverse effects is the preferred strategy for treating patients with uveitis. Pharmacotherapy for uveitis consists mainly of corticosteroids in various formulations such as topical, local, intraocular and systemic. However, monotherapy with corticosteroids is often unacceptable due to serious adverse effects on various organ systems. There exist limitations with the use of steroid-sparing systemic immunosuppressive agents, as these medications may have significant adverse events and a narrow therapeutic window. Thus, newer molecular targets that act on various steps of the inflammatory pathway appear to be promising emerging strategies for treating uveitis. Specially designed monoclonal antibodies in development can potentially halt the inflammatory processes resulting in remission of the disease. In the index review, novel molecular agents and biological therapies that have shown promising efficacy and safety data in preclinical and clinical studies have been summarized. In addition, new drug delivery systems that may ensure high intraocular therapeutic levels of pharmacologic agents have been highlighted.

Endogenous endophthalmitis: diagnosis, management, and prognosis

Endogenous endophthalmitis is an ophthalmic emergency that can have severe sight-threatening complications. It is often a diagnostic challenge because it can manifest at any age and is associated with a number of underlying predisposing factors. Microorganisms associated with this condition vary along a broad spectrum. Depending upon the severity of the disease, both medical and surgical interventions may be employed. Due to rarity of the disease, there are no guidelines in literature for optimal management of these patients. In this review, treatment guidelines based on clinical data and microorganism profile have been proposed.

High-resolution adaptive optics findings in talc retinopathy

Talc retinopathy is a recognized ocular condition characterized by the presence of small, yellow, glistening crystals found inside small retinal vessels and within different retinal layers. These crystals can be associated with retinal vascular occlusion and ischemia. Different diagnostic modalities have been used previously to characterize the retinal lesions in talc retinopathy. Adaptive optics, a high resolution imaging technique, is used to evaluate the location, appearance and distribution of talc crystals in a case of talc retinopathy.

Sustained-release fluocinolone acetonide intravitreal insert for macular edema: clinical pharmacology and safety evaluation

INTRODUCTION

Inflammation plays a key role in the pathological processes leading to macular edema. Sustained release, low-dose intraocular corticosteroid delivery devices provide long-term anti-inflammatory therapy. Recently, a novel fluocinolone acetonide intravitreal insert (FAi, Iluvien), has been introduced with promising long-term results in the treatment of macular edema.

AREAS COVERED

An extensive review of the literature in the English language was performed to provide comprehensive information on the pharmacological properties of FAi and its safety and efficacy data from various multi-center randomized clinical trials.

EXPERT OPINION

The FAc, Retisert is a sustained-release device that is surgically implanted in the vitreous and has been approved by the US FDA for the treatment of non-infectious intermediate, posterior or panuveitis. FAi was developed after FAc and is an intravitreal corticosteroid delivery system that allows controlled release of therapeutic levels of fluocinolone acetonide (FA). Initial efficacy and safety data suggest that this delivery system maintains clinical effectiveness for up to 3 years after a single delivery of the device. This second-generation fluocinolone delivery device has shown superior safety results in clinical trials compared to the previous version of the higher dose FAc (0.59 mg). Sustained delivery preparations may help to reduce the treatment burden and its associated risks by decreasing the frequency of intravitreal injections. However, much needs to be learnt from additional clinical trials, post-marketing surveillance and results of extension studies. Concerns of intravitreal corticosteroids, such as cataract and increase in intraocular pressure, remain major challenges for this therapeutic strategy.

Diabetic retinopathy: variations in patient therapeutic outcomes and pharmacogenomics

Diabetes and its microvascular complications in patients poses a significant challenge and constitutes a major health problem. When it comes to manifestations in the eye, each case of diabetic retinopathy (DR) is unique, in terms of the phenotype, genotype, and, more importantly, the therapeutic response. It is therefore important to identify factors that distinguish one patient from another. Personalized therapy in DR is a new trend aimed at achieving maximum therapeutic response in patients by identifying genotypic and phenotypic factors that may result in less than optimal response to conventional therapy, and consequently, lead to poorer outcome. With advances in the identification of these genetic markers, such as gene polymorphisms and human leucocyte antigen associations, as well as development of drugs that can target their effects, the future of personalized medicine in DR is promising. In this comprehensive review, data from various studies have been analyzed to present what has been achieved in the field of pharmacogenomics thus far. An insight into future research is also provided.

Amoxycillin in the control of furunculosis in Atlantic salmon parr

The efficacy of amoxycillin in the control of laboratory induced Aeromonas salmonicida infection in Atlantic salmon parr was investigated. When given in the diet at a dose rate of 80 mg per kg bodyweight it was effective against both a moderate and severe challenge (with mortality rates in untreated groups of 75 per cent and 45 per cent). At 40 mg per kg it was effective against the moderate challenge only. The plasma levels in these regimens were 1.25 micrograms per ml and 0.3 to 0.6 micrograms per ml and the minimum inhibitory concentration of the challenge strain of A salmonicida was 0.6 micrograms per ml. The potential of the Charm radiobioassay system in detecting antibiotic residues in fish tissue was studied. The level of amoxycillin in muscle and bone from fish in mid-treatment at 80 mg per kg was 0.32 micrograms per ml. After a 12 day withdrawal period at 18 degrees C no residue was detected within the 0.005 micrograms per ml limit of this test.

Motile aeromonas infection of striped (grey) mullet Mugil cephalus

Infection of striped mullet (Mugil cephalus) with Aeromonas hydrophila results in an acute septicemic disease. The disease can be experimentally induced by intramuscular injection, skin or gill scarification or by the oral route using pellets purposely seeded with bacteria. The organism was isolated from the blood 1-2 days after infection and from all organs 24 hr or longer after infection. The disease is characterized by early inflammatory and proliferative changes and later necrotic changes. Enteritis and hepatic necrosis are constant findings in aeromonad disease of M. cephalus but surface lesions are not pathognomic for these infections in mullet. Death of infected fish may be attributed to bacterial toxins which cause necrosis of parenchymal organs and soft tissue structure.

Studies on the physiological chemistry of the tibio-tarsal synovial fluid of healthy bovines

The physical properties, chemical composition and cytological content of the synovial fluid of healthy native breed cattle, obtained by tibio-tarsal arthrocentesis, was studied. Normally the synovial fluid of bovines is a clear, colourless or straw coloured, viscous, non-coagulable liquid with a normal mucin precipitate quality. The fluid is alkaline in reaction and with a lower specific gravity than serum. Bovine tibio-tarsal fluid exhibits no erythrocytes and presents a low leucocytic count which is dominated by lymphocytes and monocytes. Compared to bovine serum, synovial fluid contains almost the same levels of sugar, urea, creatinine and phosphorous; slightly lower calcium concentration and rather higher chlorides. The fluid is devoid of any traces of bilirubin. Young calves showed a significantly lower total leucocyte number, chloride level and sugar content and a higher calcium and inorganic phosphorous than bulls.