In The Journal Of Cataract & Refractive Surgery July 2010
Common causes of TASS
Carolee M. Cutler Peck, M.D., M.P.H., Jacob Brubaker, M.D., Sue Clouser, R.N., M.S.N., C.R.N.O., Chris Danford, Henry E. Edelhauser, Ph.D., Nick Mamalis, M.D.
Investigators in this retrospective study set out to identify the most common risk factors linked to toxic anterior segment syndrome (TASS). They analyzed 77 questionnaires involving TASS cases that occurred between June 1, 2007 and May 31, 2009 at 54 different sites in seven countries. During that period 909 TASS cases were reported. Some of the culprits that investigators found included inadequate regimes of flushing phaco and irrigation/aspiration handpieces, enzymatic cleaner usage, using the wrong concentration of detergent, ultrasonic bath usage, putting antibiotics in balanced salt solution, and using preserved epinephrine. Additional risk factors included use of powdered gloves, use of inadequate agents for skin preparation, using single use products more than once, and improperly maintaining instrumentation. Investigators here hoped that by highlighting common practices that could lead to TASS, that these could be exchanged for safe alternatives that allow practices to prevent the condition.
Effect of cyclosporine on visual acuity with multifocal IOL
Eric D. Donnenfeld, M.D., Renée Solomon, M.D., Calvin W. Roberts, M.D., John R. Wittpenn, M.D., Marguerite B. McDonald, M.D., Henry D. Perry, M.D.
The aim in this randomized, prospective study was to consider whether vision quality after multifocal intraocular lens implantation could be improved with use of cyclosporine 0.05 percent in dry eye cases. Beginning one month before surgery, patients applied cyclosporine 0.05 percent twice daily in one eye and an artificial tear in the other. They continued to do this for two months after second eye surgery. Investigators found that while at baseline there was no significant difference between the groups at the two-month postoperative mark, those in cyclosporine group had better uncorrected distance vision than those receiving artificial tears. Patients in the cyclosporine group had of 20/25 uncorrected distance acuity versus a mean of 20/30 for the other group. Corrected distance acuity was also significantly lower with a mean of 20/20 in the cyclosporine group versus a mean of 20/25 in the group receiving artificial tears. Investigators also determined that contrast sensitivity, conjunctival staining and tear break up time were all significantly improved in the cyclosporine group. Most of the patients themselves reported that they preferred the cyclosporine treated eye to the one that received artificial tears. Investigators here concluded that following placement of a multifocal IOL implant use of 0.05 percent cyclosporine could improve vision quality and reduce dry eye signs.
REVIEW/UPDATE: Value of OCT for anterior segment surgery
Muriël Doors, M.D., Tos T.J.M. Berendschot, Ph.D., John de Brabander, Ph.D., Carroll A.B. Webers, M.D., Ph.D., Rudy M.M.A. Nuijts, M.D., Ph.D.
This review highlighted use of the new non-contact imaging technology known as anterior segment optical coherence tomography. Investigators detailed that this can be used for a myriad of purposes including determining anterior chamber biometry, corneal and lens thickness, and angle configuration. Post-surgically it can also be used to evaluate anatomy, posttraumatic eyes, and to visualize pathological disease processes. Phakic intraocular lenses and intracorneal ring segments can also be imaged with this technology. Investigators believe that intraoperatively this non-contact technique could be useful during trabeculectomy and then to detect abnormalities in the cornea and interface after deep anterior lamellar keratoplasty. One downside is that AS-OCT is unable to evaluate structures behind the iris since it is unable to penetrate the iris pigment epithelium. Newer, faster AS-OCT technology, using Fourier- rather than time-domain, is now under development.