TNOA Journal of Ophthalmic Science and Research

: 2020  |  Volume : 58  |  Issue : 3  |  Page : 225--227

Journal review

Nivean Madhivanan, Pratheeba Devi Nivean 
 Department of Ophthalmology, M N Eye Hospital, Chennai, Tamil Nadu, India

Correspondence Address:
Dr. Pratheeba Devi Nivean
M N Eye Hospital, Chennai, Tamil Nadu

How to cite this article:
Madhivanan N, Nivean PD. Journal review.TNOA J Ophthalmic Sci Res 2020;58:225-227

How to cite this URL:
Madhivanan N, Nivean PD. Journal review. TNOA J Ophthalmic Sci Res [serial online] 2020 [cited 2020 Nov 25 ];58:225-227
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Full Text

 Locations, Circumstances and Outcomes of Falls in Patients With Glaucoma

Somtihen A, Onge AY, Sheila K, et al. Locations, circumstances and outcomes of falls in patients with glaucoma. Am J Ophthalmol 2018;192:131-41.

Introduction:Falls are a significant cause of morbidity and mortality in older adults aged 65 and over. Poor vision itself is an independent risk factor for these falls. Out of all the different forms of visual impairment, visual field (VF) loss is the most implicated cause and binocular VF loss is the leading risk factor for falls and fractures. Study Design and Methodology: Study participants were recruited from the Johns Hopkins Wilmer Eye Institute glaucoma clinic between September 2013 and March 2015. They included glaucoma patients who were able to interpret VF testing. Study participants were excluded if they had worse than 20/40 vision in either eye owing to any disease other than glaucoma or were confined to a bed or wheelchair. Results: Forty-two articipants experienced a total of 330 falls. Most falls were indoors (70.5%). The falls did not vary significantly with the severity of VF damage. The most commonly cited fall circumstances were tripping (43.6%), slipping (31.3%), uneven flooring (23.5%), and poor vision (15.9%).

Take home message

The study showed that glaucoma patients are most likely to fall in or near their homes. Hence, the home modification could be an ideal supportive therapy in moderate-to-severe glaucoma patientsConditions such as changes in elevation, uneven walking surfaces, and physical obstructions would be more frequently associated with falls in persons with greater visual field (VF) damageFuture research, perhaps using wearable sensors, should further explore how the immediate circumstances of a fall vary with VF damage.

 Non-Steroidal Anti-Inflammatory Drugs-Induced Corneal Melt: Clinical Importance, Pathogenesis, and Risk Mitigation

Rigas B, Huang W, et al. Jan-Feb 2020;65:1-11.

Introduction: Corneal melt is a condition in which the corneal epithelium is lost with thinning of the corneal stroma. Corneal melt is associated with various conditions such as infections, sterile inflammation, and surgical or chemical injury to the cornea. A common sequelae of this is corneal melt leading to corneal perforation. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) are important in the treatment of a wide range of conditions, including pain and inflammation caused by ocular surgery, cystoid macular edema after cataract surgery, allergic conjunctivitis. This article explains the NSAID induced corneal melt association, its underlying mechanism and potential ways to mitigate the risk. Side Effects of Nonsteroidal Anti-Inflammatory Drugs and the Mechanism of Corneal Melt: The most common local adverse events of ocular NSAIDs are conjunctival stinging (at times intense, but usually transient), burning, hyperemia, and corneal anesthesia, contact dermatitis, and a local anesthetic effect. Corneal complications of topical NSAIDs include superficial punctate keratitis, corneal infiltrates, and epithelial defects. The most severe of all is corneal melt. The initiating event is the corneal epithelial defect induced by exposure to the NSAID. When this defect fails to reepithelialize, it is followed by an enzyme-mediated attack on the exposed stroma, whose collagen fibers are hydrolyzed, leading to progressive corneal thinning, descemetocele, and ultimately corneal perforation. Diabetes, systemic immune diseases, and ocular surface diseases that compromise the cornea appear to be risk factors.

Take home message

One of the prerequisites of nonsteroidal anti-inflammatory drug-induced corneal melt is the apparent requirement for a compromised cornea for it to occurTopical anesthetics, topical ciprofloxacin abuse, and many others can also cause corneal melts. This warrants a detailed history taking from the patientAwareness, close monitoring, and stopping the medicine when needed, can avoid unnecessary complications

 Risk of Cataract Surgical Complications among Patients Exposed to Tamsulosin

Campbell RJ, El-Defrawy SR, Gill SS, Marlo Ophthalmol 2019;126:490-6.

Introduction: Tamsulosin is an alpha-1 adrenergic receptor antagonist used for the treatment of urinary retention and lower urinary tract symptoms resulting from benign prostatic hyperplasia. Tamsulosin also causes changes in iris structure and iris behavior during cataract surgery. It can cause the dreaded intraoperative floppy iris syndrome (IFIS), which constitutes intraoperative miosis, iris billowing, and prolapse. Study Design and Methodology: All cataract operations done in all male patients aged 65 years and above were evaluated in Ontario, Canada, in a 10-year period between January 1, 2003, and December 31, 2013, who were prescribed tamsulosin a year before surgery. Tamsulosin exposure was defined as the use of the drug at least a year preceding cataract surgery. This period was chosen because tamsulosin can cause IFIS even after short-term exposure, and the effect can persist even after tamsulosin cessation. Surgeon experience was evaluated by dividing surgeons into three groups. They excluded patients with combined procedures, prior lasers, or surgery within 5 years of cataract surgery. Results: The risk of cataract surgical complications among both tamsulosin-exposed and nontamsulosin-exposed patients declined between 2003 and 2013, suggesting that a decade of technical innovation and educational initiatives has resulted in important improvements in surgical care. Conclusion: This study has a number of strengths, including its population-based methodology, long study period, large sample size, evaluation of numerous clinically important outcomes such as patient-, surgeon, and institution-level covariates. Continuing medical education has increased awareness of the risks of tamsulosin in cataract surgery and insists on the use of mechanical pupil expansion devices, fluidic parameter optimization, and intensive pharmacologic pupil dilation.

Take home message

However, tamsulosin remains an important risk factor for cataract surgical adverse events, and appropriate steps and measures are required to prevent untoward complications.

 Refractive Change in Children With Accommodative Esotropia

Bonafede L, Bender L, Shaffer J, Ying GS, Binenbaum G. Refractive change in children with accommodative esotropia. British J Ophthalmol 2019.

Esotropia is an inward deviation of the eyes. There are two main types of esotropia-Accommodative and nonaccommodative. The accommodative type is further divided into refractive and nonrefractive. The refractive accommodative esotropia can be fully or partially accommodative esotropia. There is an entity called AC/A ratio (i.e.,) for any given change in the dioptric power of accommodation, there is a fixed accommodative convergence. The normal AC/A ratio is 4:1. When there is an imbalance between these parameters, it can manifest as a squint or a deviation of the eye. In accommodative esotropia, the AC/A ratio is normal, and esotropia is a physiological response to excessive hyperopia, usually between + 2.00 and + 7.00D. The considerable degree of accommodation required to focus clearly even on a distant target is accompanied by a proportionate amount of convergence, which results in a manifest squint. This study is aimed to determine if there is a measurable change in hyperopia in children with accommodative esotropia over time as they grow during the process of emmetropisation. This study included 405 children divided into two groups-3–7 years and the 7–15 years age group. They were further subdivided into two groups based on the refractive power (+4D). They found that, between ages 3 and 7, hyperopia among children with baseline hyperopia <4D increased by 0.12 (0.08–0.16) D/year, while hyperopia among those with baseline 4D or greater was stable (0.0D/year, −0.03–0.04) (P < 0.001). Hyperopia decreased from age 7–15 years in both subgroups: <4D subgroup − 0.17 (−0.20–−0.14) D/year, ≥4D subgroup − 0.18 (−0.21 to − 0.15) D/year (P = 0.58). There was no significant difference in refractive change between fully (n = 274) and partially (n = 131) accommodative esotropia (P ≥ 0.10).

Take home message

This study confirms the general trend of hyperopia to increase or remain stable up to 7 years, followed by a gradual decrease in hyperopiaParents can expect on average, a decrease in hyperopia of only about 1D, so the change is typically not large enough to allow their children to discontinue spectacle useOnly a small minority of children, with a smaller baseline refractive error and a greater than average decrease in hyperopia, experience a change that allows them to stop wearing glasses.

 Four-Year Follow-Up of the Changes in Anterior Segment After Phakic Collamer Lens Implantation

Lu Y, Yang N, Li X, Kong J. Four-year follow-up of the changes in the anterior segment after phakic collamer lens implantation. Am J Ophthalmol 2017;178:140-9.

Refractive error is the most common cause of defective vision, and laser-assisted in situ keratomileusis (LASIK) has been the most commonly used technique to correct ametropia. However, it has a limitation that it cannot be used to correct extremely high refractive error and in thin corneas. An implantable Collamer lens (ICL) can be used to correct high myopia. The ICL's are made of a hydrophilic collagen polymer that is supposed to be highly biocompatible and refrain from metabolic interferences with the crystalline lens. The purpose of this study was to assess the changes and relationships in central vaulting, flare intensity, and crystalline lens thickness during a follow-up period of 4 years after Implantable Collamer Lens (ICL) implantation in eyes with high myopia. Ninty-eight eyes of 50 patients were included in this retrospective observational study. The amount of vault is defined as the distance between the back surface of the ICL and the anterior crystalline lens pole. The postoperative change at 1 month, 3 months, 6 months, 12 months, 36 months, and 60 months were quantitatively assessed. In this consecutive 4-year follow-up, the central vaulting had a significant decrease of 0.16 ± 0.14 mm within the 1st year after surgery, and the decrease tended to be slow down thereafter. The decrease in central vaulting from the 3-year to 1-year visit was only 0.04 ± 0.16 mm, and 0.02 ± 0.19 mm from the 5-year to 3-year visit. There was a continuous reduction in central vaulting and endothelial cell density as well as an increase in crystalline lens thickness in ICL eyes from 1 month onward to 5 years postoperatively (P < 0.001). Although the trend of variation during the individual visit period was accentuated, the variation turned out to be smaller between 12 and 36 months or 60 months postoperatively (P = 0.42, 0.65). Aqueous flare intensity increased significantly after surgery and returned to normal 1 year later. In addition, a positive correlation between patient age and crystalline lens thickness (r = 0.617, P < 0.0001) was observed in eyes with ICL implantation.

Take home message

In conclusion, this study demonstrated that ICL implantation with sufficient vault is safe and effective for the correction of high myopia. The United States, the Food and Drug Administration suggests new criteria of anterior chamber depth depth no <3.0 mm, which increases the space in the anterior chamber and may help maintain the stability of overall surgical outcomes. The changes in central vaulting, endothelial cell density, and crystalline lens thickness are more prominent during the 1st year after ICL implantation, tending to be relatively stable afterward.

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Conflicts of interest

There are no conflicts of interest.