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November 2002
IN THIS ISSUE

Wavefront seeks a higher order of vision correction
New laser system for intraoperative measurement of LASIK flap thickness
Visual prostheses use neurotransmitter retinal chips to stimulate retinal function
Wavefront emerges as powerful tool for night vision
Allegretto promising for hyperopia and hyperopic astigmatism
Topography's role in wavefront systems
IOP measurement after LASIK may be unreliable
LASEK may only play support on refractive stage
Solid-state laser PRK yields favourable results for myopia
GTS-assisted DLK useful alternative to PK for keratoconus
Glaucoma common after PK bodes poorly for visual outcome
Classic drawbacks of PRK succumb to new strategies
New insight into LASIK dry eye pathogenesis
Use of anti-inflammatories after capsulotomy questioned
Good quality training leads to good quality cataract surgery
One line of regained visual acuity is a snip at just €120
Mitomycin-C provides effective haze prophylaxis
Long-term concerns linger on safety of Mitomycin-C
German politicos promise health reforms
Honey forms biblical basis for corneal oedema
Routine two-step LASIK after PK unnecessary
Plasma knife provides clean and accurate cut for capsulorhexis
Glaucoma therapy targets apoptosis and trabecular meshwork
Viscocanalostomy viable choice for cataract-glaucoma
Device allows needle-free injections into smallest vessels
New river blindness therapy may provide panacea for 18m people
Daytime running lights may soon be compulsory in all EU states
Intracorneal lamellar implants still a questionable option
Aqualase system viable for small incision cataract removal
Unilateral von-Hippel disease with optic nerve head
FEATURES
From The Editor
Reflections on Refractive Surgery
In Your Good Books
An Eye On Travel
Bio-ophthalmology
Outlook on Industry
Regulatory Matters



Use of anti-inflammatories after capsulotomy questioned

By Cheryl Guttman

FORT LAUDERDALE, FL - Topical anti-inflammatory drugs should not be prescribed routinely after Nd:YAG laser capsulotomy for prophylaxis against iritis but may be indicated in certain patients at risk from developing the complication, according to a Wilmer Eye Institute study.

Researchers reviewed the value of anti-inflammatory treatment after Nd:YAG laser capsulotomy in a series of 73 eyes. The results, presented at the annual meeting of the Association for Research in Vision and Ophthalmology (ARVO), showed iritis was relatively uncommon and most often developed despite anti-inflammatory treatment.
Of the 73 eyes, 22 received an anti-inflammatory drug, either a topical corticosteroid (20 eyes) or a nonsteroidal anti-inflammatory agent (two eyes) after the capsulotomy.
Iritis occurred in six eyes but only one of them had an unremarkable baseline exam. The remaining five were received anti-inflammatory medication because of pre-existing ocular inflammation.

Anti-inflammatory drops
Among the 67 eyes that did not develop iritis, 50 were not started on anti-inflammatory drops after the capsulotomy procedure.
Timothy Y. Chou MD said iritis is a potential complication of Nd:YAG laser capsulotomy but the value of prophylactic anti-inflammatory treatment has not been well-studied.

"There is a lot of variation among ophthalmologists prescribing patterns. My own practice is not to prescribe anti-inflammatory medication routinely, while others consider it standard postoperative care.

"We believe the results of this retrospective review support the conclusion that anti-inflammatory drops are unnecessary in uncomplicated eyes undergoing capsulotomy," he said.

Working with ophthalmology resident Lee Ann Snyder MD, Dr Chou analysed the data to find features that might be predisposed to iritis after capsulotomy.
In addition to pre-existing inflammation, higher laser energy dose and a shorter interval between cataract surgery and capsulotomy appeared to be risk factors.

The eyes that developed iritis received total laser energy ranging from 95 mJ to 251 mJ with mean and median doses of 167 mJ and 174 mJ, respectively.
Among the eyes without iritis, the range of total laser energy was between 11 mJ and
600 mJ but the mean was 118 mJ and the median only 81 mJ.

In the iritis group, all capsulotomies were performed within the first year after cataract surgery, and the mean and median times to the secondary procedure were 2.6 and 4.3 months, respectively.
In contrast, the mean and median times to capsulotomy after cataract surgery in the eyes without iritis were about 30 months.

Laser energy
"Taken together, our findings suggest anti-inflammatory treatment might be warranted routinely when performing capsulotomy in eyes with evidence of current or previous intraocular inflammation as well as in those who have sustained excessive laser energy above 100 mJ or who have more recently undergone cataract surgery," Dr Snyder said.

Noting that most of the patients who developed iritis were already receiving steroids, Dr Chou observed that more aggressive treatment might be necessary in patients with existing ocular inflammation undergoing capsulotomy.
"Most of the patients who developed iritis were being treated with prednisolone acetate 1% four times a day.

"Perhaps at-risk patients undergoing capsulotomy might benefit from increasing the frequency of administration of their anti-inflammatory medication to one drop every one to two hours," he explained.
Dr Chou acknowledged that one limitation of this study was it that might underestimate the incidence of iritis.

Not being formally followed for iritis development, most patients were seen approximately one week after the procedure at a standard follow-up visit.
Even if that were the case, however, it would not necessarily support more routine anti-inflammatory drug prescribing, he suggested.

"It seems reasonable to assume that any inflammation that might have developed prior to the scheduled follow-up was not clinically apparent or problematic or else it would have prompted an earlier return visit.

"Therefore, even if a higher proportion of patients are affected, I'm not convinced anti-inflammatory treatment would be indicated for what is most likely a mild and self-limiting problem," Dr Chou said.


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