Central, Peripheral Vision Impairment and Risk of Falls
Patino et al (p. 199) found that impairment of both central and peripheral vision independently increases the risk for falls and falls with injury. The study involved participants of the Los Angeles Latino Eye Study (LALES) who provided a self-report of falls and falls with injury in the previous 12 months at their 4-year follow-up visit. Of the 3203 participants followed in the study, 19% reported falls and 10% reported falls with an injury. Central vision impairment increased the risk of falls 2.4 times and falls with injury 2.8 times, while peripheral vision loss increased their risk of falls and falls with injury by 1.4 fold. While 70% of individuals diagnosed with central vision impairment also had peripheral vision impairment, only 7% of those with peripheral vision impairment had central vision impairment. These data suggest that correcting for central vision loss alone may not be sufficient enough effectively to decrease the rates of falls and falls with injury due to vision impairment.
Incidence of Post-LASIK Infectious Keratitis in 107613 Patients
Using data collected from 107613 patients (204586 eyes) who underwent LASIK at a clinic in Spain from September 2002 to May 2008, Llovet et al (p. 232) found the occurrence of post-LASIK infectious keratitis was 0.035% per procedure, or 1 case in 2841 procedures. A retrospective review of the medical records of these patients indicated that 73 eyes of 63 patients were diagnosed with post-LASIK infectious keratitis. In 62.5% of the cases, the infection's onset occurred within 7 days after surgery. Nine cases of the microorganism Staphylococcus epidermidis were identified. Final best spectacle-corrected visual acuity (BSCVA) was 20/20 or better in 38 patients and 20/40 or better in 67 patients, with final BSCVA worse than 20/40 in 5 patients. The authors conclude that while post-LASIK infectious keratitis is rare, it is a complication that can be vision-threatening. Consequently, clinicians should be diligent in scheduling follow-up visits. They also recommended prompt and aggressive management with early flap lifting, scraping, culture, and irrigation with antibiotics.
Effectiveness of Intravitreal Bevacizumab, Ranibizumab in AMD Compared
In a comparative retrospective case series, Fong et al (p. 298) found that intravitreal bevacizumab (Avastin) and ranibizumab (Lucentis) appear to be equally affective in stabilizing visual acuity loss in patients with exudative age-related macular degeneration (AMD). The researchers followed 342 patients treated with bevacizumab and 128 patients treated with ranibizumab for 1 year. The bevacizumab patients received 4.4 injections by 12 months, and the ranibizumab patients had 6.2 injections. At 12 months, 22.9% of the bevacizumab group and 25.0% of the ranibizumab group had visual acuity greater than or equal to 20/40. In addition, 27.3% of the bevacizumab patients and 20.2% of the ranibizumab patients experienced improvement in their vision. While there did not appear to be a statistically significant difference between these 2 treatment approaches, the investigators caution that selection bias could mask a true treatment difference. The Comparison of the Age-Related Macular Degeneration Treatment Trials promises to provide a more definitive picture about the comparative effectiveness of these drugs.
Clinical Features, Natural Course of Giant Choroidal Nevus Described
Li et al (p. 324) describe the clinical features and natural course of giant choroidal nevi (diameter ≥10 mm) in 322 eyes of 322 patients. Although rare, this benign melanocytic lesion can progress to melanoma. In this study, median nevus basal diameter was 11 mm, and median nevus thickness was 1.9 mm. The authors noted that features more consistent with giant choroidal nevi than malignant melanoma included signs of chronicity such as drusen, retinal pigment epithelial (RPE) atrophy, RPE hyperplasia, and fibrous metaplasia. In contrast, they found that serous retinal detachment, orange pigment, and acoustic hollowness were features of melanoma rather than giant choroidal nevi. In this study, while most giant choroidal nevi remained stable, over the course of 10 years 18% transformed into melanoma. Factors predictive of transformation into melanoma, indicated through multivariate analyses, included involvement or close proximity to the foveola and acoustic hollowness. These findings highlight the importance of lifelong, routine surveillance of these lesions.
Everting Sutures, Lateral Tarsal Strip for Involutional Entropion
A prospective randomized comparative trial by Scheepers et al (p. 352) involving 63 patients with primary involution lower eyelid entropion provides evidence that combining the use of everting sutures (ES) and the lateral tarsal strip procedure (LTS) to accomplish horizontal eyelid shortening is more effective than ES alone in correcting this condition. Of the 55 patients who completed the 3-, 6-, 12-, and 18-month follow-up, there were 6 failed procedures in patients who underwent ES alone and no failed procedures in the patients who had the combination ES + LTS procedure. While the 2 groups were comparable with respect to horizontal lid laxity (HLL), the average HLL was slightly greater in ES patients who suffered a recurrence of their entropion. Based on these findings, the authors recommended addressing HLL when surgically managing entropion to reduce the risk of recurrence. They conclude that treating both the horizontal and vertical lower eyelid laxity in these patients appears to have a more long-lasting effect on maintaining lower eyelid stability.
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