This Issue At A Glance

Article Outline

• Intravitreal Clindamycin, Dexamethasone for Toxoplasmic Retinochoroiditis
• Subjunctival 2% Lidocaine Reduces Pain in Laser Retinopexy Patients
• Subretinal Drusenoid Deposits, Soft Drusen Associated with Late AMD
• Tamsulosin Has Effect on Iris Dilator Smooth Muscle
• 10-Year Risk of Glaucomatous Visual Field Loss Highly Dependent on Age

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Intravitreal Clindamycin, Dexamethasone for Toxoplasmic Retinochoroiditis 

In a retrospective medical record review of 12 patients with posterior pole (zone 1) toxoplasmic retinochoroiditis (TRC), Lasave et al (p. 1831) have found that intravitreal clindamycin and dexamethasone is associated with resolution of the condition. The patients were placed on the medication due to an intolerance to oral medication, contraindication to oral medication due to pregnancy, or a lack of response despite oral antimicrobial treatment. The patients included in the study were treated weekly with intravitreal injections of clindamycin (1.5 mg/0.1 ml) and dexamethasone (400 μg/0.1 ml), with an average of 3.6 injections. (The pregnant patients were treated every 4 weeks). The treatment resolved inflammation and in most cases was associated with improvement of visual acuity and central macular thickness. At 24 months, no recurrences were reported in any of the patients. The authors call for a randomized, controlled clinical trial comparing intravitreal clindamycin and dexamethasone as an adjuvant to systemic therapy to standard oral systemic treatment to determine its efficacy and safety.

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Subjunctival 2% Lidocaine Reduces Pain in Laser Retinopexy Patients 

Tesha et al (p. 1810) have found that subjunctival 2% lidocaine significantly reduces pain in patients undergoing panretinal photocoagulation or peripheral laser retinopexy. In the prospective, masked study, 32 eyes of 32 patients received the anesthetic injection prior to laser treatment and 33 eyes of 33 patients received a sham injection. A crossover group consisting of patients who needed a second laser treatment received the opposite injection prior to treatment. Patients who received the subjunctival 2% lidocaine were over 20 times more likely to be pain free than patients receiving the sham injection. In the crossover population, patients were 20 times more likely to prefer the anesthetic over the sham. The greatest treatment benefit occurred in patients who underwent peripheral laser retinopexy for the treatment of retinal breaks as part of a pneumatic retinopexy for a retinal detachment–possibly due to the large volume of anesthetic deposited anteriorly. The authors suggest subconjunctival 2% lidocaine should be considered in patients who experience pain with laser retinopexy.

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Subretinal Drusenoid Deposits, Soft Drusen Associated with Late AMD 

Zweifel et al (p. 1775) have demonstrated that both soft drusen and subretinal drusenoid deposits occur in patients with age-related macular degeneration (AMD), and both are significantly associated with late AMD. This prospective study included 153 AMD patients, of whom 131 had at least 1 eye with late AMD, and a control group of 101 patients who did not have AMD. The investigators used 2 evaluation methods–blue channel of color fundus photographs and spectral domain optical coherence tomography (SD-OCT)–to identify subretinal drusenoid deposits in the participants. Results showed that subretinal drusenoid deposits were frequently found in eyes with AMD, but less frequently than soft drusen. In addition, subretinal drusenoid deposits were found much more frequently by SD-OCT than by examining the blue channel of the color photograph. The authors recommend that SD-OCT be part of the methodology to detect and classify drusen and assignment of risk. In addition, future studies on this subject should include SD-OCT imaging to help establish the drusen location.

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Tamsulosin Has Effect on Iris Dilator Smooth Muscle 

Tamsulosin (Flomax), a selective α_1A-adrenergic receptor antagonist, constitutes the most commonly prescribed alpha-receptor blocker for benign prostatic hyperplasia (BPH). It has also been associated with the distinctive characteristics of intraoperative floppy iris syndrome (IFIS). To better understand this effect, Santaella et al (p. 1743) examined the human iris dilator smooth muscle and stroma using light microscopy of 51 postmortem eyes of 14 patients treated with tamsulosin to determine if any changes in muscle size and iris architecture could be detected compared with 13 age-matched controls patients. They found a statistically significant decreased mean iris dilator muscle thickness in the tamsulosin-treated group, which was on average 23.2% thinner compared with the mean iris dilator muscle of the control group. They did not detect any significant difference when comparing the mean iris stromal thickness between the 2 groups. The authors call for further studies to evaluate the significance of this report that shows a correlation between tamsulosin use and a morphologic decrease in iris dilator muscle thickness.

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10-Year Risk of Glaucomatous Visual Field Loss Highly Dependent on Age 

Longitudinal data from the Rotterdam Study indicates that the 10-year risk of glaucomatous visual field loss (GVLF) in an elderly white population is highly dependent on age, with the risk increasing from 1.9% at age 55 to 59 years to 6.4% at age 80 and older. Czudowska et al (p. 1705) also found that the incidence of GVLF is significantly associated with higher baseline intraocular pressure (IOP) (incidence increased by 11% per mmHg increase in IOP), high myopia (spherical equivalent −4 diopters and more), male gender, a positive history of glaucoma, and glaucomatous optic neuropathy. The study, which involved 6630 participants aged 55 and older at risk of developing GVFL, did not show a statistically significant association between a positive family of glaucoma and incident GVFL (iGVFL). However, a positive family history was significantly associated with iGVFL if IOP was removed from the model. The authors point out that 2 major strengths of this study are the population-based design and long-term follow-up.