|Year : 2018 | Volume
| Issue : 2 | Page : 149-151
Department of Ophthalmology, Little Flower Hospital and Research Centre, Angamaly, Kerala, India
|Date of Web Publication||28-Aug-2018|
Department of Ophthalmology, Little Flower Hospital and Research Centre, Angamaly, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Joseph A. Journal review. Kerala J Ophthalmol 2018;30:149-51
| Five-Year Clinical Trial on Atropine for the Treatment of Myopia 2: Myopia Control With Atropine 0.01% Eye Drops (Atom 2 Study)|| |
Chia A, Lu QS, Tan D. Five-year clinical trial on atropine for the treatment of myopia 2: Myopia control with atropine 0.01% eye drops. Ophthalmology 2016;123:391-9.
An ultimate goal of myopia control therapy would be to slow myopic progression during the years of most active eye growth so that the eventual level of myopia was lower if the eye was allowed to grow naturally (i.e., to reduce the incidence of high myopia). If less people developed high or pathologic myopia, then less people might also develop the potentially blinding myopic complications such as posterior staphyloma, macula choroidal neovascularization, retinal detachment, and glaucoma. Much of the changes noted in this study could be explained by the pharmacologic effect of atropine on the actively growing myopic eye. The availability of an effective and low-cost myopia-retarding medication such as atropine 0.01% is timely and could make both clinical and economic sense as a public health measure. Although the exact mechanism of atropine is not known, it is believed that atropine acts directly or indirectly on the retina or scleral, inhibiting thinning or stretching of the scleral, and thereby eye growth. The purpose of this randomized, double-masked clinical trial study was to compare the safety and efficacy of different concentrations of atropine eye drops in controlling myopia progression over 5 years. A total of 400 Asian children were originally randomized to receive atropine 0.5%, 0.1%, or 0.01% once daily in both eyes in a 2:2:1 ratio. The method was such that children received atropine for 24 months (phase 1), after which medication was stopped for 12 months (phase 2). Children who had myopia progression (0.50 diopters [D] in at least 1 eye) during phase 2 were restarted on atropine 0.01% for a further 24 months (phase 3). The main outcome measured was changed in spherical equivalent and axial length over 5 years. The study revealed that there was a dose-related response in phase 1 with a greater effect in higher doses, but an inverse dose-related increase in myopia during phase 2 (washout), resulting in atropine 0.01% being most effective in reducing myopia progression at 3 years. Some 24%, 59%, and 68% of children originally in the atropine 0.01%, 0.1%, and 0.5% groups, respectively, who progressed in phase 2 were restarted on atropine 0.01%. Children who required retreatment had higher rates of myopia progression during the first 24 months (phase 1) and in the washout phase (phase 2) compared with those who did not require retreatment. Younger children and those with greater myopic progression in year 1 were more likely to require retreatment. The lower myopia progression in the 0.01% group persisted during phase 3, with overall myopia progression and change in axial elongation at the end of 5 years being lowest in this group (−1.83 ± 1.16 D, P = 0.003; 0.85 ± 0.53 mm, P = 0.144) and 0.5% (−1.98 ± 1.10 D, P < 0.001; 0.87 ± 0.49 mm, P = 0.075) groups. There was no significant difference in axial length (AL) in all three atropine groups at the start of phase 3. At 36 months, before restarting children on atropine, the pupil size, accommodation, and near vision were similar in all three groups. On restarting atropine 0.01%, there was a mean increase in photopic pupil size of approximately 1 mm and a loss of accommodation of 2.00–3.00 D, which were similar to the change noted in eyes treated with atropine 0.01% during phase 1. Thus, atropine 0.01% caused minimal pupil dilation (0.8 mm), minimal loss of accommodation (2–3 D), and no near visual loss compared with higher doses. These mild side effects were deemed clinically insignificant because there was no change or loss in the distance or near visual acuity. Children were offered progressive addition or photochromatic (tinted) glasses if they encountered near blur or glare. The strength of this study is in its randomized, double-blind design, its relatively low loss to follow rate, and its long duration. Unfortunately, the lack of a control group in this study severely limited our ability to evaluate the full effect of atropine. To conclude, over 5 years, atropine 0.01% eye drops was more effective in slowing myopia progression with less visual side effects compared with higher doses of atropine.
| Retinal and Choroidal Changes in Steroid-Associated Central Serous Chorioretinopathy|| |
Ambiya V, Goud A, Rasheed MA, Gangakhedkar S, Vupparaboina KK, Chhablani J, et al. Retinal and choroidal changes in steroid-associated central serous chorioretinopathy. Int J Retina Vitreous 2018;4:11.
Central serous chorioretinopathy (CSC) is a common chorioretinal disorder, characterized by serous retinal detachment in the posterior pole, often associated with serous pigment epithelial detachments (PED), and retinal pigment epithelium (RPE) atrophy. There is abundant literature supporting the association of CSC with endogenous and exogenous hypercortisolism. The common exogenous routes of administration of steroids associated with CSC include oral, inhaled, epidural, intra-articular, and topical skin ointments. Corticosteroid-induced CSC is also more likely to be bilateral and atypical than idiopathic CSC. Atypical forms of CSC that have been associated with the use of corticosteroids include chronic CSC or diffuse retinal pigment epitheliopathy, acute bullous retinal detachment, serous detachment with the presence of subretinal fibrin or exudates and subretinal fibrosis, and bilateral multifocal RPE detachments. It has been postulated that steroids cause inhibition of collagen synthase, increased permeability of choroidal capillaries, and dysfunction of ionic pump in the RPE leading to the accumulation of subretinal fluid. Corticosteroids are known to stimulate release of catecholamines and also to potentiate their effects, which could potentially cause microcirculatory changes in the choroidal vasculature leading to CSC. The purpose of the study is to evaluate the retinal and choroidal alterations in steroid-associated CSC in comparison to idiopathic CSC. In this retrospective cohort study, swept source optical coherence tomography (OCT) scans of eyes with steroid-associated CSC (Group A) were compared with the same in idiopathic CSC (Group B). The key features included central subfield retinal thickness, subfoveal choroidal thickness, subfoveal large choroidal vessel diameter, subretinal deposits, retinal pigment epithelial irregularities, double-layer sign, hyperreflective dots (HRDs), intraretinal fluid, and choroidal vascularity index (CVI) (ratio of choroidal luminal area and total choroidal area), measured on a high definition horizontal 9 mm OCT B-scan. There were 20 eyes in Group A and 30 in Group B. Group A had a higher female proportion (60 vs. 16.67%; P < 0.01) and higher bilaterality (30 vs. 6.67%; P = 0.03). The height of neurosensory detachment was lower in Group A (153.1 ± 175.70 μm vs. 312.9 ± 223.06 μm; P < 0.01). There was no significant difference in the prevalence of subretinal deposits, retinal pigment epithelial irregularities, PED, double-layer sign, outer retinal layer disruption, and intraretinal fluid. HRDs were less common in Group A (15 vs. 46.67%; P = 0.03). The subfoveal choroidal thickness (P = 0.65) and subfoveal large choroidal vessel diameter (P = 0.78) were comparable. There was a trend toward a higher CVI in Group A (A: mean, 82%, 95% confidence interval [CI], 66%–99%; B: mean, 58%, 95% CI, 57%–59%; P = 0.10). This study has the inherent limitations of a retrospective study and the fewer number of eyes studied can also not be overlooked. It was concluded that steroid-associated CSC has a marginally higher CVI and less common association with HRDs as compared to idiopathic CSC.
| Tripolymeric Corneal Coating Gel Versus Balanced Salt Solution Irrigation during Cataract Surgery: A retrospective Analysis|| |
Giardini P, Hauranieh N, Gatto C, D'Amato Tóthová J. Tripolymeric corneal coating gel versus balanced salt solution irrigation during cataract surgery: A retrospective analysis. Cornea 2018;37:431-5.
For anterior segment surgery, balanced salt solution (BSS) is usually used as an irrigating agent; however, the hydrating effect is short lasting, leading to frequent application by the surgeon or nurse. Repeated irrigations with BSS present a number of disadvantages. First, they may disturb and prolong the surgical procedure and be unpleasant for the patient, especially if the surgery is performed under topical anesthesia. Second, they may increase the risk of corneal epithelial damage, with possible discomfort caused by epithelial alterations and potentially prolonged postoperative recovery. However, most of the currently available viscoelastic agents were developed primarily for intraocular use to maintain anterior chamber stability during surgical maneuvers and protect the corneal endothelium. Therefore, it has been suggested that refinements in viscoelastic formulations may improve their efficacy and ease of use during cataract surgery. eyeDRO (AL. CHI. MI. A. S. R. L, Italy) is a commercially available medical device made of an advanced tripolymeric gel containing hydroxypropyl methylcellulose, xanthan gum, and carrageenan and is intended to protect and hydrate the corneal surface during ophthalmic surgery and eye examination and to maintain maximum clarity of the operating field during surgery. The study was aimed to compare the protective properties and ease of manipulation during cataract surgery of corneal coating with a gel (eyeDRO, Italy) and corneal irrigation with BSS. We analyzed the data of 51 patients receiving either eyeDRO or BSS during routine cataract surgery performed within a 20-day period in 2016. The selected parameters were intraoperative clarity and ease of manipulation; postoperative epithelial integrity; and patient discomfort. Compared with BSS irrigation, eyeDRO coating significantly increased intraoperative clarity and ease of manipulation (P = 0.01). Single application was required in eyeDRO-treated eyes, whereas BSS was applied 5.3 ± 0.4 times on average (P < 0.01). Two hours postoperatively, a normal epithelium was observed in 90.0% and 60.0% of eyeDRO-coated and BSS-irrigated eyes, respectively; punctate epithelial damage was observed in 9.7% and 40.0% (P < 0.05) of eyeDRO-coated and BSS-irrigated eyes, respectively; eye irritation and foreign-body sensation were experienced by 13.0% and 37.0% of eyeDRO-treated patients and by 65.0% and 100% of BSS-treated patients, respectively (P < 0.01). Twenty-four hours postoperatively, 80.0% of BSS-treated patients versus 19.0% of eyeDRO-treated patients still experienced foreign body sensation (P < 0.01). Cost-benefit analyses were outside the scope of this study. Nevertheless, the cost of eyeDRO gel is only slightly higher than that of a sterile BSS vial, however, considering the benefits to patients and surgeon and the simplification of surgery. To conclude, eyeDRO coating was shown to be a safer and more effective option than BSS irrigation in cataract surgery because single application provided optimal hydration and intraoperative clarity during the entire surgery, better preserved the corneal epithelium and offered postoperative comfort to the patient.
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