June 2009 Issue of Ophthalmology Covers Corneal Transplants, LASIK Infections and Glaucoma Med Compliance

June 2, 2009

The American Academy of Ophthalmology yesterday announced highlights from the June 2009 issue of Ophthalmology, including new insights on why some corneal transplants fail, why some patients skip their glaucoma medications, and why preventing infections after LASIK is a growing concern.

Patients at Higher Risk for Corneal Transplant Failure

In a recent controlled clinical trial, researchers analyzed data for 1,090 participants in the Cornea Donor Study (CDS) to identify factors linked with corneal transplant failure. The failure rate was about four times higher in patients diagnosed with corneal edema (swelling) associated with either intraocular lens (IOL) implants or no natural lens following cataract removal, than in patients diagnosed with Fuchs’ dystrophy, a disorder of the corneal endothelial layer.  The article discusses possible reasons for these outcomes.

Why do Some Glaucoma Patients Skip Their Medications?

The article cites studies covering a range of chronic diseases, which consistently show that only about 70 percent of prescribed medications are taken. With glaucoma, patients may not take their eyedrops because they often have no pain and few symptoms and because treatment benefits are apparent over years rather than immediately. To learn more about adherence, researchers from Johns Hopkins and University of Pennsylvania Schools of Medicine gave glaucoma patients a prostaglandin eyedrop medication at no cost and monitored use with an electronic device. The article discusses the outcome of the study.

Beating Bacteria to Prevent Post-LASIK Infections

While infections occur rarely in LASIK patients, the article cites data showing rates are slowly rising. A recent study at Yonsei University College of Medicine, South Korea, evaluated infection risk in 105 patients using eye surface (conjunctiva) swabs taken immediately before LASIK or similar refractive surgery to measure preexisting bacteria.

Coagulase-negative staphylococci (CNS) was found in 84.9 percent of the cultures grown from the swab samples, and 31.4 percent was antibiotic (methicillin)-resistant. In other studies over the past decade the incidence of resistant CNS was less than two percent. This significant increase suggests that resistant strains are spreading through community contact and not only through surgical units. The community-based spread of infections like CNS and methicillin-resistant staphylococcus aureus (MRSA) is raising concern world-wide.

Lead researcher Kyoung Yul Seo, M.D., and colleagues used five fluroquinolone antibiotics (three newer generation and two older) to treat the bacteria in the culture samples. The most effective was the newest fluroquinolone approved by the U.S. Food and Drug administration. Dr. Seo thinks using the newer fluroquinolones as initial treatment may limit bacterias’ ability to generate resistant mutations.

Visit the AAO website to access the full issue.




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