At multiple clinics on the Canary Islands in Spain, researchers performed a multi-center, randomized clinical trial to assess the safety and effectiveness of immediately sequential bilateral cataract surgery (ISBCS) versus delayed sequential bilateral cataract surgery (DSBCS).

They randomized patients with cataracts requiring bilateral surgery to ISBCS or DSBCS. Outcome measures were the incidence of intraoperative and postoperative surgical complications, corrected and uncorrected visual acuities and self-perceived visual function (VF-14 questionnaire). The researchers measured all outcomes 30 days postoperatively and assessed self-perceived visual function after one year. They analyzed data with repeated measures to assess temporal effects on surgical complications, visual acuity and function and also estimated effect size for self-perceived visual function.

The researchers found no differences in intraoperative or postoperative surgical complications, visual acuity 30 days postoperatively or self-perceived visual function after one year between the two techniques. They noted that effect size for visual function 30 days postoperatively was moderate in the ISBCS group (n=834) and small in the DSBCS group (n=780). This difference disappeared at one-year follow-up after second-eye surgery in the delayed group.

There were no relevant surgical complications in 1,614 operated eyes and no significant difference in surgical complications, visual acuity or long-term, self-perceived visual function between ISBCS and DSBCS, the researchers reported. They related these safety and effectiveness outcomes to careful patient selection, surgical expertise and the systematic use of standardized surgical guidelines to ensure aseptic and independent surgery in each eye.

The following observational cohort study presented and evaluated a new method of estimating rates of retinal ganglion cell (RGC) loss in glaucoma by combining structural and functional measurements.

It included 213 eyes of 213 glaucoma patients followed up for an average of 4.5 ± 0.8 years with standard automated perimetry visual fields and optical coherence tomography (OCT). A control group of 33 eyes of 33 glaucoma patients underwent repeated tests over a short period to test the specificity of the method and an additional group of 52 eyes from 52 healthy subjects followed up for an average of 4.0 ± 0.7 years was used to estimate age-related losses of RGCs. Estimates of RGC counts were obtained from standard automated perimetry and OCT, and a weighted average was used to obtain a final estimate of the number of RGCs for each eye. Additionally, the rate of RGC loss was calculated for each eye using linear regression and progression was defined by a statistically significant slope faster than the age-expected loss of RGCs.

It was reported that from the 213 eyes, 47 (22.1%) showed rates of RGC loss that were faster than the age-expected decline. A larger proportion of glaucomatous eyes showed progression based on rates of RGC loss, rather than based on isolated parameters from standard automated perimetry (8.5%) or OCT (14.6%; p<.01), while maintaining similar specificities in the stable group.

In conclusion, the rate of RGC loss estimated from combining structure and function performed better than either isolated structural or functional measures for detecting progressive glaucomatous damage.

The authors of this Japanese study enrolled 60 eyes of 52 consecutive patients with proliferative diabetic retinopathy (PDR) who underwent primary vitrectomy to determine whether vitreous and aqueous humor concentrations of vascular endothelial growth factor (VEGF) predict postoperative complications following virectomy for PDR.

They obtained vitreous and aqueous humor from eyes with PDR during primary vitrectomy and measured the levels of VEGF using a FACSCaliber flow cytometer. They also followed patients for more than six months after surgery and recorded demographic data, intraoperative and postoperative findings. The study authors also analyzed the relationship between VEGF levels in ocular fluids and the main postoperative complications of early vitreous hemorrhage (VH) and neovascular glaucoma (NVG) occurring during follow-up. Finally, they performed logistic regression analyses to examine risk factors related to postoperative complications.

According to the authors, early postoperative vitreous hemorrhage occurred in 25%, and postoperative NVG occurred in 8% of 60 eyes. They also noted that the vitreous and aqueous humor levels of VEGF were significantly higher (p=0.002 and 0.006, respectively) in eyes with early vitreous hemorrhage than in those without, and also significantly higher (p=0.023 and 0.001) in eyes with NVG than in those without. Axial length was significantly shorter in eyes with early vitreous hemorrhage than in those without (p=0.028), the authors reported. Furthermore, multivariate logistic regression analysis showed that higher vitreous VEGF level was associated with a risk of early vitreous hemorrhage after vitrectomy for PDR (odds ratio: 12.3, p=0.009).

High intraocular VEGF level at the time of primary vitrectomy in patients with PDR was identified as a significant risk factor for early postoperative vitreous hemorrhage.