A retrospective analysis of intraocular pressure changes after cataract surgery with the use of prednisolone acetate 1% versus difluprednate 0.05%

Yael Kusne,1 Paul Kang,1 Robert E Fintelmann1,2 1University of Arizona College of Medicine–Phoenix, 2Barnet Dulaney Perkins Eye Center, Phoenix, AZ, USA Purpose: To compare the effect of topical prednisolone acetate 1% (PA) used after routine cataract surgery to the effect of difluprednate 0.05% (DFBA) used for the same indication on intraocular pressure (IOP).Methods: An electronic query was created to gather information from all cataract surgeries between January 2010 and January 2015 within the electronic health record database at Barnet Dulaney Perkins, a multicenter, multiphysician private practice in Phoenix, Arizona. Information collected included age, sex, diabetes status, glaucoma history, medication regimen (use of PA or DFBA), and IOP before surgery, 5–10 days postoperatively (TP1) and 3–6 weeks postoperatively (TP2). Postoperative IOP measurements were compared to baseline IOP measurement in each patient.Results: Regardless of steroid used, all patients in this study experienced an increase in IOP within TP1 and returned to baseline IOP (±2.0 mmHg) by TP2. Patients who received DFBA showed a statistically significant increase in IOP at TP1 compared to those on PA (P<0.001) with the mean IOP an average 0.60 mmHg higher (95% CI =0.3, 0.9). The odds ratio of a clinically significantly increased IOP at TP1 (defined as overall IOP ≥21 mmHg and an increase of ≥10 mmHg) in DFBA-treated patients was 1.84 (95% CI =1.4, 2.6). In patients treated with PA, 3% reached a significantly increased IOP, compared to 4.4% of patients in the DFBA group (P<0.05). Risk factors for increased IOP were identified, and include advanced age (>75) (P<0.005) and a history of glaucoma (P<0.001).Conclusion: In postoperative cataract patients, use of DFBA increased the risk of a clinically significant IOP increase. Keywords: intraocular pressure, cataract surgery, steroid responder, glaucom

Impossibility to eliminate observer effect in the assessment of adherence in clinical trials

Jonathan S Myers,1 Scott J Fudemberg,1 Robert E Fintelmann,2 Lisa A Hark,1 Nitasha Khanna,1 Benjamin E Leiby,3 Michael Waisbourd1 1Wills Eye Hospital, Glaucoma Research Center, Philadelphia, PA, 2Barnet Dulaney Perkins Eye Center, Phoenix, AZ, 3Division of Biostatistics, Thomas Jefferson University, Philadelphia, PA, USA Purpose: To utilize the Travoprost Dosing Aid (DA) in the assessment of patient medication adherence, while also determining whether or not altering the functionality of the DA in three randomized subject groups can reduce observer effect. Methods: Forty-five subjects were randomized into three groups: two with monitored DAs and one without monitoring. One group of subjects was given a DA that both monitored drop usage and had visual and audible alarms, while the other monitored group included subjects given a DA that had no alarms but continued to monitor drop usage. The third group was given a DA that had no alarm reminders or dose usage monitoring. Subjects were informed that some monitors would not be functional, in an attempt to reduce observer effect, or the effect of being monitored on subject behavior and adherence. A six-item questionnaire was also utilized to assess how the subjects felt about their adherence and DA use. Results: The overall adherence rates were found to be 78% in the fully functional group (95% confidence interval: 70–88) and 76% in the no alarms group (95% confidence interval: 65–89). No association was seen between questionnaire response and medication adherence. The patients in the DA group without alarms had a significantly higher odds ratio of medication adherence if they reported on the questionnaire that using the DA did affect how much they used their drops. Conclusion: Though the use of DA was expected to reveal different rates of adherence depending on the functionality of the DA between groups, patients with a nonfunctioning DA did not have a significant difference in medication adherence compared to those given a fully functional DA. This supports that an observer effect was not reduced despite these interventions, and that the subjects adhered to taking their medications as if they had a functioning DA and were being monitored. Keywords: dosing aid, observer effect, glaucoma, adherenc

Boston KPro Type I: Vitreoretinal Considerations

Posterior segment complications are seen in a significant number of eyes having a keratoprosthesis (KPro) and are associated with poor visual outcomes. As the use of KPro increases dramatically, so too does the frequency of posterior segment complications seen by the vitreoretinal surgeon in this patient population, as well as the importance of addressing them expeditiously. Special consideration in diagnostic imaging and surgical planning is required in addressing the most common complications: retroprosthetic membrane (RPM), retinal detachments (RD) and other vitreous pathology, hypotony, glaucoma, epiretinal membranes (ERM), endophthalmitis, and vascular complications. This chapter seeks to summarize the diagnosis and treatment of each of these entities in the setting of KPro