Ophthalmology, December 2006
Journal Scan is the clinician's guide to the latest clinical research findings in the Archives of Ophthalmology, Ophthalmology, and other important journals of interest in ophthalmology. Short summaries of feature articles include links to the article abstracts. (Access to full-text articles usually requires registration at the specific journal's Web site.)
Shortt AJ, Bunce C, Allan BD
Ophthalmology. 2006:113
Photorefractive keratectomy (PRK) and LASIK have been safely used for surgical correction of refractive errors for over 20 years. Both have their advantages, including fast recovery and less postoperative pain with LASIK, and wider range of surgical candidates for PRK due to high myopia or thin corneas. This meta-analysis of prospective studies comparing LASIK with PRK was designed to help determine which technique is safer and more efficacious at improving refractive errors.
A total of 7 publications of 6 prospective randomized trials were identified by the study. LASIK proved more likely than PRK to achieve the benchmark of uncorrected visual acuity of ≥ 20/20 at both the 6-month (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.14-2.58; P = .009) and 12-month (OR, 1.78; 95% CI, 1.15-2.75; P = .01) interval. Subanalysis for low-to-moderate myopia only (up to 6 diopters) revealed the same results.
Although this study demonstrated a higher success rate for LASIK than PRK in prospective clinical trials, it should be noted that the data are representative of technology and techniques from 5 years ago. Technology continues to advance. Furthermore, both procedures have unique limitations, including corneal haze after PRK, interface infiltrates in LASIK, and induced corneal ectasia in some LASIK patients. Given these findings and the continued progress in refractive technology and techniques, both PRK and LASIK will continue to have overlapping but distinct roles in refractive surgery.
Abstract
http://www.medscape.com/medline/abstract/17074559
Erie JC, Raecker MA, Baratz KH, Schleck CD, Burke JP, Robertson DM
Ophthalmology. 2006:113
Cataract extraction with intraocular lens placement is a safe procedure. Its known risks including endophthalmitis, macular edema, persistent ocular inflammation, and retinal detachment. This retrospective study analyzed the risk for retinal detachment after uncomplicated cataract extraction via extracapsular (ECCE) techniques or phacoemulsification.
During the period 1980-2004, 10,256 cataract extractions were performed on 7137 residents of Olmsted County, Minnesota; in this cohort, 82 cases of retinal detachment were identified, 3 of which were bilateral. In 1980, 91% of cataract extractions were performed via ECCE, with 0% performed via phacoemulsification; in 2000, less than 1% had ECCE, with 99% by phacoemulsification.
The cumulative rate of retinal detachment at 20 years was 1.79%. The probability of retinal detachment increased linearly over the study period and was significantly higher than the rate of retinal detachment in those who did not have cataract surgery. There was no difference in rate of retinal detachment between ECCE or phacoemulsification subjects. Forty-eight of 82 retinal detachments occurred 2 or more years after surgery (59%), while 24 occurred 5 or more years after surgery (29%).
This study demonstrated that the risk for retinal detachment after cataract surgery persists upwards of 20 years after surgery. It also showed that this risk is independent of whether ECCE or phacoemulsification was performed. Limitations of this study include its retrospective nature and inability to determine confounding factors, including complications during surgery and status of myopia. However, this information is important to educate patients and to allow surgeons to follow patients for this long-term risk after cataract surgery.
Abstract
http://www.medscape.com/medline/abstract/16935341
Ophthalmology
Journal Scan is the clinician's guide to the latest clinical research findings in the Archives of Ophthalmology, Ophthalmology, and other important journals of interest in ophthalmology. Short summaries of feature articles include links to the article abstracts. (Access to full-text articles usually requires registration at the specific journal's Web site.)
Evidence for Superior Efficacy and Safety of LASIK Over Photorefractive Keratectomy for Correction of Myopia
Shortt AJ, Bunce C, Allan BD
Ophthalmology. 2006:113
Photorefractive keratectomy (PRK) and LASIK have been safely used for surgical correction of refractive errors for over 20 years. Both have their advantages, including fast recovery and less postoperative pain with LASIK, and wider range of surgical candidates for PRK due to high myopia or thin corneas. This meta-analysis of prospective studies comparing LASIK with PRK was designed to help determine which technique is safer and more efficacious at improving refractive errors.
A total of 7 publications of 6 prospective randomized trials were identified by the study. LASIK proved more likely than PRK to achieve the benchmark of uncorrected visual acuity of ≥ 20/20 at both the 6-month (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.14-2.58; P = .009) and 12-month (OR, 1.78; 95% CI, 1.15-2.75; P = .01) interval. Subanalysis for low-to-moderate myopia only (up to 6 diopters) revealed the same results.
Although this study demonstrated a higher success rate for LASIK than PRK in prospective clinical trials, it should be noted that the data are representative of technology and techniques from 5 years ago. Technology continues to advance. Furthermore, both procedures have unique limitations, including corneal haze after PRK, interface infiltrates in LASIK, and induced corneal ectasia in some LASIK patients. Given these findings and the continued progress in refractive technology and techniques, both PRK and LASIK will continue to have overlapping but distinct roles in refractive surgery.
Abstract
http://www.medscape.com/medline/abstract/17074559
Risk of Retinal Detachment After Cataract Extraction, 1980-2004: A Population-Based Study
Erie JC, Raecker MA, Baratz KH, Schleck CD, Burke JP, Robertson DM
Ophthalmology. 2006:113
Cataract extraction with intraocular lens placement is a safe procedure. Its known risks including endophthalmitis, macular edema, persistent ocular inflammation, and retinal detachment. This retrospective study analyzed the risk for retinal detachment after uncomplicated cataract extraction via extracapsular (ECCE) techniques or phacoemulsification.
During the period 1980-2004, 10,256 cataract extractions were performed on 7137 residents of Olmsted County, Minnesota; in this cohort, 82 cases of retinal detachment were identified, 3 of which were bilateral. In 1980, 91% of cataract extractions were performed via ECCE, with 0% performed via phacoemulsification; in 2000, less than 1% had ECCE, with 99% by phacoemulsification.
The cumulative rate of retinal detachment at 20 years was 1.79%. The probability of retinal detachment increased linearly over the study period and was significantly higher than the rate of retinal detachment in those who did not have cataract surgery. There was no difference in rate of retinal detachment between ECCE or phacoemulsification subjects. Forty-eight of 82 retinal detachments occurred 2 or more years after surgery (59%), while 24 occurred 5 or more years after surgery (29%).
This study demonstrated that the risk for retinal detachment after cataract surgery persists upwards of 20 years after surgery. It also showed that this risk is independent of whether ECCE or phacoemulsification was performed. Limitations of this study include its retrospective nature and inability to determine confounding factors, including complications during surgery and status of myopia. However, this information is important to educate patients and to allow surgeons to follow patients for this long-term risk after cataract surgery.
Abstract
http://www.medscape.com/medline/abstract/16935341
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