Pub Date : 2023-11-02DOI: 10.1080/17469899.2023.2275586
P. Karpecki, John D. Sheppard
ABSTRACT Introduction Perfluorohexyloctane (PFHO) ophthalmic solution (brand name, MIEBO) was recently approved by the United States Food and Drug Administration to treat the signs and symptoms of dry eye disease (DED). Unlike most DED treatments, PFHO addresses evaporative DED, which represents the vast majority of DED cases. PFHO may function as a surrogate for the tear film’s lipid layer, inhibiting evaporation. Areas covered This article summarizes data – found via PubMed and clinicaltrials.gov (May 30-1 September 2023) – surrounding PHFO and provides some considerations for its use. Preclinically, PFHO’s unique molecular properties facilitate formation of a layer at the tear film’s air-liquid interface and inhibit saline evaporation by 81%. These properties translate to improved clinical outcomes in DED: in phase 3 studies, 40% to 50% of PFHO-group patients had a ≥ 3-step total corneal fluorescein staining improvement at day 57, and approximately 60% of patients had ≥ 30% reduction in visual analog scale dryness scores, improvements that persisted to 52 weeks. Additionally, PFHO demonstrated a robust safety profile. Expert opinion PFHO is the first prescription eye drop that directly addresses hyperevaporation in DED. PFHO is poised to help fill the large unmet need of patients with evaporative DED, potentially improving patient outcomes and quality of life.
{"title":"Perfluorohexyloctane ophthalmic solution: a review of a prescription treatment for dry eye disease that directly targets tear evaporation","authors":"P. Karpecki, John D. Sheppard","doi":"10.1080/17469899.2023.2275586","DOIUrl":"https://doi.org/10.1080/17469899.2023.2275586","url":null,"abstract":"ABSTRACT Introduction Perfluorohexyloctane (PFHO) ophthalmic solution (brand name, MIEBO) was recently approved by the United States Food and Drug Administration to treat the signs and symptoms of dry eye disease (DED). Unlike most DED treatments, PFHO addresses evaporative DED, which represents the vast majority of DED cases. PFHO may function as a surrogate for the tear film’s lipid layer, inhibiting evaporation. Areas covered This article summarizes data – found via PubMed and clinicaltrials.gov (May 30-1 September 2023) – surrounding PHFO and provides some considerations for its use. Preclinically, PFHO’s unique molecular properties facilitate formation of a layer at the tear film’s air-liquid interface and inhibit saline evaporation by 81%. These properties translate to improved clinical outcomes in DED: in phase 3 studies, 40% to 50% of PFHO-group patients had a ≥ 3-step total corneal fluorescein staining improvement at day 57, and approximately 60% of patients had ≥ 30% reduction in visual analog scale dryness scores, improvements that persisted to 52 weeks. Additionally, PFHO demonstrated a robust safety profile. Expert opinion PFHO is the first prescription eye drop that directly addresses hyperevaporation in DED. PFHO is poised to help fill the large unmet need of patients with evaporative DED, potentially improving patient outcomes and quality of life.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"9 1","pages":"355 - 364"},"PeriodicalIF":0.7,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139291105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-31DOI: 10.1080/17469899.2023.2277781
Ronald H. Silverman
ABSTRACTIntroduction Ultrasound imaging of the eye was introduced over 50 years ago. While the physical principles of ultrasound imaging have not changed, technology has undergone tremendous and ongoing development.Areas covered The fundamentals of ultrasound physics, biometry (A-scan), structural imaging (B-scan) and blood-flow imaging and measurement (Doppler) will be described. Emphasis will be placed on technological development and potential future advances.Expert opinion While A- and B-scan ultrasound of the eye has traditionally been performed with focused single-element transducers, the introduction of annular and linear arrays has enhanced clinical utility. Future advances, especially in multielement arrays, and point-of-care systems promise amazing new capabilities for diagnostic imaging of the eye and orbit.KEYWORDS: UltrasoundeyeDopplertransducerDisclaimerAs a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also. Article highlightsMedical diagnostic ultrasound developed in the aftermath of the second world war as a spinoff of Sonar technology used for underwater range finding.While ophthalmic ultrasound has largely been based on mechanically scanned, focused single-element transducer technology, virtually all other clinical specialties use linear array-based systems.Array-based systems allow control of focal depth. Linear arrays offer high scan rates and can provide Doppler to visualize and measure blood-flow.The advantages and decreasing cost of linear array systems is leading towards greater utilization for ophthalmic imaging.While the principles of ultrasound imaging are unchanged, the technology, especially in array-based systems, continues to advance.Declaration of interestR H Silverman has a financial interest in Arcscan, Inc. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.Reviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Figure 1: Left: Plots representing ultrasound waveform of a highly damped (top) and a poorly damped (bottom) transducer of the same wavelength (λ). To the right of each plot is the power spectrum corresponding to each waveform. Bandwidth (usually measured at 50% of maximum spectral power) is inversely related to pulse-length.Display full sizeFigure 2: 1970’s setup for immersion ultrasonography. The probe was pivoted by hand to sweep out a B-scan or held steady for an A-scan while the sh
{"title":"Principles of ophthalmic ultrasound","authors":"Ronald H. Silverman","doi":"10.1080/17469899.2023.2277781","DOIUrl":"https://doi.org/10.1080/17469899.2023.2277781","url":null,"abstract":"ABSTRACTIntroduction Ultrasound imaging of the eye was introduced over 50 years ago. While the physical principles of ultrasound imaging have not changed, technology has undergone tremendous and ongoing development.Areas covered The fundamentals of ultrasound physics, biometry (A-scan), structural imaging (B-scan) and blood-flow imaging and measurement (Doppler) will be described. Emphasis will be placed on technological development and potential future advances.Expert opinion While A- and B-scan ultrasound of the eye has traditionally been performed with focused single-element transducers, the introduction of annular and linear arrays has enhanced clinical utility. Future advances, especially in multielement arrays, and point-of-care systems promise amazing new capabilities for diagnostic imaging of the eye and orbit.KEYWORDS: UltrasoundeyeDopplertransducerDisclaimerAs a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also. Article highlightsMedical diagnostic ultrasound developed in the aftermath of the second world war as a spinoff of Sonar technology used for underwater range finding.While ophthalmic ultrasound has largely been based on mechanically scanned, focused single-element transducer technology, virtually all other clinical specialties use linear array-based systems.Array-based systems allow control of focal depth. Linear arrays offer high scan rates and can provide Doppler to visualize and measure blood-flow.The advantages and decreasing cost of linear array systems is leading towards greater utilization for ophthalmic imaging.While the principles of ultrasound imaging are unchanged, the technology, especially in array-based systems, continues to advance.Declaration of interestR H Silverman has a financial interest in Arcscan, Inc. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.Reviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Figure 1: Left: Plots representing ultrasound waveform of a highly damped (top) and a poorly damped (bottom) transducer of the same wavelength (λ). To the right of each plot is the power spectrum corresponding to each waveform. Bandwidth (usually measured at 50% of maximum spectral power) is inversely related to pulse-length.Display full sizeFigure 2: 1970’s setup for immersion ultrasonography. The probe was pivoted by hand to sweep out a B-scan or held steady for an A-scan while the sh","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"3 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135869261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-30DOI: 10.1080/17469899.2023.2275587
Jae-Chiang Wong, Rebecca F. Neustein, Melih Ustaoglu, Eric Shiuey, Nikki Mehran, Marlene R. Moster, Reza Razeghinejad, L. Jay Katz, Jonathan Myers, Daniel Lee
{"title":"The long-term clinical outcomes of latanoprostene bunod 0.024% in glaucoma Treatment at a tertiary glaucoma center.","authors":"Jae-Chiang Wong, Rebecca F. Neustein, Melih Ustaoglu, Eric Shiuey, Nikki Mehran, Marlene R. Moster, Reza Razeghinejad, L. Jay Katz, Jonathan Myers, Daniel Lee","doi":"10.1080/17469899.2023.2275587","DOIUrl":"https://doi.org/10.1080/17469899.2023.2275587","url":null,"abstract":"","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"14 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136103558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-18DOI: 10.1080/17469899.2023.2272050
Nesime Setge Tıskaoğlu, Sevim Ayça Seyyar, Gizem Gürbostan Sosyal
ABSTRACTBackground Social media as well as YouTube are widely used to gain information on medical conditions. We aimed to assess and evaluate the quality and reliability of YouTube videos on ocular allergies and determine whether they are a trustworthy source of information.Research design and methods The first 60 videos from the search terms ‘allergic conjunctivitis’, ‘atopic conjunctivitis’, ‘allergic conjunctivitis symptoms’, and ‘allergic conjunctivitis eye drops’ were analyzed using modified DISCERN, Global Quality Score, Journal of the American Medical Association scores and Health on the Net Code criteria. The total number of views, view ratio, likes, comments, and duration were recorded and videos were evaluated as useful, non-useful, and misleading.Results The average mDISCERN score for the videos was 3.25 ± 0.76 (moderate), the average JAMA score was 2.76 ± 0.64 (intermediate), the average GQS score was 3.13 ± 0.8 (intermediate) and the average HONcode score was 7.8 ± 2.6 (intermediate). The most common video source was health professionals (61.9%).Conclusions Videos on allergic conjunctivitis while having reliable publishers are of moderate quality. Quality regulation of content uploaded on allergic conjunctivitis is needed. Health professionals should try to improve video content and provide more information on the treatment of allergic conjunctivitis.KEYWORDS: Allergic diseasesYouTubeocular allergyallergic conjunctivitismDISCERNJAMAGQS; HONcodeDisclaimerAs a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also. Declaration of interestsThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royaltiesAuthor contribution statement: All authors contributed to the conception and design of the article and interpreting the relevant literature, all authors were involved in writing the article and/or revised it for intellectual content.Reviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Figure 1: Flowchart of selection of videos included in the study.Display full sizeAdditional informationFundingThis paper was not funded.
{"title":"Are allergic conjunctivitis videos on YouTube a reliable source of information?","authors":"Nesime Setge Tıskaoğlu, Sevim Ayça Seyyar, Gizem Gürbostan Sosyal","doi":"10.1080/17469899.2023.2272050","DOIUrl":"https://doi.org/10.1080/17469899.2023.2272050","url":null,"abstract":"ABSTRACTBackground Social media as well as YouTube are widely used to gain information on medical conditions. We aimed to assess and evaluate the quality and reliability of YouTube videos on ocular allergies and determine whether they are a trustworthy source of information.Research design and methods The first 60 videos from the search terms ‘allergic conjunctivitis’, ‘atopic conjunctivitis’, ‘allergic conjunctivitis symptoms’, and ‘allergic conjunctivitis eye drops’ were analyzed using modified DISCERN, Global Quality Score, Journal of the American Medical Association scores and Health on the Net Code criteria. The total number of views, view ratio, likes, comments, and duration were recorded and videos were evaluated as useful, non-useful, and misleading.Results The average mDISCERN score for the videos was 3.25 ± 0.76 (moderate), the average JAMA score was 2.76 ± 0.64 (intermediate), the average GQS score was 3.13 ± 0.8 (intermediate) and the average HONcode score was 7.8 ± 2.6 (intermediate). The most common video source was health professionals (61.9%).Conclusions Videos on allergic conjunctivitis while having reliable publishers are of moderate quality. Quality regulation of content uploaded on allergic conjunctivitis is needed. Health professionals should try to improve video content and provide more information on the treatment of allergic conjunctivitis.KEYWORDS: Allergic diseasesYouTubeocular allergyallergic conjunctivitismDISCERNJAMAGQS; HONcodeDisclaimerAs a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also. Declaration of interestsThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royaltiesAuthor contribution statement: All authors contributed to the conception and design of the article and interpreting the relevant literature, all authors were involved in writing the article and/or revised it for intellectual content.Reviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Figure 1: Flowchart of selection of videos included in the study.Display full sizeAdditional informationFundingThis paper was not funded.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135884014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-09DOI: 10.1080/17469899.2023.2267763
Bharat Gurnani, Kirandeep Kaur
ABSTRACTIntroduction Ocular surface squamous neoplasia (OSSN) is a broad pathological entity that includes squamous neoplasm of conjunctival and corneal tissue. These various malignancies include conjunctival intraepithelial neoplasia (CIN), corneal epithelial dysplasia, squamous cell carcinoma (SCC), and mucoepidermoid carcinoma. OSSN diagnosis rests on exfoliative cytology, vital dyes, and imaging in the form of confocal microscopy and anterior segment optical coherence tomography. The medical management modalities are topical chemotherapy (Mitomycin C and 5 fluorouracil), immunotherapy (Interferon alpha 2b), and upcoming drugs, such as antivirals, anti-VEGF, and retinoic acid. Excision biopsy with no touch technique remains the gold standard for managing OSSN. However, surgery can lead to recurrence and unfavorable results in some cases.Areas Covered This article provides insights into the treatment aspects of OSSN with an overview of recent updates. The authors have discussed the current concept regarding the medical and surgical management of OSSN. The authors also dwell upon the recent updates along with the expert opinion.Expert Opinion- Although surgery remains the gold standard, topical drugs have revolutionized the management of OSSN. Patients should be closely followed up to look for any side effects. Cost, time duration, cosmesis, and side are the remaining major factors in deciding for medical versus surgical therapy.KEYWORDS: Ocular surface squamous neoplasiamitomycin C5-fluorouracilinterferon alpha 2bexcision biopsy Article highlights Ocular surface squamous neoplasia (OSSN) is a diverse ocular pathology that includes squamous neoplasm of conjunctival and corneal tissueThe important diagnostic modality includes exfoliative and impression cytology, vital dyes, high resolution anterior segment optical coherence tomography, and confocal microscopy.The medical management options of OSSN can be chemotherapeutic agents and immunotherapy.The gold standard for OSSN management is surgical excision biopsy by no touch technique and cryotherapy to the margins.The recent advances in OSSN management comprises human papilloma virus vaccine, light-activated belzupacap sarotalocan, verteporfin, cidofovir, bevacizumab, retinoic acid, and aloe vera.Declaration of interestsThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royaltiesReviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Additional informationFundingThis paper was not funded.
{"title":"Current concepts and recent updates in the treatment of ocular surface squamous neoplasia","authors":"Bharat Gurnani, Kirandeep Kaur","doi":"10.1080/17469899.2023.2267763","DOIUrl":"https://doi.org/10.1080/17469899.2023.2267763","url":null,"abstract":"ABSTRACTIntroduction Ocular surface squamous neoplasia (OSSN) is a broad pathological entity that includes squamous neoplasm of conjunctival and corneal tissue. These various malignancies include conjunctival intraepithelial neoplasia (CIN), corneal epithelial dysplasia, squamous cell carcinoma (SCC), and mucoepidermoid carcinoma. OSSN diagnosis rests on exfoliative cytology, vital dyes, and imaging in the form of confocal microscopy and anterior segment optical coherence tomography. The medical management modalities are topical chemotherapy (Mitomycin C and 5 fluorouracil), immunotherapy (Interferon alpha 2b), and upcoming drugs, such as antivirals, anti-VEGF, and retinoic acid. Excision biopsy with no touch technique remains the gold standard for managing OSSN. However, surgery can lead to recurrence and unfavorable results in some cases.Areas Covered This article provides insights into the treatment aspects of OSSN with an overview of recent updates. The authors have discussed the current concept regarding the medical and surgical management of OSSN. The authors also dwell upon the recent updates along with the expert opinion.Expert Opinion- Although surgery remains the gold standard, topical drugs have revolutionized the management of OSSN. Patients should be closely followed up to look for any side effects. Cost, time duration, cosmesis, and side are the remaining major factors in deciding for medical versus surgical therapy.KEYWORDS: Ocular surface squamous neoplasiamitomycin C5-fluorouracilinterferon alpha 2bexcision biopsy Article highlights Ocular surface squamous neoplasia (OSSN) is a diverse ocular pathology that includes squamous neoplasm of conjunctival and corneal tissueThe important diagnostic modality includes exfoliative and impression cytology, vital dyes, high resolution anterior segment optical coherence tomography, and confocal microscopy.The medical management options of OSSN can be chemotherapeutic agents and immunotherapy.The gold standard for OSSN management is surgical excision biopsy by no touch technique and cryotherapy to the margins.The recent advances in OSSN management comprises human papilloma virus vaccine, light-activated belzupacap sarotalocan, verteporfin, cidofovir, bevacizumab, retinoic acid, and aloe vera.Declaration of interestsThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royaltiesReviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Additional informationFundingThis paper was not funded.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"114 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135141515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-07DOI: 10.1080/17469899.2023.2268285
Steffani Krista Someda, Yasuhiro Takahashi
KEYWORDS: dacryoadenitisidiopathic orbital inflammationimmunoglobulin G4-related diseaselacrimal gland biopsyorbital lymphoma
关键词:泪腺炎;特发性眼眶炎;免疫球蛋白g4相关疾病
{"title":"The impact of lacrimal gland biopsies in current clinical practice","authors":"Steffani Krista Someda, Yasuhiro Takahashi","doi":"10.1080/17469899.2023.2268285","DOIUrl":"https://doi.org/10.1080/17469899.2023.2268285","url":null,"abstract":"KEYWORDS: dacryoadenitisidiopathic orbital inflammationimmunoglobulin G4-related diseaselacrimal gland biopsyorbital lymphoma","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135253563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACTIntroduction The management of keratoconus has been changed significantly due to the advancement of technology in the field of contact lens materials and designs and introduction of new surgical approaches that aim to avoid or postpone corneal transplantation until the advanced stage of the disease. Deep anterior lamellar keratoplasty (DALK) has the advantage of preserving the patient’s own endothelium and eliminating endothelial graft rejection. Since the recent trend is to perform corneal transplantation mainly for severe keratoconus that are not amenable to other less invasive approaches, this review aims to provide an update on the outcomes of DALK in eyes with the advanced stage of keratoconus.Areas covered A comprehensive literature review of studies in English was conducted using the following keywords: “deep anterior lamellar keratoplasty” or “anterior lamellar keratoplasty” or “DALK” and “keratoconus” and “severe” or “advanced.”Expert commentary DALK significantly improves vision and refraction in advanced keratoconus and provides favorable graft survival. Femtosecond laser seems to improve the technique of the DALK procedure, and future developments could improve the reproducibility of DALK even further. However, current data is inconclusive for the benefit of femtosecond laser-assisted DALK for advanced keratoconus.KEYWORDS: Keratoconusadvanced stagecorneal transplantationdeep anterior lamellar keratoplastyDALKDisclaimerAs a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also. Article highlightsAs surgeons gain more experience and modify their techniques, DALK has emerged as an acceptable alternative to PK for advanced keratoconus when other less invasive approaches have failed to restore vision.Compared to PK, DALK has a superior safety profile as it eliminates the risk of endothelial graft rejection and preserves globe integrity against trauma.Despite improved safety, the visual and refractive outcomes after DALK can be inferior to those achieved after PK in advanced keratoconus eyes.Femtosecond laser has been used for the DALK procedure to increase the rate of successful big-bubble formation, decrease the rate of intraoperative Descemet membrane perforation, and provide better visual and refractive outcomes.Femtosecond laser-assisted DALK in the present form shows limited benefit, therefore, surgical design and parameters still need to be optimized.A medical economics study is required to assess the cost-effectiveness of laser-assisted DALK techniques in this particular subgroup of patients.AbbreviationsAS-OCT=Anterior segment optical coherence tomographyCDVA
由于隐形眼镜材料领域的技术进步，设计和引入新的手术方法，旨在避免或推迟角膜移植，直到疾病的晚期，圆锥角膜的治疗已经发生了重大变化。深前板层角膜移植术(DALK)具有保留患者自身内皮和消除内皮移植排斥反应的优点。由于最近的趋势是角膜移植主要用于严重圆锥角膜，而这些严重圆锥角膜无法采用其他侵入性较小的方法，因此本综述旨在提供晚期圆锥角膜DALK的最新结果。使用以下关键词:“深前板层角膜移植术”或“前板层角膜移植术”或“DALK”和“圆锥角膜”和“严重”或“进展”，对英文研究进行了全面的文献综述。专家评论DALK可显著改善晚期圆锥角膜患者的视力和屈光，并提供良好的移植物存活率。飞秒激光似乎改进了DALK过程的技术，未来的发展可以进一步提高DALK的可重复性。然而，目前的数据还不确定飞秒激光辅助的DALK对晚期圆锥角膜的益处。【关键词】角膜圆锥;晚期角膜移植;深前板层角膜成形术(dalk)免责声明:作为对作者和研究人员的服务，我们提供此版本的已接受稿件(AM)。在最终出版版本记录(VoR)之前，将对该手稿进行编辑、排版和审查。在制作和印前，可能会发现可能影响内容的错误，所有适用于期刊的法律免责声明也与这些版本有关。随着外科医生获得更多的经验和改进他们的技术，当其他侵入性较小的方法无法恢复视力时，DALK已成为晚期圆锥角膜患者PK的可接受替代方法。与PK相比，DALK具有更高的安全性，因为它消除了内皮移植排斥的风险，并保持了创伤的全球完整性。尽管安全性有所提高，但在晚期圆锥角膜患者中，DALK术后的视力和屈光效果可能不如PK术后。飞秒激光已被用于DALK手术，以提高大泡形成的成功率，降低术中网膜穿孔的发生率，并提供更好的视力和屈光效果。目前形式的飞秒激光辅助DALK的效益有限，因此，手术设计和参数仍需优化。需要一项医学经济学研究来评估激光辅助DALK技术在这一特定亚组患者中的成本效益。缩写as - oct =前段光学相干断层扫描cdva =矫正距离视力d =DiopterDALK=深前板层角膜成形术mm=毫米- μm=微孔soct =光学相干断层扫描ypk =穿透性角膜成形术udva =未矫正距离视力利益声明作者与任何组织或实体没有任何关联或经济参与与本文所讨论的主题或材料有经济利益或经济冲突手稿。这包括雇佣、咨询、酬金、股票所有权或期权、专家证词、获得或未决的赠款或专利，或特许权使用费。审稿人披露本文的每位审稿人没有相关的财务或其他关系需要披露。图1:描述筛选过程的文献检索流程图。附加信息本文未获得资助。
{"title":"Deep anterior lamellar keratoplasty for advanced keratoconus: an updated review of indications, techniques and outcomes","authors":"Sepehr Feizi, Niloufar Bineshfar, Helia Ashourizadeh, Mahan Shafie","doi":"10.1080/17469899.2023.2268292","DOIUrl":"https://doi.org/10.1080/17469899.2023.2268292","url":null,"abstract":"ABSTRACTIntroduction The management of keratoconus has been changed significantly due to the advancement of technology in the field of contact lens materials and designs and introduction of new surgical approaches that aim to avoid or postpone corneal transplantation until the advanced stage of the disease. Deep anterior lamellar keratoplasty (DALK) has the advantage of preserving the patient’s own endothelium and eliminating endothelial graft rejection. Since the recent trend is to perform corneal transplantation mainly for severe keratoconus that are not amenable to other less invasive approaches, this review aims to provide an update on the outcomes of DALK in eyes with the advanced stage of keratoconus.Areas covered A comprehensive literature review of studies in English was conducted using the following keywords: “deep anterior lamellar keratoplasty” or “anterior lamellar keratoplasty” or “DALK” and “keratoconus” and “severe” or “advanced.”Expert commentary DALK significantly improves vision and refraction in advanced keratoconus and provides favorable graft survival. Femtosecond laser seems to improve the technique of the DALK procedure, and future developments could improve the reproducibility of DALK even further. However, current data is inconclusive for the benefit of femtosecond laser-assisted DALK for advanced keratoconus.KEYWORDS: Keratoconusadvanced stagecorneal transplantationdeep anterior lamellar keratoplastyDALKDisclaimerAs a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also. Article highlightsAs surgeons gain more experience and modify their techniques, DALK has emerged as an acceptable alternative to PK for advanced keratoconus when other less invasive approaches have failed to restore vision.Compared to PK, DALK has a superior safety profile as it eliminates the risk of endothelial graft rejection and preserves globe integrity against trauma.Despite improved safety, the visual and refractive outcomes after DALK can be inferior to those achieved after PK in advanced keratoconus eyes.Femtosecond laser has been used for the DALK procedure to increase the rate of successful big-bubble formation, decrease the rate of intraoperative Descemet membrane perforation, and provide better visual and refractive outcomes.Femtosecond laser-assisted DALK in the present form shows limited benefit, therefore, surgical design and parameters still need to be optimized.A medical economics study is required to assess the cost-effectiveness of laser-assisted DALK techniques in this particular subgroup of patients.AbbreviationsAS-OCT=Anterior segment optical coherence tomographyCDVA","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135352555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-06DOI: 10.1080/17469899.2023.2268289
Di Huang, Sam McLenachan, Fred K. Chen
ABSTRACTIntroduction ABCA4-associated Stargardt disease (STGD1) leads to bilateral central vision loss and is responsible for 12% of inherited retinal disease-related blindness.The lack of approved treatments highlights the urgent need for effective therapies.Areas covered This review explores personalized treatments for STGD1, focusing on therapeutic alternative splicing, genome editing, and translational read-through technologies. Literature searches as of July 2023 were undertaken via PubMed.Expert opinion Significant progress has been made in sequencing technology revealing the complexities of theABCA4 locus. Comprehensive functional assays now enable the determination of pathogenicity for ABCA4variants of uncertain significance. These breakthroughs facilitate the application of gene expression modulation technologies, ushering in a new era of personalized therapeutics. By targeting the ABCA4 gene and manipulating its expression, tailored treatments can address ABCA4-associated STGD1, offering enhanced efficacy and precise interventions based on the individual’s genetic profile. These advancements provide hope to those affected by STGD1, with improved treatment options and the potential to prevent vision loss. The convergence of genetic analysis breakthroughs and gene expression modulation technologies revolutionizes our understanding and treatment of inherited disorders, unlocking a promising frontier in personalized therapeutics. This transformative approach to STGD1 holds promise for similar breakthroughs in other inherited conditions.KEYWORDS: ABCA4inherited retinal diseasejuvenile macular dystrophypersonalized therapeuticsantisense oligonucleotidestherapeutic alternative splicinggene editingCRISPRbase editorprime editingDisclaimerAs a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also. Article highlightsAutosomal recessive Stargardt disease (STGD1) is a common monogenic inherited retinal dystrophy that leads to bilateral central vision loss and is responsible for 12% of IRD-related blindness.The spectrum of retinopathy associated with STGD1 includes childhood-onset cone-rod dystrophy, late-onset STGD1 with foveal sparing, and rapid-onset chorioretinopathy phenotype.STGD1 is caused by bi-allelic variants in the ATP-binding cassette transporter subfamily A4 gene (ABCA4) gene, which encodes the ABCA4 protein responsible for importing specific retinoid compounds in photoreceptor cells.Variable accumulation of cytotoxic lipofuscin-related fluorophores, such as A2E, is determined by combined deleterious effect of the biallelic ABCA4 variants and contributes to phenotypic varia
{"title":"Advances towards personalized therapies for Stargardt disease","authors":"Di Huang, Sam McLenachan, Fred K. Chen","doi":"10.1080/17469899.2023.2268289","DOIUrl":"https://doi.org/10.1080/17469899.2023.2268289","url":null,"abstract":"ABSTRACTIntroduction ABCA4-associated Stargardt disease (STGD1) leads to bilateral central vision loss and is responsible for 12% of inherited retinal disease-related blindness.The lack of approved treatments highlights the urgent need for effective therapies.Areas covered This review explores personalized treatments for STGD1, focusing on therapeutic alternative splicing, genome editing, and translational read-through technologies. Literature searches as of July 2023 were undertaken via PubMed.Expert opinion Significant progress has been made in sequencing technology revealing the complexities of theABCA4 locus. Comprehensive functional assays now enable the determination of pathogenicity for ABCA4variants of uncertain significance. These breakthroughs facilitate the application of gene expression modulation technologies, ushering in a new era of personalized therapeutics. By targeting the ABCA4 gene and manipulating its expression, tailored treatments can address ABCA4-associated STGD1, offering enhanced efficacy and precise interventions based on the individual’s genetic profile. These advancements provide hope to those affected by STGD1, with improved treatment options and the potential to prevent vision loss. The convergence of genetic analysis breakthroughs and gene expression modulation technologies revolutionizes our understanding and treatment of inherited disorders, unlocking a promising frontier in personalized therapeutics. This transformative approach to STGD1 holds promise for similar breakthroughs in other inherited conditions.KEYWORDS: ABCA4inherited retinal diseasejuvenile macular dystrophypersonalized therapeuticsantisense oligonucleotidestherapeutic alternative splicinggene editingCRISPRbase editorprime editingDisclaimerAs a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also. Article highlightsAutosomal recessive Stargardt disease (STGD1) is a common monogenic inherited retinal dystrophy that leads to bilateral central vision loss and is responsible for 12% of IRD-related blindness.The spectrum of retinopathy associated with STGD1 includes childhood-onset cone-rod dystrophy, late-onset STGD1 with foveal sparing, and rapid-onset chorioretinopathy phenotype.STGD1 is caused by bi-allelic variants in the ATP-binding cassette transporter subfamily A4 gene (ABCA4) gene, which encodes the ABCA4 protein responsible for importing specific retinoid compounds in photoreceptor cells.Variable accumulation of cytotoxic lipofuscin-related fluorophores, such as A2E, is determined by combined deleterious effect of the biallelic ABCA4 variants and contributes to phenotypic varia","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135351195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-04DOI: 10.1080/17469899.2023.2267179
Federico Rissotto, Riccardo Sacconi, Aurelio Apuzzo, Gloria Oldoni, Emanuele Fusi, Andrea Servillo, Francesco Bandello, Giuseppe Querques
ABSTRACTIntroduction Age-related Macular Degeneration (AMD) is one of the leading causes of irreversible visual acuity reduction among the elderly population. Dry AMD, the most frequent AMD form, is characterized by photoreceptor loss, Retinal Pigmented Epithelium (RPE) dysfunction and retinal degeneration. Although in the last years several clinical trials have been carried out and many therapeutic molecules have been examined to treat dry AMD, currently its treatment remains unsatisfactory.Areas covered In this review we report and analyze the most important molecules and treatment that have been studied and carried out till nowadays, and the future therapies that may be a hope in this complex and serious disease. We have provided a narrative review after having analyzed the literature and we have selected more than 120 papers to deliver this article.Expert opinion Although in 2023 has been carried out the first FDA approved drugs, there is still a long way to go in developing effective therapies for dry-AMD. In the future, a better understanding of its pathogenesis may lead to the development of targeted or genetic therapies that not only have an anatomical effect on the retina but also have a functional impact.KEYWORDS: Age related macular degenerationGeographic atrophydrusencomplement inhibitorsneuroprotectiongenetic therapyintravitreal injectionDisclaimerAs a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also. Article highlightsIn this review we have summarized the most important molecules and trials that have been carried out till now in the attempt to treat dry-AMD.AREDS nutritional supplementation remains the standard of care for dry-AMD.In 2023 FDA has approved the first proven effect therapies for dry-AMD: Pegcetacoplan, and Avacincaptad Pegol.In the future, a genetic therapy focused on preventing and blocking the development of dry-AMD could be the most effective treatment, but at the present time, its development is at the embryonic stage.Declaration of InterestsR Sacconi has the following disclosures: Allergan Inc, Bayer Shering-Pharma, Medivis, Novartis, Zeiss.G Querques has the following disclosures: Alimera Sciences, Allergan Inc, Amgen, Bayer Shering-Pharma, Heidelberg, KBH, LEH Pharma, Lumithera, Novartis, Sandoz, Sifi, Sooft-Fidea, Zeiss.F Bandello has the following disclosures: Alcon (consultant), Alimera Sciences (consultant), Allergan Inc (consultant), Farmila-Thea (consultant), Bayer Shering-Pharma (consultant), Bausch and Lomb Genentech (consultant), Hoffmann-La-Roche (consultant), Novagali Pharma (consultant), Novartis (consultant), Sanofi-Aventis (consu
{"title":"What is on the horizon for dry age-related macular degeneration drug treatment?","authors":"Federico Rissotto, Riccardo Sacconi, Aurelio Apuzzo, Gloria Oldoni, Emanuele Fusi, Andrea Servillo, Francesco Bandello, Giuseppe Querques","doi":"10.1080/17469899.2023.2267179","DOIUrl":"https://doi.org/10.1080/17469899.2023.2267179","url":null,"abstract":"ABSTRACTIntroduction Age-related Macular Degeneration (AMD) is one of the leading causes of irreversible visual acuity reduction among the elderly population. Dry AMD, the most frequent AMD form, is characterized by photoreceptor loss, Retinal Pigmented Epithelium (RPE) dysfunction and retinal degeneration. Although in the last years several clinical trials have been carried out and many therapeutic molecules have been examined to treat dry AMD, currently its treatment remains unsatisfactory.Areas covered In this review we report and analyze the most important molecules and treatment that have been studied and carried out till nowadays, and the future therapies that may be a hope in this complex and serious disease. We have provided a narrative review after having analyzed the literature and we have selected more than 120 papers to deliver this article.Expert opinion Although in 2023 has been carried out the first FDA approved drugs, there is still a long way to go in developing effective therapies for dry-AMD. In the future, a better understanding of its pathogenesis may lead to the development of targeted or genetic therapies that not only have an anatomical effect on the retina but also have a functional impact.KEYWORDS: Age related macular degenerationGeographic atrophydrusencomplement inhibitorsneuroprotectiongenetic therapyintravitreal injectionDisclaimerAs a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also. Article highlightsIn this review we have summarized the most important molecules and trials that have been carried out till now in the attempt to treat dry-AMD.AREDS nutritional supplementation remains the standard of care for dry-AMD.In 2023 FDA has approved the first proven effect therapies for dry-AMD: Pegcetacoplan, and Avacincaptad Pegol.In the future, a genetic therapy focused on preventing and blocking the development of dry-AMD could be the most effective treatment, but at the present time, its development is at the embryonic stage.Declaration of InterestsR Sacconi has the following disclosures: Allergan Inc, Bayer Shering-Pharma, Medivis, Novartis, Zeiss.G Querques has the following disclosures: Alimera Sciences, Allergan Inc, Amgen, Bayer Shering-Pharma, Heidelberg, KBH, LEH Pharma, Lumithera, Novartis, Sandoz, Sifi, Sooft-Fidea, Zeiss.F Bandello has the following disclosures: Alcon (consultant), Alimera Sciences (consultant), Allergan Inc (consultant), Farmila-Thea (consultant), Bayer Shering-Pharma (consultant), Bausch and Lomb Genentech (consultant), Hoffmann-La-Roche (consultant), Novagali Pharma (consultant), Novartis (consultant), Sanofi-Aventis (consu","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135590464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-28DOI: 10.1080/17469899.2023.2264508
Nimesh C. Patel, Avinash Pathengay, Mudit Tyagi, Rajeev Reddy Pappuru, Vivek Pravin Dave
ABSTRACTIntroduction Cataract surgery is the most commonly performed intraocular surgery all over the world. Endophthalmitis is a sight-threatening complication subsequent to intraocular procedures, open-globe injuries, metastatic systemic infections, and systemic inflammatory diseases. The incidence of post-cataract surgery endophthalmitis is 0.012% to 1.3%.Areas covered Patients’ ocular surface flora, surgical instruments, and surgical complications like posterior capsule rupture with vitreous loss and anterior vitrectomy. The most common bacteria causing post-cataract endophthalmitis in the Western world are gram-positive coagulase-negative Staphylococci, followed by Streptococci and Pseudomonas aeruginosa. Povidone-iodine (PI) is the only topical prophylactic antiseptic known to reduce endophthalmitis perioperatively with a three to five times reduction rate within one minute of irrigation. The European Society of Cataract & Refractive Surgeons (ESCRS) study recommendations are also discussed.Expert opinion There are no randomized controlled trials of PI with endophthalmitis rate as the primary end point. Based on retrospective data, 5% PI applied to conjunctiva prior to surgery reduced endophthalmitis rates four-fold. Intracameral injection of either vancomycin, cefazoline, cefuroxime, or moxifloxacin has a prophylactic effect. We recommend using preoperative 5% povidone-iodine for 30 seconds in the cul-de-sac and intracameral moxifloxacin or cefuroxime as effective prophylaxis against post-operative endophthalmitis.KEYWORDS: Endophthalmitisprophylaxisintracameral antibioticsintracameral moxifloxacinpovidone-iodineDisclaimerAs a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also. Declaration of interestThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.Reviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Table 2 Identified Risk factors and associationDownload CSVDisplay TableAdditional informationFundingThis paper was supported by funds from the Hyderabad Eye Research Foundation.
{"title":"Minimizing the risk of endophthalmitis following cataract surgery: Current antibiotic approaches","authors":"Nimesh C. Patel, Avinash Pathengay, Mudit Tyagi, Rajeev Reddy Pappuru, Vivek Pravin Dave","doi":"10.1080/17469899.2023.2264508","DOIUrl":"https://doi.org/10.1080/17469899.2023.2264508","url":null,"abstract":"ABSTRACTIntroduction Cataract surgery is the most commonly performed intraocular surgery all over the world. Endophthalmitis is a sight-threatening complication subsequent to intraocular procedures, open-globe injuries, metastatic systemic infections, and systemic inflammatory diseases. The incidence of post-cataract surgery endophthalmitis is 0.012% to 1.3%.Areas covered Patients’ ocular surface flora, surgical instruments, and surgical complications like posterior capsule rupture with vitreous loss and anterior vitrectomy. The most common bacteria causing post-cataract endophthalmitis in the Western world are gram-positive coagulase-negative Staphylococci, followed by Streptococci and Pseudomonas aeruginosa. Povidone-iodine (PI) is the only topical prophylactic antiseptic known to reduce endophthalmitis perioperatively with a three to five times reduction rate within one minute of irrigation. The European Society of Cataract & Refractive Surgeons (ESCRS) study recommendations are also discussed.Expert opinion There are no randomized controlled trials of PI with endophthalmitis rate as the primary end point. Based on retrospective data, 5% PI applied to conjunctiva prior to surgery reduced endophthalmitis rates four-fold. Intracameral injection of either vancomycin, cefazoline, cefuroxime, or moxifloxacin has a prophylactic effect. We recommend using preoperative 5% povidone-iodine for 30 seconds in the cul-de-sac and intracameral moxifloxacin or cefuroxime as effective prophylaxis against post-operative endophthalmitis.KEYWORDS: Endophthalmitisprophylaxisintracameral antibioticsintracameral moxifloxacinpovidone-iodineDisclaimerAs a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also. Declaration of interestThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.Reviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Table 2 Identified Risk factors and associationDownload CSVDisplay TableAdditional informationFundingThis paper was supported by funds from the Hyderabad Eye Research Foundation.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135385927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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