13 Clinical Trials Summary
13.0 Introduction
13.1 Cornea
13.2 Cataract
13.3 Medical Retina – Age-Related Macular Degeneration (AMD)
13.4 Medical Retina - Diabetes
13.5 Medical Retina – Retinal Vein Occlusion (RVO)
13.6 Vitreoretinal Surgery
13.7 Glaucoma
13.8 Oculoplastics
13.9 Paediatrics
13.10 Neuro-Ophthalmology
13.11 Ocular Oncology
13.2 Cataract
ESCRS [viii]
Intracameral cefuroxime decreased risk of endophthalmitis by 5x
Risk higher if male, CCI (c.f. scleral tunnel), & silicone IOL
Use of perioperative levofloxacin drops as prophylaxis was associated with reduction in endophthalmitis, although not statistically significant
Four groups studies – no drops/injection, intracameral, drops/no intracameral, drops and intracameral (lowest rate of endophthalmitis)
Barry, P., Seal, D.V., Gettinby, G. et al. 2006. ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: Preliminary report of principal results from a European multicenter study. J Cataract Refract Surg 32(3) 407-410.
EVS [ix]
Endophthalmitis Vitrectomy Study
If VA LP at presentation endophthalmitis, do better with initial vitrectomy rather than intravitreal antibiotics (3x increased chance of achieving 6/12)
IV antibiotics make no difference
Very old study, may not be applicable today, high rate of endophthalmitis in study, multiple problems with protocol)
1995. Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Endophthalmitis Vitrectomy Study Group. Arch Ophthalmol 113(12) 1479-1496.
Povidone [x]
Pre-op povidone-iodine preparation reduces the risk of endophthalmitis. 5% concentration is more efficacious than 1%
Apt, L., Isenberg, S., Yoshimori, R. et al. 1984. Chemical Preparation of the Eye in Ophthalmic Surgery: III. Effect of Povidone-Iodine on the Conjunctiva. Archives of Ophthalmology 102(5) 728-729.
ESCRS PREMED 1 [xi]
Prevention of post-op CMO in non-diabetics
Comparison of topical NSAIDs, topical steroids, or both in prevention of post-op CMO in uncomplicated cataract surgery. Findings – patients receiving combination bromfenac (0.09%) BD for 3/52 combined with dexamethasone 0.1% for 4/52 had lower risk of developing post-op CMO
Wielders, L.H.P., Schouten, J.S.A.G., Winkens, B. et al. 2018. European multicenter trial of the prevention of cystoid macular edema after cataract surgery in nondiabetics: ESCRS PREMED study report 1. Journal of Cataract & Refractive Surgery 44(4).
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Vitreoretinal Surgery Online
This open-source textbook provides step-by-step instructions for the full spectrum of vitreoretinal surgical procedures. An international collaboration from over 90 authors worldwide, this text is rich in high quality videos and illustrations.
