Highlights from the 2008 congress of the American Academy of Ophthalmology (AAO), held 8–11 November in Atlanta, Georgia, US.

Please click on any of the headlines below to see the full story.

Lowering risk of 25 G surgery
Although 25 G sutureless vitrectomy has increased in popularity, it is associated with postoperative complications including hypotony, choroidal detachment, and endophthalmitis. Richard Kaiser, MD, from the Retina Service of Wills Eye Institute, Philadelphia, noted that the 25 G procedure has a 12.4 times greater risk of endophthalmitis when compared with the 20 G procedure. 

TVT study: 3-year results announced
Three-year results from the Tube versus Trabeculectomy Study showed that tube-shunt surgery was more likely than trabeculectomy with mitomycin C to maintain IOP control and avoid persistent hypotony, loss of light perception vision, or re-operation for glaucoma. 

Distinct DME patterns seen on OCT
Optical coherence tomography (OCT) is valuable in managing diabetic macular oedema (DME), more so than fluorescein angiography, in which the degree of leakage is not correlated with visual acuity and outcomes, according to Peter Kaiser, MD. 

Phaco benefits on IOP even better
Instead of combined surgery, cataract extraction alone by phacoemulsification through a clear corneal incision with posterior chamber IOL implantation may be the most appropriate procedure for patients with controlled or modestly uncontrolled glaucoma as well as for patients with ocular hypertension or glaucoma suspects. 

Post LASIK cataract surgery woes
The difficulty of accurate IOL power calculation in postLASIK eyes is an issue being faced increasingly by cataract surgeons. Jack T. Holladay, MD, clinical professor of ophthalmology, Baylor College of Medicine, Houston, Texas, US offered several tips for achieving better refractive outcomes in this growing population of eyes. 

AAO news in brief
Wavefront better for night driving
Laser refractive surgery conducted with wavefront-guided procedures are associated with better night driving outcomes when compared with traditional LASIK treatments.

Femtosecond similarities
A study of two femtosecond lasers (IntraLase FS60; AMO & Ziemer LDV; Ziemer) found that both lasers produced very similar results at all time points examined after LASIK.

A new postLASIK entity?
Surgeons should consider the diagnosis of LASIK chronic pain syndrome in post LASIK patients complaining of moderate to severe eye pain in the absence of dry eye or any other identifiable cause.

Boosting glaucoma adherence
The Latanoprost Punctal Plug Drug Delivery System, a drug-eluting implantable stent/ punctal plug device, reduced IOP by a mean of approximately 30% in trial subjects and may increase patient compliance. Retention rates were, however, low.

DME treatment safe
A Phase I dose-escalation trial of rapamycin (Sirolimus, Wyeth) showed that the drug is safe and has biologic activity against diabetic macular oedema (DME).

Avastin for CME
Twelve month study results have shown that intravitreal bevacizumab (Avastin; Genentech) is a promising treatment of refractory pseudophakic cystoid macular oedema (CME).

OT awards writer
Jonathan Etter, MD, of the Duke Eye Center, Duke University, Durham, North Carolina, US won first-place honours in the sixth annual Ophthalmology Times Resident Writer's Award programme, for his presentation "Fungal keratitis: enhancing antifungal delivery with femtosecond laser-assisted keratectomy."

Ptosis could indicate serious illness
Ptosis, a symptom of many benign disorders, is also associated with myasthenia gravis, which first presents with ocular symptoms in over 90% of cases. Doctors should not overlook this potentially serious condition (and its high rate of morbidity and mortality) when treating ptosis.

Diet aid for retinopathy
DiaVis (ScienceBased Health) — a nutritional supplement, which delivers antioxidants as an aid to boost the vision of diabetics — has been launched.

Secondary piggyback IOLs
Given the right conditions, a secondary piggyback IOL may be the most successful solution for post-phaco refractive issues. A low-profile 3-piece IOL is the best option for this.

Dry eye in LASIK patients
Treating dry eye prior to, and taking steps to prevent its development following, LASIK surgery is the best way to minimize the incidence of this condition. Low-contrast acuity is a reliable screening tool, and patients whose preop dry eye does not interfere with vision are good candidates for surgery.

Maculopathy: laser still best
Despite growing support for anti-VEGF drug therapies, the Early Treatment Diabetic Retinopathy Study (ETDRS) laser remains the gold standard of care for diabetic maculopathy.

Anti-VEGFs for DME?
Anti-VEGFs may be a viable adjunctive treatment to vitrectomy or laser therapy for diabetic macular oedema (DME), having proved effective in trials as a temporary treatment of diabetic retinopathy.

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