Study: High daily polyunsaturated fatty acids, fiber intake associated with lower IOP in children

BERLIN — A study examining a link between dietary factors and IOP found that higher polyunsaturated fatty acids and fiber consumption were linked to lower IOP in schoolchildren.

According to Laurence S. Lim, MBBS, and Seang-Mei Saw, MBBS, PhD, it was the first population-based study to make an association between nutrient consumption and IOP.

“Higher total daily PUFA (polyunsaturated fatty acids) intake was associated with lower IOP,” they said in a poster study presented here at the World Ophthalmology Congress. “As dietary PUFA are an important source of endogenous prostaglandins (PGs), these variations may be mediated via the PG pathway.”

In addition, the study authors found that high fiber consumption could be connected to lower glycemic indices and “reduced postprandial glucose elevations.”

The cross-sectional study looked at a subset of healthy schoolchildren from the Singapore Cohort Study of Risk Factors for Myopia. According to the poster, adults were not studied because of the possibility of confounding by systemic comorbidities.

A validated semi-quantitative food frequency questionnaire determined diet, while IOP and central corneal thickness were measured by the Ocular Response Analyzer (Reichert).

Glycemic control, anti-hyperlipidemic agents may prevent macular edema progression

Anti-hyperlipidemic agents could play a role in halting macular edema in some diabetic patients with hypertension, a study of diabetic patients taking those agents found.

“These data indicated that intense glycemic control and administration of anti-hyperlipidemic agents may be effective to prevent the progression of macular edema in diabetic patients with hypertension,” Noriko Miyamoto, MD, and colleagues said in a poster study.

They presented results of 84 diabetic patients with retinopathy and hypertension who were taking anti-hypertensive agents. In the study, multiple linear regression evaluated the correlation of factors including sex, age, HbA1c, diabetic nephropathy, number of anti-hypertensive agents, insulin and systemic anti-coagulants with clinically significant macular edema.

“Significant factors for macular edema were HbA1c and anti-hyperlipidemic agents, but no correlation was found between diabetic macular edema and anti-hypertensive agents and other factors in diabetic patients with hypertension,” Dr. Miyamoto and colleagues said.

Study: Cataract surgery not a risk factor for retinal detachment in high myopia

Cataract surgery is not a demonstrated risk factor for retinal detachment in highly myopic eyes, and the risk profile for postoperative retinal detachment is the same as the risk profile for idiopathic retinal detachment, according to a study on a large cohort of patients.

“We performed a retrospective analysis of 1,519 consecutive patients (2,356 eyes) with an axial length greater than 27 mm who had planned phacoemulsification. Postoperative incidence of retinal detachment was approximately 2%, with a follow-up of 2 years in 84% of the cases,” Irmingard Neuhann, MD, reported.

This relatively high incidence confirms the results of the majority of the studies published in literature. However, no large epidemiological study has ever demonstrated that this rate is different from that of spontaneous retinal detachment in myopes with comparable axial length, she said.

“In our study, we found that the rate of idiopathic retinal detachment, occurred before surgery, was equally high. Consequently, it is difficult to demonstrate whether cataract surgery is actually a risk factor for [retinal detachment] in high myopes,” Dr. Neuhann said.

Retinal detachment is a predisposition that comes with myopia.

“I tell my patients that the risk of having retinal detachment following cataract surgery is not greater than the risk they would have anyhow. There is no evidence or scientifically plausible mechanism that should make cataract surgery an additional risk factor for retinal detachment,” she said.

Clinician: Fixed-combination drugs a compelling proposition in glaucoma therapy

More controlled studies must be performed to establish efficacy of fixed-combination medications for glaucoma treatment, a clinician said here.

Anastasios Konstas

“Fixed combinations ... do work in real-life practice by keeping medical therapy practicable. I think that fixed combinations are a compelling proposition in the management of glaucoma. They provide important benefits in most patients ... especially in real-life practice,” Anastasios Konstas, MD, PhD, said. “But we still need to see controlled evidence in the future to prove the clinical advantages.”

Dr. Konstas recommended that physicians not compare fixed combinations and monotherapy agents. He said it is more helpful to regard adjunctive therapy separately or together.

He said fixed therapy has been shown in other medical fields to decrease rates of nonadherence. Fixed combination drugs also offer fewer bottles needed for glaucoma therapy and less potential for toxicity from preservative exposure.

Large study bolsters correlation between thin corneas, glaucoma damage

A large multicenter survey of German glaucoma patients shows that thin central corneas as measured by optical coherence pachymetry may correlate with advanced stages of the disease, according to a poster presented here.

The German MoviX survey of 121,634 eyes of 62,060 patients found that patients with thinner corneas as measured by optical coherence pachymetry by Heidelberg Engineering tended to have greater visual field loss, according to the study.

“This large number of patients shows that visual field damage increases the smaller the thickness is,” Richard Stodtmeister, MD, co-author of the study, said in an interview.

Visual field loss was found to be higher in patients with thinner corneas, according to the poster. Eyes without visual field loss were found to have a median thickness of 547 µm, compared with 523 µm in eyes with Aulhorn stage 3 or greater visual field loss.

“The correlation between thin corneas and visual field damage has never been shown before on such a large scale,” Dr. Stodtmeister said.

Dr. Stodtmeister said optical coherence pachymetry was a highly reliable method of measuring central corneal thickness.

The study was supported by Pfizer Pharma GmbH.

DMEK shows good visual results at 6 months

Descemet’s membrane endothelial keratoplasty shows a high rate of success, according to a surgeon speaking here.

“In our series of 133 patients, we had an 86% success rate. Fourteen percent of the cases were unsuccessful due to graft detachment or failure to clear up but underwent secondary ... surgery with positive outcomes,” Gerrit Melles, MD, said.

Successful eyes had good visual acuity results, with 96% of the patients achieving 20/40 or better and 74% achieving 20/25 or better at 6 months.

“Almost half of the patients reached BCVA 20/25 or better within 1 month,” Dr. Melles said.

These results show the superior potential of DMEK compared with Descemet’s stripping endothelial keratoplasty. “The thinner, the better,” he said. “By adding stromal tissue, you degrade the image.”

In his busy practice, Dr. Melles has had several patients who asked him to remove a previous DSEK graft and have DMEK.

“Patients talk to each other, and DMEK patients are obviously reporting better outcomes,” he said.