Prostaglandin analogues and macular oedema after endothelial cell injection

The edition in brief

Today's ophthalmology desk leads with a complication signal from cell therapy for corneal endothelial failure. Across 57 eyes at three Japanese centres, cystoid macular oedema was detected after cultured human corneal endothelial cell injection in 15 (26.3 per cent), predominantly early, and preoperative prostaglandin analogue use was strongly associated: 60 per cent of the oedema cases against 14.3 per cent of those without (P=.001). Glaucoma, topical glaucoma medication and worse preoperative acuity also tracked with it. Every case resolved with topical NSAIDs or sub-Tenon triamcinolone, and six-month acuity did not differ. In glaucoma, retinal vasculometry derived automatically from baseline fundus photographs in 1595 eyes followed a mean 10.3 years was associated with subsequent visual field change: each standard deviation of higher venous fractal dimension corresponded to a visual field slope 0.079 dB/year less negative (95% CI 0.034 to 0.123), with smaller effects for arterial fractal dimension and tortuosity. A review of local therapy in non-infectious uveitis sets out the current ladder from topical corticosteroid through periocular and intravitreal triamcinolone and dexamethasone implants to fluocinolone implants and suprachoroidal delivery, with methotrexate and sirolimus as steroid-sparing options. The practice-changer is a masked randomised trial in 60 patients having bilateral cataract surgery with a refractive extended depth of focus lens: mini-monovision at −0.75 D gave no significant gain in near or intermediate acuity over an emmetropic target, and cost 0.10 logMAR of low-contrast acuity at both 5 per cent and 1.25 per cent contrast, with more glare.