The edition · Ophthalmology
Home tonometry captured pressure excess that clinic readings missed in treated glaucoma
In a retrospective cohort, threshold-based home IOP measures tracked visual field progression while clinic measures did not. Also: aphakia in children after congenital cataract surgery, an anti-VEGF regimen in retinal vein occlusion, and dexamethasone against triamcinolone after cataract surgery.
The edition in brief
A retrospective study of 94 treated open-angle glaucoma patients (150 eyes) compared in-office and home tonometry. Standard IOP metrics did not relate to visual field progression, but home-derived measures of how often and by how much pressure exceeded each patient's target were associated with faster progression; in-office equivalents were not. A follow-up of the Infant Aphakia Treatment Study found that 43% of children left aphakic to 4.5 years had a secondary lens implanted by 10.5 years, with wide variation by centre. A randomised trial of 255 patients with branch retinal vein occlusion macular oedema found greater early visual gain with conbercept from baseline than with a delayed-start regimen, with the gap narrowing by 12 months. A meta-analysis of 12 studies and 2,003 patients found dexamethasone and triamcinolone acetonide comparable after cataract surgery, with low-certainty evidence.
Home tonometry: pressure above target predicted field loss when clinic readings did not
Consider home tonometry in glaucoma progressing despite normal clinic pressures, where the device is accessible.
Aphakia in childhood: 43% of children left aphakic still had a secondary lens by age 10
Discuss secondary lens implantation with families as an individual choice, since it did not clearly reduce contact lens wear.
Conbercept in branch retinal vein occlusion: earlier treatment gave a larger early gain that narrowed by 12 months
Treat early, adequate loading as important for visual recovery in branch vein occlusion oedema; later gains narrow.
Check intraocular pressure after starting or changing any steroid drop
Measure pressure before and soon after starting an eye steroid, and give a planned stop date.
Dexamethasone and triamcinolone acetonide looked comparable after cataract surgery, with low certainty
Consider choosing between dexamethasone and triamcinolone by adherence and context, since efficacy looked similar.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for ophthalmology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free