The edition · Ophthalmology
Corneas from donors with diabetes graft as well at one year, and a task force questions routine high-level disinfection of tonometer tips
A secondary analysis of a 1,097-patient randomised trial finds donor diabetes severity did not affect DMEK outcomes, a multisociety task force argues routine chemical disinfection of ocular contact devices lacks evidence, and glaucoma studies look at central field progression and goniotomy arc size.
The edition in brief
In the Diabetes Endothelial Keratoplasty Study secondary analysis of 1,097 recipients, one-year graft success did not differ by donor HbA1c (97.1% for donors below 6.5%, 95.8% to 93.0% for higher bands, P = 0.72), and donor diabetes severity did not affect endothelial cell density or morphometry. A multisociety task force position paper found no published evidence that tonometer tips, gonioscopy lenses or laser lenses transmit sight-threatening infection or that high-level disinfection reduces it, and 88% of surveyed ophthalmologists agreed it should not be required routinely. A 10-year Japanese cohort of 127 glaucomatous eyes found baseline inferior or both-hemifield central defects were associated with central field progression (hazard ratios about 3.3 and 3.7). A 126-eye Chinese study of goniotomy in juvenile open-angle glaucoma found 240 and 360 degree arcs comparable and better than 120 degrees, with more hyphaema at 360. A five-study meta-analysis found tetrahydrocannabinol lowered intraocular pressure by 14.7% but not significantly more than control.
A multisociety task force questions routine high-level disinfection of ocular contact devices
Keep following your local infection-control policy and regulator requirements, but be aware that a multisociety position paper argues routine high-level disinfection is not evidence-based and is reserved for higher-risk use.
Glaucoma with central field defects: inferior or two-hemifield involvement predicted progression
Consider more frequent 10-2 field testing for glaucoma eyes with inferior or two-hemifield central defects at baseline.
Goniotomy arc size in juvenile open-angle glaucoma: 240 degrees performed like 360 with less hyphaema
Consider that a 240 degree arc may match 360 degrees in juvenile open-angle glaucoma with less bleeding, while a 120 degree arc looks less effective; this needs randomised confirmation.
Tetrahydrocannabinol lowers eye pressure, but not clearly more than control
Tell patients who ask that cannabis-derived products have not been shown to lower eye pressure better than control, and continue prescribed glaucoma therapy.
Wipe and dry tonometer tips as the manufacturer directs
Check that contact time and drying steps in your clinic's protocol match the manufacturer's instructions.
Donor diabetes severity did not affect one-year DMEK outcomes
Consider accepting corneas from donors with diabetes for DMEK in low- to moderate-risk recipients without extra donor testing, bearing in mind follow-up here was one year.
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