News reports from the conference

Poster presentations

• TNF-alpha inhibitors need randomized trial for uveitis
• Inflamed tattoos warrant tissue biopsy
• Comparison of phacoemulsification approaches gives nod to trabeculectomy
• Uveitis rate comparable in Canadian Aboriginal population
• Severe depression common in patients with age-related macular degeneration
• Checklist can improve cataract surgery safety
• Ophthalmologists see need for translational aids

TNF-alpha inhibitors need randomized trial for uveitis

A systematic review of the effectiveness of TNF-alpha inhibitors to treat severe uveitis concludes that more research is required to confirm their efficacy.

Researchers from the Shulich School of Medicine and Dentistry, Ophthalmology Department assessed 19 published studies that evaluated before-and-after case series using TNF-alpha inhibitors to treat uveitis. Posterior inflammation grade was examined in six studies and anterior inflammation grade, in 13. In these studies involving a total of 200 patients, treatment resulted in a significant decrease in pooled median inflammation grade (p < 0.05).

However, in 28 studies involving 364 patients in which visual acuity was examined, pooled median visual acuity improved from 20/40 to 20/30 over a mean 21.1 months of follow-up (not statistically significant, p > 0.05).

Given the high cost of these drugs and the lack of significant impact on visual acuity, researchers Nihal Haque, Zainab Khan, Patrick Prendergast and Dr. William Hodge concluded that a randomized controlled trial is needed to further evaluate the value of TNF-alpha drugs for this indication.

Inflamed tattoos warrant tissue biopsy

A case report of a patient who presented to an ophthalmology department with red, scaly and painful tattoo reactions and bilateral irritated red eyes highlights the need for tissue biopsy and consultation with other specialists when making a diagnosis.

The presentation from the University of Saskatchewan in Saskatoon described how the patient was diagnosed with granulomatous anterior uveitis and how involvement of the respirology department and additional laboratory testing led to a final diagnosis of systemic sarcoidosis.

Drs. Joel Post, Ravikrishna Nrusimhadevara and Peter Hull concluded that, with the growing popularity of tattoos, clinicians should be aware that itchy and painful tattoos coupled by eye symptoms coujld be a manifestation of local or systemic sarcoidosis.

Comparison of phacoemulsification approaches gives nod to trabeculectomy

Better outcomes have been seen with trabeculectomy with mitomycin C when compared with endoscopic cyclophotocoagulation (ECP) for patients undergoing combined cataract and glaucoma surgery.

The analysis was based on a review of six-month outcome data for 67 eyes in 67 patients who were matched for age, sex, pre-operative intraocular pressure (IOP) and visual acuity.

The analysis showed no significant difference for the primary outcome of mean IOP, and for the rate of complications between the 33 patients who underwent ECP and the 34 who had trabeculectomy. However, a significantly greater number achieved "complete success" (an IOP > 5 and < 21 without medication) in the trabeculectomy group (35.7% v. 8.3% p = 0.0241). Also, patients in trabeculectomy group required significantly fewer post-operative medications.

The research was conducted by Drs. Sheila Marco, Karim Damji and Christopher Rudnisky from the University of Alberta in Edmonton.

Uveitis rate comparable in Canadian Aboriginal population

A retrospective chart review of a random consecutive sample of 133 uveitis patients has shown no significant difference between the rates of uveitis in Aboriginal and non-Aboriginal patients in Manitoba and Northern Ontario.

Of the 133 charts reviewed, 16.5% were from Aboriginal people in the region where census data showed that 15.5% of the general population was Aboriginal.

Dr. Mili Roy, assistant professor of ophthalmology at the University of Toronto, who conducted the analysis while at the University of Manitoba, noted that the mean age at presentation was significantly lower (by 10.5 years) in the Aboriginal patient group and the proportion of female patients was higher (68.2% v. 53.2%) when compared with the non-Aboriginal group.

Severe depression common in patients with age-related macular degeneration

A random sample of 101 patients with age-related macular degeneration who presented to an Edmonton clinic revealed that 22.8% had severe symptoms of depression.

The finding was based on scores from the Center for Epidemiological Studies Depression Scale, one of several tests completed by study participants, and is comparable to the 33% rate found in the literature. Three of the patients (13%) had been previously diagnosed with depression.

The research was conducted by Drs. Jamil Jivraj, Imran Jivraj, Christopher Rudnisky and Matthew Tennant of the University of Alberta, in Edmonton.

Checklist can improve cataract surgery safety

A checklist can be a useful tool to improve safety in ambulatory cataract surgery.

That's the conclusion of a prospective cohort analysis involving 3800 cataract surgeries performed at one surgical facility.

The researchers from British Columbia adapted and implemented the Cataract Checklist based on the World Health Organization Safety Checklist. Staff reported better communication and workflow through the use of the checklist, though researchers found significant education was needed to implement it. No statistical reduction in wrong intraocular lens (IOL) implants was seen and one case of wrong IOL placement was reported both the pre- and post-implementation periods.

The research was conducted by Dr. Hamza Khan, a Victoria, B.C. ophthalmologist, Donna Gramigna, Courtney Addis and Carla Service.

Ophthalmologists see need for translational aids

Many Canadian ophthalmologists have reported experiencing communication difficulties with patients due to language barriers and feel they would benefit from translational aids for the languages most commonly used by their patients.

This finding comes from a survey of practising Canadian ophthalmologists conducted last fall (response rate 19.9%; 139/700).

Of the respondents, 93.5% reported that they had encountered language-related communication issues with their patients, and most (88.5%) indicated that they would benefit from having a list of ophthalmologic terms (symptoms, diagnoses, etc.) translated into languages such as Chinese, Hindi and Spanish. Most also indicated that patient pamphlets on specific ocular conditions translated into several languages would benefit their practices.

The research was conducted by Drs. Kathy Cao, Zale Mendick and Rosa Braga-Mele of the University of Toronto.