Eyeworld

EW CATARACT 37 June 2015 The Post-Vitrectomy Lenstatin Study The Post-Vitrectomy Lenstatin Study is a randomized, double-blind, pla- cebo-controlled human clinical trial in which subjects are randomized to treatment with Lenstatin (Wilming- ton, N.C.), a proprietary antioxidant nutritional supplement formulated specifically for anti-cataractogenic effect, or placebo flowing pars plana vitrectomy. In the study, cataract formation and progression are monitored by serial Pentacam Nuclear Staging measurements (Oculus, Arlington, Wash.), which has been shown to be an objective, quantitative, and reproducible measurement of nu- clear cataract density. 7 In this study a much shorter window of obser- vation is necessary than required to study senile cataract formation. Compliance, follow-up, and data collection are maximized, and the potentially misleading effects of long-term, comorbid conditions that contribute to cataract progression are minimized. Pentacam data used for outcome analysis is objective, reproducible, and may allow for the detection of far more subtle anti-cat- aractogenic effects than subjective criteria such as Snellen acuity or LOCS grading. The Post-Vitrecto- my Lenstatin Study is being con- ducted under IRB supervision, is registered at www.clinicaltrials.gov, and is compliant with all federal regulations governing the testing of human subjects. Our collective knowledge of the beneficial effects of antioxidants in a wide variety of ocular diseases continues to expand far beyond the AREDS paradigm. Despite the success of modern cataract surgery in developed countries, cataract re- mains the leading cause of visual im- pairment in the world. Innovative, non-surgical therapies and novel methods to evaluate their effective- ness are important components in the quest to minimize the world- wide impact of cataract. EW References 1. Christen WG et al. Effects of multivitamin supplement on cataract and age-related macular degeneration in a randomized trial of male physicians. Ophthalmology. 2014 Feb; 121(2):525–34. 2. Rautiainen S. Total antioxidant capacity of the diet and risk of age-related cataract: a population-based prospective cohort of wom- en. JAMA Ophthalmol. 2014;132(3):247–252. 3. Mathew MC et al. Antioxidant vitamin sup- plementation for preventing and slowing the progression of age-related cataract. Cochrane Database Syst Rev. 2012 Jun 13;6:CD004567. 4. de Bustros S et al. Nuclear sclerosis after vitrectomy for idiopathic epiretinal mem- branes. Am J Ophthalmol. 1988; 105(2):160– 164. 5. Hsuan JD et al. Posterior subcapsular and nuclear cataract after vitrectomy. J Cataract Refract Surg. 2001; 27(3):437–444. 6. Melberg NS, Thomas MA. Nuclear sclerotic cataract after vitrectomy in patients young- er than 50 years of age. Ophthalmology. 1995;102(10):1466–1471. 7. Magalhães FP et al. Comparative analysis of the nuclear lens opalescence by the Lens Opacities Classification System III with nuclear density values provided by Oculus Pentacam: a cross-section study using Pentacam Nucleus Staging software. Arq Bras Oftalmol. 2011; 74(2):110–3. Editors note: Dr. Tunis is in private practice in Wilmington, N.C. He has financial interests with Lenstatin. Contact information Tunis: swt@scottwtunismd.com much, and for how long? Although cataract surgery is readily available and generally affordable in the de- veloped countries of the world, not every patient is immediately ready for surgery and many may wish to pursue interim strategies. In con- trast, in developing countries there is a significant backlog of surgery and as a result, unacceptably high levels of visual disability from cata- ract. Statistically significant evidence from a controlled study that certain antioxidants inhibit cataract devel- opment and progression would have far-reaching, worldwide implica- tions. The Post-Vitrectomy Lenstatin Study was established in order to better answer these questions. Cataract formation following pars plana vitrectomy is a well-rec- ognized postoperative complication of the procedure, with the reported incidence of clinically significant cataract development as high as 80% within 2 years after pars plana vitrectomy. 4–6 In the news Besifloxacin appears more effective than moxifloxacin in reducing bacterial counts on eyelids, study finds B esifloxacin appeared more effective in reducing bacterial counts on eyelids of patients undergoing cataract surgery, with signif- icant reductions as early as 1 hour post-dose, compared with moxifloxacin, according to Frank A. Bucci Jr., MD, and colleagues. They prospectively randomized 59 patients (n=28 besifloxacin, n=31 moxifloxacin) to receive the drugs QID for 3 days before cataract sur- gery in the operated eye, and 1 hour before surgery in the non-operat- ed eye to investigate the ocular bacterial flora and antibacterial effects of the 2 drugs. The majority (73%) of conjunctival samples were culture negative at baseline. The most frequent isolates were coagu- lase-negative Staphylococci (CoNS, 89%), specifically Staphylococcus epidermidis (72%). Both fluoroquinolones reduced the bacterial flora load, but only besifloxacin reduced the value an hour after instillation with a single drop (P=0.039). The minimum inhibitory concentration (MIC90) of besifloxacin against methicillin-resistant S. epidermidis was eightfold lower than that of moxifloxacin. The study is published in Clinical Ophthalmology. EW

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