Once a rarely used subset of medical treatments, protein therapeutics have increased dramatically in number and frequency of use since the introduction of the first recombinant protein therapeutic--human insulin--25 years ago. Protein therapeutics already have a significant role in almost every field of medicine, but this role is still only in its infancy. This article overviews some of the key characteristics of protein therapeutics, summarizes the more than 130 protein therapeutics used currently and suggests a new classification of these proteins according to their pharmacological action.

Protein therapeutics: a summary and pharmacological classification

Purpose: To compare laser in situ keratomileusis (LASIK) results obtained with the femtosecond laser (IntraLase Corp.) to those obtained using 2 popular mechanical microkeratomes. Setting: Private practice, Greensboro, North Carolina, USA. Methods: This retrospective analysis compared LASIK outcomes with the femtosecond laser to those with the Carriazo-Barraquer (CB) microkeratome (Moria, Inc.) and the Hansatome ® microkeratome (Bausch & Lomb, Inc.). The 3 groups were matched for enrollment criteria and were operated on under similar conditions by the same surgeon. Results: There were 106 eyes in the IntraLase group, 126 eyes in the CB group, and 143 eyes in the Hansatome group. One day postoperatively, the uncorrected visual acuity (UCVA) results in the 3 groups were similar; at 3 months, the UCVA and the best spectacle-corrected visual acuity results were not significantly different. A manifest spheroequivalent of ±0.50 diopter (D) was achieved in 91% of eyes in the IntraLase group, 73% of eyes in the CB group, and 74% of eyes in the Hansatome group ( P P P P = .001). Surgically induced astigmatism in sphere corrections was significantly less with the IntraLase than with the other devices ( P Conclusions: The IntraLase demonstrated more predictable flap thickness, better astigmatic neutrality, and decreased epithelial injury than 2 popular mechanical microkeratomes.

Comparison of the IntraLase femtosecond laser and mechanical keratomes for laser in situ keratomileusis

LASIK complications: etiology, management, and prevention.

Clinical outcomes after deep anterior lamellar keratoplasty using the big-bubble technique in patients with keratoconus

The tenth annual survey of complications associated with foldable intraocular lenses (IOLs) requiring explantation or secondary intervention was sent to members of the American Society of Cataract and Refractive Surgery and the European Society of Cataract and Refractive Surgeons. Preoperative data about visual acuity, patient signs and symptoms, and complications requiring IOL removal were evaluated. Complications were then tabulated for each of the following major foldable IOL groups: 1-piece (plate) silicone, 1-piece hydrophobic acrylic with haptics, 3-piece silicone, 3-piece hydrophobic acrylic, 3-piece hydrophilic acrylic (hydrogel), 3-piece unknown, multifocal acrylic, and multifocal silicone. One hundred forty-two surveys were returned for evaluation. Dislocation/decentration, incorrect IOL power, glare/optical aberrations, and IOL calcification were the most common reasons for removing foldable IOLs. Good surgical technique, accurate IOL power measurements, and high manufacturing standards for foldable IOL materials and designs are the most important factors in preventing complications.

Complications of foldable intraocular lenses requiring explantation or secondary intervention--2003 survey update

Purpose To study the long-term complications of penetrating keratoplasty (PKP) to evaluate current recommendations to patients with keratoconus. Setting John Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Methods Retrospective study of all PKP procedures for keratoconus performed by 4 surgeons during a 312 year period. Follow-up was 1 day and 1, 3, 6, 12, and 24 months post-PKP. Data from 93 eyes were reviewed for allograft reaction, astigmatism, visual acuity, reasons for decreased visual acuity, and other complications. Results Allograft reaction was seen in 31% of cases but no graft failure due to allograft reaction. Mean astigmatism was 2.76 diopters (D) ± 1.99 (SD) at 24 months, with only 15% > 5.00 D. Last best corrected visual acuity was 20/25 or better in 77% of cases (87% had 20/25 or better at some time during follow-up). Complications that did not cause decreased visual acuity were noted. Punctate keratitis was noted in 20% of patients 180 days or more after surgery. Conclusion Penetrating keratoplasty is a good treatment option for patients with keratoconus but should be reserved for those who do not tolerate contact lenses or do not get needed visual acuity with contact lenses because of complications. This procedure has become a second-line treatment for keratoconus patients and has generally good results.

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Penetrating keratoplasty for keratoconus: a long-term review of results and complications.

A comparison of topical and retrobulbar anesthesia for cataract surgery.

Excimer laser refractive surgery: practice and principles

Purpose To retrospectively review the occurrence, treatment, and visual outcomes associated with various etiologies of keratitis as a postoperative complication of laser in situ keratomileusis (LASIK) at an academic surgical center Setting John A Moran Eye Center, University of Utah, Salt Lake City, Utah, USA Methods The charts of 5618 post-LASIK patients (10 477 eyes) were reviewed for the development of keratitis Occurrence rates, management regimens, and final best spectacle-corrected visual acuity (BSCVA) were reported for infectious and noninfectious keratitis etiologies Results Post-LASIK keratitis was diagnosed in 279 eyes The keratitis was diagnosed as infectious in 33 eyes (12%) and as noninfectious in 246 eyes (88%) Infectious cases included 5 eyes (15%) with herpes simplex keratitis (HSV), 18 (55%) with adenoviral keratitis, and 10 (30%) with nonviral (including bacterial, fungal, and parasitic) keratitis Of noninfectious cases, 193 (78%) were classified as diffuse lamellar keratitis (DLK), 36 (15%) as staphylococcal marginal hypersensitivity, and 17 (15%) as localized debris-related keratitis Conclusions The occurrence of post-LASIK keratitis was 266%, with DLK being the most common diagnosis overall The occurrence of noninfectious keratitis (234%) was 75 times greater than the occurrence of infectious keratitis (031%) Adenoviral keratitis had the best visual outcomes overall, with all 18 patients achieving 20/20 BSCVA In contrast, all 5 eyes with HSV keratitis lost 1 or 2 lines of BSCVA Excluding adenoviral keratitis, infectious etiologies had significantly worse visual outcomes than noninfectious etiologies at the 20/40 and 20/20 levels ( P = 0013 and P

Infectious and noninfectious keratitis after laser in situ keratomileusis Occurrence, management, and visual outcomes.

Sloughing of corneal epithelium and wound healing complications associated with laser in situ keratomileusis in patients with epithelial basement membrane dystrophy

Thomas E. Clinch

Papers

Penetrating keratoplasty for keratoconus: a long-term review of results and complications.

A comparison of topical and retrobulbar anesthesia for cataract surgery.

Excimer laser refractive surgery: practice and principles

Infectious and noninfectious keratitis after laser in situ keratomileusis Occurrence, management, and visual outcomes.

Sloughing of corneal epithelium and wound healing complications associated with laser in situ keratomileusis in patients with epithelial basement membrane dystrophy