We describe bilateral phacoemulsification and implantation of foldable silicone intraocular lenses in a 25-year-old woman with Alport's syndrome and severe anterior lenticonus. Contrary to previous reports of lens capsule fragility in Alport's syndrome, this patient had relatively tough capsules, as do most patients her age. Apart from the tough capsules and positive pressure, which required the use of a viscoelastic to maintain the anterior chamber, the surgeries were unremarkable. The patient achieved excellent visual and refractive results.

Background and Aims: This phase 3, randomized, parallel-arm study compared the efficacy and safety of 2 doses of dulaglutide (DU) with exenatide (EX) or placebo (PL) in type 2 diabetes patients treated with metformin and pioglitazone. Materials and Methods: Patients (n¼976; mean baseline characteristics: age 55.7 years; HbA1C 8.1%; weight 96.0 kg) were randomized (2:2:2:1) openly to EX 10 mcg BID or, in a double-blind fashion, to once-weekly DU 1.5 mg, DU 0.75 mg or PL. After 26 weeks, the PL group was randomized to DU 1.5 mg or 0.75 mg for 26 additional weeks. All others continued with originally assigned treatments for the study duration (52 weeks). The primary hypothesis was that DU 1.5 mg is superior to PL for change in HbA1C from baseline to 26 weeks. Results: Both DU (1.5 mg, 0.75 mg) doses were superior to EX and PL, as measured by HbA1C change at 26 weeks (e1.51%, e1.30%, e0.99% and e0.46%, respectively, adjusted p<0.001), and to EX at 52 weeks (e1.36%, e1.07% and e0.80%, respectively, adjusted p<0.001). The incidence of serious adverse events (AEs) was similar among PL and DU groups. The rank order for incidence of gastrointestinal-related AEs among groups was: EX w DU 1.5 mg > DU 0.75 mg > PL. The incidence of symptomatic hypoglycaemia (3.9 mmol/L) was 3.2%, 4.3%, 12.3% and 1.4% for DU 1.5 mg, DU 0.75 mg, EX and PL, respectively. Conclusions: Both once-weekly DU doses demonstrated superior glycemic control compared with PL or EX, and were well tolerated.

Deep tunnel scleral pocket incisions were developed to control surgically induced astigmatism following cataract and intraocular lens implantation surgery. A more superficial, shallow scleral pocket incision was developed to reduce the rate of postoperative hyphema. To test its effectiveness, a randomized prospective clinical study was performed. One hundred twenty-nine eyes of 129 patients were randomized: 66 to receive a deep tunnel pocket and 63 to receive the superficial pocket. In both groups the incision was made 3 mm posterior to the limbus. For the deep pocket cases, a blade setting of 0.27 mm was used and the wound was dissected forward toward the entry site, creating a long, deep, narrow tunnel. For the superficial wound cases, a 0.17 mm blade setting was used and the entire wound was dissected to the edge of the anatomic limbus, creating a thin scleral flap. The left side was then fanned out toward the left with the entry site slightly into clear cornea. At one day after surgery, 22 cases (34%) in the deep pocket group and four cases (6%) in the superficial pocket group had hyphemas. The difference in hyphema rates was statistically significant (P less than .001).

Twenty-eight patients who had an intraocular pressure greater than 30 mm Hg within 24 hours after cataract surgery were randomly assigned to be treated with medication or by paracentesis through a sideport incision. Paracentesis provided an immediate reduction in intraocular pressure, but within one hour pressures rebounded. Within two to three hours after treatment, the medication group had significantly greater mean reductions in intraocular pressure than the paracentesis group.