This Issue At A Glance

Abstract

Lepore et al (p. 2212) addressed the question of whether intravitreal bevacizumab is safe over the long term for type 1 retinopathy of prematurity (ROP) and found that pretreatment structural abnormalities were less likely to resolve in eyes treated with intravitreal bevacizumab than in eyes treated with conventional laser photoablation. All 13 infants in this case series had type 1 zone 1 ROP; 1 eye was randomized to receive 0.5 mg bevacizumab, while the fellow eye was treated with laser. Twenty-three eyes completed the study. At 9 months, macular abnormalities were still evident in 9 of the 12 bevacizumab eyes (75%) and in 4 of the 11 lased eyes (36.4%), while capillary bed loss was noted in 11 of the bevacizumab eyes (91.6%) and 3 of the lased eyes (27.3%). Similarly, branching abnormalities (tangles) were present in 11 of the bevacizumab eyes (91.6%), vs. 3 of the lased eyes (27.3%). The results argue for erring on the side of caution, the researchers concluded. In a systematic review and meta-analysis, Tham et al (p. 2081) examined the global prevalence of primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) and projected the number of persons likely to be affected in 2020 and 2040. In 2013, 64.3 million persons (aged 40 to 80 years) worldwide had glaucoma, for a global prevalence rate of 3.54%. The total number of cases can be expected to increase to 76 million in 2020 and to 111.8 million in 2040, with the disease burden continuing to fall disproportionately on people living in Africa and Asia (in 2013, Asia had 60% of all cases of glaucoma, and Africa had 13% of all cases). With regard to POAG and PACG, the prevalence of POAG is highest in Africa (4.2%), while the prevalence of PACG is highest in Asia (1.09%). Srikumaran et al (p. 2159) evaluated long-term outcomes with the Boston Type 1 Keratoprosthesis (KPro) and found that half of patients were able to achieve and retain vision of 20/200 or better. This retrospective series analyzed outcomes for 139 eyes of 133 patients. Mean follow-up was 46.7±26 months (range, 6 weeks to 8.7 years). Slightly more than half (52.5%) of eyes had more than 4 years of follow-up, and 15 eyes (19.95%) had 7 years of follow-up. Preoperatively, only 10.8% of eyes were 20/200 or better; postoperatively, this rose to 70% and then leveled off at 50% of eyes at the last follow-up visit. The overall probability of retention was 84% at 2 years and 67% at 7 years. The cumulative incidence of complications was 49.7% for retroprosthetic membrane formation, 21.6% for glaucoma surgery, 18.6% for retinal detachment, and 15.5% for endophthalmitis. As these complications can occur long after initial surgery, continued close follow-up is essential, the researchers said. Open-globe injuries in combat soldiers are a well-documented phenomenon and are usually detected early during triage. But what about closed-globe injuries, which may coexist with normal or near-normal vision? Cockerham et al (p. 2165) evaluated closed-globe conjunctival and corneal injuries and endothelial cell abnormalities in a 65 blast-exposed veterans with traumatic brain injury (TBI). The researchers found that 16 (25%) of the veterans, who were examined 2 weeks after blast exposure, had ocular surface trauma in zone 1 without full-thickness penetration or compromise of the eye wall. Injuries included corneal scars, Descemet membrane ruptures, and embedded metallic foreign bodies. In addition, affected eyes were more likely to have endothelial cell abnormalities. These injuries occurred independently of TBI severity or the use of protective eyewear. The researchers noted that this study is the first to document Descemet membrane ruptures from blast exposure, and they recommended that all combat soldiers with TBI undergo a thorough ophthalmic examination for blast injuries (see Figure on page 2168).