This Issue at a Glance

Abstract

Weleber et al (p. 1606) investigated the use of rAAV2-CB-hRPE65 (recombinant adeno-associated virus vector expressing RPE65) for retinal degeneration caused by RPE65 mutations. They found that the AAV2-mediated RPE65 gene replacement therapy was generally safe and associated with improvement in at least 1 measure of visual function in 75% of the patients. In addition, they found a trend for this improvement to be clustered in the younger subjects, suggesting that treatment at an early age may prevent progression of photoreceptor degeneration. This nonrandomized trial involved 12 patients with Leber congenital amaurosis (LCA) or severe early childhood-onset retinal degeneration. Participants were given a subretinal injection of the gene therapy in the poorer-seeing eye and followed for 2 years. No serious treatment-related adverse reactions were noted, and improvement in 1 or more measures of visual function was observed in 9 of 12 patients. Borderie et al (p. 1428) set out to analyze the cumulative incidence of glaucoma after 3 types of keratoplasty (penetrating, anterior lamellar, and endothelial). They found that the incidence of postoperative glaucoma was lower following anterior lamellar or endothelial keratoplasty than it was after penetrating keratoplasty (PK). This cohort study involved 1657 consecutive eyes of 1657 patients who underwent corneal transplantation between 1992 and 2013. Main outcome measures were postoperative intraocular pressure (IOP), glaucoma treatments, and glaucoma-related loss of vision. The 10-year cumulative incidences of elevated IOP and elevated IOP requiring treatment following keratoplasty were 46.5% and 38.7%, respectively. The 10-year probability of glaucoma-related vision loss was 1.0% after endothelial keratoplasty, 2.1% after anterior lamellar keratoplasty, and 3.6% after PK. In the first study to evaluate the association of each type of pseudodrusen with late age-related macular degeneration (AMD), Zhou et al (p. 1530) evaluated the link between pseudodrusen and late AMD incidence in the fellow eyes of patients who had unilateral neovascular AMD (nAMD) and were enrolled in the Comparison of AMD Treatments Trials (CATT). They found that baseline pseudodrusen were associated with a 2 times higher risk of developing late AMD through 2 years of follow-up. Dot pseudodrusen were most highly associated with nAMD, while confluent pseudodrusen were most highly associated with geographic atrophy (GA). This cohort study involved 620 fellow eyes of 620 patients, 176 of whom had baseline pseudodrusen. Within 2 years, nAMD occurred in 54 eyes (30.7%) with pseudodrusen and in 72 (16.2%) without pseudodrusen; GA occurred in 27 eyes with pseudodrusen (15.3%) and in 37 (8.3%) without pseudodrusen; and late AMD occurred in 73 eyes (41.5%) with pseudodrusen and in 101% (22.8%) without pseudodrusen. The presence of pseudodrusen confers considerable additional risk to eyes with large drusen or pigment abnormalities, the researchers noted. In the first study to do so, Skaat et al (p. 1476) investigated the impact of race and ethnicity on the frequency of optic disc hemorrhage (DH) and the prevalence of beta-zone parapapillary atrophy (βPPA), both of which are independent risk factors for glaucoma progression. They found that individuals of European descent are at greater risk of developing DH than are those of African descent—and, conversely, that people of African descent have a greater prevalence of βPPA than do those of European descent. For this prospective multicenter study, known as the African Descent and Glaucoma Evaluation Study, the researchers evaluated 1172 participants (1950 eyes) over a 13-year period. Creuzot-Garcher et al (p. 1414) used a national database to assess the incidence of acute postoperative endophthalmitis after cataract surgery from 2005 to 2014 in France. They found a decrease in the incidence of endophthalmitis—and a concomitant rise in the use of intracameral antibiotics—during the study period. For this cohort study, the researchers evaluated data on 3 983 525 patients (6 371 242 eyes). In 2005, 495 765 cataract surgeries were performed, 719 cases of endophthalmitis were recorded, and 2989 injections of intracameral antibiotics were given. In comparison, in 2014, 757 993 cataract surgeries were performed, 405 cases of endophthalmitis were recorded, and 605 586 intracameral antibiotic injections were given. Overall, the incidence of acute postoperative endophthalmitis following phacoemulsification decreased from 0.145% to 0.053% during the study period.