This Issue At A Glance

Abstract

In the largest study of the issue to date, Bertelsen et al (p. 637) evaluated the mortality rate of patients with central retinal vein occlusion (CRVO). They found that CRVO was associated with an overall increase in mortality and that the increase could be attributed to cardiovascular and cerebrovascular disease. For this registry-based study, Danish researchers evaluated 439 patients with CRVO and 2195 age- and gender-matched controls. Over a mean follow-up period of 5.1 years for the CRVO patients and 5.7 years for the controls, the overall mortality rate was 5.9 deaths/100 person years for the CRVO patients and 4.3 deaths/100 person years for the controls. In addition, CRVO patients were at increased risk of developing peripheral artery disease, congestive heart failure, ischemic heart disease and myocardial infarction, and cerebrovascular disease. Given this association, the researchers recommended that CRVO patients be treated for such conditions as hypertension and diabetes and, if needed, be referred to a primary care physician. What are the risk factors for scar formation in eyes treated with monthly or as-needed ranibizumab or bevacizumab for wet age-related macular degeneration (AMD)? Daniel et al (p. 656) found that eyes with classic choroidal neovascularization, blocked fluorescence on fluorescein angiography, increased retinal thickness, and more fluid or material under the foveal center of the retina were more likely to develop a scar. For this prospective cohort study within the larger Comparison of AMD Treatments Trial (CATT), the investigators found that scar developed in 480 (45.3%) of 1059 eyes by the 2-year mark, with 339 of the 480 eyes developing a scar during the first year of treatment. Fibrotic scars developed in 262 eyes (24.7%) and nonfibrotic scars developed in 218 eyes (20.6%). Baseline risk factors for scar types were similar, except that eyes with larger lesion size or visual acuity below 20/40 were more likely to develop fibrotic scars. Drug choice, dosing regimen, and genotyping had no impact on scar risk. Yehoshua et al (p. 693) evaluated the effect of eculizumab, a systemic inhibitor of complement component 5 (C5), on the growth of geographic atrophy (GA) in eyes with dry age-related macular degeneration (AMD). They found that the drug failed to reduce the growth rate of GA. For this prospective, double-masked trial, the investigators evaluated 30 eyes of 30 patients, with 18 fellow eyes analyzed as a secondary endpoint. All eyes had a total GA area of 1.25-18 mm2 and visual acuity of 20/63 or better. The patients were randomized to receive low-dose eculizumab, high-dose eculizumab, or placebo. After the treatment period ended at the 26-week mark, patients were followed without treatment every 3 months for an additional 6 months. Although the drug was well tolerated, GA enlarged at 26 weeks in the eculizumab and placebo groups by 0.19 mm and 0.18 mm, respectively, and by 0.37 mm in both groups at 52 weeks. None of the eyes converted to wet AMD. Okada et al (p. 763) evaluated the effect of the centration and circularity of manually created capsulorrhexes on refractive outcomes. They found no correlation between the degree of capsulorrhexis circularity, diameter, decentration, and rim-to-optic overlap and postoperative refractions at 1 month or 1 year of follow-up. However, decentration >0.4 mm was associated with a 0.25 D postoperative change in spherical equivalent, and incomplete capsulorrhexis-optic overlap was associated with a 0.50 D change in spectacle cylinder from 1 month to 1 year. For this prospective, observational study, the researchers evaluated 113 eyes from 108 patients undergoing cataract surgery with manual continuous curvilinear capsulorrhexis (CCC). At 1 month, the mean circularity index was 0.83±0.01 and the mean decentration from pupillary center was 0.30±0.14 mm. At 1 year, the capsulorrhexes were more circular (mean circularity index, 0.87±0.03), more centered (0.23±0.12 mm), and smaller (4.18±0.68 mm). Levy-Clarke et al (p. 785) conducted a systematic review of published studies on anti-tumor necrosis factor alpha (TNF-α) biologic agents in patients with ocular inflammatory diseases. They recommended the following strategies: (1) Infliximab and adalimumab should be considered first-line agents for the treatment of ocular manifestations of Behçet's disease, and (2) the 2 drugs should be used as second-line agents for treating uveitis associated with juvenile arthritis. Methotrexate may, if tolerated, be combined with infliximab therapy. Moreover, (3) infliximab and adalimumab should be second-line therapy in patients with chronic uveitis from seronegative spondyloarthropathy, and (4) may be considered for other forms of ocular inflammation in patients with vision-threatening, corticosteroid-dependent disease who have failed first-line treatments. Additional recommendations are as follows: (5) Adalimumab appears to show similar efficacy to infliximab, although more comparative data are needed. Adalimumab may be efficacious in patients who have become intolerant to or have developed reduced response to infliximab. (6) Infliximab or adalimumab should be considered before etanercept.