This Issue at a Glance

Abstract

Dunker et al (p. 1152) compared best spectacle-corrected visual acuity (BSCVA), endothelial cell density, refraction, and complications after Descemet membrane endothelial keratoplasty (DMEK) and ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) in pseudophakic eyes with Fuchs endothelial corneal dystrophy. In a prospective randomized controlled trial, 54 eyes of 54 patients were assigned to either DMEK (n = 29) or UT-DSAEK (n = 25). There were no statistically significant differences in mean BSCVA between both techniques 3, 6, and 12 months after surgery. The percentage of eyes reaching 20/25 or better Snellen BSCVA at 12 months was significantly higher in DMEK patients (66%) compared with UT-DSAEK patients (33%), but significantly more adverse events occurred after DMEK. Endothelial cell density did not differ significantly 12 months after DMEK and UT-DSAEK, and both techniques induced a mild hyperopic shift. The researchers concluded that DMEK and UT-DSAEK did not differ significantly in mean BSCVA, but the percentage of eyes achieving 20/25 Snellen vision was significantly higher with DMEK. Solebo et al (p. 1220) set out to identify the predictors of visual axis opacity (VAO) after primary intraocular lens (IOL) implantation for unilateral or bilateral congenital or infantile cataract in children younger than 2 years of age. They conducted a population-based prospective cohort study of 162 eyes from 105 children (57 with bilateral cataract, 48 with unilateral cataract) undergoing primary IOL implantation between January 2009 and December 2010 at centers in the United Kingdom and Ireland. Visual axis opacity occurred in 67 eyes (45%), typically within the first postoperative year. Older age at surgery and the use of 3-piece IOL models over single-piece models were independently associated with reduced risk of proliferative VAO. Additionally, children living in socioeconomically deprived areas were more likely to develop infiammatory VAO. The authors suggest that VAO is common after IOL implantation in children younger than 2 years of age, and proliferative VAO is more common in those who undergo surgery at a younger age and in eyes implanted with single-piece IOL models. Kiss et al (p. 1179) conducted a retrospective analysis of EHRs to assess anti-VEGF management patterns and anatomic and visual acuity (VA) outcomes among patients with neovascular age-related macular degeneration (nAMD) in United States clinical practice. They analyzed EHRs from 30 106 patients initiating intravitreal anti-VEGF treatment for nAMD between October 2009 and November 2016. On average, during the first 12 months of treatment, patients attended 8.1 ophthalmology clinic visits, received 6.0 intravitreal anti-VEGF injections, and underwent 7.2 OCT and 5.3 fiuorescein angiography examinations per eye. For eyes with paired baseline and 12-month readings, mean central retinal thickness declined from 320 to 271 μm and mean VA increased from 60.3 to 61.0 approximate ETDRS letters. Each unit increase in the number of anti-VEGF injections resulted in an estimated gain of 0.37 approximate ETDRS letters. The authors suggest that the low anti-VEGF injection frequencies and moderate anatomic and limited functional outcomes revealed by the study may indicate that there is scope for improved management of nAMD in clinical practice. Swaminathan et al (p. 1162) described visual field (VF) outcomes in the Tube Versus Trabeculectomy Study, a multicenter randomized clinical trial comparing the safety and efficacy of tube shunt surgery and trabeculectomy with mitomycin C (MMC) in patients with previous cataract or glaucoma surgery. The study included 122 eyes of 122 patients and 436 reliable VFs were analyzed with an average of 3.6 VFs per eye. Baseline mean deviation (MD) and rate of change in MD were −13.07±8.4 dB and −0.60 dB/year in the tube shunt group and −13.18±8.2 dB and −0.38 dB/year in the trabeculectomy group, respectively. Patients with diabetes, higher preoperative IOP, and more severe baseline VF loss were at higher risk for VF progression. The authors concluded that slow rates of VF loss were observed after both tube shunt implantation and trabeculectomy with MMC, but there was no significant difference in the rate of VF progression between the 2 procedures.