This Issue At A Glance

Abstract

Permanent Visual Loss Uncommon in Patients with Proliferative Sickle Cell RetinopathyThe Jamaican Cohort Study of Sickle Cell (SS) disease has yielded longitudinal data for more than 2 decades. The study has followed 307 SS disease patients and 166 SS–hemoglobin C (SC) disease patients born between 1973 and 1981 living in Jamaica. Downes et al (p. 1869) used information from the study to explore the incidence, prevalence, and natural history of proliferative sickle cell retinopathy (PSR). As of January 2000, PSR had developed in 59 patients. The prevalence was greater in SC disease, and by the ages of 24 to 26 years, PSR had occurred in 43% of patients with SC disease and in 14% of patients with SS disease. Although the data confirmed a greater incidence and severity of PSR in SC disease, permanent visual loss was not common in individuals observed up to age 26 years. This discrepancy between the frequency of PSR and that of visual loss makes it difficult to answer the question of whether routine screening and prophylactic treatment are justified.Trimethoprim/Sulfamethoxazole Similar to Classic Therapy in Treatment of Ocular ToxoplasmosisWhen comparing pyrimethamine and sulfadiazine (classic therapy) with trimethoprim/sulfamethoxazole in the treatment of ocular toxoplasmosis, Soheilian et al (p. 1876) found similar drug efficacies in terms of reduction in retinal lesion size and improvement in visual acuity (VA). The authors conducted a prospective randomized single-blind clinical trial of 59 patients with active ocular toxoplasmosis who were randomly assigned to 1 of the 2 treatment groups. Mean reductions in size of retinal lesions were 61% in the classic therapy group and 59% in the trimethoprim/sulfamethoxazole group. In addition, no significant difference was found in VA after treatment between the 2 groups. The overall recurrence rate after 24 months’ follow-up was about 10%, with no significant difference between the 2 treatment groups. The authors conclude that trimethoprim/sulfamethoxazole is a viable alternative to classic treatment, with greater availability, less cost, and a safer drug profile in immunocompetent patients with 2 functional eyes and with lesions outside of immediate proximity to the macula.Thrombophilic Gene Polymorphisms Are Not Major Risk Factors for Branch Retinal Vein OcclusionAre thrombophilic gene polymorphisms major risk factors for branch retinal vein occlusion (BRVO)? According to data from Weger et al’s retrospective case–control study (p. 1910), the answer is no. The researchers conducted the study in response to earlier hypotheses indicating that gene polymorphisms affecting hemostasis may play a role in the pathogenesis of BRVO. Six gene polymorphisms affecting hemostasis were investigated in a cohort of 294 patients with BRVO and 294 controls matched for age and gender. Genotype distributions of the 6 gene polymorphisms did not differ significantly between the patients and control subjects. In contrast, significantly increased prevalences of arterial hypertension and hypercholesterolemia were found among patients with BRVO. Even taking into consideration the general limitations of a retrospective study, the authors conclude that routine screening for polymorphisms should not be recommended for these patients, given the data suggesting that none of the investigated gene polymorphisms was a major risk factor for BRVO.Intravitreal Triamcinolone Acetate Potent in Treating Uveitic Cystoid Macular EdemaA retrospective noncomparative case series studying intravitreal triamcinolone acetate (TA) in the treatment of uveitic cystoid macular edema (CME) indicates that intravitreal TA is a potent form of treatment for this condition. Kok et al’s study (p. 1916) involved 65 eyes of 54 patients with uveitis-related CME who had not adequately responded to treatment combinations of an oral corticosteroid, periocular orbital floor corticosteroid injections, and second-line immunosuppressive agents. Each eye received an intravitreal injection of 4 mg/0.1 ml of TA. Eyes with the most visual improvement had CME for less than a year. Eyes of younger patients also attained better vision after treatment. In 43.1% of eyes, treatment was associated with a rise in intraocular pressure—a transient and treatable side effect. The authors warn that results of this study should be interpreted with caution, given its nonrandomized and uncontrolled design. Nevertheless, intravitreal TA shows potential in treating uveitic CME—especially in those with CME for <12 months.Liquid Bandage (2-Octyl Cyanoacrylate) Promising as Wound Barrier in Clear Corneal Cataract SurgeryIn light of reports questioning the stability of sutureless clear corneal wounds in cataract surgery, Meskin et al (p. 2015) investigated whether 2-octyl cyanoacrylate with parabens (Liquid Bandage) would serve effectively as an adjunct wound sealant and barrier against the inflow of ocular surface fluid after this procedure. In this small prospective pilot research study, 51 eyes of 51 patients underwent a 2.75-mm clear corneal, triplanar, temporal incision, followed by routine phacoemulsification. At the conclusion of each case, a modified microsponge with 1 to 2 drops of 2-octyl cyanoacrylate with parabens was applied in a smooth layer to the wound. All 51 eyes demonstrated intraoperative watertight wound closure after application of the material. Forty-five eyes had tissue adhesive still completely covering the wound on postoperative day 1. The authors conclude that 2-octyl cyanoacrylate with parabens shows potential as a temporary barrier and sealant for clear corneal wounds, and call for further investigation of this compound to establish evidence-based practice guidelines. Permanent Visual Loss Uncommon in Patients with Proliferative Sickle Cell RetinopathyThe Jamaican Cohort Study of Sickle Cell (SS) disease has yielded longitudinal data for more than 2 decades. The study has followed 307 SS disease patients and 166 SS–hemoglobin C (SC) disease patients born between 1973 and 1981 living in Jamaica. Downes et al (p. 1869) used information from the study to explore the incidence, prevalence, and natural history of proliferative sickle cell retinopathy (PSR). As of January 2000, PSR had developed in 59 patients. The prevalence was greater in SC disease, and by the ages of 24 to 26 years, PSR had occurred in 43% of patients with SC disease and in 14% of patients with SS disease. Although the data confirmed a greater incidence and severity of PSR in SC disease, permanent visual loss was not common in individuals observed up to age 26 years. This discrepancy between the frequency of PSR and that of visual loss makes it difficult to answer the question of whether routine screening and prophylactic treatment are justified. The Jamaican Cohort Study of Sickle Cell (SS) disease has yielded longitudinal data for more than 2 decades. The study has followed 307 SS disease patients and 166 SS–hemoglobin C (SC) disease patients born between 1973 and 1981 living in Jamaica. Downes et al (p. 1869) used information from the study to explore the incidence, prevalence, and natural history of proliferative sickle cell retinopathy (PSR). As of January 2000, PSR had developed in 59 patients. The prevalence was greater in SC disease, and by the ages of 24 to 26 years, PSR had occurred in 43% of patients with SC disease and in 14% of patients with SS disease. Although the data confirmed a greater incidence and severity of PSR in SC disease, permanent visual loss was not common in individuals observed up to age 26 years. This discrepancy between the frequency of PSR and that of visual loss makes it difficult to answer the question of whether routine screening and prophylactic treatment are justified. Trimethoprim/Sulfamethoxazole Similar to Classic Therapy in Treatment of Ocular ToxoplasmosisWhen comparing pyrimethamine and sulfadiazine (classic therapy) with trimethoprim/sulfamethoxazole in the treatment of ocular toxoplasmosis, Soheilian et al (p. 1876) found similar drug efficacies in terms of reduction in retinal lesion size and improvement in visual acuity (VA). The authors conducted a prospective randomized single-blind clinical trial of 59 patients with active ocular toxoplasmosis who were randomly assigned to 1 of the 2 treatment groups. Mean reductions in size of retinal lesions were 61% in the classic therapy group and 59% in the trimethoprim/sulfamethoxazole group. In addition, no significant difference was found in VA after treatment between the 2 groups. The overall recurrence rate after 24 months’ follow-up was about 10%, with no significant difference between the 2 treatment groups. The authors conclude that trimethoprim/sulfamethoxazole is a viable alternative to classic treatment, with greater availability, less cost, and a safer drug profile in immunocompetent patients with 2 functional eyes and with lesions outside of immediate proximity to the macula. When comparing pyrimethamine and sulfadiazine (classic therapy) with trimethoprim/sulfamethoxazole in the treatment of ocular toxoplasmosis, Soheilian et al (p. 1876) found similar drug efficacies in terms of reduction in retinal lesion size and improvement in visual acuity (VA). The authors conducted a prospective randomized single-blind clinical trial of 59 patients with active ocular toxoplasmosis who were randomly assigned to 1 of the 2 treatment groups. Mean reductions in size of retinal lesions were 61% in the classic therapy group and 59% in the trimethoprim/sulfamethoxazole group. In addition, no significant difference was found in VA after treatment between the 2 groups. The overall recurrence rate after 24 months’ follow-up was about 10%, with no significant difference between the 2 treatment groups. The authors conclude that trimethoprim/sulfamethoxazole is a viable alternative to classic treatment, with greater availability, less cost, and a safer drug profile in immunocompetent patients with 2 functional eyes and with lesions outside of immediate proximity to the macula. Thrombophilic Gene Polymorphisms Are Not Major Risk Factors for Branch Retinal Vein OcclusionAre thrombophilic gene polymorphisms major risk factors for branch retinal vein occlusion (BRVO)? According to data from Weger et al’s retrospective case–control study (p. 1910), the answer is no. The researchers conducted the study in response to earlier hypotheses indicating that gene polymorphisms affecting hemostasis may play a role in the pathogenesis of BRVO. Six gene polymorphisms affecting hemostasis were investigated in a cohort of 294 patients with BRVO and 294 controls matched for age and gender. Genotype distributions of the 6 gene polymorphisms did not differ significantly between the patients and control subjects. In contrast, significantly increased prevalences of arterial hypertension and hypercholesterolemia were found among patients with BRVO. Even taking into consideration the general limitations of a retrospective study, the authors conclude that routine screening for polymorphisms should not be recommended for these patients, given the data suggesting that none of the investigated gene polymorphisms was a major risk factor for BRVO. Are thrombophilic gene polymorphisms major risk factors for branch retinal vein occlusion (BRVO)? According to data from Weger et al’s retrospective case–control study (p. 1910), the answer is no. The researchers conducted the study in response to earlier hypotheses indicating that gene polymorphisms affecting hemostasis may play a role in the pathogenesis of BRVO. Six gene polymorphisms affecting hemostasis were investigated in a cohort of 294 patients with BRVO and 294 controls matched for age and gender. Genotype distributions of the 6 gene polymorphisms did not differ significantly between the patients and control subjects. In contrast, significantly increased prevalences of arterial hypertension and hypercholesterolemia were found among patients with BRVO. Even taking into consideration the general limitations of a retrospective study, the authors conclude that routine screening for polymorphisms should not be recommended for these patients, given the data suggesting that none of the investigated gene polymorphisms was a major risk factor for BRVO. Intravitreal Triamcinolone Acetate Potent in Treating Uveitic Cystoid Macular EdemaA retrospective noncomparative case series studying intravitreal triamcinolone acetate (TA) in the treatment of uveitic cystoid macular edema (CME) indicates that intravitreal TA is a potent form of treatment for this condition. Kok et al’s study (p. 1916) involved 65 eyes of 54 patients with uveitis-related CME who had not adequately responded to treatment combinations of an oral corticosteroid, periocular orbital floor corticosteroid injections, and second-line immunosuppressive agents. Each eye received an intravitreal injection of 4 mg/0.1 ml of TA. Eyes with the most visual improvement had CME for less than a year. Eyes of younger patients also attained better vision after treatment. In 43.1% of eyes, treatment was associated with a rise in intraocular pressure—a transient and treatable side effect. The authors warn that results of this study should be interpreted with caution, given its nonrandomized and uncontrolled design. Nevertheless, intravitreal TA shows potential in treating uveitic CME—especially in those with CME for <12 months. A retrospective noncomparative case series studying intravitreal triamcinolone acetate (TA) in the treatment of uveitic cystoid macular edema (CME) indicates that intravitreal TA is a potent form of treatment for this condition. Kok et al’s study (p. 1916) involved 65 eyes of 54 patients with uveitis-related CME who had not adequately responded to treatment combinations of an oral corticosteroid, periocular orbital floor corticosteroid injections, and second-line immunosuppressive agents. Each eye received an intravitreal injection of 4 mg/0.1 ml of TA. Eyes with the most visual improvement had CME for less than a year. Eyes of younger patients also attained better vision after treatment. In 43.1% of eyes, treatment was associated with a rise in intraocular pressure—a transient and treatable side effect. The authors warn that results of this study should be interpreted with caution, given its nonrandomized and uncontrolled design. Nevertheless, intravitreal TA shows potential in treating uveitic CME—especially in those with CME for <12 months. Liquid Bandage (2-Octyl Cyanoacrylate) Promising as Wound Barrier in Clear Corneal Cataract SurgeryIn light of reports questioning the stability of sutureless clear corneal wounds in cataract surgery, Meskin et al (p. 2015) investigated whether 2-octyl cyanoacrylate with parabens (Liquid Bandage) would serve effectively as an adjunct wound sealant and barrier against the inflow of ocular surface fluid after this procedure. In this small prospective pilot research study, 51 eyes of 51 patients underwent a 2.75-mm clear corneal, triplanar, temporal incision, followed by routine phacoemulsification. At the conclusion of each case, a modified microsponge with 1 to 2 drops of 2-octyl cyanoacrylate with parabens was applied in a smooth layer to the wound. All 51 eyes demonstrated intraoperative watertight wound closure after application of the material. Forty-five eyes had tissue adhesive still completely covering the wound on postoperative day 1. The authors conclude that 2-octyl cyanoacrylate with parabens shows potential as a temporary barrier and sealant for clear corneal wounds, and call for further investigation of this compound to establish evidence-based practice guidelines. In light of reports questioning the stability of sutureless clear corneal wounds in cataract surgery, Meskin et al (p. 2015) investigated whether 2-octyl cyanoacrylate with parabens (Liquid Bandage) would serve effectively as an adjunct wound sealant and barrier against the inflow of ocular surface fluid after this procedure. In this small prospective pilot research study, 51 eyes of 51 patients underwent a 2.75-mm clear corneal, triplanar, temporal incision, followed by routine phacoemulsification. At the conclusion of each case, a modified microsponge with 1 to 2 drops of 2-octyl cyanoacrylate with parabens was applied in a smooth layer to the wound. All 51 eyes demonstrated intraoperative watertight wound closure after application of the material. Forty-five eyes had tissue adhesive still completely covering the wound on postoperative day 1. The authors conclude that 2-octyl cyanoacrylate with parabens shows potential as a temporary barrier and sealant for clear corneal wounds, and call for further investigation of this compound to establish evidence-based practice guidelines.