This Issue At A Glance

Abstract

DSEK More Cost-Effective than PK for Endothelial Disease TreatmentAlthough Descemet's stripping endothelial keratoplasty (DSEK) is more expensive to perform compared to the traditional full-thickness penetrating keratoplasty (PK) for endothelial disease, Bose et al (p. 464) found that DSEK should be the preferred treatment alternative from a cost-effectiveness perspective. The study demonstrated that for a given budget, it was possible to achieve greater quality adjusted life years (QALY) gains by providing DSEK to as many patients as possible – and no intervention to others – rather than providing PK. The retrospective cohort study involved 171 patients who underwent PK and 93 who underwent DSEK from January 2001 to December 2007. Three-year costs for DSEK were $7476 and $7236 for PK. Incremental cost effectiveness ratios were $567 409 per QALY for PK relative to no intervention and $5209 per QALY for the DSEK relative to PK. The researchers suggest that DSEK patients would fare even better if follow-up had been longer, as late graft failures from endothelial loss would be more likely to occur with PK.Prismatic Correction for Consecutive EsotropiaIn most patients with consecutive esotropia after unilateral recession-resection (RR) for exodeviation, prismatic correction can lead to good motor outcome results while maintaining favorable sensory status. The retrospective cohort study by Lee and Hwang (p. 504) involved 110 patients (average age, 4.7 years) with esodeviation ≥5 prism diopters at 4 weeks after unilateral RR for primary exotropia. They were fitted with prism glasses and followed for a minimum of 2 years following primary surgery. The patients were split into 2 groups: those who were weaned off the prism glasses within 1 year and those who wore prism glasses for more than 1 year. Prism-weaned patients demonstrated more preoperative constant deviation and anisometropia. Additionally, they experienced a faster change in esodeviation after prismatic correction and more exotropic drift after prism weaning. This resulted in a higher recurrence rate of exotropia. The study also indicated that patients experienced different clinical manifestations and outcomes according to the prismatic correction period.Genetic Role in Proliferative Vitreoretinopathy following Retinal DetachmentA study by Pastor-Idoate et al (p. 623) indicates that the p53 codon 72 polymorphism (rs1042522) represents a significant risk factor for the development of proliferative vitreoretinopathy (PVR) following primary retinal detachment (RD). This case-controlled, gene association study was part of the European Retina 4 Project, involving 550 DNA samples: 134 with PVR secondary to primary RD and 416 with RD without PVR. Results showed that Spanish and Portuguese carriers of the homozygous Pro variant in homozygosis had a four-fold increased risk of developing PVR after RD compared with those who carried the homozygous Arg variant – an observation confirmed in Dutch patients but not in British participants. The researchers speculate that a reduction in the levels of apoptosis, which is associated with the Pro allele of the p53 gene, could energize migrating retinal pigment epithelium cells and inflammatory mediators directly, allowing a more aggressive cellular response. They conclude that genetics may play a useful role in the identification of high-risk RD patients who may be susceptible to PVR.Infliximab for Inflammation Control in Birdshot RetinochoroidopathyArtornsombudh et al (p. 588) found that infliximab effectively controls inflammation in patients with treatment-refractory birdshot retinochoroidopathy (BSRC), a chronic, slowly progressive ocular inflammatory disease with distinctive, ovoid, hypopigmented retinal pigment epithelial, and choroidal lesions. Infliximab is a chimeric monoclonal antibody against tumor necrosis factor alpha (TNF-α), designed to block receptor binding sites on TNF-α and create sustained neutralization of TNF-α bioactivities. This retrospective analysis involved 22 patients who had BSRC for a mean of 58.6 months prior to taking infliximab. All patients received 4–5 mg/kg of infliximab at 4–8 week intervals. The therapy controlled inflammation in 82% of the patients at 6 months and in 75% of the patients at 1 year. While infliximab appeared well-tolerated in most patients, 6 of the 22 patients (27%) stopped therapy due to adverse side effects. The researchers caution that since long-term effects of the treatment remain unknown, clinical evaluation and serology should be performed to identify potential side effects before and during treatment.Improving SRK/T Formula Accuracy With Corneal Power-Specific ConstantsIn a retrospective case series involving cataract patients undergoing phacoemulsification with intraocular lens (IOL) implantation, Eom et al (p. 477) confirmed their hypothesis that the use of corneal power (K)-specific constants will improve the accuracy of the Sanders-Retzlaff-Kraff (SRK)/T formula for IOL power calculation. Patients were fitted with either the Acrysof IQ (314 eyes) or the Akreos AO (323 eyes). The authors found that for a steep cornea (greater than or equal to 44.2 diopters (D) for the Acrysof IQ and 44.0 D for the Akreos AO), the refractive error prediction was myopic and the data-adjusted A-constant was smaller than the overall K. In contrast, for a flat cornea (less than than 44.2 D and 44.0 D, respectively), the refractive error prediction was hyperopic and a larger A-constant was calculated. They conclude that using different A-constants based on the K improved the refractive outcomes predicted by the SRK/T formula, and call for a prospective study with a larger number of patients to confirm their findings. DSEK More Cost-Effective than PK for Endothelial Disease TreatmentAlthough Descemet's stripping endothelial keratoplasty (DSEK) is more expensive to perform compared to the traditional full-thickness penetrating keratoplasty (PK) for endothelial disease, Bose et al (p. 464) found that DSEK should be the preferred treatment alternative from a cost-effectiveness perspective. The study demonstrated that for a given budget, it was possible to achieve greater quality adjusted life years (QALY) gains by providing DSEK to as many patients as possible – and no intervention to others – rather than providing PK. The retrospective cohort study involved 171 patients who underwent PK and 93 who underwent DSEK from January 2001 to December 2007. Three-year costs for DSEK were $7476 and $7236 for PK. Incremental cost effectiveness ratios were $567 409 per QALY for PK relative to no intervention and $5209 per QALY for the DSEK relative to PK. The researchers suggest that DSEK patients would fare even better if follow-up had been longer, as late graft failures from endothelial loss would be more likely to occur with PK. Although Descemet's stripping endothelial keratoplasty (DSEK) is more expensive to perform compared to the traditional full-thickness penetrating keratoplasty (PK) for endothelial disease, Bose et al (p. 464) found that DSEK should be the preferred treatment alternative from a cost-effectiveness perspective. The study demonstrated that for a given budget, it was possible to achieve greater quality adjusted life years (QALY) gains by providing DSEK to as many patients as possible – and no intervention to others – rather than providing PK. The retrospective cohort study involved 171 patients who underwent PK and 93 who underwent DSEK from January 2001 to December 2007. Three-year costs for DSEK were $7476 and $7236 for PK. Incremental cost effectiveness ratios were $567 409 per QALY for PK relative to no intervention and $5209 per QALY for the DSEK relative to PK. The researchers suggest that DSEK patients would fare even better if follow-up had been longer, as late graft failures from endothelial loss would be more likely to occur with PK. Prismatic Correction for Consecutive EsotropiaIn most patients with consecutive esotropia after unilateral recession-resection (RR) for exodeviation, prismatic correction can lead to good motor outcome results while maintaining favorable sensory status. The retrospective cohort study by Lee and Hwang (p. 504) involved 110 patients (average age, 4.7 years) with esodeviation ≥5 prism diopters at 4 weeks after unilateral RR for primary exotropia. They were fitted with prism glasses and followed for a minimum of 2 years following primary surgery. The patients were split into 2 groups: those who were weaned off the prism glasses within 1 year and those who wore prism glasses for more than 1 year. Prism-weaned patients demonstrated more preoperative constant deviation and anisometropia. Additionally, they experienced a faster change in esodeviation after prismatic correction and more exotropic drift after prism weaning. This resulted in a higher recurrence rate of exotropia. The study also indicated that patients experienced different clinical manifestations and outcomes according to the prismatic correction period. In most patients with consecutive esotropia after unilateral recession-resection (RR) for exodeviation, prismatic correction can lead to good motor outcome results while maintaining favorable sensory status. The retrospective cohort study by Lee and Hwang (p. 504) involved 110 patients (average age, 4.7 years) with esodeviation ≥5 prism diopters at 4 weeks after unilateral RR for primary exotropia. They were fitted with prism glasses and followed for a minimum of 2 years following primary surgery. The patients were split into 2 groups: those who were weaned off the prism glasses within 1 year and those who wore prism glasses for more than 1 year. Prism-weaned patients demonstrated more preoperative constant deviation and anisometropia. Additionally, they experienced a faster change in esodeviation after prismatic correction and more exotropic drift after prism weaning. This resulted in a higher recurrence rate of exotropia. The study also indicated that patients experienced different clinical manifestations and outcomes according to the prismatic correction period. Genetic Role in Proliferative Vitreoretinopathy following Retinal DetachmentA study by Pastor-Idoate et al (p. 623) indicates that the p53 codon 72 polymorphism (rs1042522) represents a significant risk factor for the development of proliferative vitreoretinopathy (PVR) following primary retinal detachment (RD). This case-controlled, gene association study was part of the European Retina 4 Project, involving 550 DNA samples: 134 with PVR secondary to primary RD and 416 with RD without PVR. Results showed that Spanish and Portuguese carriers of the homozygous Pro variant in homozygosis had a four-fold increased risk of developing PVR after RD compared with those who carried the homozygous Arg variant – an observation confirmed in Dutch patients but not in British participants. The researchers speculate that a reduction in the levels of apoptosis, which is associated with the Pro allele of the p53 gene, could energize migrating retinal pigment epithelium cells and inflammatory mediators directly, allowing a more aggressive cellular response. They conclude that genetics may play a useful role in the identification of high-risk RD patients who may be susceptible to PVR. A study by Pastor-Idoate et al (p. 623) indicates that the p53 codon 72 polymorphism (rs1042522) represents a significant risk factor for the development of proliferative vitreoretinopathy (PVR) following primary retinal detachment (RD). This case-controlled, gene association study was part of the European Retina 4 Project, involving 550 DNA samples: 134 with PVR secondary to primary RD and 416 with RD without PVR. Results showed that Spanish and Portuguese carriers of the homozygous Pro variant in homozygosis had a four-fold increased risk of developing PVR after RD compared with those who carried the homozygous Arg variant – an observation confirmed in Dutch patients but not in British participants. The researchers speculate that a reduction in the levels of apoptosis, which is associated with the Pro allele of the p53 gene, could energize migrating retinal pigment epithelium cells and inflammatory mediators directly, allowing a more aggressive cellular response. They conclude that genetics may play a useful role in the identification of high-risk RD patients who may be susceptible to PVR. Infliximab for Inflammation Control in Birdshot RetinochoroidopathyArtornsombudh et al (p. 588) found that infliximab effectively controls inflammation in patients with treatment-refractory birdshot retinochoroidopathy (BSRC), a chronic, slowly progressive ocular inflammatory disease with distinctive, ovoid, hypopigmented retinal pigment epithelial, and choroidal lesions. Infliximab is a chimeric monoclonal antibody against tumor necrosis factor alpha (TNF-α), designed to block receptor binding sites on TNF-α and create sustained neutralization of TNF-α bioactivities. This retrospective analysis involved 22 patients who had BSRC for a mean of 58.6 months prior to taking infliximab. All patients received 4–5 mg/kg of infliximab at 4–8 week intervals. The therapy controlled inflammation in 82% of the patients at 6 months and in 75% of the patients at 1 year. While infliximab appeared well-tolerated in most patients, 6 of the 22 patients (27%) stopped therapy due to adverse side effects. The researchers caution that since long-term effects of the treatment remain unknown, clinical evaluation and serology should be performed to identify potential side effects before and during treatment. Artornsombudh et al (p. 588) found that infliximab effectively controls inflammation in patients with treatment-refractory birdshot retinochoroidopathy (BSRC), a chronic, slowly progressive ocular inflammatory disease with distinctive, ovoid, hypopigmented retinal pigment epithelial, and choroidal lesions. Infliximab is a chimeric monoclonal antibody against tumor necrosis factor alpha (TNF-α), designed to block receptor binding sites on TNF-α and create sustained neutralization of TNF-α bioactivities. This retrospective analysis involved 22 patients who had BSRC for a mean of 58.6 months prior to taking infliximab. All patients received 4–5 mg/kg of infliximab at 4–8 week intervals. The therapy controlled inflammation in 82% of the patients at 6 months and in 75% of the patients at 1 year. While infliximab appeared well-tolerated in most patients, 6 of the 22 patients (27%) stopped therapy due to adverse side effects. The researchers caution that since long-term effects of the treatment remain unknown, clinical evaluation and serology should be performed to identify potential side effects before and during treatment. Improving SRK/T Formula Accuracy With Corneal Power-Specific ConstantsIn a retrospective case series involving cataract patients undergoing phacoemulsification with intraocular lens (IOL) implantation, Eom et al (p. 477) confirmed their hypothesis that the use of corneal power (K)-specific constants will improve the accuracy of the Sanders-Retzlaff-Kraff (SRK)/T formula for IOL power calculation. Patients were fitted with either the Acrysof IQ (314 eyes) or the Akreos AO (323 eyes). The authors found that for a steep cornea (greater than or equal to 44.2 diopters (D) for the Acrysof IQ and 44.0 D for the Akreos AO), the refractive error prediction was myopic and the data-adjusted A-constant was smaller than the overall K. In contrast, for a flat cornea (less than than 44.2 D and 44.0 D, respectively), the refractive error prediction was hyperopic and a larger A-constant was calculated. They conclude that using different A-constants based on the K improved the refractive outcomes predicted by the SRK/T formula, and call for a prospective study with a larger number of patients to confirm their findings. In a retrospective case series involving cataract patients undergoing phacoemulsification with intraocular lens (IOL) implantation, Eom et al (p. 477) confirmed their hypothesis that the use of corneal power (K)-specific constants will improve the accuracy of the Sanders-Retzlaff-Kraff (SRK)/T formula for IOL power calculation. Patients were fitted with either the Acrysof IQ (314 eyes) or the Akreos AO (323 eyes). The authors found that for a steep cornea (greater than or equal to 44.2 diopters (D) for the Acrysof IQ and 44.0 D for the Akreos AO), the refractive error prediction was myopic and the data-adjusted A-constant was smaller than the overall K. In contrast, for a flat cornea (less than than 44.2 D and 44.0 D, respectively), the refractive error prediction was hyperopic and a larger A-constant was calculated. They conclude that using different A-constants based on the K improved the refractive outcomes predicted by the SRK/T formula, and call for a prospective study with a larger number of patients to confirm their findings.