This Issue at a Glance

Abstract

Lenis et al (p. 12) evaluated concurrent implantation with the type I Boston Keratoprosthesis (KPro) and the Ahmed glaucoma valve (AGV) and compared it with KPro implantation alone. They found no increase in postoperative complications in those who received both devices. For this single-surgeon retrospective study, the researchers evaluated 137 KPro procedures (129 patients), 46 of which (33.6%) involved both devices. Pre-, intra-, and postoperative data were collected for each procedure, and patients were followed for up to 10 years, with a mean follow-up of 44 months. No significant differences emerged between patient cohorts regarding vision-threatening postoperative complications, including hypotony maculopathy, suprachoroidal hemorrhage, retinal detachment, or infectious keratitis. In addition, none of the 46 AGVs became exposed during follow-up. In the longest single-center case series with the longest average follow-up, Lee et al (p. 27) assessed long-term visual outcomes and complications following implantation with the Boston Keratoprosthesis (KPro) type II device. They found that the leading postoperative challenges include retroprosthetic membranes, keratoprosthesis retention, and glaucoma—but that, despite these challenges, the KPro type II is a viable option for a select group of patients who are unlikely to benefit from other corneal procedures. For this retrospective review, the researchers assessed data on 48 eyes (44 patients). The most common indications for surgery were Stevens-Johnson syndrome and mucous membrane pemphigoid. Visual acuity improved following surgery, with 44 of the eyes (95.8%) improving to 20/200 or better and 36 of the eyes (75%) improving to 20/100 or better. The type II device is distinguished from its predecessor by a titanium back plate (Fig 1), as titanium has been found to be less likely than PMMA to lead to development of a retroprosthetic membrane. In addition, its optic extends through surgically closed eyelids. Some 200 of the type II devices have been implanted to date. Hogg et al (p. 82) examined the link between diet and prevalence of age-related macular degeneration (AMD) in 7 European countries. Although they found evidence supporting the ability of a Mediterranean diet to protect against late AMD, their findings do not confirm previous reports of a relationship with genetic susceptibility. For this cross-sectional population-based study, the researchers evaluated a year’s worth of dietary data on 4753 people, using the previously published Mediterranean Diet Score (MDS). Those participants in the highest category of MDS had a 20% reduced risk of developing late AMD. No link emerged between diet score, presence of AMD, and the presence of complement factor H Y402H alleles. The researchers cautioned that this study was carried out prior to the routine use of optical coherence tomography; thus, some of the early features of AMD may have been misclassified. Grunwald et al (p. 97) set out to estimate the incidence, size, and growth rate of geographic atrophy (GA) during the Comparison of Age-related Macular Degeneration Treatments Trials (CATT). They found that development of GA is common 5 years after anti-VEGF therapy is initiated. For this analysis, masked graders assessed GA presence and size at baseline and at years 1, 2, and 5. Among 1011 CATT participants who did not have GA at baseline and had gradable images, the cumulative incidence of GA was 12% at 1 year, 17% at 2 years, and 38% at 5 years. Risk factors for GA growth included ranibizumab treatment during the first 2 years of the study, hypercholesterolemia, GA in the fellow eye, intraretinal fluid (especially in the fovea), and absence of subretinal fluid. Of note, many of these risk factors were identified in a previous report after 2 years of CATT.