This Issue at a Glance

Abstract

Sugisaki et al (p. 488) conducted a 5-year prospective study to identify risk factors for further deterioration of central visual function in patients with advanced glaucoma. Analysis of 175 eyes of 175 patients revealed probabilities of deterioration in Humphrey Field Analyzer (HFA) 10-2 and 24-2 results and best-corrected visual acuity (BCVA) of 0.269 ± 0.043, 0.173 ± 0.031, and 0.194 ± 0.033, respectively. Lower BCVA at baseline was significantly associated with further deterioration of HFA 10-2 results, whereas higher mean deviation of HFA 24-2 visual field and use of systemic antihypertensive agents were significant risk factors for further HFA 24-2 visual field deterioration. A greater β-peripapillary atrophy area-to-disc area ratio, use of systemic antihypertensive agents, and lower BCVA were significantly associated with further BCVA deterioration. The authors conclude that lower BCVA, greater β-peripapillary atrophy area-to-disc area ratio and use of systemic antihypertensive agents could serve as negative prognostic factors for central visual function in advanced glaucoma. Leclercq et al (p. 520) retrospectively analyzed the efficacy of anti-tumor necrosis factor-α (TNF-α) agents or tocilizumab to control ocular infiammation and their corticosteroid-sparing effect in patients with refractory uveitic macular edema. Analysis of 204 patients revealed Behçet’s disease (17.2%), birdshot chorioretinopathy (11.3%), and sarcoidosis (7.4%) as the main causes of uveitis in this cohort. Overall improvement of uveitic macular edema at 6 months of treatment was obtained in 46.2% of patients with anti-TNF-α agents and 58.5% with tocilizumab, with tocilizumab improving the odds of complete resolution of uveitic macular edema by 2 times compared with anti-TNF-α agents. Anti-TNF-α agents and tocilizumab did not differ significantly in terms of relapse rate or occurrence of low vision or corticosteroid-sparing effect, and no new safety concerns were identified beyond their known safety profiles. The authors conclude that tocilizumab may be more effective than anti-TNF-α agents at improving uveitic macular edema. In a systematic review, Nanji et al (p. 498) investigated the effect of the anti-vascular endothelial growth factor (VEGF) agents aflibercept, bevacizumab, and ranibizumab on intraocular pressure (IOP) 12 and 24 months after initiation. In a network meta-analysis of data derived from 26 randomized controlled trials that included 12 522 eyes, ranibizumab 0.5 mg showed higher rates than bevacizumab of IOP measurements of 30 mmHg or more at 12 months, but with low certainty of evidence. Additionally, ranibizumab 0.5 mg showed higher rates of consecutive IOP increases of 5 mmHg or more at 24 months, again with low certainty of evidence. The authors conclude that their study showed no clear effects on IOP among anti-VEGF agents and between anti-VEGF agents and controls but suggest that the level of evidence precludes definitive conclusions. Hoffman et al (p. 530) investigated whether topical chlorhexidine 0.2%, was noninferior to topical natamycin 5% for the treatment of filamentous fungal keratitis in a tertiary-level ophthalmic hospital in Nepal. Results from 141 patients receiving chlorhexidine and 143 receiving natamycin were analyzed. Natamycin-treated participants had significantly better 3-month best spectacle-corrected visual acuity (BSCVA) than chlorhexidine-treated participants, after adjusting for baseline BSCVA, and were less likely to develop a perforation or need therapeutic penetrating keratoplasty. Natamycin was also associated with faster re-epithelialization and a slightly smaller scar or infiltrate size from day 7 onwards. The authors conclude that natamycin is superior to chlorhexidine for filamentous fungal keratitis and remains the preferred first-line treatment. Malwankar et al (p. 478) retrospectively analyzed data from 1 944 979 Medicare beneficiaries to examine the incidence of immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS) and to assess factors associated with undergoing ISBCS. The researchers identified 4014 cases (0.20%) of ISBCS between 2011 and 2019. Black, Asian, and Native American patients were more likely to receive ISBCS than White patients. Patients from rural areas showed higher odds of undergoing ISBCS that those in metropolitan areas. Additionally, patients undergoing surgery at a hospital were more likely to receive ISBCS than those in an ambulatory setting. Patients with bilateral complex cataract were more likely to receive ISBCS than those with noncomplex cataract, whereas patients with ocular comorbidities such as glaucoma and maculopathies were less likely to undergo ISBCS. Endophthalmitis and cystoid macular edema rates were comparable between ISBCS and DSBCS patients. The researchers conclude that overall use of ISBCS remained low among Medicare beneficiaries and suggest that utilization of ISBCS may represent an opportunity to improve access to cataract surgery.