This Issue at a Glance

Abstract

Dohlman et al (p. 865) prospectively evaluated the safety and efficacy of local treatment with bevacizumab on endothelial rejection in high-risk corneal transplantation. Analysis of 92 patients randomized to either bevacizumab (n = 48) or control (n = 44) treatment arms revealed a 52-week endothelial rejection rate of 10% in the bevacizumab group and 19% in the control group, and the difference was not statistically significant. Post hoc analysis of long-term graft survival beyond 52 weeks showed an endothelial rejection rate of 3% in the bevacizumab group and 38% in the control group. In post hoc Cox regression analysis, treatment with bevacizumab demonstrated a statistically significant hazard ratio of 0.15 for both endothelial rejection and overall graft failure. The authors conclude that treatment with bevacizumab did not lead to a statistically significant improvement in the rate of endothelial rejection at 52 weeks but suggest that their study may have been under-powered and post hoc analyses may indicate some beneficial effects of bevacizumab on corneal transplant survival. Fang et al (p. 841) conducted a systematic review and meta-analysis to assess endothelial cell density (ECD) loss following glaucoma surgery, with or without cataract surgery. Following a systematic electronic database search, 39 interventional studies were included in the quantitative analysis. Overall, ECD loss was not clinically significant after glaucoma surgery procedures at 12 months follow-up. ECD loss was lower in non-penetrating glaucoma surgery compared with penetrating filtration surgery, and lower with vitreous compared with anterior cavity placement of Baerveldt implant. ECD loss was less than 30% up to 24 months follow-up for most studies included in the review. The researchers note that ECD loss happens over a longer period of time and may not be captured by most of these studies. The researchers conclude that there is low certainty evidence suggesting that surgery involving long-term implants had greater ECD loss compared with glaucoma filtration surgeries not using implants and recommend long-term follow-up beyond 36 months to assess ECD loss and corneal decompensation. Caputo et al (p. 955) conducted a phase II/III prospective clinical study to assess the efficacy and safety of administration of topical Kedrion human plasma-derived eye drops (Ked-hPLG) in patients affected by Ligneous conjunctivitis (LC) associated with hypoplasminogenemia. A total of 11 symptomatic patients were enrolled for assessment of efficacy and safety and a further patient was added when assessing long-term safety. Overall success was achieved in 83.3% of treated eyes, with complete success achieved in 3 treated eyes (25.0%) and partial success achieved in 7 eyes (58.3%). Analysis of pseudomembrane recurrence found a 100% success rate with no relapses in any of the treated eyes. There were no deaths, no withdrawals resulting from adverse events, and no seroconversions indicating viral transmission. The study concludes that Ked-hPLG appears effective in preventing pseudomembrane recurrence and in reducing pseudomembranes in patients with LC, with a favorable safety and tolerability profile, offering a possible treatment for this form of LC in the future. In two studies, Tomar et al (p. 923 and 933) used a multicenter internet-based registry to retrospectively assess the association of high-risk pathologic features with high-risk clinical features for advanced intraocular retinoblastoma, as well as to assess the risk of metastatic mortality based on presenting clinical features, intraocular tumor size, and treatment modalities. In the first study, analysis of 942 retinoblastoma eyes treated by primary enucleation found that both American Joint Committee on Cancer (AJCC) clinical cT3 subcategories and AJCC Ophthalmic Oncology Task Force Size Groups were associated with high-risk pathologic features. In the second study, analysis of 1841 patients with advanced retinoblastoma showed that increasing AJCC cT3 subcategories, increasing age at presentation, and attempt at eye salvage by systemic chemotherapy were associated with a higher risk of metastatic death. The study concludes that AJCC retinoblastoma clinical high-risk features can predict the presence of high-risk pathologic features and the risk for metastatic death in eyes with advanced intraocular retinoblastoma. The findings also suggest that primary enucleation may offer higher survival rates than attempts at eye salvage with systemic chemotherapy for patients with advanced intraocular retinoblastoma.