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This Issue At A Glance
This Issue At A Glance
Ophthalmology Volume 117, Number 3, March 2010
Hormone Replacement Is Associated with Increased Risk of Cataract Extraction In a population-based prospective cohort study, Lindblad et al (p. 424) found a statistically significant positive association between hormone replacement therapy (HRT) and the risk of cataract extraction. This increased risk was higher in current users of HRT with longer duration of use, compared with women who never used HRT. In addition, current users of HRT consuming more than 1 alcoholic beverage per day had further increased risk of cataract extraction. The study involved 30 861 postmenopausal women aged 40 to 83 participating in the Swedish Mammography Cohort who completed a self-administered questionnaire in 1997 about hormone status and HRT. They were followed up through October 2005. In the multivariate adjusted analysis, previous use of HRT was associated with a 14% increased risk of cataract extraction compared with those who never used HRT, and current use was associated with an 18% increased risk. The authors conclude that if these findings are confirmed, an increased rate of cataract extraction may be yet another potential negative outcome associated with HRT.
Greater Endothelial Cell Loss with DSAEK Compared with Penetrating Keratoplasty Price et al (p. 438) have found that at 1 year following surgery, the overall graft success rate for Descemet’s stripping automated endothelial keratoplasty (DSAEK) is comparable to the success rate for penetrating keratoplasty (PKP) in patients with a moderate-risk condition (principally Fuchs’ dystrophy or pseudophakic/aphakic corneal edema). However, endothelial cell loss is higher with DSAEK. In this multicenter, prospective, nonrandomized clinical trial, 173 patients undergoing DSAEK were compared with 410 patients undergoing PKP from the Specular Microscopy Ancillary Study (SMAS) of the Cornea Donor Study. While the 1-year graft rate was comparable, endothelial cell loss in the DSAEK group at 6 months (34%) and 12 months (38%) was significantly greater than the PKP group from the SMAS at 6 months (11%) and 12 months (20%), a finding the researchers attribute primarily to greater surgical manipulation and trauma to the graft. They call for the further data collection on longer-term graft success and cell loss with objective determination of endothelial cell density.
Effects of Simvastatin on Visual Field Progression in Glaucoma Patients In light of the hypothesis that normal tension glaucoma (NTG) may be a variant of open-angle glaucoma influenced by vascular factors, Leung et al (p. 471) investigated whether statins have beneficial effects on NTG. Specifically, they conducted a prospective cohort study looking at the effects of simvastatin on visual field (VF) progression in NTG patients. In this study, 31 of 256 Chinese NTG patients (12.1%) were taking simvastatin and 225 (87.9%) were not. After adjusting for other risk factors, simvastatin use was associated with a reduced risk of VF progression in
patients with NTG. Logistic regression showed that a history of disc hemorrhage, history of cerebrovascular accidents, and baseline age (10 years older) represented significant risk factors of VF progression, while simvastatin use offered a protective effect. The authors conclude their data demonstrate the need for a randomized, controlled clinical trial that looks both at the association between statins and visual field stabilization in patients with NTG and the cost-effectiveness of this treatment approach.
Drusenoid Pigment Epithelial Detachment in AMD Described Using participants enrolled in the Age-Related Eye Disease Study, Cukras et al (p. 489) designed a long-term evaluation of the natural history of eyes with drusenoid pigment epithelial detachments (DPED) associated with age-related macular degeneration (AMD). The researchers identified 311 eyes of 255 patients with DPED, and followed up for 8 years. Of the 282 eyes that did not have advanced AMD at baseline, 119 eyes (42%) developed advanced AMD within 5 years. Researchers detected progressive fundus changes including the development of calcified drusen and pigmentary changes in the 163 eyes that did not develop advanced AMD. About 40% of all eyes experienced visual acuity decreases by 15 or more letters at 5 years follow-up. Mean visual acuity averaged 26 letters for eyes progressing to advanced AMD, and 8 letters for eyes that did not progress to advanced AMD. The authors conclude that studies incorporating imaging modalities, such as optical coherence tomography and fundus autofluoresence, may provide additional information about the pathogenesis of DPED.
Intravitreal Fluocinolone Acetonide Implant for Uveitis The intravitreal fluocinolone acetonide (FA) sustained-released implant is a nonsystemic alternative for patients with chronic noninfectious posterior uveitis. Pavesio et al (p. 567) present the 2-year results from a 3-year multicenter study comparing the FA implant with standard of care (SOC): either systemic prednisolone or the equivalent corticosteroid as monotherapy, or combination therapy with an immunosuppressive agent plus a lower dose of prednisolone or equivalent corticosteroid. Eyes with the implant had delayed onset and a lower rate of uveitis recurrence compared with the SOC eyes. Adverse events with the implant included elevated intraocular pressure (IOP) requiring IOP lowering surgery in 21.2% of implanted eyes, and cataracts requiring extraction in 87.8% of phakic implanted eyes. In contrast, 25.7% of patients in the SOC group experienced non–ocular-related adverse events, compared with no events in the implant group. The authors conclude that while increased rates of cataract development and elevated IOP were associated with the FA implant, these adverse events were managed by medical or surgical treatment.
Lori Baker Schena and John Kerrison, MD
Ophthalmology Volume 117, Number 3, March 2010
Hormone Replacement Is Associated with Increased Risk of Cataract Extraction In a population-based prospective cohort study, Lindblad et al (p. 424) found a statistically significant positive association between hormone replacement therapy (HRT) and the risk of cataract extraction. This increased risk was higher in current users of HRT with longer duration of use, compared with women who never used HRT. In addition, current users of HRT consuming more than 1 alcoholic beverage per day had further increased risk of cataract extraction. The study involved 30 861 postmenopausal women aged 40 to 83 participating in the Swedish Mammography Cohort who completed a self-administered questionnaire in 1997 about hormone status and HRT. They were followed up through October 2005. In the multivariate adjusted analysis, previous use of HRT was associated with a 14% increased risk of cataract extraction compared with those who never used HRT, and current use was associated with an 18% increased risk. The authors conclude that if these findings are confirmed, an increased rate of cataract extraction may be yet another potential negative outcome associated with HRT.
Greater Endothelial Cell Loss with DSAEK Compared with Penetrating Keratoplasty Price et al (p. 438) have found that at 1 year following surgery, the overall graft success rate for Descemet’s stripping automated endothelial keratoplasty (DSAEK) is comparable to the success rate for penetrating keratoplasty (PKP) in patients with a moderate-risk condition (principally Fuchs’ dystrophy or pseudophakic/aphakic corneal edema). However, endothelial cell loss is higher with DSAEK. In this multicenter, prospective, nonrandomized clinical trial, 173 patients undergoing DSAEK were compared with 410 patients undergoing PKP from the Specular Microscopy Ancillary Study (SMAS) of the Cornea Donor Study. While the 1-year graft rate was comparable, endothelial cell loss in the DSAEK group at 6 months (34%) and 12 months (38%) was significantly greater than the PKP group from the SMAS at 6 months (11%) and 12 months (20%), a finding the researchers attribute primarily to greater surgical manipulation and trauma to the graft. They call for the further data collection on longer-term graft success and cell loss with objective determination of endothelial cell density.
Effects of Simvastatin on Visual Field Progression in Glaucoma Patients In light of the hypothesis that normal tension glaucoma (NTG) may be a variant of open-angle glaucoma influenced by vascular factors, Leung et al (p. 471) investigated whether statins have beneficial effects on NTG. Specifically, they conducted a prospective cohort study looking at the effects of simvastatin on visual field (VF) progression in NTG patients. In this study, 31 of 256 Chinese NTG patients (12.1%) were taking simvastatin and 225 (87.9%) were not. After adjusting for other risk factors, simvastatin use was associated with a reduced risk of VF progression in
patients with NTG. Logistic regression showed that a history of disc hemorrhage, history of cerebrovascular accidents, and baseline age (10 years older) represented significant risk factors of VF progression, while simvastatin use offered a protective effect. The authors conclude their data demonstrate the need for a randomized, controlled clinical trial that looks both at the association between statins and visual field stabilization in patients with NTG and the cost-effectiveness of this treatment approach.
Drusenoid Pigment Epithelial Detachment in AMD Described Using participants enrolled in the Age-Related Eye Disease Study, Cukras et al (p. 489) designed a long-term evaluation of the natural history of eyes with drusenoid pigment epithelial detachments (DPED) associated with age-related macular degeneration (AMD). The researchers identified 311 eyes of 255 patients with DPED, and followed up for 8 years. Of the 282 eyes that did not have advanced AMD at baseline, 119 eyes (42%) developed advanced AMD within 5 years. Researchers detected progressive fundus changes including the development of calcified drusen and pigmentary changes in the 163 eyes that did not develop advanced AMD. About 40% of all eyes experienced visual acuity decreases by 15 or more letters at 5 years follow-up. Mean visual acuity averaged 26 letters for eyes progressing to advanced AMD, and 8 letters for eyes that did not progress to advanced AMD. The authors conclude that studies incorporating imaging modalities, such as optical coherence tomography and fundus autofluoresence, may provide additional information about the pathogenesis of DPED.
Intravitreal Fluocinolone Acetonide Implant for Uveitis The intravitreal fluocinolone acetonide (FA) sustained-released implant is a nonsystemic alternative for patients with chronic noninfectious posterior uveitis. Pavesio et al (p. 567) present the 2-year results from a 3-year multicenter study comparing the FA implant with standard of care (SOC): either systemic prednisolone or the equivalent corticosteroid as monotherapy, or combination therapy with an immunosuppressive agent plus a lower dose of prednisolone or equivalent corticosteroid. Eyes with the implant had delayed onset and a lower rate of uveitis recurrence compared with the SOC eyes. Adverse events with the implant included elevated intraocular pressure (IOP) requiring IOP lowering surgery in 21.2% of implanted eyes, and cataracts requiring extraction in 87.8% of phakic implanted eyes. In contrast, 25.7% of patients in the SOC group experienced non–ocular-related adverse events, compared with no events in the implant group. The authors conclude that while increased rates of cataract development and elevated IOP were associated with the FA implant, these adverse events were managed by medical or surgical treatment.
Lori Baker Schena and John Kerrison, MD