This Issue of Acta (2004)

There are many important scientific original papers in the current issue. In the first one Reinhard and coworkers studied endothelial cell loss after penetrating keratoplasty. Two hundred and thirty-three patients were divided into three classes depending on the degree of HLA matching between donor and recipient. It is known that proper HLA matching decreases the risk of immune reactions after keratoplasty. Despite this, and somewhat surprising, the authors found that better HLA matching was not associated with lower rates of endothelial cell loss than groups with more mismatches. This paper and histocompatibility and grafting in general are discussed in the Guest Editorial by Ehlers. There are two epidemiological papers in this issue of Acta. Bergman et al. performed a highly unusual prospective study of a representative population sample between 70 and 97 years of age in Gothenburg. The subjects were examined at age 70 in 1971, and then again at ages 82, 85, 95 and 97. The study sheds new light on visual function at higher ages. At 82 years 20% of subjects demonstrated decreased vision, defined as visual acuity ≤0.5. At 97 years of age 80% had reduced visual function. Reduced blood folate levels, smoking and high BMI correlated with reduced visual acuities at higher ages. The study clearly shows that ‘normal VA’ is age dependent, but also raises questions about what the requirements should be for defining a normal subject at very high ages. The other epidemiological study published in the current issue also deals with visual acuity. This Inter99 study has been conducted in Copenhagen. Very different age groups have been studied and in this, much younger, population, the most important cause of visual impairment was strabismic amblyopia. Myopia was twice as common in subjects with a university degree as in those without such a degree. Quality of life has very properly come into the focus of ophthalmic researchers. Chabert and coworkers studied the influence of uveal melanoma diagnosis and therapy on QoL. Their results are encouraging; compared to patients with other types of cancer patients with uveal melanoma had relatively satisfactory QoL levels, that were also not seriously reduced by radiotherapy. Fledelius and coworkers present two papers dealing with retinopathy of prematurity. The first one has a provoking subtitle: Has progress reached a plateau? This suggestion by the authors – that ‘the apparent progress in the fight against ROP over many years seems to have come to a halt’– agrees with the impression of many ROP specialists, and is a challenge for specialists in neonatology and ophthalmologists working with premature infants. The accompanying paper presents epidemiological county-based ROP data; one of the differences was a ROP frequency of 31% in 1998–2001 compared to only 10% in the preceding 4-year period. Despite the suggested worsening the authors propose a lowering of gestational age and birthweight limits for ROP screening. Fechtner and coworkers present results from two large 3-month randomised studies with altogether 544 patients comparing Xalatan and Cosopt. There was no difference in IOP-lowering efficacy between the two treatment alternatives. Ocakoglu et al. measured optic nerve head and peripapillary blood flow with the Heidelberg flowmeter in 22 patients with unilateral exfoliation syndrome and 30 age-matched controls. The exfoliation eyes had lowest blood flow, but flow was also somewhat lower in the nonexfoliative fellow eyes than in the normal controls. Exfoliations have been shown to be an independent risk factor for glaucoma damage, and reduced blood flow in exfoliation eyes has, of course, often been considered a possible explanation. In a study of vigabatrin-treated patients using a novel type of visual field testing Frisén reports perimetric deficits that were proportional to the total dose of vigabatrin. There are two papers about pterygium in this issue of Acta. In a retrospective study Frau and coworkers report very positive surgical results in 104 patients operated with corneo-conjunctival autografts. They saw no recurrences at all. In a study from Jordan Al-Bdour and coworkers studied risk factors for this condition. Sun exposure was the most important risk factor, and the authors recommend preventive measures. There are two experimental studies in the current issue. Wasselius et al. studied Cystatin C in the rat and mouse, and found a striking similarity of localization of Cystatin C and cathepsin B, indicating that in the eye the former substance may be a regulator of the latter. Lin and coworkers found a significant association of p21 codon 31 polymorphism and POAG in China. The Diagnosis/Therapy in Ophthalmology section shows an unusual case of an isolated metastasis to the eye from a gastric adenocarcinoma. In the current issue there are also three case reports, all worth reading, on morning glory syndrome (cf. the cover illustration!), on telangiectasis in optic disc maculopathy, and on ERG abnormalities after methotrexate therapy, plus – as always – a number of interesting letters.