This Issue At A Glance
Authors: Jean Shaw, John Kerrison
Journal: Ophthalmology (2014)

In the first randomized controlled trial to do so, Jayaramachandran et al (p. 1827) compared soft contact lenses with rigid gas permeable contact lenses in patients with infantile nystagmus (IN). They found no significant differences in nystagmus intensity between the 2 forms of treatment; in addition, they found no improvement in any nystagmus parameter associated with contact lens wear compared with baseline spectacle wear. This cross-over trial with an intention-to-treat design included 24 patients with IN. The main outcome measure was mean intensity of nystagmus at the null region viewing at 1.2 m; secondary outcomes included the same measure at 0.4 m viewing and across the horizontal meridian for distance and near as well as best corrected visual acuity. Although neither type of contact lens improved the patients' nystagmus, soft contacts led to a minimal deterioration in visual acuity compared to rigid gas permeable contacts and spectacles. Pakravan et al (p. 1693) investigated whether the early use of aqueous suppressants has an effect on Ahmed glaucoma valve surgery outcomes. They found that early treatment produces greater reductions in intraocular pressure (IOP), leads to a higher surgical success rate, and lowers hypertensive phase frequency. For this randomized trial, 94 patients (94 eyes) with refractory glaucoma received either conventional stepwise treatment (control group, n = 47) or topical timolol-dorzolamide fixed-combination drops twice daily (early treatment group, n = 47). At baseline, IOP was 31.8±9.3 mmHg (range, 13–56 mmHg) in the control group and 30.9±9.3 mmHg (range, 16–56 mmHg) in the treatment group. At 1 year, the final mean IOP was16.8±4.4 mmHg (range, 9–28 mmHg) in the control group, vs. 14±4.5 mmHg (range, 0–22 mmHg) in the early treatment group. In addition, patients in the early treatment group had a higher surgical success rate (63.2% vs. 33.3%) and a reduced hypertension phase frequency (23.4% vs. 66.0%). What effect do monthly injections of ranibizumab have on posterior retinal nonperfusion (RNP) in patients with diabetic macular edema (DME)? Campochiaro et al (p. 1783) found that monthly injections of the drug can slow—but not completely prevent—retinal capillary closure in patients with DME. For this unplanned retrospective analysis of prospectively collected data from 2 phase 3 trials, the area of RNP in 666 patients with DME was measured on fluorescein angiograms. Patients were randomized to 3 groups (control, 0.5 mg ranibizumab, and 0.3 mg ranibizumab) and were followed for 36 months. The percentage of patients who showed an increase in posterior RNP from baseline increased over time in all 3 groups, occurring at a faster rate in the control group. In their discussion, the authors state that the data (1) support the hypothesis that DME and worsening of RNP are both consequences of high intraocular levels of vascular endothelial growth factor (VEGF) and (2) suggest that VEGF-induced worsening of retinal perfusion in DME is superimposed on another cause of more gradually worsening perfusion, possibly glucotoxicity. Adelman et al (p. 1715) set out to identify risk factors associated with failure of anatomic reattachment in cases of primary rhegmatogenous retinal detachment repair. They found that the following variables are independent, negative prognostic factors for final anatomic outcome: choroidal detachment, significant hypotony, Grade C-1 or higher proliferative vitreoretinopathy (PVR), 4 detached quadrants, and large or giant retinal breaks. However, in contrast to previous reports, this study did not confirm the significance of phakic vs. pseudophakic status, vitreous hemorrhage, or the number of retinal tears in predicting the final anatomic outcome. For this nonrandomized study, the researchers analyzed 7678 cases of rhegmatogenous retinal detachment repair reported by 176 surgeons from 48 countries. Cases were identified as Level 1 Failure Rate (full failure of repair), Level 2 Failure Rate (silicone oil remaining at end of study), or Level 3 Failure Rate (additional procedures needed to repair the detachment). Bock et al (p. 1677) investigated whether subconjunctival implants that deliver cyclosporine A have an impact on corneal neovascularization following high-risk penetrating keratoplasty (PK). They found that the implants do not have an effect, suggesting that local cyclosporine A has negligible antiangiogenic effects in the human cornea, at least in the transplant setting. For this report, which was a substudy of a prospective phase 2/3 trial, 97 patients were randomized to either a control group (n = 21); treatment group A (n = 36), which received low-dose cyclosporine A at the time of PK; or treatment group B (n = 40), which received high-dose cyclosporine A at the time of surgery. At week 52, the mean corneal neovascularization area was 2.32%±1.79 in group A, 2.74%±2.22 in group B, and 2.79%±2.11 in the control group.