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Factors Predictive of Corneal Graft Survival
March JAMA Ophthalmology
To assess the relationship between donor and recipient factors and corneal graft survival at 10 years in the Cornea Donor Study, Sugar et al. evaluated graft failure, defined as a regrafting procedure or a cloudy cornea for three consecutive months. They found that although the majority of penetrating keratoplasty (PK) grafts remained clear at this time point, certain factors were associated with a higher rate of failure.
The graft failure rate was higher in recipients with pseudophakic or aphakic corneal edema (PACE) than with Fuchs dystrophy (37 percent vs. 20 percent, respectively; p < .001). Recipients with a history of glaucoma prior to PK, particularly those with prior glaucoma surgery, also had a significantly higher risk of failure (58 percent with prior glaucoma surgery and medications at time of surgery vs. 22 percent with no history of glaucoma; p < .001). There were trends toward increased graft failure in recipients who were older (p = .04), African-American (p = .11), or had a history of smoking (p = .02). Lower endothelial cell density and higher corneal thickness at six months, one year, and five years were associated with subsequent graft failure (p = .04 to < .001). The authors concluded that most PK grafts for Fuchs dystrophy or PACE remain clear at 10 years, although the risk for failure is greater for graft recipients with PACE.
Teleophthalmology and Neovascular Age-Related Macular Degeneration
March JAMA Ophthalmology
Li et al. evaluated teleophthalmology as a tool for the screening and monitoring of neovascular age-related macular degeneration (AMD). In a randomized clinical trial, patients received either 1) routine clinical assessment and diagnostic imaging at a retina clinic or 2) an examination and diagnostic imaging at a teleophthalmology site, where patient information and imaging studies were acquired and electronically sent to retina specialists.
For neovascular AMD screening, the average referral-to-diagnosticimaging time was 22.5 days for the teleophthalmology group and 18.0 days for the routine group, for a difference of 4.5 days (95 percent confidence interval [CI], 11.8 to −2.8 days; p = .23). The average diagnostic-imaging-totreatment time was 16.4 days for the teleophthalmology group and 11.6 days for the routine group, for a difference of 4.8 days (95 percent CI, 10.7 to −1.1 days; p = .11). For neovascular AMD monitoring, the average recurrenceto-treatment time was shorter for the routine group (0.04 days) compared with 13.6 days for the teleophthalmology group, for a difference of −13.5 days (95 percent CI, −18.2 to −9.0 days; p < .01). However, no differences were identified in end-of-study visual acuities between the two groups (p = .99). The data suggest that teleophthalmology has the potential to reduce costs and inconveniences associated with frequent patient visits.
Predictors of Referral-Warranted ROP in a Telemedicine Approach
March JAMA Ophthalmology
Recognizing that detection of treatment-requiring retinopathy of prematurity (ROP) involves serial eye examinations, Ying et al., for the e-ROP Cooperative Group, studied predictive factors for the development of referral-warranted (RW) ROP. Among a group of 979 infants without RW-ROP at first study-related eye examination (median postmenstrual age, 33 weeks; range, 29-40 weeks) who underwent at least two eye examinations, the researchers found that 149 (15.2 percent) developed RW-ROP.
In a multivariate model, significant predictors for RW-ROP emerged. These were male sex (odds ratio [OR], 1.80; 95 percent confidence interval [CI], 1.13-2.86 vs. female), nonblack race (OR, 2.76; CI, 1.50-5.08 for white vs. black race; and OR, 4.81; CI, 2.19-10.6 for other vs. black race), low birth weight (OR, 5.16; CI, 1.12-7.20 for ≤500 g vs. >1,100 g), younger gestational age (OR, 9.79; CI, 3.49-27.5 for ≤24 weeks vs. ≥28 weeks), number of quadrants with preplus disease (OR, 7.12; CI, 2.53-20.1 for 1-2 quadrants vs. no preplus disease; and OR, 18.4; CI, 4.28-79.4 for 3-4 quadrants vs. no preplus disease), stage 2 ROP (OR, 4.13; CI, 2.13-8.00 vs. no ROP), the presence of retinal hemorrhage (OR, 4.36; CI, 1.57-12.1 vs. absence), the need for respiratory support (OR, 4.99; CI, 1.89-13.2 for the need for controlled mechanical ventilator vs. no support; and OR, 11.0; CI, 2.26-53.8 for the need for high-frequency oscillatory ventilation vs. no respiratory support), and slow weight gain (OR, 2.44; CI, 1.22-4.89 for weight gain ≤12 g/d vs. >18 g/d).
The combination of these characteristics predicted the development of RW-ROP significantly better than the more commonly used factors of birth weight and gestational age combined (area under receiver operating characteristic curve, 0.88 vs. 0.78; p < .001). The researchers suggested that this model could help identify those infants at highest risk for ROP who could benefit from an intensive imaging and examination schedule, while reducing the burden of ROP examinations on the infants at lower risk.
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JAMA Ophthalmology summaries are based on authors' abstracts as edited by senior editor(s).
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