Primary Sjögren Syndrome in Men
Mathews et al. reported on the ocular complications of primary Sjögren syndrome (SS) in men, using a retrospective cohort study design. A total of 163 consecutive cases of primary SS were evaluated, and the frequency of extraglandular ocular and systemic manifestations and serologic results in men were compared with those in women.
Of the 163 primary SS patients, 14 (9%) were men. On presentation, men were a decade older (61 vs. 50 years) and less likely than women to have a prior diagnosis of SS (43% vs. 65%). A majority of men reported dry eye on presentation (92%), but it was of a shorter duration compared to women (5.9 vs. 10.8 years). Men, however, were more likely to present with serious ocular complications than women (43% vs. 11%). Extraglandular systemic complications of SS (e.g., vasculitis, interstitial nephritis) were also more common in men (64% vs. 40%). Men were more likely to be negative for anti-SSA/Ro, anti-SSB/La, and antinuclear antibodies than women (36% men vs. 11% women).
The authors concluded that men with primary SS have a higher frequency of serious ocular and systemic manifestations but are likely to be underdiagnosed. Physicians, therefore, should have a lower threshold to test for SS in men with dry eye.
Effect of Cataract Surgery on Wet Macular Degeneration
Saraf et al. used a retrospective cohort study design to evaluate whether cataract surgery contributes to the progression of wet age-related macular degeneration (AMD) in patients who received at least 1 anti-VEGF injection during a 1-year study period. A control arm included eyes with wet AMD that received anti-VEGF injections but did not undergo cataract surgery during the study period. Best-corrected visual acuity (BCVA), number of anti-VEGF injections, and optical coherence tomography (OCT) features were compared between the 2 arms.
There were 40 eyes in the surgical group and 42 in the control group. BCVA was equivalent between the groups in the first half of the study, but it became significantly better in the surgical group after cataract surgery was performed at the midpoint of the study. No significant change occurred in the number or injections before and after cataract surgery. However, the mean central retinal thickness on OCT was greater in postsurgical eyes compared with control eyes. In addition, surgical eyes were more likely to develop new or worse cystoid changes after the study midpoint (54.2% vs. 28.1%, respectively).
The authors concluded that cataract surgery leads to vision improvement and does not appear to contribute to worsening of wet AMD. However, anatomic changes based on OCT analysis suggest a subclinical susceptibility to cystoid macular edema or exacerbation of choroidal neovascularization.
Iris Fixation vs. Scleral Fixation for Intraocular Lens Dislocation
Kim et al. compared the efficacy and safety of iris fixation versus scleral fixation in surgical repositioning of dislocated IOLs. This study was a retrospective, consecutive, comparative interventional case series at a single referral hospital in South Korea.
The study evaluated 78 consecutive patients who required surgical IOL repositioning: 44 eyes of 44 patients underwent scleral fixation, and 35 eyes of 34 patients had iris fixation of the dislocated IOL. Corrected distance visual acuity (CDVA) improved significantly 1 week postoperatively in the scleral-fixation group but not in the iris-fixation group. However, at 1 month postoperatively CDVA had improved significantly in both groups and remained stable for 12 months.
The authors concluded that iris-fixation and scleral-fixation techniques had similar efficacy in the repositioning of dislocated IOLs. Iris fixation had the advantage of a shorter operative time; however, it had several disadvantages, including induced astigmatism, immediate postoperative inflammation, and less stable refraction. Although recurrence rates for dislocation were similar between the 2 groups, the mean time to recurrence was significantly shorter in the iris-fixation group.
Rejection Following Endothelial Keratoplasty and Penetrating Keratoplasty
On behalf of the National Health Service Blood and Transplant Ocular Tissue Advisory Group, Maior Figueiredo et al. reported on rates of corneal transplant rejection. Specifically, the researchers compared the incidence and outcome of corneal transplant rejection following endothelial keratoplasty (EK) and penetrating keratoplasty (PK) for Fuchs endothelial dystrophy (FED) and pseudophakic bullous keratopathy (PBK) using a multicenter cohort study.
The study included patients registered on the United Kingdom Transplant Registry who had EK or PK for FED or PBK between 2005 and 2011. Postoperative steroid use varied between surgeons and could not be captured in the reporting system. Rejection events were identified as those recorded as endothelial rejection.
A total of 3,486 corneal transplants were undertaken: 1,973 for FED and 1,513 for PBK. For FED, 2-year rejection-free survival was 93% for PK and 94% for EK. In transplants that had a rejection episode, 50% of PKs (17) and 60% of EKs (15) subsequently failed. For PBK, 2-year rejection-free survival for PK was 88% and 90% for EK. In transplants that had a rejection episode, 85% of PKs (41) and 76% of EKs (22) subsequently failed. Inflammation (i.e., conjunctival injection, presence of keratic precipitates, and intraocular signs) at the time of surgery for patients with FED was significant for developing rejection: 3.5 times greater compared with those with no inflammation.
The authors found no significant difference in rejection-free graft survival between EK and PK for either FED or PBK. However, the presence of inflammation at the time of surgery for FED was a significant risk factor for developing rejection, and attention to its control before and after surgery is important.
American Journal of Ophthalmology summaries are edited by Thomas J. Liesegang, MD.
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