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    Tear Fluid Production Increases in Meibomian Gland Loss

    May Ophthalmology

    Arita et al. set out to investigate the role of homeostasis in the tear film by evaluating tear film parameters and meibomian gland features and function in patients with and without dry eye. They found that an increase in tear fluid production appears to compensate for the loss of meibomian glands in patients with meibomian gland dysfunction (MGD).

    For this cross-sectional, observational case series, the researchers evaluated one eye of each participant in the following groups: 41 patients with dry eye, 70 patients with MGD, 17 patients with both dry eye and MGD, and 70 control participants with neither condition. (Of note, all of the patients with dry eye had non–Sjögren syndrome aqueous deficiency.) All study participants were female.

    Tear fluid secretion, as reflected by Schirmer’s test value, increased markedly in the MGD patients according to the extent of meibomian gland loss, the researchers found. This change did not occur in the dry eye patients with aqueous deficiency nor in the control group, which suggests that tear secretion increases to compensate for a deficiency of the oily layer, thereby improving tear film stability.

    Bevacizumab vs. Laser for ROP

    May Ophthalmology

    Hwang et al. evaluated the effectiveness and major complications associated with two treatments for type 1 retinopathy of prematurity (ROP): intravitreal injections of bevacizumab and panretinal photocoagulation (PRP). They found that both are effective options for treating type 1 ROP.

    For this retrospective case series, the researchers evaluated 28 patients (54 eyes) who had been treated between 2008 and 2012. Main outcome measures were recurrence rate, complication rate, and refractive error.

    A total of 11 patients (22 eyes) received bevacizumab; of these, 16 eyes had zone 1 ROP and six had posterior zone 2 ROP. Of the 17 patients (32 eyes) who were treated with PRP, five eyes had zone 1 ROP and 27 eyes had posterior zone 2 ROP. Over five years, ROP recurred in three of the bevacizumab eyes and in one PRP eye. None of the bevacizumab-treated eyes developed retinal detachment or macular ectopia, while one PRP-treated eye developed retinal detachment, and five PRP-treated eyes developed macular ectopia.

    Finally, intravitreal bevacizumab was associated with lower myopia than PRP, with a mean spherical equivalent at the last refraction of –2.4 D for bevacizumab-treated eyes and –5.3 D for PRP-treated eyes. However, given the relative novelty of bevacizumab as a treatment for ROP, longer follow-up is needed to confirm this finding, the researchers said.

    AREDS Report: Lens Opacity Changes and Risk of Progression

    May Ophthalmology

    In a report from the Age-Related Eye Disease Study (AREDS) Research Group, Indaram et al. investigated whether the two-year change in lens opacity severity on the AREDS lens-grading scale predicts progression to cataract surgery or loss of visual acuity (VA) by five years. They found that this is indeed the case, making these early changes potential surrogate end points in follow-up studies.

    For this report, the researchers analyzed 3,466 AREDS participants (6,054 eyes). Main outcome measures were progression of lens opacities at two years, cataract surgery, and VA loss of two or more lines at five years.

    Even a modest progression of opacities (a worsening of 1 or more units for nuclear cataract or a 5 percent or more increase in opacity grade for cortical or posterior subcapsular cataract) at two years increased the likelihood of cataract surgery by five years, the researchers found. Similarly, the same modest changes by the five-year mark also increased the risk of progression to cataract surgery by the 10-year mark, they reported.

    Increased severity of nuclear and posterior subcapsular opacities was predictive of a loss of two or more lines of VA by the five-year follow-up. The results with cortical opacities were less consistent.

    RVO Linked to Increased Stroke Risk

    June Ophthalmology

    In a nationwide longitudinal study in Korea, Rim et al. evaluated the risk of stroke following retinal vein occlusion (RVO). They found that RVO was significantly associated with stroke development, particularly in younger patients.

    For this study, the researchers randomly selected 1,025,340 subjects from a database of more than 46 million residents of Korea. Within that group, they identified 1,031 patients with RVO and then randomly selected a comparison group consisting of 5,074 socioeconomically and demographically matched individuals.

    During an eight-year follow-up period, stroke developed in 173 (16.8 percent) of the RVO patients and in 543 (10.7 percent) of the comparison group. The most common subtype of stroke was ischemic, occurring in 145 (14.1 percent) of the RVO patients and in 438 (8.6 percent) of the comparison group. Hypertension, diabetes, and chronic kidney disease—all of which were more common in the RVO group—were linked to an increased risk of stroke.

    Both hypertension and RVO were more closely associated with stroke in younger adults (those below 50 years of age) than in older cohorts, the researchers found, and they flagged this finding as one that warrants close attention from clinicians caring for patients with RVO.


    Ophthalmology summaries are written by Jean Shaw and edited by Susan M. MacDonald, MD.

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