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  • Journal Highlights

    Ophthalmology

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    Predicting DME Response to Anti-VEGF Therapy

    July Ophthalmology

    Sophie et al. investigated why visual outcomes vary in patients who receive intravitreal injections of ranibizumab for diabetic macular edema (DME). They found that certain factors at baseline—including good BCVA and the presence of submacular fluid—could be used to predict positive outcomes after 2 years of treatment.

    This study involved post hoc analysis of patients who were enrolled in 2 randomized phase 3 studies, RISE and RIDE. All told, 502 patients received 0.3 or 0.5 mg of ranibizumab, and 257 patients received sham treatment. Macular laser was used at the discretion of the investigator starting at month 3. At the 24-month primary endpoint, 15.2% of the sham-treated patients had gained 15 or more letters compared with 39.2% of the 0.3-mg ranibizumab group and 42.5% of the 0.5-mg ranibizumab group.

    The researchers found that ranibizumab-treated patients were more likely to achieve a final BCVA of 20/40 or better if they were male and had submacular fluid and good BCVA at baseline. Ranibizumab-treated patients were less likely to achieve this outcome, however, if they had cardiovascular disease at baseline or had previously undergone panretinal photocoagulation.

    As for sham-treated patients, a final BCVA of 20/40 or better was correlated with good BCVA at baseline, mild foveal thickening, and hard exudates within 2 disc areas of the fovea. This outcome was less likely in patients who had renal disease.

    Smoking Linked to Uveitis

    July Ophthalmology

    In this population-based case-control study, Yuen et al. implicated cigarette smoking as a risk factor for uveitis.

    The researchers examined electronic health records from Kaiser Permanente Hawaii dating back 2 years and identified 100 cases of uveitis. For controls, they randomly selected 522 patients from the general Kaiser Hawaii population and 528 patients from the Kaiser Hawaii ophthalmology clinic.

    Current smokers had 1.63 and 2.33 times greater odds of developing uveitis compared with those who had never smoked in the general and ophthalmology control groups, respectively. The association was even stronger with noninfectious uveitis, which yielded odds ratios of 2.10 and 2.96 in the same respective control populations. The majority of uveitis cases were anterior (n = 86) and noninfectious (n = 80) in nature. Intermediate and posterior uveitis accounted for 3 and 11 cases, respectively.

    The researchers concluded that further investigation into the pathologic mechanisms that underlie the association between smoking and uveitis are necessary to establish causality.

    CMV Retinitis, AIDS, and Survival

    July Ophthalmology

    What is the impact of modern combination antiretroviral therapy on long-term outcomes of patients with cytomegalovirus (CMV) retinitis and AIDS? Jabs et al. found that prolonged survival was possible if immune recovery was achieved. In addition, rates of ocular complications and vision loss were substantially lower than those observed before this era of therapy.

    For this prospective cohort study, the researchers evaluated 479 patients who were diagnosed with CMV retinitis after 1996. Nearly all (98.1%) had received antiretroviral therapy at one time, either before enrollment or during follow-up.

    Affected patients who experienced immune recovery as a result of antiretroviral therapy had an estimated median survival of 27.0 years; in comparison, those with no immune recovery had an estimated median survival of 13.5 months. Framing the impact on survival in another way, the researchers stated that 75% of those with immune recovery would be alive more than 10 years after diagnosis of CMV retinitis, while less than 10% of those with no immune recovery would be alive 5 years after diagnosis.

    They also found that the rates of bilateral visual impairment and blindness did not differ by immune recovery status and remained relatively low 10 years after diagnosis of CMV retinitis. At 5 years after diagnosis, the rates of visual impairment and blindness were 9.5% and 3.2%, respectively. At the 10-year mark, these rates increased to 11.2% and 5.7%.

    Progression From Ocular to Generalized Myasthenia Gravis

    July Ophthalmology

    Nagia et al. calculated the rate of conversion from ocular to generalized myasthenia gravis and found it was lower than what has previously been reported. They also noted that a subset of patients continued progressing to the systemic form 2 years after the initial onset of ocular symptoms, making continued follow-up a necessity.

    For this retrospective analysis, the researchers reviewed the charts of 158 patients who were diagnosed with myasthenia gravis between 1993 and 2012 and divided them into 2 subgroups: those treated with immunosuppressant drugs (n = 76) and those who did not undergo such treatment (n = 82). Two-thirds of all patients were male, and symptom onset occurred at a median age of 61.5 years. Median follow-up was 60.5 months.

    The overall conversion rate to generalized myasthenia gravis was 20.9%, significantly lower than previously reported rates of 50% to 64%. At 2 years, generalized disease had developed in 10.5% of patients treated with immunosuppressants and 18.3% of nontreated patients. Median time for disease conversion was 20 months in the nontreated group and 24 months in the immunosuppressant group. Conversion occurred after 2 years of ocular symptom onset in 30% of patients.

    The researchers noted that, as with any retrospective chart review, this study did have limitations, including a small sample size, heterogeneity of treatment, and nonstandardized evaluation criteria.

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

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