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In This Issue of JAMA Ophthalmology
June 2014


JAMA Ophthalmol. 2014;132(6):663. doi:10.1001/jamaophthalmol.2013.5943


From a database analysis of a 5% random sample of all Medicare beneficiaries 65 years or older with continuous Part B (medical insurance) coverage and no enrollment in a health maintenance organization for each year from 2002 through 2009, Jampel and colleagues counted unique claims with a Current Procedural Terminology code of 65855 (laser trabeculoplasty [LTP]). The authors examined trends over time and regional variation in LTP rates in 9 large geographic regions. The LTP rates per 10 000 Medicare beneficiary person-years were 36.3, 60.1, and 53.5 for 2002, 2006, and 2009, respectively. The rates per 10 000 open-angle glaucoma person-years differed by region, being lowest in the East South-Central region and highest in the East North-Central region in 2002 (P < .001).

Because the treatment of juxtapapillary choroidal melanoma is challenging owing to the proximity of the tumor to visually important structures, Sagoo and colleagues reported the complications of the treatment of 650 consecutive eyes with juxtapapillary choroidal melanoma with plaque radiotherapy in a retrospective case series. Using Kaplan-Meier analysis, the 10-year rates of the following complications were estimated as follows: nonproliferative retinopathy, 75%; proliferative retinopathy, 32%; maculopathy, 65%; papillopathy, 77%; cataract, 80%; neovascular glaucoma, 22%; vitreous hemorrhage, 42%; secondary enucleation, 26%; and visual acuity of 20/200 or worse, 87%. This case series confirmed the challenges of treating juxtapapillary choroidal melanoma.

With increasing reports of iatrogenic occlusion of the ophthalmic artery as a rare but devastating complication of cosmetic facial filler injections, Park and colleagues collated data from 44 patients with occlusion of the ophthalmic artery obtained retrospectively from a national survey of the Korean Retina Society from 27 sites. Occlusions were classified into 6 types according to angiographic findings including diffuse retinal and choroidal artery occlusions, localized posterior ciliary artery occlusion, branch retinal artery occlusion, and posterior ischemic optic neuropathy. Patients receiving autologous fat injections (n = 22) appeared more likely to have a worse visual prognosis and a higher incidence of combined brain infarction compared with patients having hyaluronic acid injections (n = 13). The authors concluded that extreme caution and care should be taken during these injections and that physicians should be aware of a diverse spectrum of complications following cosmetic facial filler injections.