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Penetrating and Lamellar Transplants in Failed Corneal Grafts
Aboshiha and coauthors investigate if survival of replacement corneal transplants is associated with primary corneal diagnosis and type (lamellar or penetrating) of regraft donor. In a national transplant registry study in the United Kingdom of 9925 regrafts, the proportion of endothelial keratoplasty regrafts increased to 38.0%, and stratification of 5-year survival was found for successive grafts in the same eye. For first regrafts in keratoconus and pseudophakic bullous keratopathy but not Fuchs dystrophy, no differences in survival after lamellar and penetrating keratoplasty procedures were identified. These findings suggest survival of replacement grafts had greater association with the number of prior grafts than primary corneal diagnosis or type of regraft procedure.
Continuing Medical Education
Macular Measurements for Detection of Glaucoma
Wan and coauthors evaluate if optical coherence tomography angiography (OCT-A) measurement of inner macular vessel density outperforms optical coherence tomography measurement of inner macular thickness in the diagnostic evaluation of glaucoma. In a cross-sectional study including 115 patients with glaucoma and 35 healthy individuals, at 90% specificity, the sensitivity to discriminate glaucomatous eyes from healthy eyes was 60.2% for inner macular vessel density and 81.4% for inner macular thickness. The strength of the structure-function association was stronger for inner macular thickness for both linear and nonlinear regression analyses than inner macular vessel density. These data suggest that OCT-A of the macula is limited in the diagnostic evaluation of glaucoma at this time.
Emergency Department Visits for Pediatric Ocular Injury
Matsa and coauthors determine what were the demographics and trends of pediatric ocular injuries presenting to emergency departments in the United States from 2006 to 2014 based on data from the Nationwide Emergency Department Sample. In this cohort study, 340 218 children from birth to age 17 years presented to Nationwide Emergency Department Sample emergency departments for care of acute ocular injuries, corresponding to 1 533 034 cases nationwide from 2006 to 2014. During the study, there was a 26.1% decline in ocular injuries observed across all demographics, mechanisms of injury, and injury patterns. The authors hypothesize that the decline in pediatric ocular injuries in the United States may have resulted from prevention efforts.
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Fellow Eye Involvement and Unilateral Exudative AMD
Yanagi and coauthors describe the incidence of fellow eye involvement in patients with unilateral exudative age-related macular degeneration (AMD) with and without nonexudative neovascularization as detected by OCT-A or indocyanine green angiography. In a prospective observational study of 95 patients with unilateral AMD, the estimated annual incidence of fellow eye involvement was 18.1% and 2.0% in those with and without nonexudative neovascularization, respectively. These findings suggest the presence of nonexudative neovascularization predisposes to the development of exudative changes; however, the authors recommend that treatment only should commence when exudation develops.
Highlights. JAMA Ophthalmol. 2018;136(8):847. doi:10.1001/jamaophthalmol.2017.3738
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