Current Issue

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In this week’s issue

• Nearly half of childhood glaucoma surgeries in a new IRIS analysis failed, with younger age, higher IOP, poorer visual acuity, active uveitis, and heavier medication use as predictors for failure.
• Diabetes does not impair endothelial outcomes at one year, supporting greater inclusion of transplant donors with diabetes and widening the pool of corneal tissue availability.
• Statins may be beneficial in slowing AMD progression in type 2 diabetics with dyslipidemia. 
• Anti-miR-184 in vivo and vitro models reveal significantly faster corneal epithelial wound healing, turnover, and migration.

https://open.spotify.com/episode/2IV8G6qk3rQw9JbWRjClNk?si=H3k-O3pMQuShQ9-Pq2cKXw 

Ophthalmology

Surgical outcomes & risk factors for failure in childhood glaucoma

Pressure doesn't always make diamonds, especially when it comes to childhood glaucoma. Childhood glaucoma is characterized by high intraocular pressure (IOP) and pathologic ocular changes. Because of its low prevalence, failure rates for childhood glaucoma procedures have not been previously examined in large cohorts. In this retrospective cohort study of 2,380 eyes from the AAO IRIS registry, researchers extracted clinical characteristics and patient demographics associated with failure. Failure was recorded in 1,081 eyes (45.4%) at a mean of 9.1 (10.4) months. Factors associated with higher likelihood of failure include younger age (HR 1.12, 95% CI 1.06-1.18, per 5 years), higher IOP on the index date (HR 1.10, 95% CI 1.08-1.12, per 3 mmHg), worse visual acuity on the index date (HR 1.33, CI 1.23-1.44), and more glaucoma medications on the index date. Iris-based surgery, laser, and trabecular/angle-based implants were associated with higher failure rates. With a better understanding of childhood glaucoma from large-scale clinical registries, researchers may address the knowledge gaps, cost-effectiveness, and risks and benefits in children with glaucoma. 

JAMA Ophthalmology

Diabetic & non-diabetic donor grafts in corneal transplants

Sugar may rot your teeth but not your graft? With the rising prevalence of diabetes, eye banks are seeing more donor corneas from individuals with diabetes. Concerns remain over whether these tissues are viable for Descemet membrane endothelial keratoplasty (DMEK) since the Cornea Preservation Time Study (CPTS) showed a higher rate of graft failure. This multicenter, double-masked randomized clinical trial evaluated whether donors with or without diabetes affect endothelial cell loss (ECL), endothelial cell density (ECD), percentages of hexonal cells (HEX), and coefficient of variation in cell area (CV) at 1 year after DMEK. 1,274 eyes from 982 recipients were included, 816 eyes with diabetic donor corneas and 458 non-diabetic donor corneas. At 1 year, mean ECL was virtually identical between the diabetic and non-diabetic donor group (28.0% vs 28.3%). There was no significant difference in ECD based on donor diabetes severity score. Mean CV (31.4% vs. 31.5%) and HEX (57.2% vs. 57.7%) did not have significant differences between groups. These findings confirm that diabetes status should not negatively affect corneal endothelial health at 1 year, supporting broader acceptance of diabetic donor tissue and expanding the available corneal graft pool.

American Journal of Ophthalmology (AJO)

Statin intensity modulates risk of age-related macular degeneration

Turns out your cholesterol meds may be helping your eyesight too. Age-related macular degeneration (AMD) is a leading cause of vision loss and is influenced by risk factors such as smoking, hypertension, and high cholesterol. Statins, widely used for dyslipidemia, have shown mixed results in prior studies for AMD. Some studies suggested that high-potency statins may reduce drusen deposits while others found no association between statin use and progression to late-stage AMD. This retrospective cohort study of adults >40 with type 2 diabetes, dyslipidemia, and at least 1 ophthalmologic visit evaluated the association between high, medium, and low-intensity statin therapy versus statin-naïve controls and risk of AMD. After propensity score matching, high-intensity statin use was associated with reduced risk of combined AMD at 3 and 5 years. Medium-intensity statin use was associated with a significantly lower risk of combined AMD at all timepoints; all statin intensities were associated with reduced mortality. In conclusion, high and medium-intensity statins may be beneficial in slowing AMD progression in type 2 diabetics. 

Investigative Ophthalmology & Visual Science (IOVS)  

Targeting miR-184 to enhance corneal epithelial wound healing

Micro molecules with major healing power. MicroRNA-184 (miR-184), one of the most abundant corneal microRNAs, acts as a molecular brake on corneal epithelial wound healing (CEWH) by repressing key regenerative pathways. A corneal epithelial-specific miR-184 knockout mouse model demonstrated significantly faster wound closure, enhanced epithelial turnover in vivo, increased migration in vitro, and upregulation of target proteins (CDC25A, CARM1, LASP1). Therapeutic inhibition using locked nucleic acid (LNA) anti-miR-184, delivered via intrastromal injection, soluble microneedle patches, or exosome carriers, recapitulated the knockout phenotype, reducing miR-184 levels and accelerating healing. Targeting miR-184 may offer a novel strategy to boost epithelial regeneration, with microneedle and exosome platforms showing translational potential for persistent epithelial defects and postoperative corneal wounds.

Journal: Ophthalmology Science

Implementation of autonomous AI in diabetic retinopathy

Autonomous artificial intelligence (AI) in diabetic retinopathy (DR) screening has been available for commercial use for at least 5 years. There are currently 3 US Food and Drug Administration-cleared AI systems: LumineticsCore, EyeArt, and AEYE Diagnostic Screening (AEYE-DS). Their adoption has been somewhat limited, so researchers conducted a systematic review to examine evidence about their performance in clinical settings. The authors also conducted interviews with academic physicians leading implementation of AI in DR. Adopters of autonomous AI did not have to dilate eyes to get usable images ranging from 49% to 75% of the time. Sensitivity of these systems was 87% to 100% and specificity was 60% to 91%. Utilization of AI led to an increase in annual eye exam rates among diabetics of 8% to 18%. Success of AI implementation was credited to a number of factors including proper site selection, aligning AI tools with primary care clinic workflows, streamlining patient engagement and referrals, and ongoing training of staff.

Cornea

Can IPL give new light to severe dry eye in SJS/TEN?

Sometimes the best way to soothe a burning eye is… a flash of light? Chronic Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) often leave patients with severe dry eye disease and meibomian gland dysfunction (MGD), conditions that are difficult to manage with standard therapies. This prospective interventional study evaluated whether three sessions of intense pulsed light (IPL) followed by meibomian gland expression (MGX) could improve symptoms and ocular surface parameters in this uniquely challenging population. 29 patients (57 eyes) underwent IPL and MGX at two-week intervals and were followed over 12 weeks with comprehensive subjective and objective testing. After 90 days, IPL and MGX reduced ocular surface disease index scores from 60.1 to 38.4, decreased corneal fluorescein staining, reduced conjunctival lissamine green staining, and increased lipid layer thickness and meibomian gland expressibility. Measures such as Schirmer, TBUT, MMP-9 positivity, and meibomian gland dropout showed no significant change. No ocular or skin complications occurred. Although the effect size was smaller than previous reports in typical dry eye and MGD populations, IPL appears to be a safe option for patients with limited therapeutic alternatives.

DRCR-I: Prompt or deferred anti-VEGF for macular edema

Trick or treat? While eyeball injections and lasers give off haunted house vibes, patients may be in for a treat! The DRCR I evaluated the safety and efficacy of intravitreal ranibizumab with prompt or deferred laser and intravitreal triamcinolone with laser as compared to laser alone for the treatment of diabetic macular edema over 1 year.

Key Points

• Regardless of laser timeline, ranibizumab treatment led to significantly improved visual acuity
• Treatment with either ranibizumab or triamcinolone in addition to laser led to a decrease in mean central subfield thickness on OCT compared to laser alone
• While ranibizumab may uncommonly lead to retinal detachments or endophthalmitis secondary to injection, it is an overall safe treatment option

DRCR I demonstrated that treating patients with intravitreal ranibizumab + prompt or deferred laser is a safe and efficacious option to improve visual acuity and decrease central subfield thickness in patients with diabetic macular edema. This study introduced anti-VEGF agents as a leading option for the treatment of diabetic macular edema.