Current Issue

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In this week’s issue

• Patients with pseudoexfoliation glaucoma had a higher risk of developing CSCR compared with POAG, suggesting shared pathophysiology.
• In anophthalmic patients with chronic prosthesis-related socket discomfort, vitamin A ointment was the most effective first-line treatment.
• In a 10-year retrospective cohort of patients with non-paraneoplastic autoimmune retinopathy, IVIg showed limited benefit, with most experiencing continued visual decline over time.
• Short-term periocular 0.025% triamcinolone did not cause clinically meaningful IOP elevation overall, supporting its relative safety in oculoplastic practice.

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American Journal of Ophthalmology (AJO)

Pseudoexfoliation glaucoma a risk factor for central serous chorioretinopathy?

Pseudoexfoliation glaucoma’s posterior secret…Is the choroid in on it too? Central serous chorioretinopathy (CSCR) is a condition characterized by choroidal vascular dysregulation and retinal pigment epithelium dysfunction that leads to subretinal fluid accumulation. Choroidal microvascular instability may also contribute to the pathogenesis of pseudoexfoliation glaucoma (PXG), the most common secondary open-angle glaucoma. Given these potential shared mechanisms, the authors investigated whether patients with PXG have an increased risk of developing CSCR compared with patients with primary open-angle glaucoma (POAG). This retrospective study analyzed 10,347 patients with PXG and 205,065 with POAG using the TriNetX U.S. database to evaluate the development of CSCR at 1- and 5-year follow-ups after glaucoma diagnosis. PXG was associated with a significantly higher hazard of developing CSCR than POAG at 1 and 5 years (adjusted hazard ratios of 1.807 and 1.631, respectively). Additional risk factors included male sex, obesity, phobic anxiety disorders, sympathomimetic use, and systemic corticosteroids. This study suggests that PXG may be associated with an increased susceptibility to posterior segment vascular pathology, particularly when coexisting with established CSCR risk factors. However, prospective studies with longitudinal OCT imaging are needed to determine whether subclinical choroidal changes in PXG precede the onset of CSCR.

British Journal of Ophthalmology 

Can simple topical therapies reduce irritation in anophthalmic sockets?

Managing the uncomfortable side effects of ocular prostheses. Chronic discharge and irritation are common concerns among anophthalmic patients wearing ocular prostheses, yet evidence-based treatment strategies remain limited. In this prospective, crossover randomized trial, 40 prosthesis-wearing patients with persistent socket discomfort underwent four sequential 2-week treatment periods, receiving each of the following interventions: artificial tears, vitamin A ointment, low-dose fluorometholone drops, and no treatment, separated by 2-week washout intervals. Symptom frequency and severity were measured using visual analogue scale questionnaires. Vitamin A ointment produced the most consistent clinical improvements across outcomes, significantly reducing both irritation (frequency -1.77; severity -1.45) and discharge (frequency -1.19; severity -1.15). Artificial tears significantly decreased irritation frequency but had less consistent effects on discharge, while low-dose steroid drops showed no significant benefit. Notably, individual responses varied widely, suggesting that optimal treatment may differ between patients. These findings highlight vitamin A ointment as a simple, effective first-line option for managing chronic prosthesis-related socket symptoms, while simultaneously reinforcing the importance of individualized treatment approaches.

Eye

Use of IV immunoglobulin for autoimmune retinopathy

When the immune system attacks the retina, can borrowed antibodies help fight back? Autoimmune retinopathy (AIR), including non-paraneoplastic autoimmune retinopathy (npAIR), is a rare condition caused by antibodies that target retinal proteins. Because responses to traditional immunosuppressive therapies are inconsistent, clinicians have explored alternative treatments such as intravenous immunoglobulin (IVIg). This study reviewed a decade of clinical data using IVIg in patients with suspected autoimmune retinopathy to understand its effectiveness in stabilizing vision. A total of 18 patients with npAIR treated with IVIg between 2009-2019 were analyzed, and visual acuity, retinal imaging, and electroretinography after treatment cycles were evaluated. Among patients that received more than three IVIg cycles (potential responders), n=2 stabilized at one year, and n=8 later deteriorated. Anti-retinal antibodies were present in 72% of patients but did not reliably predict treatment response. Overall, IVIg showed limited long-term benefit for autoimmune retinopathy in this cohort. These findings highlight the need for better diagnostic markers and more effective immunomodulatory therapies for this challenging disease.

Ophthalmic Plastic and Reconstructive Surgery

Does short-term periocular triamcinolone 0.025% elevate IOP?

Can brief periocular steroid use increase intraocular pressure? Steroids are notoriously known for elevating intraocular pressure (IOP), raising concern even when used just around the eye. A retrospective review at a single specialty oculoplastic practice was conducted to evaluate short-term periocular steroid use and the risk of developing elevated IOPs. Sixty-two patients (120 eyes) with baseline and follow-up IOP measurements were included in the study with analysis including associations with age, dosing frequency, procedure type, application site, and concomitant steroid or 5-fluorouracil use. Mean IOP remained unchanged overall (14.35 vs 14.32 mmHg), with no significant increases across most variables. Bilateral upper eyelid application was associated with a small but statistically significant increase of 1.7 mmHg, which remained within normal limits. Overall, short-term periocular 0.025% triamcinolone was not associated with clinically meaningful IOP elevation, supporting its safety in oculoplastic care.

HORIZON (Hydrus Microstent)

The horizon may be out of sight, but thanks to the HORIZON trial, a brighter future for glaucoma patients is now in sight. Combined glaucoma and cataract surgery has become increasingly common in North America with the introduction of minimally invasive glaucoma surgery devices and techniques. The HORIZON trial compared clinical outcomes of patients following cataract surgery with (n=369) and without a Hydrus Microstent (n=187).

Key Points

• At 5 years, the Hydrus Microstent and Cataract Surgery group (HMS) included a higher proportion of eyes with IOP of 18 mmHg or less without medications than the Cataract Surgery Only (CS) group (49.5% vs. 33.8%; P = 0.003)
• The HMS group had a greater likelihood of IOP reduction of 20% or more without medications than the CS group (54.2% vs. 32.8%; P < 0.001). 
• The number of glaucoma medications was 0.5 ± 0.9 in the HMS group and 0.9 ± 0.9 in the CS group (P < 0.001), and 66% of eyes in the HMS group were medication free compared with 46% in the CS group (P < 0.001). 
• No clinical or statistically significant differences were found in the rate of endothelial cell loss from 3 to 60 months between the HMS and CS alone groups (P = 0.261).

Overall, the HORIZON landmark study demonstrated that use of a Schlemm's canal microstent in addition to traditional cataract surgery was found to be safe and resulted in lowered intraocular pressure and a reduction in medication use. The study also found that the long-term presence of the microstent did not have a negative impact on the corneal endothelium