Investigators sought to better understand the molecular underpinnings of age-related macular degeneration (AMD) by performing the first comparative transcriptome analysis of AMD and normal human donor eyes.

They obtained retinal pigmented epithelium (RPE)-choroid and retina tissue samples from a common cohort of 31 normal, 26 AMD and 11 potential pre-AMD human donor eyes. They also generated transcriptome profiles for macular and extramacular regions, and employed statistical and bioinformatic methods to identify disease-associated gene signatures and functionally enriched protein association networks. They validated selected genes of high significance using an independent donor cohort.

The study investigators identified more than 50 annoted genes enriched in cell-mediated immune responses that are globally over-expressed in RPE-choroid AMD phenotypes. Using a machine learning model and a second donor cohort, they show that the top 20 global genes are predictive of AMD clinical diagnosis. They also discovered functionally enriched gene sets in the RPE-choroid that delineate the advanced AMD phenotypes, neovascular AMD and geographic atrophy. Moreover, they identified a graded increase of transcript levels in the retina related to wound response, complement cascade and neurogenesis that strongly correlates with decreased levels of phototransduction transcripts and increased AMD severity. Based on their findings, the investigators assembled protein-protein interactomes that highlight functional networks likely to be involved in AMD pathogenesis.

They discovered new global biomarkers and gene expression signatures of AMD. These results are consistent with a model whereby cell-based inflammatory responses represent a central feature of AMD etiology, and depending on genetics, environment or stochastic factors, may give rise to the advanced AMD phenotypes characterized by angiogenesis and/or cell death. Genes regulating these immunological activities, along with numerous other genes identified here, represent promising new targets for AMD-directed therapeutics and diagnostics.

This retrospective analysis of a noncomparative, interventional case series evaluated the long-term improvement of visual acuity after Descemet's stripping automated endothelial keratoplasty (DSAEK) surgery.

A total of 108 patients undergoing DSAEK surgery for Fuchs' endothelial dystrophy and pseudophakic bullous keratopathy without other ocular comorbidities who completed a full 3-year follow-up period were included.

Postoperative best spectacle-corrected visual acuity (BSCVA) was recorded at 6, 12, 24 and 36 months and improvement in BSCVA between each time point was evaluated using paired-samples t tests. Additionally, subanalysis evaluating the percentage of eyes achieving a BSCVA of 20/20, 20/25, 20/30, and 20/40 at each time point was performed. The main outcome measure was improvement in postoperative BSCVA.

It was reported that there was a statistically significant trend toward improvement in average BSCVA with time at postoperative month 6 and postoperative years 2 and 3. There were also increasing proportions of eyes reaching vision of 20/20, 20/25 and 20/30 from 6 months to 1 year, 1 year to 2 years, and 2 years to 3 years. The percentage of patients achieving 20/25 BSCVA improved from 36.1% at 6 months to 70.4% at 3 years after surgery. A similar increase in the percentage of patients reaching a BSCVA of 20/20 after DSAEK surgery also was observed from 11.1% at 6 months to approximately 47.2% at 3 years.

To conclude, there is gradual improvement of visual acuity over time after DSAEK surgery for Fuchs' endothelial dystrophy and pseudophakic bullous keratopathy in patients without other vision-limiting ocular comorbidities.

Japanese researchers conducted a cross-sectional observational case series to examine effects of long-term topical anti-glaucoma medications on meibomian gland morphology and function and assess their relationship with slit-lamp findings.

They looked at 31 patients with glaucoma (mean age ± standard deviation, 65.0 ± 13.0 years; mean duration of eye drop use, 7.9 ± 6.0 years) treated with topical anti-glaucoma drugs in only one eye for more than 1 year: 13 receiving prostaglandin analogues (PGs) alone, eight receiving β-blockers alone, and 10 receiving multiple treatments. Untreated contralateral eyes served as controls. The researchers observed lid margin (lid margin abnormality score 0–4) and superficial punctate keratopathy (SPK score: 0–1) with a slit lamp. They also turned over upper and lower eyelids to observe meibomian glands using non-contact meibography and scored meibomian gland loss for each eyelid from grade 0 (no loss of meibomin glands) through grade 3 (loss >2/3 of total meibomian gland area). Finally, they scored meibomian lipid content (meibum)(meibum score: 0–3).

The study researchers reported that treated eyes had significantly higher scores for lid margin abnormality (p=0.001), SPK (p<0.001), meibo-score (p<0.001) and meibum (p<0.001) than control eyes. Tear film break-up time (BUT) was significantly shorter in treated eyes than in control eyes (p=0.001) and Schirmer values were significantly lower in treated eyes than in control eyes (p=0.0039). Furthermore, subgroup analysis indicated a significantly higher meibo-score in eyes treated with PGs (p=0.0046) and in eyes treated with β-blockers (p=0.0231) than in the corresponding controls.

Long-term anti-glaucoma eye drop use affects meibomian gland morphology and function.

The authors of the following case series reported the presentation and subsequent management of a series of patients presenting with cosmetic iris implants.

In this evaluation of patients with newColorIris cosmetic iris implants, data collected included patient demographics, visual acuity, intraocular pressure (IOP), endothelial cell count and slit lamp examination findings at presentation. The study authors recorded medical and surgical interventions and the postoperative course.

They identified 14 eyes of 7 patients (ages 22 to 60; 71% men) and reported that nine eyes (64%) presented with decreased visual acuity, 7 (50%) had elevated IOP, 5 (36%) had corneal edema and 5 (36%) had anterior uveitis. They also noted that all 14 eyes had explantation of the iris prosthesis (range 4 to 33 months after placement). The minimum follow up after implant removal in all eyes was 2 months (range 2 to 28 months). Intraoperative complications included suprachoroidal hemorrhage during explantation in 1 eye, while postoperative complications included corneal edema (8 eyes), cataract (9 eyes) and increased IOP/glaucoma (7 eyes). Secondary surgeries included Descemet-stripping automated endothelial keratoplasty (5 eyes), cataract extraction with intraocular lens placement (7 eyes), trabeculectomy (3 eyes), glaucoma drainage implant placement (3 eyes) and penetrating keratoplasty (1 eye).

In conclusion, the cosmetic iris implants may result in severe ocular morbidity. Complications in this series included uveitis, glaucoma, corneal edema and decreased visual acuity. Although explantation helped stabilize symptoms, additional medical and surgical intervention to control IOP and corneal decompensation was required in many cases.