The Eye and Vision Research Institute, Sydney, Australia, retrospectively reviewed 3,580 consecutive cases of neovascular age-related macular degeneration (AMD) in an effort to quantify and categorize lesions of on the basis of fluorescein angiographic morphology.

Lesions were graded in terms of the location, size and composition, and categorized according to the lesion components. There were 2,642 subfoveal lesions (73.8 percent), 658 juxtafoveal lesions (18.4 percent) and 276 extrafoveal lesions (7.7 percent). After investigators excluded disciform lesions, they found that 1,337 subfoveal lesions (72.3 percent), 580 juxtafoveal lesions (88.1 percent) and 242 extrafoveal lesions (87.7 percent) consisted of at least 50 percent choroidal neovascularization. Most of this included a classic or an occult component, but not both. Subfoveal lesions (mean size, 2.82 Macular Photocoagulation Study disc areas) were significantly larger than juxtafoveal (mean size, 0.89 Macular Photocoagulation Study disc areas) or extrafoveal lesions (mean size, 1.04 Macular Photocoagulation Study disc areas), but overall the lesions were substantially smaller than those found in the major trials. It’s estimated that photodynamic therapy or photocoagulation may be offered to one-half to two-thirds of all patients with nondisciform neovascular AMD.

The authors concluded that the smaller lesion size and low proportion of mixed choroidal neovascularization lesions in their study suggest that treatment benefit and eligibility may be greater in the clinical setting than previously believed.

This study by Duke University Medical Center in Durham, NC, is a review of 30 years of clinical experience with Fuchs’ corneal endothelial dystrophy leading to penetrating keratoplasty (PK).

Investigators reviewed the clinical records of patients diagnosed histopathologically as having Fuchs’ corneal endothelial dystrophy who underwent PK at the university’s medical center between January 1, 1972, and December 31, 2001. The observational case series included 424 patients (546 eyes).

Women represented 77.6 percent of patients. Mean age at the time of PK for all patients was 69.2 years. Bilateral PK was required in 28.8 percent of patients, and the mean interval between the two PKs was 3.2 years. There was no gender difference in the likelihood of requiring bilateral PK. Among 376 documented family histories, 13.6 percent were known to be positive for Fuchs’ dystrophy. Patients with a positive family history underwent PK a mean of five years earlier than those without a positive history, and they were more likely to require bilateral PK. Patients who underwent bilateral PK were twice as likely to have a positive family history compared with those undergoing unilateral PK. Mean visual acuity was 20/60 at corneal thicknesses of 539 to 650 microns, 20/60 at 651 to 750 microns and 20/80 at greater than 750 microns. Patients who underwent bilateral PK and had a preceding cataract extraction on one eye required PK of the pseudophakic eye on average 3.2 years earlier than the fellow eye. The mean time from cataract extraction to PK was 2.2 years.

The study affirms that Fuchs’ dystrophy is a disorder of aging that predominantly affects women and is often familial. Pachymetry-determined corneal thickness was a poor predictor of visual acuity until extreme levels of corneal edema were reached. Cataract extraction in an eye with Fuchs’ dystrophy leads to earlier PK.