Beaver Dam Eye Study participants aged 43 to 86 years were involved in the baseline examination in 1988–1990 of the following longitudinal population-based study of age-related eye diseases to examine the associations of cataract and cataract surgery with early and late age-related macular degeneration (AMD) over a 20-year interval.

Participants were followed up at five-year intervals after the baseline examination. Examinations consisted of ocular examination with lens and fundus photography, medical history, measurements of blood pressure, height, and weight. Values of risk variables were updated, and incidences of early and late AMD were calculated for each five-year interval. Additionally, odds ratios were computed using discrete linear logistic regression modeling with generalized estimating equation methods to account for correlation between the eyes and multiple intervals. AMD was the main outcome measure.

After adjusting for age and sex, neither cataract nor cataract surgery was associated with increased odds for developing early AMD. Further adjusting for high-risk gene alleles (CFH and ARMS2) and other possible risk factors did not materially affect the odds ratio (OR). However, cataract surgery was associated with incidence of late AMD (OR 1.93; 95% confidence interval [CI], 1.28–2.90). This OR was not materially altered by further adjusting for high-risk alleles (CFH Y402H, ARMS2) or other risk factors. It was noted that the OR for late AMD was higher for cataract surgery performed five or more years prior compared with less than five years prior.

These data strongly support the past findings of an association of cataract surgery with late AMD independent of other risk factors, including high-risk genetic status, and suggest the importance of considering these findings when counseling patients regarding cataract surgery. These findings should provide further impetus for the search for measures to prevent or delay the development of age-related cataract.

Vitreomacular adhesion (VMA) can lead to pathologic traction and macular hole. The standard treatment for severe, symptomatic VMA is vitrectomy. Ocriplasmin is a recombinant protease with activity against fibronectin and laminin, components of the vitreoretinal interface.

Researchers conducted two multicenter, randomized, double-blind, Phase III clinical trials to compare a single intravitreal injection of ocriplasmin (125 µg) with a placebo injection in patients with symptomatic VMA. The primary end point was resolution of VMA at day 28. Secondary end points were total posterior vitreous detachment and nonsurgical closure of a macular hole at 28 days, avoidance of vitrectomy, and change in best-corrected visual acuity (BCVA).

Overall, the researchers treated 652 eyes: 464 with ocriplasmin and 188 with placebo. They reported that VMA resolved in 26.5% of ocriplasmin-injected eyes and in 10.1% of placebo-injected eyes (p<0.001). They also found that total posterior vitreous detachment was more prevalent among the eyes treated with ocriplasmin than among those injected with placebo (13.4% vs. 3.7%, p<0.001). The study researchers achieved nonsurgical closure of macular holes in 40.6% of ocriplasmin-injected eyes, as compared with 10.6% of placebo-injected eyes (p<0.001). They noted that the BCVA was more likely to improve by a gain of at least three lines on the eye chart with ocriplasmin than with placebo. Furthermore, ocular adverse events (e.g., vitreous floaters, photopsia, or injection-related eye pain—all self-reported—or conjunctival hemorrhage) occurred in 68.4% of ocriplasmin-injected eyes and in 53.5% of placebo-injected eyes (p<0.001), and the incidence of serious ocular adverse events was similar in the two groups (p=0.26).

In conclusion, intravitreal injection of the vitreolytic agent ocriplasmin resolved vitreomacular traction and closed macular holes in significantly more patients than did injection of placebo and was associated with a higher incidence of ocular adverse events, which were mainly transient.

High levels of plasma homocysteine have been reported to be toxic to the vascular endothelium, thereby creating an environment of hypercoagulability and occlusion. Elevated homocysteine has been reported as a risk factor for young adult central retinal vein occlusion (CRVO) cases. In India, investigators aimed to determine whether oxidative stress is an independent risk factor or is homocysteine-dependent.

They included 23 young adult CRVO patients and 54 age and sex-matched controls in the study and estimated oxidative stress markers thiobarbituric acid-reacting substance (TBARS), superoxide dismutase (SOD), total thiols, glutathione peroxidase, and total antioxidant capacity (TAC). Finally, they measured the effect of homocysteine (25 µm to 200 µm) on cultured bovine retinal endothelial cells (BREC) on oxidative stress parameter TBARS.

According to the investigators, there was a significant increase in the plasma TBARS in CRVO cases compared with controls (p=0.000). They found that SOD and TAC were significantly lower in CRVO cases than controls (p=0.000, p=0.022) and that there was a significant negative correlation between TAC and TBARS (p=0.00) and a significant positive correlation between homocysteine and TBARS (p=0.029). Nominal regression analysis showed that TAC and homocysteine influence TBARS significantly. The in vitro study in BREC cells revealed that homocysteine increased the TBARS dose and time dependently.

TBARS and homocysteine are known to be independent risk factors for CRVO. TBARS can be influenced by both homocysteine and TAC, thereby contributing to the aetiopathology of CRVO by increasing oxidative stress, the investigators determined.