Researchers for the SENTINEL Working Group looked at the prevalence of spondyloarthritis in patients with anterior uveitis in a multicenter, observational, prospective study. The study’s findings demonstrate that a large percentage of patients with clinically significant AU also have undiagnosed SpA.

The study looked at consecutive patients with AU who were human leukocyte antigen-B27 positive or HLA-B27 negative, with more than one episode of AU separated by at least three months. The study excluded patients previously diagnosed with SpA.

Of the 798 patients, most being men with a mean age of 45 years, 60 percent were AU HLA-B27 positive, and 40 percent had recurrent negative AU HLA-B27. A total of 50.2 percent and 17.5 percent of patients presented with axial and peripheral SpA according to ASAS criteria, respectively. Patients with AU who were HLA-B27 positive were more frequently diagnosed with axial (69.8 percent vs. 27.3 percent p<0.0001) and peripheral SpA (21.9 percent vs. 11.1 percent p<0.0001) than patients with recurrent negative AU HLA-B27. In general, there were no important differences between the groups in terms of ophthalmologic variables.

Ophthalmology 2016;123:1632-1636
Juanola X, Loza E, Cordero-Coma M.

Retinoblastoma Research
Researchers from the Children’s Oncology Group Study sought to determine whether insurance status, race and ethnicity correlate with increased retinoblastoma invasiveness as a marker of both risk and time to diagnosis in a retrospective, case-control study. The study’s findings suggest a higher rate of more advanced disease associated with non-private insurance, non-white race and Hispanic ethnicity.  

Researchers looked at 203 patients from the United States enrolled in the Children’s Oncology Group trial ARET0332, a study of patients with unilateral retinoblastoma requiring enucleation. Each surgical participant underwent institutional pathologic review and central pathologic review to determine the presence of well-defined histopathologic features correlating with a higher risk of disease progression. Insurance status, race and ethnicity were compiled from the study record for each patient.

On institutional pathologic review, the results of the study revealed that non-private insurance, non-white race and Hispanic ethnicity all correlated significantly with a greater rate of high-risk pathologic findings. Hispanic ethnicity remained a significant predictor. On central pathologic review, these correlations remained but did not reach statistical significance. The researchers theorize that these differences likely resulted from institutional versus central pathologic reviews, and they also appeared to result from a higher likelihood of patients in minority groups being misclassified as high-risk by institutional pathologists. The researchers note that these findings may also be due to delays in diagnosis for these groups, and say further focus should be on where in the diagnostic process potential delays exist so that these barriers are overcome to care for these groups.

Ophthalmology 2016;123:1817-1823
Green AL, Chintagumplala M, Krailo M, Langholz B, Albert D.

Surgical Management of Boston KPro
In a retrospective chart review, researchers set out to determine the rate of Boston type 1 keratoprosthesis-related corneal melts, leaks and extrusions that required surgical repair. They also evaluated the post-melt repair visual outcomes. The study determined that patients who undergo KPro with severe ocular surface disease are at greater risk for corneal melts, leaks and extrusions.

The researchers examined 110 patients (128 eyes) who received a KPro between November 2004 and December 2010. They also evaluated the rate of complications, risk factors for melts and post-melt repair visual outcomes.

The study found that 20 eyes from 18 patients developed KPro-related melts that required surgical repair. In total, there were 33 episodes of melt-related complications, the rate of which was 16 percent. The surgical repairs included lamellar patch grafts (15), KPro removal with penetrating keratoplasty (seven), reassembly of KPro onto a new cornea (four), replacement of KPro (three), suturing of a leak (three) and enucleation (one). The majority of eyes (18/20) did not regain their best post-KPro vision at final follow-up. Significant risk factors for melt included previous infectious keratitis (p<0.0001, odds ratio: 12.50, 95 percent confidence interval, 4.02-38.9) and conjunctival deficiency (including Stevens-Johnson syndrome, mucous membrane pemphigoid and chemical injury).

Cornea 2016;35:1049-1056
Chan CC, LoVerde L, Qiang J, Nordlund ML, Holland EJ.

Pigmentary Glaucoma and Nuclear Cataracts
In a retrospective, consecutive case series, researchers sought to describe a new association between nonsenile nuclear cataracts and pigmentary glaucoma in patients with controlled intraocular pressure. Investigators say that awareness of the purely nuclear cataract and its clinical presentation can assist the clinician when approaching the patient with pigment dispersion and decreasing vision.

Researchers examined nonsenile nuclear cataracts seen in patients with pigmentary glaucoma with controlled IOP in a single glaucoma specialist practice. The average age of these patients was 50.3 years, a much younger age than the average seen in senile nuclear sclerotic cataracts. Eight eyes of seven patients with pigmentary glaucoma and visually significant cataract that underwent cataract removal were reviewed.

They found that patients with pigmentary glaucoma developed rapidly progressing, nonsenile nuclear cataracts, with resulting myopic shifts between 4 and 13 D from baseline in less than two years. The patients had controlled IOP, and there were no associations between medication use and cataract development. According to researchers, this is a new association and warrants further investigation.

J Glaucoma 2016;25:547-550
Mosaed S, Haider A, Kim D, Zhang Z.