Researchers evaluated the relative proportion of conjunctival MUC5AC+ and MUC5AC- goblet cells in a post-LASIK population and their association with dry-eye indicators and corneal nerve morphology using a MUC5AC+ Goblet Cell Index.

After recruiting 20 subjects who underwent LASIK>12 months previously and 20 age-matched controls, they examined dry-eye symptoms, tear breakup time, osmolarity, meniscus area and corneal nerve morphology. And they collected conjunctival impression cytology samples from inferior-temporal bulbar conjunctiva using Millicell inserts. Researchers determined total goblet cell density from positive cytokeratin-7 immunolabeling, and MUC5AC+ goblet cell density from CK7± and MUC5AC± immunolabeled cells. Researchers defined the ratio of MUC5AC+ to total density as the MUC5AC+ Goblet Cell Index. They examined differences in variables between groups, and associations between goblet cell variables and clinical assessments.

Researchers found no significant differences in total and MUC5AC+ goblet cell densities and tear film parameters between the groups, although greater ocular discomfort was reported in the post-LASIK group (p=0.02). A higher MUC5AC+ Index was associated with worse/greater dry-eye symptoms (ρ=0.55, p=0.01) and higher nerve tortuosity (ρ=0.57, p=0.01) in the post-LASIK group; lower nerve density and thickness was found in controls (ρ>-0.45, p<0.05), but not associated with tear film parameters.

Researchers determined that the MUC5AC+ Goblet Cell Index provided an indicator of mucin secretion for assessing the goblet cell function in dry eye. In post-LASIK participants, they found an increased MUC5AC+ Index associated with worse dry-eye symptoms and adverse changes in corneal nerve morphology.

Investigators evaluated the efficacy and safety of 0.5-mg intravitreous ranibizumab vs. panretinal photocoagulation over five years for proliferative diabetic retinopathy. They evaluated 394 study eyes in the Diabetic Retinopathy Clinical Research Network multicenter randomized clinical trial with PDR, enrolled February through December 2012.

Eyes were randomly assigned to receive intravitreous ranibizumab (n=191) or PRP (n=203). The frequency of ranibizumab was based on a protocol-specified retreatment algorithm. Diabetic macular edema could be managed with ranibizumab in either group. The main outcome was mean change in visual acuity (intention-to-treat analysis). Secondary outcomes included peripheral visual field loss, development of vision-impairing DME and ocular and systemic safety.

The five-year visit was completed by 184 of 277 participants (66 percent excluding deaths). Of 305 enrolled participants, the mean (SD) age was 52 (12) years; 135 (44 percent) were women and 160 (52 percent) were white.

For the ranibizumab and PRP groups, respectively:
• the mean (SD) number of injections over five years was 19.2 (10.9) and 5.4 (7.9);
• the mean (SD) change in VA letter score was 3.1 (14.3) and three (10.5) letters (adjusted difference, 0.6; CI, -2.3 to 3.5; p=0.68);
• the mean VA was 20/25 (approximate Snellen equivalent) in both groups at five years; and
• the mean (SD) change in cumulative VF total point score was -330 (645) (n=41) vs. -527 (635) dB (n=38) groups (adjusted difference, 208 dB; CI, 9 to 408);
• vision-impairing DME developed in 27 vs. 53 eyes (cumulative probabilities: 22 percent vs. 38 percent; HR, 0.4; CI, 0.3 to 0.7); and
• no statistically significant differences were identified between groups in major systemic adverse event rates.

Investigators wrote that, although loss to follow-up was relatively high, VA in most study eyes that completed follow-up was very good at five years and similar in both groups. They added that severe vision loss or serious PDR complications were uncommon with PRP or ranibizumab; however, the ranibizumab group had lower rates of developing vision-impairing DME and less VF loss. Lastly, they wrote that the findings supported anti-vascular endothelial growth factor therapy or PRP as viable treatments for PDR. Investigators suggested that clinicians should consider patient-specific factors—including anticipated visit compliance, cost and frequency of visits—when choosing treatment for individuals with PDR.