Corneal Involvement in Rheumatoid Arthritis 
This study by Italian investigators analyzed the in vivo morphology of corneal cells and nerves in patients with rheumatoid arthritis (RA), with or without secondary Sj'gren

syndrome (SSII), and investigated the correlations between corneal alterations and RA activity.
Fifty patients with RA and 30 age- and gender-matched control subjects participated.

SSII was diagnosed according to the American-European Consensus Group criteria,

and RA activity was evaluated by the Lansbury index (LI). Using confocal microscopy,

investigators assessed corneal thickness, the number of epithelial and stromal cells and

keratocyte hyperreflectivity. In addition, they assessed the sub-basal plexus for the number,

tortuosity and reflectivity of the nerve fibers and the presence of beadlike formations.

Sixteen percent of patients with RA also had SSII. Between the SSII and non-SSII groups, no significant differences appeared in the LI or in the clinical and confocal variables. Significant differences were present between patients with RA and control subjects for all the variables studied except nerve reflectivity. In patients with RA with and without SSII, LI correlated significantly with the number of beadlike formations and the number of hyperreflective, activated keratocytes.

The authors suggest that the number of beadlike formations and the number of activated

keratocytes could be interpreted as confocal signs of ocular surface disease activity. These

correlations with the index of systemic disease activity, LI, may provide insight regarding the

pathogenic mechanisms of dry eye in patients with RA.
SOURCE: Villani E, Galimberti D, Viola F, et al. Corneal involvement in rheumatoid arthritis: An in vivo confocal study. Invest Ophthalmol Vis Sci 2008;49(2):560-4.

Clinical Features of CMV Anterior Uveitis

in Immunocompetent Patients 
Singapore scientists conducted this retrospective, interventional case series study in an

effort to describe the clinical presentation of cytomegalovirus (CMV) anterior uveitis in human

immunodeficiency virus (HIV)-negative patients.

A total of 105 (of 106) HIV-negative patients with anterior uveitis associated with elevated IOP

(hypertensive anterior uveitis) who were seen at the Singapore National Eye Centre had their

aqueous analyzed for viral DNA by polymerase chain reaction. Their medical records were

reviewed for demographic data, ocular findings, laboratory results and treatment.

Twenty-four eyes (22.8 percent) demonstrated positive results for CMV. Eighteen of those

eyes (75 percent) had Posner-Schlossman syndrome (PSS) at presentation, five eyes (20.8

percent) had Fuchs' heterochromic iridocyclitis (FHI) and one eye had a presumed herpetic

anterior uveitis. Twelve of the 24 eyes were treated with ganciclovir. Of the 12 who completed

treatment, all responded clinically, and their aqueous demonstrated negative results for CMV

on repeat testing. However, nine had recurrences within eight months of stopping treatment

and required further courses of ganciclovir. The 81 CMV-negative eyes included 30 with PSS,

11 with FHI, 27 with uveitic glaucomas of unknown cause and 13 with presumed herpetic

anterior uveitis.

CMV anterior uveitis is not uncommon in immunocompetent patients, and the authors believe

that it may present as a recurrent acute or chronic inflammation resembling PSS, herpetic

anterior uveitis or FHI.
SOURCE: Chee SP, Bacsal K, Jap A, et al. Clinical features of cytomegalovirus anterior

uveitis in immunocompetent patients. Am J Ophthalmol 2008; Feb 5 [Epub ahead of print]

Prevalence of Antiplatelet and Anticoagulant Use and Local Anesthetic in Cataract Surgery Patients 
This study by Britain's Gloucestershire Hospitals NHS Foundation Trust aimed to establish the

prevalence of aspirin, dipyridamole, clopidogrel and warfarin use in patients undergoing

cataract surgery, and to compare local anesthetic and intraoperative complication rates

between users and non-users.

The Cataract National Dataset was remotely extracted and anonymized on 55,567 operations

at 12 NHS Trusts using electronic patient records (EPRs) between 2001 and 2006. The authors

report on 48,862 of the 55,567 operations from the eight centers, which routinely recorded a

drug history.

In all, 28.1 percent of the 48,862 patients were taking aspirin, 5.1 percent were taking warfarin,

1.9 percent were taking clopidogrel and 1.0 percent were taking dipyridamole. The recording

of any complication of a sharp needle or subtenon's cannula local anesthetic block was

increased in patients taking clopidogrel (8.0 percent) or warfarin (6.2 percent) vs. non-users

(4.3 percent), but no increase in potentially sight-threatening complications was identified.

The incidence of subconjunctival hemorrhage was increased in patients taking clopidogrel

(4.4 percent) or warfarin (3.7 percent) vs. non-users (1.7 percent). The recording of any

operative complication was increased in those taking clopidogrel (7.3 percent) vs. non-users

(4.4 percent), but the hemorrhagic operative complications of choroidal/suprachoroidal

hemorrhage and hyphema were not significantly increased. The non-hemorrhagic

complication of posterior capsular rupture (PCR) was increased in those taking clopidogrel

(3.23 percent) vs. non-users (1.77 percent).

Results suggest that clopidogrel or warfarin use is associated with a significant increase in

minor complications of sharp needle and subtenon's cannula local anesthesia, but their use

is not associated with a significant increase in potentially sight-threatening local anesthetic

or operative hemorrhagic complications.
SOURCE: Benzimra JD, Johnston RL, Jaycock P, et al. The Cataract National Dataset

electronic multicentre audit of 55,567 operations: Antiplatelet and anticoagulant medications.

Eye 2008; Feb 8 [Epub ahead of print]

Association of Two Genotypes with Response of Exudative AMD to Intravitreal Bevacizumab
St. Louis' Washington University School of Medicine conducted a retrospective cohort study

to determine whether an association exists between complement factor H (CFH) or LOC387715

genotypes with response to treatment with intravitreal bevacizumab for exudative age-related

macular degeneration (AMD).

The study consisted of 86 patients under treatment for neovascular AMD with bevacizumab

alone. Researchers performed genotype determination for the CFH Y402H and LOC387715

A69S polymorphisms using allele-specific digestion of polymerase chain reaction products.

All patients were treated with 1.25 mg intravitreal bevacizumab at six-week intervals until

choroidal neovascularization (CNV) was no longer active. Choroidal neovascular lesion

characteristics were ascertained by fluorescein angiography and Snellen visual acuity (VA)

was measured before and after treatment.

For the CFH Y402H polymorphism, patients with the CFH TT genotype had the largest

choroidal neovascular lesions. With treatment, VA improved from 20/248 to 20/166 for the CFH

TT genotype and from 20/206 to 20/170 for the TC genotype, but it fell from 20/206 to 20/341 for

the CFH CC genotype. Only 10.5 percent of patients with the CFH CC genotype demonstrated

improved VA with treatment, compared with 53.7 percent of CFH TT and TC genotypes. For the

LOC387715 A69S variant, patients with the TT genotype had the largest choroidal neovascular

lesions. There was no significant difference in response to bevacizumab treatment according

to LOC387715 genotype.

The AMD-associated CFH Y402H and LOC387715 A69S variants were associated with

differences in choroidal neovascular lesion size in this study. Patients with the CFH CC

genotype fared significantly worse with intravitreal bevacizumab than did those with the CFH

TC and TT genotypes, suggesting a potential pharmacogenetic relationship. The authors

suggest that prospective studies to confirm or refute this observation be considered.
SOURCE: Brantley MA Jr, Fang AM, King JM, et al. Association of complement factor H and

LOC387715 genotypes with response of exudative age-related macular degeneration to

intravitreal bevacizumab. Ophthalmol 2007;114(12):2168-73