The association between early age-related macular degeneration (AMD) and some risk factors of subclinical atherosclerotic cardiovascular disease (CVD) differs among patients of various ethnic backgrounds, according to the University of Wisconsin"s Multiethnic Study of Atherosclerosis, suggesting that medical practitioners should avoid generalizing from one racial/ethnic group to another.

The study included 6,176 white, black, Hispanic and Chinese participants aged 44 to 84 years from six communities in the United States. Investigators performed measurements of subclinical CVD according to standardized protocols and graded fundus images using the Wisconsin Age-Related Maculopathy Grading System.

In analyses controlled for age, sex, race/ethnicity and study location, early AMD was associated with a higher serum high-density lipoprotein cholesterol level (odds ratio per 15 mg/dL 1.16; 95 percent CI 1.01 to 1.36) and the presence of echolucent carotid artery plaque (OR for present vs. no plaque 0.37; 95 percent CI 0.18 to 0.74) in the whole cohort. Results showed interactions of race/ethnicity and early AMD for carotid intima-media thickness, increasing severity of maximum carotid artery stenosis, serum triglyceride level, subclinical CVD severity and Agatston calcium score. Few associations were found between subclinical CVD and CVD risk factors with early AMD.

Researchers at London"s Moorfields Eye Hospital conducted a double-masked, prospective, randomized, placebo-controlled trial to determine the efficacy of a combination of 5-fluorouracil (5FU) and low-molecular-weight heparin (LMWH) in treating unselected rhegmatogenous retinal detachment (RRD) undergoing primary vitrectomy.

The study included 641 patients presenting with primary RRD who were recruited from two specialized vitreoretinal units: Moorfields Eye Hospital (553 patients) and St. Paul"s Eye Unit, Liverpool (88 patients). All underwent primary vitrectomy and gas endotamponade. Adjuvant therapy in the treatment group consisted of 5 IU/ml LMWH and 200 mug/ml 5FU added to the perioperative infusion fluid. The primary outcome measure was retinal reattachment after primary vitrectomy without any reoperations at six months. Secondary outcome measures recorded at six months were the occurrence and grade of proliferative vitreoretinopathy (PVR), best-corrected visual acuity in logMAR, intraocular pressure (mm Hg), corneal clarity and complications.

The overall primary success rate was 84.4 percent; in the treatment group, the primary success rate was 82.3 percent compared with 86.8 percent in the placebo group. At six months, the final complete anatomical reattachment rate was 97.9 percent in both treatment and placebo groups. The number of patients who failed because of the development of PVR was not statistically significant: 23 in the treatment group (7.0 percent) and 14 in the placebo group (4.9 percent). There was no significant difference in the mean visual acuity at six months in the placebo group (0.48) versus the treatment group (0.53). Visual acuity at six months of patients presenting with a macula-sparing retinal detachment was significantly worse in the treatment group; no significant difference was evident between the two groups in patients who presented with a macula involving retinal detachment.

The authors concluded that primary vitrectomy has a high anatomic and visual success rate for RRD. Adjuvant therapy with 5FU and LMWH does not improve the anatomic or visual success rate of unselected primary retinal detachments undergoing vitrectomy. Because a worse visual outcome was observed in patients presenting with macula-sparing retinal detachments after adjuvant therapy, the authors suggest that this combination of 5FU and LMWH not be used routinely for primary RRD surgery.