This case report described the corneal findings and management of a 61-year-old female with vortex keratopathy following short-term, high-dose hydroxychloroquine used in the setting of a clinical trial for recurrent breast cancer.

The patient was found to have significant corneal vortex keratopathy without retinal pathology within three months of 1,200mg daily hydroxychloroquine treatment as an adjuvant medication for cancer therapy. Cessation of the medication led to the resolution of the corneal verticillata within one month, yet the vision did not return to baseline. Ultimately, remaining irregular astigmatism and ocular surface disease required a scleral contact lens to achieve a BSCVA of 20/25 OU.

Hydroxychloroquine-induced vortex keratopathy is largely considered dose and duration dependent and is uncommon with most standard treatment algorithms. However, researchers wrote that, with increasing use of high-dose hydroxychloroquine in adjunct cancer therapy, corneal findings are likely to become more frequent. They added that persistent visual impairment may occur, thus increased understanding of this pathology can aid in counseling patients and guiding treatment recommendations.

The crystalline lens plays an important role in the pathophysiology of primary angle closure (PAC) and primary angle-closure glaucoma (PACG). The aging process is associated with a progressive enlargement of the lens, resulting in greater iridolenticular and iridotrabecular contact, which exacerbates both pupillary block and appositional angle closure, irrespective of the cataract status of the lens. Cataract surgery has been shown to widen the angle and reduce intraocular pressure in eyes with PAC or PACG. Recently, clear lens phacoemulsification has been suggested as a treatment modality in such eyes.

The authors reviewed the literature on clear lens extraction in eyes with angle closure, and discussed its efficacy, safety and indications. Although, they wrote, it is evident that clear lens extraction is beneficial in eyes with PAC and PACG, it is technically challenging and should be performed by experienced surgeons who not only master the procedure, but are also able to deal with potential complications.

Authors wrote, since the follow-up of the reviewed studies was relatively short, long-term follow-up (>10 years) of patients who undergo this procedure would be needed to evaluate the safety and confirm the early benefits reported.

Geographic atrophy secondary to age-related macular degeneration (GA) is considered a single entity. This study aimed to determine whether there are GA subgroups that can be defined by their genotype and phenotype.

Individuals (196 eyes of 196 patients) 50 years or older with GA from the EYE-RISK database were included. Participants were graded for the presence of each of the following fundus features on color fundus photography: large soft drusen, reticular pseudodrusen (RPD), refractile drusen, hyperpigmentation, location of atrophy (foveal vs extrafoveal) and multifocal lesions. Genotypes of 33 single nucleotide polymorphisms previously assigned to the complement, lipid metabolism or the extracellular matrix (ECM) pathways; and ARMS2 were also included, and genetic risk scores (GRS) for each of those three pathways calculated. Hierarchical cluster analysis was used to determine subgroups of participants defined by these features. The discriminative ability of genotype, phenotype or both for each subgroup was determined with 10-fold cross-validated areas under the curve (cvAUC). The agreement between predicted and actual subgroup membership was assessed with calibration plots.

Cluster analyses identified three subgroups of GA. Subgroup 1 was characterized by high complement GRS, frequently associated with large soft drusen and foveal atrophy; subgroup 2 generally showed low GRS, foveal atrophy and few drusen (any type); and subgroup 3 presented a high ARMS2 and ECM GRS, RPD and extrafoveal atrophy. There was a high discriminative ability between subgroups for the genotype (cvAUC≥0.94) and modest for the phenotype (cvAUC<0.65), with good calibration.

Investigators identified three GA subgroups that differed mostly by their genotype. Atrophy location and drusen type were the most relevant phenotypic features.