Researchers report increasing interest in anti-VEGF therapy for treating proliferative diabetic retinopathy, since anti-VEGF therapy has been shown to be noninferior to panretinal photocoagulation, the heretofore standard treatment for achieving regression and stabilization of PDR. Their study shows that interruptions in anti-VEGF treatment for PDR can result in marked progression of disease and potentially devastating visual consequences.
In a retrospective, multicenter case series, researchers analyzed 13 eyes of 12 patients with type 2 diabetes, aged 57 ±10 years. To reflect real-world conditions in which diabetic patients tend to “underuse eye care services and are prone to significant losses to follow-up” because of illness, financial hardship or noncompliance, the study sample included only those patients who were temporarily lost to follow-up and treated exclusively with anti-VEGF therapy for either PDR or nonproliferative diabetic retinopathy, with or without diabetic macular edema.
Baseline disease characteristics, cause and duration of treatment interruption, resulting disease progression, complications and outcomes were assessed. Reasons for treatment hiatus (median: 12 months) included intercurrent illness (31 percent), noncompliance (31 percent) and financial issues (15 percent). The authors report that 77 percent of eyes lost ≥3 lines of visual acuity on the Snellen chart, with 46 percent of eyes having a final visual acuity of hand motion or worse.
Though studies have shown closely-monitored anti-VEGF therapy is effective, especially for ischemic diabetic retinopathy and PDR, the study authors conclude that these controlled studies may give false assurance because anti-VEGF therapy is unable to reverse retinal ischemia or fully address diabetic retinopathy. Additionally, the real-world situations faced by diabetic patients lead to interruptions in treatment that negatively affect outcomes.
J Ophthalmol 2019;204:13-18.
Wubben TJ and Johnson MW. For the Anti-VEGF Treatment Interruption Study Group.
Impact of EBMD and SND on Biometry Measurements
In a retrospective case series, researchers from Duke University analyzed 39 eyes of 30 patients who were evaluated for cataract surgery with documented evidence of Salzmann’s nodular degeneration (SND) or epithelial basement membrane dystrophy (EBMD) and who were also scheduled for surgical intervention for corneal irregularities before cataract surgery. The study found that SND and EBMD can adversely affect keratometry and biometry measurements for IOL selection. Here are some of the findings:
• The EBMD group (26 eyes). The difference in K measurements before and after intervention showed a mean K value increase (p< 0.001). For biometry, the predicted IOL spherical power closest to a spherical equivalent of zero (p<0.001) changed in 21 of 26 eyes (8=0.5 D; 9=1.0 D; 4>1.0 D). For toric IOL-eligible eyes, there was a mean predicted cylinder power change of 1.2 D; recommended toric power changed for 16 of 24 eyes.
• The SND group (13 eyes). The difference in K measurements before and after intervention showed a mean K value increase (p=0.023). For biometry, the predicted IOL spherical power closest to a SE of zero (p<0.041) changed in 11 of 13 eyes (3=0.5 D; 3=1.0 D; 5>1.0 D). For toric IOL-eligible eyes, there was a mean predicted cylinder power change of 1.5 D; recommended toric power changed for 10 of 11 eyes.
The researchers conclude that EBMD and SND have significant effects on biometry measurements and IOL calculations, and that optimizing the ocular surface and being aware of the effects of these conditions are important steps in planning cataract procedures. REVIEW
J Cataract Refract Surg 2019;45:1119-1123.
Goerlitz-Jessen MF, Gupta PK, Kim T. De Salles MC, Amrén U, Kvanta A, and Epstein DL.