From the editors of Review of Ophthalmology:
AUGUST IS CHILDREN’S EYE HEALTH/SAFETY MONTH
In this issue: (click heading to view article)
Changes in the Choroid After Water Drinking Test
Investigators determined whether the water drinking test altered the choroidal structure using binarization of enhanced-depth imaging (EDI) optical coherence tomographic images.
They performed a prospective study of 57 eyes of 57 normal subjects. They recorded the intraocular pressure, EDI-OCT images and laser speckle flowgraphic images at baseline, and at 15, 30, 45 and 120 min after the WDT. Investigators converted the EDI-OCT images to binary images using ImageJ software. They examined the luminal interstitial area and whole choroidal areas, in addition to the ratio of luminal area to whole choroidal area (L/W ratio), subfoveal choroidal thickness and central retinal thickness. Here were some of the findings:
• The luminal area, L/W ratio, whole choroidal area and IOP were significantly increased 30 minutes after water drinking; levels returned to baseline at 120 minutes.
• No significant changes were found in the CRT and interstitial area.
• Fluctuations in the SCT after water intake were significantly correlated with those in the L/W ratio and luminal area, but not with those of the interstitial area.
• The choroidal blood flow velocity was significantly decreased at 30 minutes.
• Fluctuations in the luminal area, L/W ratio and whole choroidal area were significantly correlated with IOP fluctuations.
Investigators determined that the changes in the SCT after water drinking were mainly due to the changes in the choroidal vascular space. They added that dilations of the choroidal vessels after water drinking might lead to choroidal thickening and subsequent IOP elevation. Investigators concluded that these findings should be considered in the evaluation of choroidal structure in individuals with retinal disease.
SOURCE: Nagasato D, Mitamura Y, Egawa M, et al. Changes of choroidal structure and circulation after water drinking test in normal eyes. Graefes Arch Clin Exp Ophthalmol 2019; Aug 5. [Epub ahead of print].
DALK: The Risk for Descemet's Membrane Folds and Their Clinical Properties
Scientists reported the clinical properties of and risk factors for corneal Descemet’s membrane folds after deep anterior lamellar keratoplasty in individuals with keratoconus, as part of a retrospective, case-control study. Study participants included 44 eyes with DM folds after DALK, and 135 eyes without DM folds after DALK (controls). Here were some of the findings:
• In 40 eyes, the DM folds appeared as one or two translucent lines in the DM layer.
• In three eyes, the folds appeared as several arcuate shape lines, and as a radial shape in one eye.
• DM folds impaired best-corrected visual acuity after DALK (p=0.018).
• Age older than 20.5 years at surgery, and disease duration longer than 5.5 years were independent risk factors for DM fold formation after DALK (OR, 5.39; CI, 2.11 to 13.73; p<0.001; 6.60, CI: 2.92 to 14.94, p<0.001).
• Preoperative Kmean (P1=0.775), Kmax (P2=0.896), central corneal thickness (P3=0.555), anterior chamber depth (P4=0.182), sex (P5=0.656), history of rigid gas permeable contact lens wearing (P6=0.237), Vogt striae (P7=1.000), stromal scar (P8=0.587) and intraoperative microperforation (P9=0.798) had no influence on the occurrence of DM folds.
SOURCE: Li X, Zhao Y, Chen H, et al. Clinical properties and risk factors for Descemet membrane folds after deep anterior lamellar keratoplasty in patients with keratoconus. Cornea 2019; Jul 31. [Epub ahead of print].
Factors Associated with Two-year Outcomes in BRVO vs. CRVO Treated with Ranibizumab
Researchers assessed characteristics associated with visual and anatomic outcomes in individuals with branch and central retinal vein occlusion treated with ranibizumab (Lucentis, Genentech). The post-hoc analysis included 205 BRVO and 181 CRVO patients from two multicenter clinical trials who completed month 12 of an extension of the Genentech-sponsored HORIZON trial.
Using logistic regression, covariates with p-value <0.20 from univariable analysis were included in multivariable models to identify independent factors associated with a given outcome (at p-value <0.05). Preset variables included disease duration and original treatment assignment.
Main outcome measures included best-corrected visual acuity ≥20/40 (≥70 letters), gain ≥15 letters and central subfield thickness ≤250 μm at HORIZON month 12. Here were some of the findings:
- In BRVO patients,
- good baseline BCVA (OR=1.53; CI, 1.30 to 1.79), male sex (OR=2.48; 1.20 to 5.13) and normal hematocrit (low vs. normal, OR=0.26; 0.12 to 0.59) predicted a BCVA ≥20/40;
- high CFT (OR=1.03; 1.01 to 1.04) and normal hematocrit (low vs. normal, OR=0.31; 0.15 to 0.66) predicted an improvement in BCVA ≥15 letters; and
- extensive baseline subretinal fluid modestly predicted CST ≤250 μm (OR=1.08; 1 to 1.16).
- In CRVO patients,
- good baseline BCVA (OR=1.59; 1.35 to 1.89), never smoking (OR=2.80; 1.27 to 6.17) and young age (OR=0.58; 0.41 to 0.82) predicted a BCVA ≥20/40;
- o never smoking (OR=2.13; 1.03 to 4.39), young age (OR=0.41; 0.28 to 0.59), poor baseline BCVA (OR=0.82; 0.73 to 0.93), hypertension (OR=4.47; 1.70 to 11.75) and low diastolic ocular perfusion pressure throughout the study (OR=0.39; 0.21 to 0.72) predicted BCVA improvement ≥15 letters; and
- young age (OR=0.65; 0.47 to 0.90), lower mean hematocrit (low vs. normal, OR=2.81; 1.06 to 7.49), high systolic OPP throughout (OR=1.61; 1.14 to 2.27), large areas of central hemorrhage (OR=1.44; 1.04 to 2) and no subretinal fluid (OR=2.15; 1.06 to 4.40) predicted CST ≤250 μm.
Researchers found substantial differences in good outcome factors in CRVO vs. BRVO, suggesting differences in pathophysiology. They added that young age, never smoking, hemodilution, hypertension/high systolic perfusion pressure were more beneficial in CRVO, suggesting that avoidance of sluggish blood flow and maintenance of perfusion might be particularly important in CRVO.
Source: Sophie R, Wang P-W, Channa R, et al. Different factors associated with two-year outcomes in patients with branch versus central retinal vein occlusion treated with ranibizumab. Ophthalmology 2019; July 23. [Epub ahead of print].
Glaucoma Drainage Devices and Reasons for Keratoplasty
Researchers aimed to determine whether the reason for an increase in the number of keratoplasty procedures had changed over the last 10 years in a tertiary care setting was associated with the increase of glaucoma drainage devices (GDDs).
They studied patients ages ≥18 who underwent keratoplasty at the Mayo Clinic from 2005 to 2006 and 2015 to 2016. They analyzed all possible reasons for keratoplasty performed in the study time period, including previously implanted GDDs in the same eye. Here were some of the findings:
• The number of keratoplasty procedures performed in the two time periods increased by 62 percent—from 163 (2005 to 2006) to 264 (2015 to 2016); GDD placements increased by 164 percent—from 80 GDDs (2005 to 2006) to 211 GDDs (2015 to 2016).
• While the performance of keratoplasty procedures increased between the two points in time, the frequency of each cause for keratoplasty didn’t change significantly.
• The majority of keratoplasties were performed due to corneal disease; GDDs made up a small portion of the reasons for keratoplasty (2005 to 2006, 4.29 percent; 2015 to 2016, 5.68 percent).
Researchers found that the frequency of GDDs as a reason for keratoplasty hadn’t changed significantly between 10 years in the tertiary care setting. They wrote further that individuals with glaucoma drainage devices who later required keratoplasties had related features including multiple surgical procedures and co-morbid infections, pseudophakic bullous keratopathy, Fuchs’ dystrophy, PXE, uveitis and congenital glaucoma.
SOURCE: Knier CG, Wang F, Baratz K, et al. Glaucoma drainage devices and reasons for keratoplasty. J Glaucoma 2019; Aug 6. [Epub ahead of print].
Stowe Subsidiary to Develop Broad-spectrum Antimicrobial Ophthalmic Therapeutics
Harrow Health’s newly formed subsidiary, Stowe Pharmaceuticals, entered into an agreement with TGV Health to acquire worldwide rights to the Zian anti-microbial molecule for ophthalmic and otic uses. Zian, a patented small molecule that’s water soluble, colorless and odorless, was developed to treat various complex bacterial, fungal and viral infections, including in the eye and ear. The initial primary indication for Stowe’s initial drug candidates is expected to be adenoviral conjunctivitis, with secondary indications for mixed bacterial-viral infections, keratitis, endophthalmitis and corneal ulcers. Stowe says that, in initial preclinical models, STE-006 was shown to be significantly more effective compared with conventional therapies against numerous bacterial and viral pathogens, including strains of MRSA and herpes simplex virus. Read more.
System to Image the Human Eye Corrects for Chromatic Aberrations
Researchers from the University of Washington, Seattle, reported on a new imaging system that cancels the chromatic optical aberrations present in a person’s eye, which they say produces a more accurate assessment of vision and eye health. By taking pictures of the eye’s smallest light-sensing cells with multiple wavelengths, the system also provides the first objective measurement of longitudinal chromatic aberrations, which could lead to new insights on their relationship to visual halos, glare and color perception, the researchers say. Read more.
Kodiak Announces Positive Data from Phase Ib Clinical Study of KSI-301
Kodiak Sciences announced positive interim results from its Phase Ib study of KSI-301, an investigational, intravitreal, anti-VEGF antibody biopolymer conjugate in individuals with anti-VEGF treatment-naïve neovascular age-related macular degeneration, diabetic macular edema and macular edema due to retinal vein occlusion. The results were presented at the American Society of Retina Specialists 2019 Annual Meeting. Across all three diseases under study, strong improvements in vision and retinal anatomy were observed over 12 weeks, Kodiak says. Read more.
Sight Sciences Hires Industry Executives
Sight Sciences announced that Jessica Holmes joined the company as vice president of health policy and reimbursement, Brian Regan joined as vice president of strategy and professional relations, and Jim Sluck joined as vice president of dry eye marketing. Read more.
Bionic Vision Technologies Hires New CEO
Australia's Bionic Vision Technologies announced that Ash Attia recently joined the company as its chief executive officer. The company says that Mr. Attia has more than 30 years of senior executive management experience in implantable devices and biotechnology.
Bionic Vision is working on an artificial vision system for patients with vision impairment. Read more.
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