From the editors of Review of Ophthalmology:
Monday, February 11, 2019
FEBRUARY IS AGE-RELATED MACULAR
DEGENERATION AWARENESS MONTH
In this issue: (click heading to view article)
Topical ROCK Inhibitors to Treat Fuchs’ After DSO
Researchers wrote that a recent series of Fuchs’ corneal dystrophy cases treated with just Descemet’s stripping demonstrated recovery of the central endothelium without transplantation of donor cells. They also wrote that ripasudil, a rho-kinase inhibitor, has been shown to promote corneal endothelial wound healing in animal models, and aimed to prospectively evaluate its use in individuals undergoing Descemet’s stripping only (DSO) for Fuchs’.
Enrolled participants underwent DSO, with or without cataract surgery, performed by one surgeon. On the first postoperative day, individuals were assigned to topical ripasudil 0.4% (Glanatec) four times a day for two months, or no ripasudil, and followed up monthly for the first six months, and at nine and 12 months after surgery. Endothelial cell density and pachymetry were evaluated at each postoperative visit. Eighteen individuals were enrolled, including eight women and one man in each group. Here were some of the findings:
• Overall, individuals who underwent DSO with ripasudil recovered vision more quickly (4.6 vs. 6.5 weeks, p<0.01).
• The ripasudil group had a statistically significantly higher average ECD at three, six and 12 months.
• Individuals in the DSO observation group had a 10 percent decrease in peripheral ECD when comparing counts before surgery with counts 12 months after surgery (p<0.05).
• In the DSO ripasudil group, no significant difference was found between peripheral ECD at preoperative baseline vs. 12 months after surgery.
Researchers concluded that DSO with topical ROCK inhibitors might be an alternative treatment for individuals with Fuchs’ corneal dystrophy and a peripheral ECD greater than 1,000 cells/mm2.
SOURCE: Macsai MS, Shiloach M. Use of topical rho kinase inhibitors in the treatment of Fuchs’ dystrophy after Descemet stripping only. Cornea 2019; Feb 1. [Epub ahead of print].
Outcomes of Intravitreal Aflibercept for nAMD Using Treat-and-extend Regimen
Investigators reported outcomes in individuals with neovascular age-related macular degeneration after treatment with aflibercept for up to four years using a treat-and-extend regimen, as part of an observational study.
Participants included people with newly diagnosed nAMD treated with aflibercept in a treat-and-extend protocol. Subjects received three injections of aflibercept at monthly intervals followed by a treat-and-extend protocol for at least 12 months. At each clinical visit after the loading phase, optical coherence tomography and best-corrected visual acuity testing were performed to monitor of disease activity.
Main outcome measures included change in BCVA over time, number of injections and visits per year, and the percentage of individuals reaching a treatment interval of ≥12 weeks. Of 231 consecutive eyes (231 individuals) with a mean follow-up time of 2.9 (1 to 5.5) years, 173 were followed up for ≥2 years, 112 for ≥3 years and 62 for ≥4 years. Some of the findings included:
• Mean BCVA increased from 59.8 letters (20/60) at diagnosis to 65.8 letters (20/50) after the loading phase (+6 ±11.1 letters) and to 65.5 letters at 12 months (+5.7 ± 17 letters).
• After four years of treatment, mean BCVA was maintained insignificantly better than baseline (mean: 63.4 letters; gain: +3.6 ±20.6 letters; p>0.05).
To achieve this response, a mean of 7.7 ±1.2 injections and 4.4 ±1.6 clinic visits in the first year, and 4.4 ±1.9 injections and 4.3 ±1.3 clinic visits per year thereafter were required. By two years of follow-up, 46.9 percent of individuals reached a treatment interval of ≥12 weeks.
Investigators determined that individuals with nAMD maintained stable visual function over four years in a real-world setting with a reasonable treatment burden using the treat-and-extend regimen.
SOURCE: Traine PG, Pfister IB, Zandi S, et al. Long-term outcome of intravitreal aflibercept treatment for neovascular age-related macular degeneration using a "treat-and-extend“ regimen. Ophthalmology Retina 2019; Feb. 1. [Epub ahead of print].
Cataract Surgery & Rate of VF Progression in POAG
Scientists tested the hypothesis that cataract surgery slowed the apparent rate of visual field decay in primary open-angle glaucoma suspects compared with rates measured during cataract progression, as part of a retrospective cohort study.
They retrospectively reviewed consecutive OAG cases that underwent cataract surgery and had ≥4 VFs and ≥3 years of follow-up before and after surgery. They compared mean deviation (MD) rate, visual field index rate (VFI), pointwise linear regression (PLR), pointwise rate of change (PRC) and the Glaucoma Rate Index (GRI) before and after cataract surgery.
A total of 134 eyes of 99 individuals were included. Median (interquartile range) follow-up was 6.5 (range: 4.7 to 8.1) before cataract surgery and 5.3 (range: 4 to 7.3) years after cataract surgery. Here were some of the findings:
• All intraocular pressure parameters (mean IOP, SD of IOP and peak IOP) significantly improved (p<0.001) after cataract surgery.
• All VF indices indicated an accelerated VF decay rate after cataract surgery: MD rate (-0.18 ±0.40 dB/year vs. -0.40 ±0.62 dB/year, p<0.001); VFI rate (-0.44 ±1.09 percent/year vs. -1.19 ±1.85 percent/year, p<0.001); GRI (-5.5 ±10.8 vs. -13.5 ±21.5; p<0.001); PRC (-0.62 ±2.47 percent/year before and -1.35 ±3.71 percent/year after surgery; p<0.001); and PLR (-0.20 ±0.82 dB/year before and -0.42 ±1.16 dB/year after surgery; p<0.001) for all VF locations.
• Worse baseline MD and postoperative peak IOP were significantly associated with the postoperative VF decay rate and change in the decay rate after cataract surgery.
Scientists found that VFs continued to progress, despite the fact that IOP parameters improved, after cataract surgery. They added that cataract surgery didn’t slow the apparent rate of glaucomatous VF decay compared with rates measured during the progression of the cataract.
SOURCE: Kim JH, Rabiolo A, Morales E, et al. Cataract surgery and rate of visual field progression in primary open-angle glaucoma. Am J Ophthalmol 2019; Jan 28. [Epub ahead of print].
Genetics of Large PED in nAMD
Researchers hypothesized that severe forms of neovascular age-related macular degeneration such as large pigment epithelial detachments poorly responding to anti-vascular endothelial growth factor therapy might present a distinct genotype compared with an overall series of neovascular AMD.
In the multicenter genetic association study, 68 individuals presenting with PEDs resistant to ranibizumab (issued from the ARI2 study) were compared with two series of individuals derived from previously published clinical studies, presenting neovascular AMD (NAT2 study n=300 and PHRC study n=1,127) and with healthy controls (n=441). The phenotype of nAMD groups was based on visual acuity measurement, fundus examination, spectral-domain optical coherence tomography and angiographic data. All samples were genotyped for three single-nucleotide polymorphisms: CFH (rs1061170); ARMS2 (rs10490924); and C3 (rs2230199). Significant differences in allele frequency between participants with neovascular AMD and control was the main outcome measurement. Here were some of the findings:
• The GG genotype of the C3 rs2230199 was significantly more frequent in the ARI2 group (55.9 percent) than the PHRC group (6 percent, p<0.0001; OR=24 [CI, 10.4 to 55]) and the NAT2 group (5.1 percent, p<0.0001; OR=16.1 [CI, 5 to 51.9]).
• The repartition of individuals carrying a T allele of the ARMS2 (rs10490924) or patients carrying a C allele of the CFH (rs1061170) was similar in the ARI2 group when compared with the NAT2 and PHRC groups.
Researchers wrote that the genotype GG of C3 rs2230199 was more significantly associated with the phenotype of large vascularized PED poorly responding to anti-VEGF therapy than with a global AMD series.
SOURCE: Mouallem-Beziere A, Blanco-Garavito R, Richard F, et al. Genetics of large pigment epithelial detachments in neovascular age-related macular degeneration. Retina 2019; Jan 23. [Epub ahead of print].
B+L Launches Sightmatters.Com to Help People With AMD
Bausch + Lomb announced the launch of SightMatters.com, an educational online resource for people living with age-related macular degeneration, in conjunction with the start of AMD Awareness Month. B+L says that the resource, which was designed for the visually impaired with an increased font size and distinctive color contrast between different elements in the site, will help individuals take charge of their condition by offering a singular resource that is clear, concise and offers actionable content. Visitors will have the opportunity to join a supportive online community of people living with AMD, the company adds. Read more.
J&J Vision Tecnis Eyhance IOL Now Available in Europe
Johnson & Johnson Vision announced the launch in Europe of its Tecnis Eyhance intraocular lens for implantation during cataract surgery. The company says the monofocal IOL is designed to help individuals experience high-quality vision at intermediate and far distances. In addition, J&J says that data has shown a low incidence of halo, glare and starbursts, comparable with what has been reported with the Tecnis 1-piece IOL. Read more.
Eyenuk to Provide AI Eye Screening to Thousands of Italians
Eyenuk is providing EyeArt AI eye screening as part of the Month of Prevention of Diabetic Retinopathy and Maculopathy taking place throughout Italy in February. The company says that the EyeArt AI Eye Screening System is designed to make it possible for a physician to quickly and accurately detect referable DR patients in less than a minute during a diabetic patient’s regular exam. Read more.
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