From the editors of Review of Ophthalmology:
JANUARY IS GLAUCOMA AWARENESS MONTH
In this issue: (click heading to view article)
Secondary IOL Implantation After Simultaneous Penetrating Keratoplasty and Cataract Surgery
Researchers reported on a new approach to the two-stage surgical management of coexisting visually significant corneal opacities and cataract. The retrospective study included eyes with corneal opacities and cataract that were surgically treated with simultaneous penetrating keratoplasty and cataract surgery, followed by secondary intraocular lens implantation after removal of the corneal sutures.
Parameters used for assessment included: mean percentage of graft endothelial cell loss after IOL implantation; deviation of the postoperative mean spherical equivalent from the target refraction; and mean uncorrected distance visual acuity.
Twenty-nine eyes were included in the study. The mean baseline UDVA was 1.94 ±0.46 (a little better than 20/2000), and the mean baseline best-corrected distance visual acuity was 1.56 ±0.42 (around 20/80). The mean interval between the two surgical interventions was 13.3 ±2.2 months. The following included some of the results:
• Just before secondary IOL implantation, the mean endothelial cell density was 2,198 ±311 cells.
• The mean percentage of corneal endothelial cell loss was 7.3 percent at six months after IOL implantation (p=0.16).
• Before IOL implantation, the mean spherical equivalent was +11.75 ±3.38 D. After IOL implantation, the mean spherical equivalent improved to -0.19 ±0.93 D (p=0.003) at six months.
• The mean UDVA improved to 0.34 ±0.18 (a little worse than 20/40; p=0.017), whereas the mean corrected distance visual acuity improved to 0.18 ±0.29 at six months (a little better than 20/32; p=0.016).
• All grafted corneas maintained their clarity until the final follow-up visit.
Researchers concluded that postponing IOL implantation some months after simultaneous penetrating keratoplasty and cataract extraction had a negligible effect on the corneal graft endothelium and achieved near postoperative target refraction with significant improvement in UDVA.
SOURCE: Solaiman KAM, El-Haig WM, Borʼi A, et al. Secondary intraocular lens implantation after simultaneous penetrating keratoplasty and cataract extraction for coexisting corneal and lens opacities. Cornea 2019; Jan 9. [Epub ahead of print].
Rates of Exudative Recurrence for Inactivated Wet AMD Eyes on Interval Dosing With Bevacizumab
Investigators determined the recurrence rate of exudative age-related macular degeneration in individuals on a 12-week dosing interval of anti-vascular endothelial growth factor bevacizumab therapy.
The retrospective chart review was performed on wet AMD patients treated with anti-VEGF therapy using a “treat-and-extend” methodology at one physician's practice site over two years (2012 to 2014). Charts were evaluated for visual acuity, anti-VEGF agent used, treatment interval and duration, participation in trials while off of anti-VEGF therapy, evidence of exudation and wet AMD recurrence characteristics. The following were some of the results:
• Of 321 wet AMD patients treated, 57 eyes were without active exudation by clinical exam or optical coherence tomography and were maintained on 12-week interval suppressive anti-VEGF therapy.
• Sixteen percent (8/49) showed exudation recurrence, with an average 10 percent cumulative recurrence rate per year for eyes on bevacizumab.
• Eight eyes without active exudation were discontinued off of bevacizumab therapy.
• Sixty-three percent (5/8) of eyes discontinuing therapy demonstrated recurrence on average four months after stopping therapy.
Investigators wrote that the findings suggested that patients who were extended to 12-week interval bevacizumab therapy had on average a 10 percent chance of recurrence with each successive year. They added that discontinuing anti-VEGF therapy increased the chance of recurrence by four months.
SOURCE: Hwang RY, Santos D, Oliver SCN, et al. Rates of exudative recurrence for eyes with inactivated wet age-related macular degeneration on 12-week interval dosing with bevacizumab therapy. Retina 2018; Jan. 14. [Epub ahead of print].
Relationship Between Interocular Asymmetry of VF Defects and ONH Blood Flow in Glaucoma
Scientists investigated the association between asymmetry of visual field defects and optic nerve head blood flow in individuals with glaucoma using laser speckle flowgraphy.
A total of 170 eyes of 85 individuals with primary open-angle glaucoma were included. Scientists measured:
• intraocular pressure;
• VFs (Humphrey 24-2, SITA);
• mean blur rate in the tissue area of the optic nerve head (MBR-T) measured by laser speckle flowgraphy;
• axial length;
• circumpapillary retinal nerve fiber layer thickness (cpRNFLT);
• disc area;
• cup/disc area ratio; and
• parapapillary atrophy area (PPA) in each eye.
They divided paired eyes into better and worse eyes according to the mean deviation of VF, and examined inter-eye differences of various parameters (better MD eye minus worse MD eye). In addition, scientists assessed factors associated with differences for MD, MBR-T or cpRNFLT. Here were some of the findings:
• The MD of VF in better eyes was -10.2 ±7.3 dB and -16.8±7.4 dB in worse eyes.
• In stepwise multiple regression analyses, the following differences were significantly correlated with MD differences: MBR-T (beta, 0.26; p=0.01); cpRNFLT (beta: 0.21; p=0.04); and sex (male)(beta: 0.20; p=0.05).
• MD and MBR-T differences were significantly associated with MD differences (beta: 0.29; p=0.007).
• For cpRNFLT, differences in β-PPA area (beta: -0.26; p=0.02) and MD (beta: 0.24 p=0.02) were identified as significant factors.
Scientists determined that asymmetry of optic nerve head blood flow was significantly associated with asymmetry of VF defects in individuals with glaucoma independent of cpRNFLT.
SOURCE: Yamada Y, Higashide T, Udagawa S, et al. The relationship between interocular asymmetry of visual field defects and optic nerve head blood flow in patients with glaucoma. J Glaucoma 2018; Jan 7. [Epub ahead of print].
Simulating an Anti-VEGF Switch in nAMD: HARBOR Subanalysis
Researchers conducted a post hoc analysis of the Phase III HARBOR clinical trial—a simulated switching study that assessed the effects of continuing the same anti-vascular endothelial growth factor treatment among individuals who were typically considered for a therapy switch.
Individuals with neovascular age-related macular degeneration who demonstrated a suboptimal response after three or six months of ranibizumab treatment were identified as switching candidates. Rather than switching, however, patients continued on ranibizumab treatment, and researchers examined visual/anatomic outcomes from the time of the “hypothetical” switch.
Subjects were included in the three-month “switcher” analysis if they received three of three initial monthly ranibizumab doses, and six-month switcher analysis if they received five of six initial monthly ranibizumab doses, and achieved: ≤5-letter gain from baseline; best-corrected visual acuity 20/40 or worse; and intraretinal or subretinal fluid with central foveal thickness ≥central subfield thickness.
Researchers examined subject data at months three and six to identify those who met predetermined switching criteria. They examined BCVA and CFT from the point at which switching criteria were met through months six, 12, 18 and 24 of HARBOR, and compared them with those who didn’t meet the criteria. Main outcome measures included mean BCVA and CFT change over time from the point at which switching criteria were met (month three or six). Here were some of the findings:
• By month three, only 44 of 1,059 (4.2 percent) met inclusion criteria for hypothetical switching; and by month six, 37 of 769 (4.8 percent) individuals did.
• Individuals who met switching criteria at month three gained, on average, 5.3 letters from months three to 12, and 2.7 letters from months three to 24.
• Month-six switchers gained, on average, 1.6 letters from months six to 12, and 1.8 letters from months six to 24.
• Both three- and six-month switcher groups experienced significant CFT reductions over 24 months.
Researchers found that month-three hypothetical switchers achieved vision and anatomic improvement while remaining on their original ranibizumab treatment. They added that month-six switcher outcomes replicated those commonly reported in published anti-VEGF switching studies: stable vision or nominal improvements in vision with continued substantial anatomic improvement.
SOURCE: Zarbin M, Tsuboi M, Hill LF, et al. Simulating an anti-vascular endothelial growth factor switch in neovascular age-related macular degeneration: A HARBOR subanalysis. Ophthalmology 2019; Jan 11. [Epub ahead of print].
Cleveland Clinic Surgeon Takes on the Physician Crisis in Autobiography
Steven Wilson, MD, professor of ophthalmology and director of corneal research and the staff of the refractive surgery and cornea departments at the Cleveland Clinic's Cole Eye Institute, recently published the book, "The Making, Breaking, and Renewal of a Surgeon-Scientist: A Personal Perspective of the Physician Crisis in America." The story is described as an "autobiographical narrative about how a middle-class youth endured personal turmoil and family crisis to achieve his lifelong goal of becoming a physician ... only to be disheartened and disillusioned by the ongoing tainting of medicine by bureaucrats, bungling administrators, and federal prosecutors." Read more.
Aerie to Initiate Phase II Clinical Study in First Quarter 2019
Aerie Pharmaceuticals announced that the FDA reviewed its Investigational New Drug Application for AR-1105 (dexamethasone intravitreal implant), and authorized the company to initiate human studies in the treatment of macular edema due to retinal vein occlusion. Aerie expects to initiate a Phase II clinical study later in the first quarter of 2019. AR-1105 is a bio-erodible implant designed to release the steroid dexamethasone over a six-month period. The method of administration is intravitreal injection. Read more.
Acuity Pro Launches Pro Ten Digital Acuity Software And System
The Acuity Pro Version 10 digital acuity software and system incorporates user-interface enhancements designed for ease-of-use, and a new method of rendering optotypes for sharper appearance at the edges, its maker says. New features include optotype sizes up to 20/800, Patti Pics pediatric optotypes, facilitated macro creation and import and display of photos and videos. Acuity Pro Ten is downloadable and no longer requires a licensed piece of hardware. Visit the company at booth #1237 at SECO. Learn more.
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