From the editors of Review of Ophthalmology:
JANUARY IS GLAUCOMA AWARENESS MONTH
In this issue: (click heading to view article)
Using SS-OCT VRI Slab vs. FA to Detect Diabetic Retinal Neovascularization
Researchers compared neovascularization in proliferative diabetic retinopathy eyes, identified by widefield swept-source optical coherence tomography angiography using vitreoretinal interface (VRI) slab images composed by automated and manual segmentation, with that identified by fluorescein angiography.
The retrospective study included 42 eyes of 30 treatment-naïve PDR patients who visited the outpatient clinic of the Ophthalmology Department of Nagano, Japan’s Shinshu University from June 2018 through October 2019.
All individuals underwent comprehensive ophthalmological exams, including SS-OCTA and FA. Researchers compared NV detected by en face SS-OCTA 15×15-mm VRI slab images and FA in the same 15×15-mm areas in terms of number and structure. Here were some of the findings:
• Among 100 NVs detected by FA, 73 were also visualized as NV in SS-OCTA VRI slab images using automated segmentation.
• The sensitivity of VRI slab images for detecting NV was 73 percent.
• Among the remaining 27 NVs detected only by FA, but not by VRI slab:
o 15 were intraretinal microvascular abnormalities with fluorescence leakage;
o one was a diabetic papillopathy; and
o 11 were flat NVs on the internal limiting membrane surface that were missed because of segmentation error.
• Among the 98 NVs detected on VRI slab images:
o 25 weren’t detected as NVs by FA;
o nine were small NVs that exhibited too little leakage on FA; and
o 16 were false-positives due to segmentation errors.
• After reconstruction of SS-OCTA VRI slab images by means of manual segmentation, the sensitivity of VRI slab images for detecting NVs increased to 84 percent.
Researchers determined that the efficacy of SS-OCTA VRI slab images for detecting NVs in PDR was comparable to that of FA. They wrote that SS-OCTA VRI slab images might be better than FA for differentiating intraretinal microvascular abnormalities and diabetic papillopathy from NVs. They noted that FA and SS-OCTA VRI slab images demonstrated differences in identification efficacy in cases of small and flat NVs, and suggested that further exploration of SS-OCTA technology was warranted to address this issue.
Source: Hirano T, Hoshiyama K, Hirabayashi K, et al. Vitreoretinal interface slab in optical coherence tomography-angiography for detecting diabetic retinal neovascularization. Ophthalmology Retina 2020; Jan 10. [Epub ahead of print].
Corneal Light Scatter After Ultrathin DSAEK vs. DMEK
Investigators compared the degree of corneal light scatter as measured by densitometry in ultrathin Descemet’s stripping automated endothelial keratoplasty vs. Descemet’s membrane endothelial keratoplasty in the Descemet Endothelial Thickness Comparison Trial (DETECT).
In the pre-specified secondary analysis of the DETECT prospective, randomized controlled trial, subjects with isolated endothelial dysfunction were enrolled and randomized to UT-DSAEK or DMEK. Corneal opacity was quantitatively measured by Pentacam densitometry (OCULUS) at three, six and 12 months.
Fifty eyes of 38 individuals were enrolled at the Casey Eye Institute at Oregon Health & Science University and the Byers Eye Institute at Stanford University. Here were some of the findings:
• Corneal densitometry for the anterior and posterior layers improved in both UT-DSAEK and DMEK after surgery; the decrease was more pronounced in the posterior layer for both groups.
• No difference was found in the degree of corneal light scatter between UT-DSAEK and DMEK at postoperative month 12.
• No difference was observed in the densitometry change between the two arms from baseline to month 12.
Investigators found that the UT-DSAEK and DMEK groups improved in the degree of corneal light scatter after surgery. However, investigators found no difference in densitometry between the two groups at month 12. Therefore, they wrote, other factors such as higher order aberrations in the posterior cornea rather than stromal-stromal interface haze must mediate the superior visual outcomes in DMEK compared with UT-DSAEK.
SOURCE: Hirabayashi KE, Chamberlain W, Rose-Nussbaumer J, et al. Corneal light scatter after ultrathin Descemet stripping automated endothelial keratoplasty versus Descemet membrane endothelial keratoplasty in Descemet endothelial thickness comparison trial: A randomized controlled trial. Cornea 2020; Jan 14. [Epub ahead of print].
Fewer Microaneurysms in DME After Anti-VEGF
Scientists evaluated changes in the numbers of microaneurysms (MAs) on fluorescein angiography and indocyanine green angiography (ICGA) in eyes with diabetic macular edema following intravitreal injection of anti-vascular endothelial growth factor agents.
Twenty-one eyes of 16 individuals with DME were included in this retrospective study. All patients received an initial loading dose of three monthly injections of anti-VEGF agents; thereafter, they received a pro re nata
regimen for at least 12 months of follow-up. FA and ICGA images were obtained before and at six months after the initial injection. Here were some of the findings:
• The median numbers of MAs significantly decreased from six (interquartile range [IQR], three to seven) MAs to two (IQR, one to three) MAs in early-phase FA; three (IQR, three to five) leaky MAs to one (IQR, zero to two) leaky MA in late-phase FA; and two (IQR, one to four) MAs in late-phase ICGA at baseline to one (IQR, zero to two) MA in late-phase ICGA at six months (p
<0.0001 for all).
• Only the median numbers of MAs in late-phase ICGA at baseline and at six months were significantly higher in the recurrent DME group (13 eyes) than in the non-recurrent DME group (five eyes) (p
=0.0185 and p
Scientists reported that intravitreal injection of anti-VEGF agents reduced the numbers of MAs in individuals with DME. They added that the numbers of MAs detected by late-phase ICGA might be useful predictors of DME recurrence.
SOURCE: Mori K, Yoshida S, Kobayashi Y, et al. Decrease in the number of microaneurysms in diabetic macular edema after anti-vascular endothelial growth factor therapy: Implications for indocyanine green angiography-guided detection of refractory microaneurysms. Graefes Arch Clin Exp Ophthalmol 2020; Jan 21. [Epub ahead of print].
GCC Thickness & Macula Vessel Density Loss in POAG
Researchers characterized the rate of change of ganglion cell complex thickness and macula vessel density in healthy, pre-perimetric glaucoma and primary open-angle glaucoma eyes, as part of a prospective, longitudinal study.
A total of 139 eyes (23 healthy eyes, 36 pre-perimetric glaucoma eyes and 80 POAG eyes) of 94 individuals who had at least three visits were included from the Diagnostic Innovations in Glaucoma Study. The mean follow-up was two years for healthy eyes, 2.6 years for pre-perimetric glaucoma eyes and 2.6 years for POAG eyes.
Optical coherence tomography angiography-based vessel density and OCT-based structural thickness of the same 3 mm2
GCC scan slab were evaluated at each visit. Researchers calculated the dynamic range-based normalized rates of vessel density and thickness change, and compared them within each diagnostic group. They evaluated the association between the rates of thickness and vessel density change, and potential factors including severity of disease and intraocular pressure.
The main outcome measures were the rates of GCC thinning and macula vessel density loss. Significant rates of whole-image GCC thinning and macula vessel density decreases were detectable in all diagnostic groups (all p
<0.05). Here were some of the findings:
• In healthy eyes and pre-perimetric glaucoma eyes, the normalized rates of GCC thinning and macula vessel density decrease were comparable (all p
• The normalized rate (mean; 95% CI) of macula vessel density decrease in POAG eyes (-7.12; CI, -8.36 to -5.88 percent/year) was significantly faster than GCC thinning (-2.13; CI, -3.35 to -0.90 percent/year) (p
• In the POAG group, more than two-thirds of eyes showed faster macula vessel density decreases than GCC thinning; the faster macula vessel density decrease rate was significantly associated with worse glaucoma severity (p
• The association between GCC thinning rate and glaucoma severity wasn’t significant (p
• IOP during follow-up significantly affected the rate of GCC thinning in all groups (all p
<0.05), but had no association with the rate of macula vessel density decrease.
Researchers uncovered that both GCC thinning and macula vessel density decrease were detectable over time in all three diagnostic groups. They determined that, in POAG eyes, the macula vessel density decrease was faster than GCC thinning and associated with the severity of disease. Researchers concluded that macula vessel density was useful for evaluating glaucoma progression, particularly in more advanced disease.
SOURCE: Hou H, Moghimi S, Proudfoot JA, et al. Ganglion cell complex thickness and macula vessel density loss in primary open angle glaucoma. Opthalmology 2019; Jan 13. [Epub ahead of print].
Ocuphire Pharma In-license Phase II Oral Small Molecule Drug Candidate for DR & DME from Apexian Pharmaceuticals
Ocuphire Pharma entered into an agreement with Apexian Pharmaceuticals granting Ocuphire an exclusive worldwide sublicense to Apexian’s Ref-1 Inhibitor program, including its lead drug candidate APX3330, for all ophthalmic and diabetic indications. APX3330 is a first-in-class, orally administered, small molecule drug candidate that selectively targets and inhibits the reduction-oxidation effector factor-1(Ref-1) protein, a novel upstream regulator of critical transcription factors controlling inflammatory and angiogenesis pathways implicated in diabetic retinopathy and diabetic macular edema, the company says. Read more.
New Lid Hygiene System from Bruder
Bruder recently introduced a Hygienic Eyelid Care Kit. The kit contains:
· Bruder Moist Heat Eye Compress (1)
· Bruder Hygienic Eyelid Sheets (10)
· Bruder Hygienic Eyelid Cleansing Wipes (30)
· Bruder Hygienic Eyelid Solution (1 fl. oz.)
Bruder also offers a Hygienic Eyelid Cleansers Combo Pack that offers 30 Bruder Hygienic Eyelid Cleansing Wipes and a 1 fl. oz. bottle of Bruder Hygienic Eyelid Solution. If someone from your practice plans to attend the SECO meeting (March 4 to 8, in Atlanta), the kit will be available for ordering at booth #625. Learn more.
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