From the editors of Review of Ophthalmology:
JUNE IS FIREWORKS EYE SAFETY & CATARACT AWARENESS MONTH
In this issue: (click heading to view article)
Impact of Short-term Anti-inflammatory Treatment on SLT Efficacy
Researchers examined whether short-term use of topical NSAID or steroid therapy affected the efficacy of selective laser trabeculoplasty, as part of a double-masked, randomized, placebo-controlled, dual-center, multi-surgeon trial.
Individuals over 18 years with IOP >18 mmHg for whom the clinician decided SLT would be appropriately indicated were randomized to one of three groups in a ratio of 1:1:1 as follows: ketorolac 0.5%; prednisolone 1%; or saline tears.
After SLT was performed, individuals randomized into each group were instructed to use an unmarked drop four times per day starting the day of the SLT and continuing for four additional days. Researchers used Kruskal Wallis tests and Wilcoxon Rank Sum tests for continuous variables when comparing two or three treatment groups, respectively. They used Fisher’s Exact test for categorical variables.
The primary outcome was intraocular pressure at 12 weeks. Secondary outcome measures included IOP at one and six weeks, patient-reported pain and detectable anterior chamber inflammation. A total of 96 eyes of 85 individuals fit inclusion criteria and were enrolled between the two sites. Here were some of the findings:
- The NSAID, steroid and placebo groups were similar in baseline demographics and baseline IOP (mean 23.3 ±3.9 mmHg; p=0.57).
- No statistically significant differences were found in IOP decrease among the groups at week six.
- Both the NSAID group (-6.2 ±3.1 mmHg) and steroid group (-5.2 ±2.7 mmHg) had a statistically significant greater decrease in IOP at week 12 compared with placebo (-3 ±4.3 mmHg); ANOVA p-value 0.02; T test p=0.002 for NSAID vs. placebo; p=0.02 for steroid vs. placebo.
Researchers reported better IOP reduction at 12 weeks in eyes treated with steroids or NSAID drops following SLT. They added that short-term postoperative use of NSAID or steroid drops might improve IOP reduction after SLT, although longer-term follow-up studies would be needed to confirm this.
SOURCE: Groth SL, Albeiruti E, Nunez M, et al. Steroids After Laser Trabeculoplasty (SALT) trial: Impact of short-term anti-inflammatory treatment on SLT efficacy. Ophthalmology 2019; June 5. [Epub ahead of print].
Biomechanical Parameters of Corneas Following DMEK & Contralateral Healthy Corneas
Investigators compared the biomechanical properties of the unilateral operated corneas in individuals who had undergone Descemet’s membrane endothelial keratoplasty for pseudophakic bullous keratopathy with those of the contralateral normal corneas.
The retrospective cohort study was conducted at Rabin Medical Center, Petach (Tikva, Israel) and S. Fyodorov Eye Microsurgery State Institution (Moscow). Forty eyes of 20 individuals who underwent DMEK for unilateral PBK 3.5 to 36 months earlier with normal fellow eyes were included. An Ocular Response Analyzer was used to measure corneal biomechanical properties in procedure and normal fellow eyes. The main outcome measures were corneal hysteresis and corneal resistance factor.
The mean CH (8.4 ±1.5 mmHg vs. 8.2 ± 1.5 mmHg, p=0.707) and the mean CRF (8.7 ±1.6 mmHg vs. 8.3 ±1.6 mmHg, p=0.419) values didn’t show any statistically significant difference between the procedure and the normal fellow eyes.
Investigators determined that the corneas that underwent DMEK for PBK showed normal values for biomechanical parameters. They wrote that these findings supported previous studies that have reported near-complete visual, functional and ultra-structural rehabilitation of the corneas following DMEK.
SOURCE: Shilova NF, Nahum Y, Adler A, et al. Comparative analysis of biomechanical parameters of the corneas following Descemet membrane endothelial keratoplasty and contralateral healthy corneas. Graefes Arch Clin Exp Ophthalmol 2019; June 11. [Epub ahead of print].
Pachychoroid vs. Nonpachychoroid Polypoidal Choroidal Vasculopathy and Responses to Anti-VEGF
Recent investigations have found a biphasic pattern of choroidal thickness within polypoidal choroidal vasculopathy individuals. This study aimed to investigate the relationship between choroidal thickness and the clinical features of PCV eyes.
Scientists evaluated the correlation between various clinical features including subfoveal choroidal thickness and the response to three monthly anti-vascular endothelial growth factor treatments in 62 consecutive, treatment-naive PCV individuals (66 eyes). After determining that SFCT was the only factor correlating with anti-VEGF treatment, scientists aimed to determine a best cutoff line for SFCT that could be used as a parameter to differentiate PCV patients into pachychoroid and nonpachychoroid groups using the Youden index for best combined specificity and sensitivity. They then compared the demographic features, clinical characteristics and the response to anti-VEGF to determine any differences between the two groups. Here were some of the findings:
- Subfoveal choroidal thickness was the only significant factor for the treatment effect.
- The SFCT of 267.5 µm was the best cutoff line.
- Compared with the nonpachychoroid group, the pachychoroid group revealed:
- statistically significant younger ages (64.1 ±9.6 vs. 72 ±8.2, p=0.004);
- fewer age-related macular degeneration-like features (50 vs. 81.3 percent, p=0.027);
- more central serous chorioretinopathy-like features (typical retinal pigment epithelial mottling [61.1 vs. 16.7 percent, p=0.0014]);
- greater choroidal vascular hyperpermeability (88.9 vs. 37.5 percent, [p=0.0002]); and
- less robust treatment response (27.8 vs. 83.3 percent, p<0.0001) compared with the nonpachychoroid group.
Scientists concluded that polypoidal choroidal vasculopathy patients could be subclassified into pachychoroid and nonpachychoroid groups. They also found that the pachychoroid subtype of PCV had statistically significantly younger ages, fewer age-related macular degeneration-like features, more central serous chorioretinopathy-like features and a more modest response to anti-VEGF treatment.
SOURCE: Chang YC, Cheng CK, et al. Difference between pachychoroid and nonpachychoroid polypoidal choroidal vasculopathy and their response to anti-vascular endothelial growth factor therapy. Retina 2019; June 4. [Epub ahead of print].
Clinical Factors Contributing to Postop AFI After 27-Gauge Pars Plana Vitrectomy for Primary RRD
Researchers assessed perioperative clinical factors that contribute to postsurgical aqueous flare intensity following 27-gauge pars plana vitrectomy for primary rhegmatogenous retinal detachment, as part of a retrospective clinical study.
They performed retrospective analyses of the medical records of 47 eyes of 47 individuals with primary RRD who had undergone 27-ga. PPV with a wide-angle viewing system. AFI was measured preoperatively, and one week, one month, three months, six months and 12 months after the surgery. Here were some of the findings:
- AFI significantly increased one week after the surgery (p<0.01) and then decreased over time.
- At six months after surgery, it was still statistically significantly higher than preoperative AFI (p=0.03).
- There was no statistical difference between preoperative AFI and AFI at 12 months following surgery.
- Multiple regression analyses revealed that the number of retinal photocoagulations had positive correlation with AFI at one week, one month, three months and six months; and with the performance of scleral indentation at one month and three months after the surgery.
Researchers reported that intraoperative retinal photocoagulation and scleral indentation were probable causes of increased AFI after 27-ga. PPV for RRD.
Source: Tetsumoto A, Imai H, Otsuka K, et al. Clinical factors contributing to postoperative aqueous flare intensity after 27-gauge pars plana vitrectomy for the primary rhegmatogenous retinal detachment. Jpn J Ophthalmol 2019; May 18. [Epub ahead of print].
Invitae Announces ID Your IRD Program
Invitae launched ID Your IRD, an initiative with Spark Therapeutics, to offer genetic testing at no charge to patients suspected by their health-care providers of having an inherited retinal disease. The new genetic testing panel associated with the program tests for approximately 250 genes associated with IRDs. Read more.
Aerpio Initiates Phase Ib Trial of Topical AKB-9778 Formulation for POAG
Aerpio Pharmaceuticals announced dosing of the first subject in a Phase Ib trial of a topical ocular formulation of AKB-9778 in development for treatment of primary open-angle glaucoma. The double-masked, multiple-ascending dose trial will enroll four cohorts of 12 subjects, who will receive increasing daily doses of a topical ocular formulation of AKB-9778 or placebo for seven days. The primary endpoint of the trial is ocular safety and tolerability, with IOP lowering as the key pharmacodynamic endpoint. Read more.
OcuSoft Introduces Allergy Lid Scrub
OcuSoft announced the availability of new OcuSoft Lid Scrub Allergy Eyelid Cleanser for allergy conditions in pre-moistened pads. The cleanser removes oil, debris, pollen and other contaminants from the eyelids while utilizing green tea extract, tea tree oil and PSG-2 (Phytosphingosine) to reduce redness, inflammation and itching of allergy eyelids. Read more.
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