From the editors of Review of Ophthalmology:
MARCH IS WORKPLACE EYE WELLNESS MONTH
In this issue: (click heading to view article)
Association of CD11b+ Monocytes and Anti-VEGF Injections in Treating nAMD & PCV
Researchers looked at whether the proportion of CD11b+ circulating monocytes was associated with the number of anti-vascular endothelial growth factor injections in neovascular age-related macular degeneration and polypoidal choroidal vasculopathy.
The observational cohort study collected data from Jan. 1, 2010, through Dec. 31, 2013, and from Jan. 1, 2015, through Dec. 31, 2018. Fresh venous blood samples were acquired for flow cytometric immune studies in individuals with neovascular AMD or PCV receiving treatment with aflibercept or ranibizumab as needed for 36 months. Individuals (n=81) without immune diseases were consecutively recruited from a single center in Denmark.
Main outcomes and measures included estimation of the number of intravitreal anti-VEGF injections given at 12, 24 and 36 months by the proportion of CD11b+ circulating monocytes and the correlation between these values. The angiogenic role of CD11b+ circulating monocytes was further evaluated by investigating the expression of the known proangiogenic receptor CCR2. Eighty-one individuals were included in the analysis (54 percent women; mean age: 76 ±7] years). Here were some of the findings:
• The proportion of CD11b+ monocytes at baseline positively estimated the future number of anti-VEGF injections at 12 months (ρ=0.77; CI, 0.35 to 0.93; p=0.004), 24 (ρ=0.82; CI, 0.44 to 0.95; p=0.002) and 36 months (ρ=0.78; CI, 0.34 to 0.94; p=0.005).
• This association was also found retrospectively in a larger sample of individuals with neovascular AMD: at 12 months (ρ=0.46; CI, 0.16 to 0.68; p=0.004), 24 months (ρ=0.49; CI, 0.20 to 0.70; p=0.002) and 36 months (ρ=0.65; CI, 0.41 to 0.80; p<0.001).
• This association was also found retrospectively in a larger sample of individuals with individuals with PCV at 12 (ρ=0.27; CI, -0.28 to 0.68; p=0.30), 24 (ρ=0.60; CI, 0.12 to 0.85; p=0.02) and 36 months (ρ=0.70; CI, 0.27 to 0.90; p=0.005).
• The findings suggested that this association was not specific to AMD but rather reflected VEGF activity in neovascularization.
• CD11b+ monocytes highly co-expressed CCR2, a monocytic marker of proangiogenic activity.
Researchers wrote that the proportion of circulating CD11b+ monocytes estimated and correlated with the number of anti-VEGF injections in individuals with neovascular AMD and PCV. They added that additional longitudinal studies would be needed to determine whether the findings had clinical relevance to influence treatment algorithms or provide novel targets for medical therapy.
SOURCE: Subhi Y, Krogh Nielsen M, Molbech CR, et al. Association of CD11b+ monocytes and anti-vascular endothelial growth factor injections in treatment of neovascular age-related macular degeneration and polypoidal choroidal vasculopathy. JAMA Ophthalmol 2019; Mar 7. [Epub ahead of print].
Posteriorly Inserted Vitreous Base After Vitrectomy
Investigators determined the preoperative characteristics, intraoperative and postoperative complications, and outcomes of eyes with a posteriorly inserted vitreous base.
In the retrospective, observational, consecutive case series at two academic centers, 37 individuals were studied who had a posteriorly inserted vitreous base noted during vitrectomy. A posteriorly inserted vitreous base was defined as posterior hyaloid membrane insertion located posterior to the vortex veins. Fifteen eyes were analyzed in a histopathologic study of donor eyes to determine the average distance of the ora serrata from the vortex veins, as investigators noted that this distance was uncertain. Here were some of the findings:
• A posteriorly inserted vitreous base was identified during vitrectomy in the following eyes: 31 with rhegmatogenous retinal detachment (84 percent), four with macular holes (11 percent), one with vitreous hemorrhage and one with epiretinal membrane.
• Adjunctive buckle was used in 24 percent of eyes; 54 percent had 360-degree laser.
• Average number of tears seen preoperatively in those with rhegmatogenous retinal detachment was 3.1.
• Thirty percent of eyes had new breaks identified intraoperatively.
• Forty-one percent of eyes had lattice degeneration; new breaks were found in 40 percent of eyes with lattice.
• Thirteen percent of rhegmatogenous retinal detachments developed proliferative vitreoretinopathy.
• Average distance from the ora serrata to the vortex veins was 7.6 mm.
Investigators determined that any eye undergoing vitrectomy might have a posteriorly inserted vitreous base, but those with a high number of retinal breaks and lattice near the equator might be at highest risk. They added that redetachment and proliferative vitreoretinopathy still occurred in the study, despite knowledge of the disorder and adjuvant treatments.
SOURCE: Sohn EH, Strohbehn A, Stryjewski T, et al. Posteriorly inserted vitreous base: Preoperative characteristics, intraoperative findings, and outcomes after vitrectomy. Retina 2019; Feb 15. [Epub ahead of print].
Quantitative Analysis of Retinal and Choroidal Vascular Parameters in LTG
Scientists assessed macular and optic disc vascular parameters in individuals with low-tension glaucoma using optical coherence tomography angiography as part of a cross-sectional study.
They prospectively acquired images from both eyes of 26 individuals with clinically diagnosed LTG and 22 age-matched volunteers with normal healthy eyes using the Zeiss swept-source OCTA (Plex Elite 9000, Carl Zeiss Meditec). And they analyzed perfusion density and vessel length density within a 5-mm diameter circle centered over the macula and optic nerve head. The final analysis cohort included 49 eyes with LTG and 40 healthy control eyes. Here were some of the findings:
• Mean age was 60 ±10 years in the LTG group and 60 ±17 years in the control group.
• The LTG group had a statistically significant reduction in perfusion density of the choriocapillaris compared with normal controls (71.74 ±8.37 percent vs. 80.48 ±3.84 percent, p<0.001).
• No statistically significant difference was found in perfusion density between LTG and control groups for the superficial vascular plexus deep capillary plexus, or optic nerve head and peripapillary area (ONH + PP) (p>0.05).
• The LTG group showed statistically significant reductions in vessel length density compared with normal controls for the superficial vascular plexus (2,083.64 ±153.76 mm/mm2 vs. 2,154.63 ±144.18 mm/mm2; p=0.03) and ONH + PP (1,813.76 ±271.69 mm/mm2 vs. 1,950.23 ±169.33 mm/mm2; p=0.03), whereas the deep capillary plexus vessel density was similar between the two groups (p>0.05).
Scientists found that eyes with LTG appeared to show a lower choriocapillaris perfusion density, as well as a lower superficial vascular plexus and ONH + PP vessel length density compared with normal eyes.
SOURCE: Tepelus TC, Song S, Borrelli E, et al. Quantitative analysis of retinal and choroidal vascular parameters in patients with low tension glaucoma. J Glaucoma 2019; March 18. [Epub ahead of print].
Management of HSV with Oral Valganciclovir in Patients Unresponsive or Allergic to Conventional Antiviral Therapy
Researchers described four cases of presumably immunocompetent patients with herpes simplex virus keratitis unresponsive (n=3) or allergic (n=1) to conventional antiviral therapy that improved with oral valganciclovir treatment.
The retrospective case series included four individuals with HSV keratitis treated with oral valganciclovir between March 2016 and June 2018. Researchers reviewed the records of individuals with recurrent epithelial HSV keratitis. Three individuals were on antiviral prophylaxis because of a history of HSV keratitis. All were on oral acyclovir, valacyclovir and/or famciclovir treatment with/without topical antiviral therapy for four to six months for prophylaxis and/or recurrent dendriform epithelial keratitis.
Three individuals had recurrent episodes during their active prophylaxis with oral antiviral therapies, and one had a recurrence after discontinuing her oral prophylactic antiviral therapy due to recurrent self-reported allergic reactions. The individuals presented with recurrent dendriform epithelial keratitis despite conventional antiviral therapy.
Researchers initiated oral valganciclovir 900 mg twice a day for 10 days as a treatment dose, followed by 900 mg daily for prophylaxis. The corneal epithelium subsequently healed within the first two weeks in all individuals. The mean follow-up time while on valganciclovir prophylaxis was eight months (range: 6 to 12 months), and no individuals presented with any further recurrences.
Researchers concluded that oral valganciclovir might present an alternative for the treatment and prophylaxis of HSV keratitis in cases of treatment-related side effects or failure with conventional antiviral therapies.
SOURCE: Koseoglu ND, Strauss BR, Hamrah P. Successful management of herpes simplex keratitis with oral valganciclovir in patients unresponsive or allergic to conventional antiviral therapy. Cornea 2019; Mar 12. [Epub ahead of print].
Aerie Initiates Phase II Clinical Trial of AR-1105
Aerie Pharmaceuticals commenced patient dosing in a Phase II clinical trial of AR-1105, its investigational dexamethasone intravitreal implant, in individuals with macular edema due to retinal vein occlusion. The study will be conducted at approximately 20 centers in the United States and enroll up to 45 patients. The primary objectives of the trial are to evaluate the safety, tolerability and efficacy of the AR-1105 dexamethasone intravitreal implant. The study will be conducted in two stages. Read more.
Alcon Acquires PowerVision
Alcon acquired PowerVision, a U.S.-based medical device development company focused on creating fluid-based intraocular lens implants. Commercial availability of the IOL technology will be determined following additional development and clinical trials of the intraocular lens. PowerVision's fluid-based design creates a continuously variable monofocal lens, utilizing the natural contraction of the eye's muscles. Alcon says this technology allows the patient to actively focus on objects, providing individuals with a natural, continuous range of vision. Under the terms of the agreement, Alcon paid $285 million to PowerVision at closing. Read more.
Genentech Presents New Data for Actemra in Treatment of Giant Cell Arteritis
At the 2019 North American Neuro-Ophthalmology Society annual meeting (March 16 to 21) in Las Vegas, Genentech presented real-world vision data for Actemra (tocilizumab) in giant cell arteritis. This new, retrospective analysis assessed disease flares and visual manifestations of 60 individuals treated with Actemra for GCA at a single center from 2010 to 2018. The researchers say that Actemra treatment was associated with a significantly reduced number of disease flares and decreased incidence of new visual manifestations in GCA patients. Read more.
Aerpio TIME-2b Study of AKB-9778 in DR Doesn’t Meet Primary Endpoint
Aerpio Pharmaceuticals announced that the company’s TIME-2b study, a Phase IIb clinical trial designed to assess the efficacy and safety of its lead candidate, AKB-9778, for moderate to severe non-proliferative diabetic retinopathy didn’t meet the primary endpoint. Administration of AKB-9778 twice daily didn’t increase the percentage of patients with an improvement of two or more steps in the study eye’s diabetic retinopathy severity score compared with placebo. Read more.
SynergEyes Launches Tangible Hydra-PEG Coating on SynergEyes VS Scleral Lens
SynergEyes announced that the SynergEyes VS scleral lens is now available with Tangible Hydra-PEG on Contamac material. The Tangible Hydra-PEG coating is designed to solve the problem of contact lens discomfort and dry eyes by minimizing deposits and lens fogging, increasing lens surface water retention, improving wettability, increasing lubricity and increasing comfort, the company says. SynergEyes VS lenses are now available in the United States in both Contamac Optimum Extreme material with Tangible Hydra-PEG as an option, and Menicon Z material, available with its own proprietary plasma treatment. Read more.
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