Review of Ophthalmology Online



Vol. 20, #45   •   Monday, October 26, 2020


In this Issue:


DALK After ALK to Improve Visual Outcomes

Researchers reported on a series of patients who underwent deep anterior lamellar keratoplasty after previous anterior lamellar keratoplasty to improve their visual outcomes, as part of a retrospective case series of nine DALK eyes (nine individuals) with a history of previous ALK and an unsatisfactory visual outcome.

Surgery was performed in all cases at least three years after ALK. Cannula big bubble, air viscobubble and manual dissection techniques were performed. Researchers evaluated preoperative and postoperative best-corrected visual acuity, residual recipient bed thickness and endothelial cell count. Follow-up was at least 24 months for all eyes.

Here were some of the findings:
• Two subtotal anterior lamellar keratoplasties (through one type 1 big bubble and one air viscobubble) and seven manual dissection DALKs were achieved.
• A small rupture of the residual recipient bed occurred during one case, which was managed without penetrating keratoplasty conversion.
• Mean best-corrected visual acuity improved from 0.64 to 0.09 logMAR.
• Postoperative residual recipient central bed thickness was less than 80 μm in all cases.
• No postoperative complications were recorded at the last follow-up (24 to 36 months postoperatively).

Researchers wrote that different DALK techniques can be successfully used to improve visual acuity in previous ALK eyes with an unsatisfactory visual outcome.

SOURCE: Sarnicola C, Sarnicola E, Cheung AY, et al. Deep anterior lamellar keratoplasty after previous anterior lamellar keratoplasty to improve the visual outcomes. Cornea 2020; Oct 9. [Epub ahead of print].


Complimentary CME Education Videos


Retinal Layer Thickness in Fellow Eyes with Unilateral CRAO

Investigators evaluated microstructural changes in the macular inner retinal layers over time in the fellow eyes of patients with unilateral central retinal artery occlusion.

Spectral-domain optical coherence tomography scans of 16 individuals with central retinal artery occlusion were performed at the initial exam (first day), and at the first, third and sixth month, and the central macular thickness and inner retinal layer thicknesses in the fellow eyes were compared between each visit. The thicknesses of retinal nerve fiber layer, ganglion cell layer (GCL), inner plexiform layer (IPL) and inner nuclear layer (INL) were calculated in nine quadrants according to the definition by the Early Treatment Diabetic Retinopathy Study.

Here were some of the findings:
• CMT decreased over a six-month period, but the difference was insignificant among visits (p=0.072).
• No significant differences were found in the thicknesses of RNFL and GCL among visits (p>0.05 for all quadrants).
• Within six months of follow-up, in the fellow eyes of individuals with CRAO, thinning was detected in:
   o the parafoveal superior and perifoveal superior quadrants of the IPL (p=0.007, p=0.01); and
   o the parafoveal temporal quadrant of the INL (p=0.033).

Investigators reported that their findings demonstrated subclinical alterations of the macular inner retinal layers over time in the fellow eyes of CRAO patients.

SOURCE: Mirza E, Mirza GD, Oltulu R, et al. Subclinical inner retinal layer thickness changes in the fellow eyes of patients with unilateral central retinal artery occlusion: A pilot study. Int Ophthalmol 2020;40:11:2979-86.


Complimentary CME Education Videos


Short-term Choroidal Vascular Changes After Aflibercept for nAMD

Scientists evaluated choroidal vascular changes in individuals with neovascular age-related macular degeneration treated with aflibercept injection over a three-month period.

Scientists retrospectively analyzed enhanced depth imaging optical coherence tomography scans of 60 eyes with treatment-naïve nAMD and 60 unaffected fellow eyes. They collected data at baseline and after three monthly intravitreal injections of aflibercept. ImageJ software was used to binarize OCT scans and measure total choroid area (TCA), luminal area (LA) and stromal area (SA). Choroidal vascularity index (CVI) was defined as the ratio of LA to TCA.

Here were some of the findings:
• After treatment, subfoveal choroidal thickness (CT) in nAMD eyes significantly decreased from 210.6 ±61.6 to 194.6 ±58.7 μm (p<0.001);
   o TCA from 1.620 ±0.502 to 1.500 ±0.451 mm2 (p< 0.001);
   o LA from 1.075 ±0.335 to 0.985 ±0.307 mm2 (p< 0.001);
   o SA from 0.545 ±0.176 to 0.516 ±0.153 mm2 (p=0.005); and
   o CVI from 66.36 ±2.89 to 65.46 ±2.87 percent (p=0.009).
• The decrease of CVI after treatment was significantly correlated with baseline CVI (Rs=0.466, p<0.001), but not with the change in BCVA and presence of dry macula after treatment (always p>0.05).

Scientists wrote that choroidal thickness and vascularity significantly decreased after treatment with aflibercept in nAMD eyes. They added that, in addition to the pharmacologic effect on the neovascular lesion, aflibercept may also induce vascular changes on the underlying choroid.

SOURCE: Pellegrini M, Bernabei F, Mercanti A, et al. Short-term choroidal vascular changes after aflibercept therapy for neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2020; Oct 13. [Epub ahead of print].


Time-course Changes in ONH Blood Flow & RNFL Thickness in OAG Eyes

Researchers assessed whether decreased optic nerve head blood flow (ONH BF) preceded or followed decreased circumpapillary retinal nerve fiber layer thickness (cpRNFLT) in eyes with open-angle glaucoma, as part of a retrospective, longitudinal study.

Participants included 350 eyes of 225 OAG patients. Data was collected from each subject from at least five exams over two years made with laser speckle flowgraphy (LSFG) and optical coherence tomography.

In the superior, temporal and inferior ONH quadrants, tissue-area mean blur rate (MT), representing ONH-tissue BF, was measured with LSFG, while cpRNFLT was measured with OCT. A multivariable linear mixed-effects model was used to identify potential predictors of faster MT decrease, adjusting for possible confounding factors.

Each quadrant of each patient was assigned a risk point if it was superior or temporal: patient age older than median (61 years); and patient pulse rate higher than median (74 bpm). The quadrants were then compared with a mixed-effects Cox model for MT and cpRNFLT changes, defined as a difference between the baseline value and the values from the latest two consecutive follow-up visits greater than 1.96—the corresponding coefficient of variation.

Main outcome measures included ophthalmic and systemic variables, and MT and cpRNFLT in the superior, temporal and inferior quadrants.

Here were some of the findings:
• The multivariable model showed that MT decrease was faster in older individuals with higher pulse rates and slower in inferior quadrants (p<0.05).
• Quadrants with zero risk points showed primary cpRNFLT decreases (p=0.048).
• One-risk point quadrants showed simultaneous cpRNFLT and MT decreases (p=0.260).
• Two-risk and three-risk point quadrants showed primary MT decreases (p<0.001).

Researchers concluded that older patients with higher pulse rate were at greater risk of a primary reduction in ONH-tissue BF, i.e., preceding cpRNFLT decrease, in the superior and temporal quadrants.

SOURCE: Kiyota N, Shiga Y, Omodaka K, et al. Time-course changes in optic nerve head blood flow and retinal nerve fiber layer thickness in eyes with open-angle glaucoma. Ophthalmology 2020; Oct 13. [Epub ahead of print].






Industry News

New Portable Fundus Imager from Volk

If you regularly visit patients in nursing homes, need to get a fundus image in the parking lot to follow your COVID-19 protocols or participate in screening events, Volk Optical says its new VistaView portable mydriatic retinal camera may be worth a look. The VistaView integrates Volk’s high-resolution, all-glass, double aspheric optics with an intuitive digital platform to capture sharp, wide-field fundus images while managing patient data right on the device, the company says. Volk says the VistaView is an all-in-one device that offers the widest field of view of any mydriatic fundus camera in its class at 55 degrees. The onboard app includes features such as image review, enhancement and analysis; and instant password protected report generation and transmission. A voice capture option leaves both hands free to position the device for the best quality images, the company adds. The device has both autofocus and manual focus modes, as well as an illumination adjustment to help make photophobic patients more comfortable. Password protected reports and DICOM images are easily shared or exported for billing, consultation and referral, Volk says. Learn more.



Apellis Announces Data from Phase Ib Study of Pegcetacoplan

Apellis Pharmaceuticals announced 18-month data from the Phase Ib APL2-103 study of pegcetacoplan (APL-2) in individuals with advanced geographic atrophy secondary to age-related macular degeneration and low vision. The study, which enrolled 12 patients with bilateral GA, assessed the safety of the Phase III formulation of pegcetacoplan (15 mg/0.1mL). Individuals were dosed monthly with pegcetacoplan in one eye using the fellow eye as an untreated control. In the current post hoc analysis, the growth rate of GA lesions in the treated eye was on average 52 percent (mean square root) slower than the opposite untreated eye (p=0.01). Of the 12 enrolled patients, no reported cases of inflammation were found, and one patient (8 percent) developed new-onset exudation at month 12. Read more.



Adverum to Present Data from the OPTIC Phase I Trial of ADVM-022

Adverum Biotechnologies will present additional clinical data for cohorts one to four in its OPTIC Phase I clinical trial of ADVM-022 intravitreal injection gene therapy in wet age-related macular degeneration during a live broadcast at the American Academy of Ophthalmology 2020’s virtual meeting. See the schedule of presentations.



Katena Acquires Micro-Select Instruments

Katena Products, a global provider of precision ophthalmic instruments, biologics and devices announced the purchase of Micro-Select Instruments. Micro-Select, located in St. Clair, Missouri, specializes in manufacturing high-precision ophthalmic instruments including forceps, needle holders and speculums. Read more.



Fighting Blindness to Host Free Webinar on Low-vision Resources

The Foundation Fighting Blindness is hosting a low-vision webinar to inform eye-care professionals about opportunities to enhance quality of life for their retinal disease patients. The organization says the interactive webinar is appropriate for all eye-care professionals, including retinal specialists, ophthalmologists, optometrists, rehabilitation professionals, occupational therapists, and orientation and mobility instructors. Register for the webinar.






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