Review of Ophthalmology Online



Vol. 22, #38  •   Monday, September 13, 2021


In this Issue:




Central Macular OCTA Parameters in Glaucoma

Researchers investigated the relationship between the foveal avascular zone parameters assessed by optical coherence tomography angiography and central visual field parameters in glaucoma and healthy subjects.

One hundred and eighty-eight subjects (248 eyes), including 24 healthy (38 eyes), 37 glaucoma suspects (42 eyes and 127 primary open-angle glaucoma patients [168 eyes]), underwent imaging using OCTA and standard automated perimetry using the 24-2 and 10-2 Swedish Interactive Thresholding Algorithm. OCTA-based and OCT-based FAZ parameters (superficial FAZ area, FAZ circumference), foveal vessel density (FD300) and foveal thickness were measured. Researchers assessed the correlation between FAZ parameters and VF parameters using a linear mixed model.

Here are some of the findings:
• Axial length adjusted-FAZ area wasn’t different among the three groups:
   o in healthy individuals: 0.31 (CI, 0.27 to 0.36) mm2;
   o glaucoma suspects: 0.29 (CI, 0.26 to 0.31) mm2; and
   o POAG eyes 0.28 (CI, 0.27 to 0.30) mm2 (p=0.578).
• Foveal vessel density was lower in glaucoma suspects (49.1 percent [CI, 47.9 to 50.4 percent]) and POAG eyes (48.7 percent [CI, 48.1 to 49.4 percent) than healthy eyes (50.5 percent [49.3 to 51.7 percent]) though the difference was not statistically significant (p=0.071).
• Lower foveal vessel density was associated with worse 24-2 and 10-2 VF mean deviation and foveal threshold in multivariable linear mixed models (all p<0.05).
• A smaller FAZ area was associated with lower intraocular pressure (p=0.026).

Researchers concluded that the foveal vessel density, but not FAZ area, was correlated with 10-degree central VF mean deviation and foveal threshold in healthy, glaucoma suspect and POAG eyes. In contrast, they found, a smaller FAZ area was associated with lower IOP.

SOURCE: Nishida T, Oh WH, Moghimi S, et al. Central macular OCTA parameters in glaucoma. Br J Ophthalmol. 2021 Aug 23:bjophthalmol-2021-319574. [Epub ahead of print].




Localized Choriocapillaris Perfusion & Macular Function in GA

Investigators tested the hypothesis that choriocapillaris perfusion correlates with visual function in geographic atrophy, as part of a cross-sectional, single-center study.

Investigators imaged choriocapillaris flow using 6 mm x 6 mm swept-source optical coherence tomography angiography scans and measured retinal sensitivity using fundus-guided microperimetry in the central 20 degrees in 18 eyes of 12 subjects with GA, and seven eyes of four normal subjects. OCTA scans were divided into a grid, and microperimetry results were superimposed using retinal vascular landmarks. The main outcome measure correlated choriocapillaris flow deficit with retinal sensitivity at each localized region. Robust linear mixed effects regression compared flow deficit or sensitivity with distance from the fovea. The Pearson ρ correlation described the relationship between flow deficit or retinal sensitivity and distance from the GA border.

Here are some of the findings:
• Choriocapillaris flow deficit was significantly greater in GA than normal (mean ± standard deviation 24.2 ±7.9 percent vs. 7.9 ±2.3 percent, p=0.0015), while retinal sensitivity was significantly lower in GA than normal (mean difference -17.0 ±1.2 dB, p<0.001).
• In GA, choriocapillaris flow deficit decreased (ρ=-0.40; CI, -0.54 to -0.27), while retinal sensitivity increased (ρ=+0.63; CI, 0.30 to 0.81) with distance from the GA margin.
• Choriocapillaris flow deficits inversely correlated with retinal sensitivity (ρ=-0.61; CI, -0.75 to -0.42).

Investigators found that choriocapillaris flow and retinal sensitivity improved with distance from the GA margin. Furthermore, they wrote, choriocapillaris flow deficit was inversely correlated with sensitivity, supporting the hypothesis that choriocapillaris perfusion correlated with macular function.

SOURCE: Rinella NT, Zhou H, Wong J, et al. Correlation between localized choriocapillaris perfusion and macular function in eyes with geographic atrophy. Am J Ophthalmol 2021; Aug 23. [Epub ahead of print].


Complimentary CME Education Videos


Trends in Early Graft Failure Leading to Regrafting After Endothelial Keratoplasty

Scientists reported trends in the prevalence of early graft failure after endothelial keratoplasty in the United States.

Descemet’s membrane endothelial keratoplasty and Descemet’s stripping automated endothelial keratoplasty graft volumes were collected from records maintained by six major eye banks in the United States from January 1, 2013, to December 31, 2018. The prevalence and presumed cause of early graft failures, defined as a graft with persistent edema or regrafted within eight weeks after keratoplasty, each year were sourced from surgeon-reported adverse events. Failed graft cases from the three eye banks were compared with nonfailures at the donor and recipient levels to perform a subset analysis of factors associated with early graft failure.

A total of 51,887 endothelial keratoplasty tissues were distributed during the study period; 72 percent were DSAEK grafts. Here are some of the findings:
• The total number of early graft failures reported was 168 of 14,284 (1.18 percent) for DMEK and 322 of 37,603 (0.86 percent) for DSAEK.
• Early DMEK failures decreased from 2013 (7.69 percent) to 2018 (0.68 percent).
• In generalized linear mixed model analyses adjusting for donor tissue characteristics, recipient age and diagnosis, an association of borderline significance was found between higher donor age and early failure cases [OR: 1.03; CI, 1.00 to 1.05); unit change of one year] and DSAEK [OR; 1.02; CI, 1.00 to 1.04); unit of change one year].

Scientists determined that the proportion of early graft failures in DMEK decreased over time and was comparable with failure rates in DSAEK at the end of the study period. They added that a surgical learning curve might have played a role.

SOURCE: Fliotsos MJ, Campbell JA, Li X, et al. Trends in early graft failure leading to regrafting after endothelial keratoplasty in the United States. Cornea 2021; Aug 6. [Epub ahead of print].


OCT Features of Polypoidal Lesion Closure in PCV Treated with Aflibercept

Researchers evaluated whether optical coherence tomography can determine polypoidal lesion (PL) perfusion in polypoidal choroidal vasculopathy eyes following 12-months of aflibercept monotherapy. They wrote that PL perfusion status, assessed by indocyanine green angiography, is an important anatomical outcome in PCV management.

Researchers used post hoc data from a prospective, randomized, open-label, study in eyes with PCV undergoing monotherapy with aflibercept to evaluate PL perfusion status based on ICGA (gold standard) and OCT features from baseline to 12-months.

Here are some of the findings:
• Individual PLs (110 in total) from 48 eyes (48 patients) showed at 12-months; 57/110 PLs (51.8 percent) were closed on ICGA.
• At 12-months, eyes with closed PLs were more likely to have the following OCT features:
   o no SRF (67.1 vs. 32.9 percent);
   o smaller PED height (67.2 [±43.8] vs. 189.2 [±104.9] μm);
   o densely hyper-reflective PED contents (84 vs. 16 percent);
   o an absence of a hyper-reflective ring (64 vs. 36 percent); and
   o an indistinct overlying RPE (71.4 vs. 28.6 percent)(all p<0.05).
• The three OCT features that most reliably differentiated perfused from closed PLs were: no SRF; densely hyper-reflective PED contents; and an absence of hyper-reflective ring (area under the ROC curve, respectively: 0.85, 0.73 and 0.70). A combination of these three features achieved an AUC-ROC of 0.90.

Researchers wrote that PL closure, an important anatomical treatment outcome in PCV typically defined by ICGA, can be accurately detected by specific OCT features.

SOURCE: Tan ACS, Jordan-Yu JM, Vyas CH. Optical coherence tomography features of polypoidal lesion closure in polypoidal choroidal vasculopathy treated with aflibercept. Retina 2021; Aug 16. [Epub ahead of print].




Industry News

MeiraGTx Announces Data Demonstrating Reversal of Disease Progression in X-Linked Retinitis Pigmentosaa

MeiraGTx announced new data from subjects treated in the Phase I/II dose-escalation phase of study MGT009 indicated that AAV5-RPGR, an investigational gene therapy in development for the treatment of X-linked retinitis pigmentosa, reversed the course of disease progression when retinal function was assessed 12 months when compared with retinal function in the same subjects up to 48 months prior to treatment. The data were presented at the EURETINA 2021 Virtual Meeting. Read more.


Luneau Introduces Visionix VX650

Luneau Technology introduced the Visionix VX650 ocular measuring device with retinal screening, which the company says can deliver a comprehensive eye exam in minutes, and provide screening data on anterior and posterior eye segments to identify and detect the early signs of cataracts, glaucoma, retinal and corneal pathologies. The device also offers detection and management of keratoconus. A 45-degree fundus camera along with topography, wavefront aberrometry, tomography and retinal screening are all built in. Read more.

Glaukos Submits Supplemental Pre-market Approval Application for iStent infinite

Glaukos submitted a supplemental pre-market approval application to the FDA for the iStent infinite Trabecular Micro-Bypass System. The investigational device is designed for use in a standalone procedure to reduce elevated intraocular pressure in patients with open-angle glaucoma uncontrolled by prior surgical or medical therapy. It includes three heparin-coated titanium stents preloaded into an auto-injection system that allows the surgeon to inject stents across a span of up to approximately six clock hours around Schlemm’s canal. Once in place, the stents are designed to lower IOP by restoring the natural, physiological outflow of aqueous humor. The iStent infinite is similar to the company’s two-stent iStent inject W Trabecular Micro-Bypass System. Read more.

ARVO Women’s Leadership Development Program welcomes Class of 2021

The Association for Research in Vision and Ophthalmology recently recognized the 2021 class of its popular Women’s Leadership Development Program (WLDP). The program, provided through the support of Aerie Pharmaceuticals, is a “highly interactive, year-long learning experience focused on leadership skill development and facilitating leadership opportunities and networking within ARVO.” View the Class of 2021.





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