Volume 13, Number 1
Monday, January 7, 2013


In this issue: (click heading to view article)
######### Phacoemulsification vs. Trabeculectomy in Medically Uncontrolled Chronic Angle-Closure Glaucoma Without Cataract
######### Link Between RNFL Atrophy and VF Loss Over Time in Glaucoma Suspect and Glaucomatous Eyes
######### Morphology, Prevalence, Topography and Biogenesis of Subretinal Drusenoid Deposits in Non-Neovascular AMD
######### PRK in Patients with Suspected Keratoconus
######### Briefly



Phacoemulsification vs. Trabeculectomy in Medically Uncontrolled Chronic Angle-Closure Glaucoma Without Cataract

In this prospective, randomized clinical trial, 50 medically uncontrolled chronic angle-closure glaucoma (CACG) eyes without cataract of 50 patients were investigated to compare phacoemulsification versus trabeculectomy with adjunctive mitomycin C.

Patients were randomized into undergoing either phacoemulsification or trabeculectomy with adjunctive mitomycin C. After surgery, patients were followed up every three months for two years. Main outcome measures were IOP and requirement for glaucoma drugs.

A total of 26 CACG eyes were randomized to receive phacoemulsification, and 24 eyes underwent trabeculectomy with mitomycin C. Phacoemulsification and trabeculectomy resulted in significant and comparable IOP reduction at 24 months following surgery (reduction of 8.4 mmHg or 34% for phacoemulsification vs. 8.9 mmHg or 36% for trabeculectomy; p=0.76). It was reported that over the first 24 months, trabeculectomy-treated eyes required on average 1.1 fewer drugs than phacoemulsification-treated eyes (p<0.001). However, trabeculectomy was associated with significantly more surgical complications than phacoemulsification (46% vs. 4%; p=0.001). Furthermore, eight (33%) of 24 trabeculectomy eyes demonstrated cataract during follow-up.

To conclude, both phacoemulsification and trabeculectomy are effective in reducing IOP in medically uncontrolled CACG eyes without cataract. Trabeculectomy is more effective than phacoemulsification in reducing dependence on glaucoma drugs, but is associated with more complications.

SOURCE: Tham CC, Kwong YY, Baig N, et al. Phacoemulsification versus trabeculectomy in medically uncontrolled chronic angle-closure glaucoma without cataract. Ophthalmology. 2013;120(1):62–67.


Link Between RNFL Atrophy and VF Loss Over Time in Glaucoma Suspect and Glaucomatous Eyes

The authors of the following prospective, longitudinal clinical trial compared detection of progressive retinal nerve fiber layer thickness (RNFL) atrophy identified using time-domain optical coherence tomography (TD-OCT) with visual field progression using standard automated perimetry in glaucoma suspect and preperimetric glaucoma patients or perimetric glaucoma patients.

They noted that eligible eyes with two years or more of follow-up underwent TD-OCT and standard automated perimetry every six months. They defined the occurrence of visual field progression as the first follow-up visit reaching a significant (p<.05) negative visual field index slope over time. Additionally, they defined RNFL progression or improvement as a significant negative or positive slope over time, respectively. They also defined specificity as the number of eyes with neither progression nor improvement, divided by the number of eyes without progression. The study authors calculated Cox proportional hazard ratios using univariate and multivariate models with RNFL loss as a time-dependent covariate.

They reported that 310 glaucoma-suspect and preperimetric glaucoma eyes and 177 perimetric glaucoma eyes were included in their study. A total of 89 eyes showed visual field progression and 101 eyes showed RNFL progression. The average time to detect visual field progression in those 89 eyes was 35 ± 13 months, and the average time to detect RNFL progression in those 101 eyes was 36 ± 13 months. According to the authors, in multivariate Cox models, average and superior RNFL losses were associated with subsequent visual field index loss in the entire cohort (every 10-µm loss; hazard ratio, 1.38; p=.03; hazard ratio, 1.20; p=.01; respectively). Among the entire cohort of 487 eyes, 42 had significant visual field index improvement and 55 had significant RNFL improvement (specificity, 91.4% and 88.7%, respectively).

Structural progression is associated with functional progression in glaucoma suspect and glaucomatous eyes. Average and superior RNFL thickness may predict subsequent standard automated perimetry loss.

SOURCE: Sehi M, Zhang X, Greenfield DS, et al.; Advanced Imaging for Glaucoma Study Group. Retinal nerve fiber layer atrophy is associated with visual field loss over time in glaucoma suspect and glaucomatous eyes. Am J Ophthalmol. 2013;155(1):73–82.


Morphology, Prevalence, Topography and Biogenesis of Subretinal Drusenoid Deposits in Non-Neovascular AMD

Researchers sought to characterize the morphology, prevalence and topography of subretinal drusenoid deposits, a candidate histological correlate of reticular pseudodrusen, with reference to basal linear deposit (BlinD), a specific lesion of age-related macular degeneration (AMD), and to propose a biogenesis model for both lesions.

They postfixed donor eyes with median death-to-preservation of 2:40 hours in osmium tannic acid paraphenylenediamine and prepared them for macula-wide high-resolution digital sections. They determined annotated thicknesses of 21 chorioretinal layers at standard locations in sections through the fovea and the superior perifovea.

In 22 eyes of 20 white donors (83.1 ± 7.7 years), SDD appeared as isolated or confluent drusenoid dollops punctuated by tufts of retinal pigment epithelium apical processes and associated with photoreceptor perturbation, the researchers noted. They detected subretinal drusenoid deposits and BlinD in 85 and 90% of non-neovascular AMD donors, respectively. The study researchers observed that subretinal drusenoid deposit was thick (median, 9.4 µm) and more abundant in the perifovea than in the fovea (p<0.0001). Additionally, BlinD was thin (median, 2.1 µm) and more abundant in the fovea than in the perifovea (p<0.0001).

In conclusion, subretinal drusenoid deposits and BlinD prevalence in AMD eyes are high. Subretinal drusenoid deposits organized morphology, topography and impact on surrounding photoreceptors imply specific processes of biogenesis. Contrasting topographies of subretinal drusenoid deposits and BlinD suggest relationships with differentiable aspects of rod and cone physiology, respectively. A two-lesion, two-compartment biogenesis model incorporating outer retinal lipid homeostasis is presented.

SOURCE: Curcio CA, Messinger JD, Sloan KR, et al. Subretinal drusenoid deposits in non-neovascular age-related macular degeneration: morphology, prevalence, topography, and biogenesis model. Retina. 2013;Dec 21 [Epub ahead of print].

PRK in Patients with Suspected Keratoconus

To assess the long-range outcomes of photorefractive keratectomy (PRK) using functional and topographic criteria in myopic eyes with suspected keratoconus, French investigators conducted this retrospective interventional case series. They found that PRK in eyes with suspected keratoconus based on a Placido neural network may be safe and effective for myopia and astigmatism in carefully selected patients.

They included eyes of patients classified as keratoconus suspects or keratoconus by the Corneal Navigator software of the OPD-Scan II device and treated them with myopic PRK using an EC-5000 excimer laser between 2004 and 2007. The main outcome measures were refractive stability, mean corneal keratometry, mean central pachymetry, mean thinnest point value and the occurrence of postoperative complications such as corneal ectasia.

The study evaluated 62 eyes of 42 patients. According to the researchers, the mean patient age was 34.6 years ± 15.1 (SD) and the mean spherical equivalent (SE), –3.96 ± 3.05D. They also reported that the mean central pachymetry was 529.4 ± 32.8 μm and the mean simulated keratometry, 45.75 ± 1.75D. Furthermore, the percentage of similarity to keratoconus suspects or keratoconus was positive in all 62 eyes and exceeded a 50% similarity score in 30 eyes (48.4%). The mean follow-up was 4.8 ± 1.4 years and the mean magnitude of the SE was –0.53 ± 1.35D over the follow-up. Two patients required glasses postoperatively because of significant myopic regression and no case of corneal ectasia was reported.

SOURCE: Guedj M, Saad A, Audureau E, Gatinel D. Photorefractive keratectomy in patients with suspected keratoconus: five-year follow-up. J Cataract Refract Surg. 2013;39(10):66–73.

  • HAAG-STREIT LAUNCHES NEW DIVISION. Haag-Streit USA has launched a new vision: Haag-Streit Surgical, which will market a line of surgical microscopes that already available in Europe. Formerly known as Möller-Wedel, the devices are now being offered in the United States under the new Haag-Streit Surgical brand. The company has also launched a network of independent sales representatives to introduce the product line to U.S. doctors and is leveraging its existing toll-free number and website to connect interested doctors with information on its products. The surgical microscope line will be on display at the Haag-Streit booth at leading ophthalmology conferences throughout 2013. More information is available at www.haag-streit-usa.com or by calling (800) 787-5426.
  • POSITIVE iCO-007 PHASE II CLINICAL UPDATE. In a recent news release, iCo Therapeutics Inc. announced that at the midpoint of its Phase II iDEAL study for the treatment of diabetic macular edema (DME), there have been no drug-related serious adverse events among patients receiving repeat doses of iCo-007. The trial explores whether varying combinations of iCo-007 are effective in improving visual acuity in DME patients. The Phase II trial is studying patients at 26 clinical sites across the United States and iCo also reported that it has exceeded its recruitment threshold of patients for statistical analysis of the study and expects to announce final data for the primary endpoint in the fourth quarter of 2013. Additional information on the Phase II iDEAL study can be found here as well as here.
  • U.S. LAUNCH OF JETREA SET FOR JANUARY 14. ThromboGenics NV recently confirmed its U.S. launch date of Monday, January 14, 2013 for JETREA (ocriplasmin) Intravitreal Injection, which is indicated for the treatment of symptomatic vitreomacular adhesion. The company states that the price for a single-use glass vial of JETREA is set at $3,950. For further information, visit www.jetrea.com.
  • QLT EXTENDS EXCLUSIVE OPTION AGREEMENT FOR POTENTIAL SALE OF PUNCTAL PLUG DELIVERY SYSTEM TO MATI THERAPEUTICS. QLT Inc. has entered into an exclusive option agreement with Mati Therapeutics Inc., under which QLT has granted Mati a 90-day option to acquire assets related to QLT's punctal plug drug delivery system (“PPDS”) technology in exchange for $500,000. According to QLT, the option may be extended by Mati for up to three successive 30-day periods with payment of an additional $100,000 for each extension. If Mati exercises the option, the two companies will enter into an asset purchase agreement and QLT will be entitled to a closing payment of $750,000, certain milestone payments and a low single-digit royalty on worldwide net sales of all products using or developed from the PPDS technology. Visit the company's website for more information.
  • GLAUKOS RECEIVES RED HERRING GLOBAL TOP 100 AWARD. Glaukos Corporation has been selected to receive the Red Herring Global Top 100 award, which recognizes leading private companies from North America, Europe and Asia, celebrating these startups' innovations and technologies across their respective industries. Red Herring's Top 100 Global list identifies promising new companies and entrepreneurs. Its editorial staff evaluated the companies on both quantitative and qualitative criteria, such as financial performance, technology innovation, management quality, strategy and market penetration. Visit www.glaukos.com to read more.

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