Volume 14, Number 10
Monday, March 10, 2014


In this issue: (click heading to view article)
######### Retinal Vascular Abnormalities in Neovascular AMD
######### Mortality of Patients with CRVO
######### How Nepafenac Eye Drops Affect IOP in Eyes with Cataract
######### Changes in Intraoperative and Postoperative Corneal Thickness Following CXL Therapy
######### Briefly

Retinal Vascular Abnormalities in Neovascular AMD

To determine the prevalence of retinal vascular abnormalities (RVA) in neovascular age-related macular degeneration (AMD), a post hoc subanalysis of images acquired during a Phase III randomized, controlled trial was undertaken, selecting images from participants with untreated, neovascular AMD in at least one eye.

Protocol mandated fundus photographs and fluorescein angiograms were acquired at baseline and year two, from 107 sham-treated study eyes with neovascular AMD and 107 untreated fellow eyes. Images were reanalyzed by an independent reading center for the presence of RVA, defined as at least one of the following: microaneurysms; vessel staining or leakage; dilated or tortuous vessels; intraretinal hemorrhage; vessel sheathing or narrowing; capillary nonperfusion; or capillary infarcts.

The baseline prevalence of RVA in the sham-treated study eyes was 14.4% (15 of 104 gradable images) versus 8.3% (five of 60) in the fellow eyes with dry AMD. The baseline prevalence of individual RVAs in study eyes was: microaneurysms (6.7%), vessel staining or leakage (6.7%); dilated or tortuous vessels (4.8%); intraretinal hemorrhage (4.8%); vessel sheathing or narrowing (2.9%); capillary nonperfusion (0%); and capillary infarcts (0%). Results were similar at 24 months.

Compared with several studies that relied solely on fundus photographs, this study included fluorescein angiography and found a higher prevalence of RVAs occurring in eyes with neovascular AMD.

SOURCE: Jackson TL, Danis RP, Goldbaum M, et al. Retinal vascular abnormalities in neovascular age-related macular degeneration. Retina. 2014;34(3):568–575.

Mortality of Patients with CRVO

Researchers in Denmark assessed mortality in patients with central retinal vein occlusion (CRVO) in the following registry-based cohort study.

Included were 439 photographically verified CRVO patients and a control cohort of 2,195 unexposed subjects matched by age and gender and alive on the date CRVO was diagnosed in the corresponding case. The researchers used data from nationwide registries to compare mortality rates in CRVO patients with a control cohort over a mean follow-up of 5.1 years for cases and of 5.7 years for controls. Hazard ratios (HRs) obtained by Cox regression and standardized mortality ratios (SMRs) stratified by age and gender served as measures of relative mortality risk.

According to the researchers, mortality was higher in patients with CRVO (HR, 1.45; 95% confidence interval [CI], 1.19 to 1.76) than in the control cohort, adjusted for age, gender and time of diagnosis. They noted that mortality was comparable between the two groups (HR, 1.19; 95% CI, 0.96 to 1.46) when adjusting for overall occurrence of cardiovascular disease and diabetes. Additionally, subgroup analysis found that the age-stratified mortality rate was increased significantly in the total group of men (SMR, 1.27; 95% CI, 1.03 to 1.56) and in women 60 to 69 years of age (SMR, 1.94; 95% CI, 1.22 to 3.08).

In conclusion, CRVO was associated with an overall increase in mortality compared with controls that was attributed statistically to cardiovascular disorders and diabetes. The researchers recommend treatment of hypertension and diabetes, if present, and referral of patients found to have CRVO who are not already being treated by a primary care physician.

SOURCE: Bertelsen M, Linneberg A, Christoffersen N, et al. Mortality in patients with central retinal vein occlusion. Ophthalmol. 2014;121(3):637–642.

How Nepafenac Eye Drops Affect IOP in Eyes with Cataract

The authors of the following prospective, randomized clinical trial reported the effect of nepafenac (0.1%) eye drops on intraocular pressure (IOP) in eyes with cataract.

They included 327 patients with bilateral cataracts in an institutional setting. They noted that all patients had a baseline IOP ≤21 mmHg without a history of intraocular surgery in the past three months. The authors randomized one eye of each individual to the treatment group, with the other eye acting as a control. They instilled nepafenac (0.1%) eye drops three times a day in the eye that received treatment and measured IOP with Goldmann applanation tonometer (GAT) at baseline and at four and eight weeks. Proportion of eyes with an IOP elevation of >4 mmHg was the main outcome measure.

The mean age of the participants was 45.7 ± 4.4 years. Participants included 192 female and 135 male patients. The study authors reported that the mean IOP at baseline in the treated and control eyes was, respectively, 13.8 ± 2.5 mmHg and 13.4 ± 3.0 mmHg, which reduced to 12.0 ± 2.0 mmHg and 12.1 ± 1.5 mmHg, respectively, at the end of eight weeks. While this reduction in IOP in both groups was significant (p<0.01), the difference between the IOP in the treated and control eyes at eight weeks was not statistically significant (p=0.34). One eye in the treated group and two eyes in the control group had an IOP elevation of >4 mmHg.

Nepafenac eye drops do not increase the IOP, the authors concluded. They can possibly be used as an alternative to steroid medications where steroid responsiveness is a concern.

SOURCE: Dave P, Shah K, Ramchandani B, Jain R. Effect of nepafenac eye drops on intraocular pressure: a randomized prospective study. Am J Ophthalmol. 2014;157(3):735–738.

Changes in Intraoperative and Postoperative Corneal Thickness Following CXL Therapy

In this study, investigators assessed intraoperative and postoperative changes in corneal thickness subsequent to riboflavin-UVA (collagen crosslinking [CXL]) treatment.

They treated 41 eyes of 41 patients (mean age 27.97 ± 6.97 years) with CXL technique. During treatment, they instilled isotonic riboflavin and obtained corneal thickness measurements at the cornea apex, the thinnest point, and the pupil center at 15 and 30 minutes, then three days, one week, and one, three, six, and 12 months after surgery using Pentacam HR and an ultrasound pachymeter.

The investigators detected a decrease in corneal thickness 15 minutes intraoperatively with a value of 108.95 ± 48.6 µm, and 112.35 ± 47.3 µm at 30 minutes (p<0.001). Three days after the operation, they found no deviation from the initial values (p=0.17). No further changes were detected during the follow-up period.

To conclude, isotonic riboflavin solution used during CXL treatment resulted in a significant decrease in corneal thickness, but its effect had disappeared by postoperative day three.

SOURCE: Hasan Z, Modis L, Szalai E, et al. Intraoperative and postoperative corneal thickness change after collagen crosslinking therapy. Eur J Ophthalmol. 2014;24(2):179–185.

  • JAPANESE MINISTRY OF HEALTH APPROVES VISIAN IMPLANTABLE COLLAMER LENS WITH CENTRAFLOW TECHNOLOGY. Staar Surgical Co.'s Visian Implantable Collamer Lens with CentraFlow technology has been approved by the Japanese Ministry of Health, Labor and Welfare. According to Staar Surgical, with this approval, the range of treatment has been expanded to include not only the CentraFlow technology, but also the treatment of myopia down to –3.0D (the current range is –5.0D). The approved treatment range for the Visian ICL with CentraFlow is now –3.0D to –18D of myopia and the same spherical range for the Vision Toric ICL with CentraFlow, and from +1.0D to +4.5D of astigmatism. Read about it here.
  • THROMBOGENICS PLANS TO BEGIN PHASE IV STUDY OF JETREA. ThromboGenics NV will soon initiate a prospective, observational Phase IV study with Jetrea to generate further data on the real-world use of the drug. The Ocriplasmin Research to Better Inform Treatment (ORBIT) study will recruit 1,500 patients with symptomatic vitreomacular adhesion (VMA)/vitreomacular traction (VMT) across 120 retina centers in the United States. The study will assess clinical outcomes and safety of Jetrea administered in a real-world setting for the treatment of symptomatic VMA/VMT by assessing both anatomical and functional outcomes. Patients will be followed for up to 12 months after treating with Jetrea. Patient recruitment is expected to begin this month. For additional information, visit www.thrombogenics.com.
  • PREVENT BLINDNESS TO HOLD THIRD ANNUAL FOCUS ON EYE HEALTH NATIONAL SUMMIT. Prevent Blindness and its partners have announced that the third annual Focus on Eye Health National Summit will be held on Wednesday, June 18, 2014 from 8:30 a.m. to 3:00 p.m. at the National Press Club in Washington, D.C. The mission of the summit is to elevate the national dialogue around vision and public health issues. Prevent Blindness will release a new report projecting the potential burden and economic impact of vision problems into the future. In conjunction with the summit, Prevent Blindness will hold the 9th annual Eyes on Capitol Hill event, bringing those directly impacted by vision loss and blindness together with their government representatives. Find out more here.
  • DR. ALICE MCPHERSON RECEIVES PRESTIGIOUS GONIN MEDAL. Dr. Alice McPherson, a professor of Ophthalmology at Baylor College of Medicine and founder of the Retina Research Foundation, has been selected for the oldest and most prestigious medal in ophthalmology, the Gonin Medal. The medal was established in 1937 in memory of Dr. Jules Gonin from Switzerland, considered the father of retina surgery. Dr. McPherson is an accomplished teacher, scholar, leader and pioneer dedicated to the study and treatment of diseases of the retina. She received the Gonin Medal diploma and delivered a special lecture on February 13th at the Jules Gonin Eye Hospital in Switzerland.

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