Volume 14, Number 17
Monday, April 28, 2014

In this issue: (click heading to view article)
######### Factors Associated with Exudation Recurrence Following Cataract Surgery in Patients Previously Treated with Anti-VEGF for Exudative AMD
######### Cellular Changes in Tears Associated with Keratoconjunctival Responses Induced by Nasal Allergy
######### Retinal Vascular Oximetry During Ranibizumab Treatment of CRVO
######### RNFL Thickness Modification Following ILM Peeling
######### Briefly

Factors Associated with Exudation Recurrence Following Cataract Surgery in Patients Previously Treated with Anti-VEGF for Exudative AMD

To investigate factors influencing exudation recurrence following cataract surgery in patients already treated with anti-vascular endothelial growth factor (VEGF) agents for exudative age-related macular degeneration (AMD), investigators retrospectively reviewed the medical records of patients who underwent cataract surgery and had been previously treated with anti-VEGF for exudative AMD.

They examined visual acuity before surgery and one and six months after surgery. They also examined the time between diagnosis and surgery, and the exudation-free period before surgery and compared these between patients who had exudation recurrence and those who did not.

A total of 39 eyes of 39 patients were included in analyses. The logarithm of the minimum angle of resolution visual acuity was 1.02 ± 0.58 and had significantly improved one month (0.81 ± 0.62, p<0.001) and six months (0.85 ± 0.64, p=0.001) following surgery. The study investigators noted that both the diagnosis-to-surgery period (p=0.001) and the preoperative exudation-free period (p<0.001) were significantly longer in patients without recurrence than in patients with recurrence.

They concluded that cataract surgery was beneficial in patients previously treated with anti-VEGF for exudative AMD. Their data suggests that cataract surgery should be performed after a sufficiently long exudation-free period to minimize exudation recurrence. However, larger prospective studies are required to draw definitive clinical guidelines.

SOURCE: Lee TG, Kim JH, Change YS, et al. Factors influencing the exudation recurrence after cataract surgery in patients previously treated with anti-vascular endothelial growth factor for exudative age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol. 2014; Apr. [Epub ahead of print].

Cellular Changes in Tears Associated with Keratoconjunctival Responses Induced by Nasal Allergy

Allergic keratoconjunctivitis occurs in a primary form, caused by an allergic reaction localized in the conjunctiva, and in a secondary form, induced by an allergic reaction originating in the nasal mucosa. Various hypersensitivity mechanisms involved in the keratoconjunctivitis forms result in different keratoconjunctival response types. The Dutch author of this study investigated the cytologic changes in tears during the secondary immediate (SIKCR), late (SLKCR), and delayed (SDYKCR) keratoconjunctival responses. He found that the SIKCR, SLKCR, and SDYKCR, induced by nasal allergy, were associated with different cellular profiles in the tears. In 61 patients, comprising 20 SIKCRs, 23 SLKCRs, and 18 SDYKCRs, he repeated nasal provocation tests (NPTs) with allergens and 61 phosphate-buffered control challenges and supplemented this with cell counting in the tears.

According to the author, the SIKCR (p<0.01), appearing 10 to 120 minutes after the NPT, was associated with increased eosinophil and mast cell counts in tears. He also reported that the SLKCR (p<0.01), appearing five to 12 hours after the NPT, was accompanied by increased counts of eosinophils, neutrophils, basophils, and conjunctival epithelial and goblet cells. Finally, the SDYKCR (p<0.05), appearing 24 to 48 hours after NPT, was associated with increased counts of lymphocytes, neutrophils, monocytes, basophils, conjunctival epithelial, corneal epithelial and goblet cells.

In conclusion, the cells, except mast, epithelial and goblet cells, displaying no intracellular changes, migrated probably from the conjunctival capillaries, in response to the factors released during the primary allergic reaction in the nasal mucosa and subsequently penetrating into the conjunctiva. These results demonstrate a causal role of nasal allergy and diagnostic value of NPT combined with recording of ocular features and cellular profiles in tears in some keratoconjunctivitis patients.

SOURCE: Pelikan Z. Cellular changes in tears associated with keratoconjunctival responses induced by nasal allergy. Eye. 2014;28(4):430–438.

Retinal Vascular Oximetry During Ranibizumab Treatment of CRVO

Researchers in Denmark examined the effect of intravitreal injections of the vascular endothelial growth factor (VEGF) inhibitor ranibizumab on retinal oxygenation in patients with central retinal vein occlusion (CRVO). They analyzed retinal oxygen saturation in patients with CRVO using the Oxymap Retinal Oximeter P3, before and during six months of treatment with intravitreal injections of ranibizumab.

At presentation, they found that retinal venous oxygen saturation was lower in eyes with CRVO than in the healthy fellow eyes (32 ± 13% vs. 59 ± 10%, respectively, p=0.001), whereas retinal arterial saturation was higher in eyes with CRVO than in the fellow eyes (95% ± 8% and 91% ± 3%, p=0.04). The researchers noted that mean visual acuity increased from 51 ± 24 letters ETDRS at baseline to 66 ± 24 and 69 ± 20 letters ETRDS, respectively, at three months and six months treatment (mean ± SD, p<0.0001, repeated measures analysis of variance), and central retinal thickness was reduced from 697 ± 139 µm to 368  ± 113 µm and 340  ± 96 µm, respectively, from baseline to three months and six months treatment (p<0.0001). Furthermore, venous saturation increased during treatment (from 35.5%  ± 13.8% at baseline to 43.1% ± 10.8% and 43.5% ± 13.7% after three months and six months treatment, respectively, p=0.012), while no significant change was found in arterial saturation (p=0.24).

Retinal venous oxygen saturation was markedly reduced in untreated CRVO and was roughly halfway normalized during intravitreal ranibizumab treatment. Retinal artery oxygen saturation was not reduced in CRVO.

SOURCE: Traustason S, la Cour M, Larsen M. Retinal vascular oximetry during ranibizumab treatment of central retinal vein occlusion. Br J Ophthalmol. 2014; Apr 12. [Epub ahead of print].

RNFL Thickness Modification Following ILM Peeling

To identify early and late retinal nerve fiber layer thickness (RNFLT) modification after internal limiting membrane (ILM) peeling for idiopathic macular hole or epiretinal membrane and to correlate RNFLT to visual field indices, this single-center, prospective, interventional consecutive case series was performed.

Complete ophthalmic examination, fundus images, and spectral-domain optical coherence tomography (SD-OCT) were performed in 30 eyes of 30 patients before and one, three, and six months after surgery. Six peripapillary sectors (superotemporal, temporal, inferotemporal, inferonasal, nasal, superonasal) and global RNFLT were evaluated. Visual field was performed preoperatively and six months postoperatively.

Significant RNFLT modification was found after surgery (p<0.0001). Specifically, RNFLT significantly increased in all, but the temporal sectors, one month after surgery, and it returned to preoperative values at the third month. Six months after surgery, RNFLT was lower than basal values in the superotemporal, inferotemporal, and temporal sectors (p<0.001, p<0.05, and p<0.001, respectively) with an average reduction of 18.2 ± 9.8 µm. No correlation was found between RNFLT and the visual field indices.

To conclude, the diffuse RNFLT increase one month postoperatively could be because of inflammatory responses. The reduction of RNFLT in the temporal sectors six months postoperatively could indicate damage to the macular retinal nerve fiber layer caused by internal limiting membrane peeling.

SOURCE: Balducci N, Morara M, Veronese C, et al. Retinal nerve fiber layer thickness modification after internal limiting membrane peeling. Retina. 2014;34(4):655–663.

  • MERGE HEALTHCARE TO LAUNCH NEW RETINAL SCREENING SOLUTION. Merge Healthcare Inc. plans to release iConnect Retinal Screening, an end-to-end retinal screening solution allowing providers to quickly identify and diagnose patients with diabetic retinal disease. According to the company, its interoperable, subscription-based service leverages Merge's cloud infrastructure (iConnect Cloud Archive and Merge Eye Care PACS) to streamline operational workflow, reduce financial costs and enable the improvement of clinical care quality. iConnect Retinal Screening allows providers to efficiently capture retinal images through an automated camera, reducing the need for staff to receive specialty training. Images are transferred via the cloud to a reading center, where trained technicians and pathologists identify, diagnose and deliver results. iConnect Retinal Screening is currently undergoing a pilot program launch and is scheduled for availability by the end of Q2. The first phase of the solution will offer diabetic retinopathy screenings. Future stages of the solution will include screenings for glaucoma, age-related macular degeneration, and other serious neurological disease. Additional information is available at www.merge.com.

  • LENSAR AND TRUEVISION 3D SURGICAL ENTER INTO CO-DEVELOPMENT AND DISTRIBUTION AGREEMENT. Lensar Inc. and TrueVision 3D Surgical have announced a global co-development and distribution agreement that integrates TrueVision's TrueGuide system into the Lensar Laser System's advanced technology suite. The Lensar Laser System with TrueGuide will premiere at the American Society of Cataract and Refractive Surgery (ASCRS) Annual Symposium and Congress in Boston, April 25-29, 2014.

  • VALEANT PROPOSES TO COMBINE WITH ALLERGAN. Valeant Pharmaceuticals International Inc. has submitted a merger proposal to Allergan Inc.'s board of directors, under which each Allergan share would be exchanged for $48.30 in cash and 0.83 shares of Valeant common stock, based on the fully diluted number of Allergan shares outstanding. Shareholders will be able to elect a mix of cash and shares, subject to proration. The proposed merger agreement, which you can read more about here, will be filed with the Securities and Exchange Commission. Allergan has confirmed receipt of an unsolicited proposal from Valeant to acquire all of the outstanding shares of the company. It has stated that its board of directors, in consultation with its financial and legal advisors, will carefully review and consider the proposal and pursue the course of action that it believes is in the best interests of its stockholders.
  • BAUSCH + LOMB TO INTRODUCE ACTIVATE SYSTEM CONTROL SOFTWARE AT ASCRS. Bausch + Lomb has announced that it will introduce its Activate System Control Software, for the Stellaris and Stellaris PC line of phacoemulsification and vitrectomy equipment, at the American Society of Cataract and Refractive Surgery (ASCRS) Annual Symposium and Congress in Boston, April 25–29. According to the company, Activate System Control Software adds more than 40 features and controls (e.g., file transportability from Stellaris to Stellaris PC, enhanced on-screen user controls and drop-down menus) to the Stellaris and Stellaris PC platforms. For additional information, click here.

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