Volume 14, Number 19
Monday, May 12, 2014

In this issue: (click heading to view article)
######### AMD Findings During Screening for Diabetic Retinopathy
######### Impact of Image Compression on the Interpretation of SD-OCT in Exudative AMD
######### Incidence of Bleb-Related Infection and Its Risk Factors Following Filtering Surgeries with Adjunctive Mitomycin C
######### Outcomes of Cataract Surgery in Adult Patients with Down's Syndrome
######### Briefly


AMD Findings During Screening for Diabetic Retinopathy

Researchers performed a prospective study including 2,003 subjects with diabetes mellitus who underwent photographic screening for diabetic retinopathy (DR) to determine the reliability of detecting age-related macular degeneration (AMD) during screening.

They tested the reliability of detecting AMD lesions by interobserver and intraobserver agreement, and the sensitivity and specificity of diagnosing AMD at different grades of severity using the consensus grading of a group as the reference standard.

According to the researchers, DR affected 24.7% of the subjects. They also noted that the age-standardized prevalence of early AMD was 17.9% and late AMD was 0.1%. They also reported that interobserver and intraobserver agreement for grading AMD was substantial (k=0.72 and 0.71 respectively, p<0.001) and that it was equally good in those with different severities of DR. The researchers also found that there was no difference in sensitivity and specificity of detecting AMD in those with different levels of DR (sensitivity 62% to 68% and specificity 97% to 98%).

They concluded that intermediate- and high-risk AMD that warrant treatment with zinc and anti-oxidant supplements could be reliably detected during screening for DR.

SOURCE: Gangwani R, Lai WW, Sum R, et al. The incidental findings of age-related macular degeneration during diabetic retinopathy screening. Graefes Arch Clin Exp Ophthalmol. 2014;252(5):723–729.

Impact of Image Compression on the Interpretation of SD-OCT in Exudative AMD

In South Korea, investigators sought to evaluate the effect of image compression of spectral-domain optical coherence tomography (OCT) images in the examination of eyes with exudative age-related macular degeneration (AMD).

They included 30 eyes from 30 patients who were diagnosed with exudative AMD in their retrospective observational case series. They conducted the horizontal OCT scans of the center of the fovea using spectral-domain OCT and exported the images to Tag Image File Format (TIFF) and 100%, 75%, 50%, 25% and 10% quality of Joint Photographic Experts Group (JPEG) format. The investigators took the OCT images before and after intravitreal ranibizumab injections, and after relapse. They then determined prevalence of subretinal and intraretinal fluids and compared differences in choroidal thickness between the TIFF and JPEG images with the intra-observer variability.

The prevalence of subretinal and intraretinal fluids was comparable regardless of the degree of compression, the study investigators found. However, the chorio-scleral interface was not clearly identified in many images with a high degree of compression. In images with 25% and 10% quality of JPEG, the difference in choroidal thickness between the TIFF images and the respective JPEG images was significantly greater than the intra-observer variability of the TIFF images (p=0.029 and p=0.024, respectively).

In OCT images of eyes with AMD, 50% of the quality of the JPEG format would be an optimal degree of compression for efficient data storage and transfer without sacrificing image quality.

SOURCE: Kim JH, Kang SW, Kim J, Chang YS. Influence of image compression on the interpretation of spectral-domain optical coherence tomography in exudative age-related macular degeneration. Eye. 2014;May 2. [Epub ahead of print].

Incidence of Bleb-Related Infection and Its Risk Factors Following Filtering Surgeries with Adjunctive Mitomycin C

The authors of this Japanese prospective, observational cohort study reported the five-year incidence of bleb-related infection after mitomycin C-augmented glaucoma filtering surgery and investigated the risk factors for infections.

Their study included 1,098 eyes of 1,098 glaucoma patients who had undergone mitomycin C-augmented trabeculectomy or trabeculectomy combined with phacoemulsification and intraocular lens implantation performed at 34 clinical centers. They followed patients at six-month intervals for five years, with special attention given to bleb-related infections. They then analyzed their follow-up data via Kaplan-Meier survival analysis and the Cox proportional hazards model. The main outcome measure was the incidence of bleb-related infection over five years and risk factors for infections.

Of the 1,098 eyes, a bleb-related infection developed in 21 eyes, the authors reported. They noted that Kaplan-Meier survival analysis revealed that the incidence of bleb-related infection was 2.2 ± 0.5% (cumulative incidence ± standard error) at the five-year follow-up for all cases, whereas it was 7.9 ± 3.1% and 1.7 ± 0.4% for cases with and without a history of bleb leakage, respectively (p=0.000, log-rank test). When only eyes with a well-functioning bleb were counted, the incidence of bleb-related infection was 3.9 ± 1.0%. The authors found no differences between the trabeculectomy cases and the combined surgery cases (p=0.398, log-rank test) or between cases with a fornix-based flap and those with a limbal-based flap (p=0.651, log-rank test). The Cox model revealed that a history of bleb leakage and younger age were risk factors for infections.

To conclude, the five-year cumulative incidence of bleb-related infection was 2.2 ± 0.5% in eyes treated with mitomycin C-augmented trabeculectomy or trabeculectomy combined with phacoemulsification and intraocular lens implantation in our prospective, multicenter study. Bleb leakage and younger age were the main risk factors for infections.

SOURCE: Yamamoto T, Sawada A, Mayama C, et al; The Collaborative Bleb-Related Infection Incidence and Treatment Study Group. The 5-year incidence of bleb-related infection and its risk factors after filtering surgeries with adjunctive mitomycin c: Collaborative Bleb-Related Infection Incidence and Treatment Study 2. Ophthalmology. 2014;121(5):1001–1006.

Outcomes of Cataract Surgery in Adult Patients with Down's Syndrome

To describe the outcomes of cataract surgery in adult patients with Down's syndrome at a tertiary eye hospital in Hong Kong, the following retrospective case-file analysis was performed. Patients with Down's syndrome who underwent cataract surgery between January 2002 and December 2012 were identified and morphology of cataract, associated ocular features and surgical and visual outcomes were analyzed.

Cataract surgery was performed in 33 eyes of 20 patients (12 males, eight females, mean age 42.9 ± 10.6 years) over a 10-year period. Nine patients (nine/20, 45.0%) had bilateral cataracts at the time of diagnosis, and white cataracts were noted in 12 eyes of 10 patients (12/33, 36.3%) at the time of presentation. Associated ocular problems included myopic maculopathy (18 eyes, 54.5%), keratoconus (12 eyes, 36.3%), nystagmus (two eyes, 6.0%), corneal scar (two eyes, 6.0%) and glaucoma (two eyes, 6.0%). Five eyes (15.1%) underwent extracapsular cataract extraction, whereas a phacoemulsification was performed in 28 (84.9%) eyes. Intraocular lens implantation was performed in 32/33 eyes. The most common postoperative complication was posterior capsular opacification (eight eyes, 24.2%). Moreover, the mean best-corrected visual acuity improved from 0.07 ± 0.11 preoperatively to 0.17 ± 0.19 at three months postoperatively (p=0.000).

A high incidence of bilateral cataracts as well as white cataracts was observed in patients with Down's syndrome in this study. Although the surgical outcomes of cataract surgery were good, the visual outcomes were suboptimal in these cases due to associated ocular comorbidities.

SOURCE: Li EY, Chan TC, Lam NM, Jhanji V. Cataract surgery outcomes in adult patientn with Down’s syndrome. Br J Ophthalmol. 2014;May 2. [Epub ahead of print].

  • OWL NAMES AWARD WINNERS. On April 28th, Ophthalmic Women Leaders (OWL) presented its annual awards at a reception held concurrent with the 2014 meeting of the American Society of Cataract and Refractive Surgery in Boston. This year, the Visionary Woman Award went to Jane Rady of Abbott Medical Optics. The Visionary Award honors a woman who has paved the way for other women in her field through significant professional achievement. The Catalyst Award, which honors an individual who has contributed significantly to helping women advance in eye care, was presented to Georgette Pascale of Pascale Communications. Lastly, the Rising Star Award went to Tammy Bogetti of Bryn Mawr Communications.

  • ZIEMER RECEIVES CE APPROVAL FOR FEMTO LDV Z8. Ziemer Ophthalmic Systems AG has received CE approval for the high-end Femto LDV Z8 workstation. Approval is given for clear corneal and arcuate incisions, capsulotomy, lens fragmentation and all previously covered cornea and presbyopia applications. According to the company, the monitored rollout of the device will now begin in combination with an in-depth education program for femtosecond laser-assisted cataract surgery. To learn more, visit www.ziemergroup.com.

  • ICON BIOSCIENCE'S PIPELINE PRODUCT, IBI-10090, NOW IN PHASE III STUDY. Icon Bioscience Inc. recently reported that IBI-10090, its lead pipeline product, is in a pivotal Phase III study as a sustained-release therapy for inflammation associated with cataract surgery. IBI-10090 employs Icon's Verisome drug delivery platform to dispense a long-acting, biodegradable formulation of the anti-inflammatory agent dexamethasone into the anterior chamber of the eye through a single injection administered immediately after surgery. IBI-10090 has been specifically designed to provide a controlled release of the active agent for approximately three weeks, and in a previous Phase II/III study involving more than 170 patients and three dosing strengths, it was found to be safe and efficacious. The current randomized, double blind, placebo-controlled Phase III study is expected to enroll 390 patients across 28 centers in the United States and employs the two lower doses used in the prior Phase II/III study. The primary endpoint is the percent of patients with anterior chamber cell clearing at day eight. Icon expects to complete patient enrollment later this year.
  • REGENERON AND AVALANCHE BIOTECHNOLOGIES TO COLLABORATE ON DEVELOPMENT OF NEXT-GENERATION GENE THERAPY PRODUCTS. Regeneron Pharmaceuticals Inc. and Avalanche Biotechnologies Inc. recently announced the formation of a broad collaboration to discover, develop and commercialize novel gene therapy products for the treatment of ophthalmologic diseases. The collaboration covers novel gene therapy vectors and proprietary molecules, discovered jointly by Avalanche and Regeneron, and developed using the Avalanche Ocular BioFactory. Under the terms of the agreement, Avalanche will receive an up-front cash payment, contingent payments of up to $640 million upon achievement of certain development and regulatory milestones, plus a royalty on worldwide net sales of collaboration products. Plus, Avalanche has the option to share in development costs and profits for products directed toward two collaboration therapeutic targets selected by Avalanche. Regeneron has a time-limited right of first negotiation for certain rights to Avalanche's gene therapy product targeting vascular endothelial growth factor currently under development for the treatment of wet age-related macular degeneration, upon completion of the ongoing Phase IIa trial. Click here

  • PRECLINICAL DATA ON SUSTAINED RELEASE OF AVASTIN USING TETHADUR PRESENTED. At the recent 2014 Association for Research in Vision and Ophthalmology Annual Meeting, pSivida Corp. presented the first peer-reviewed preclinical data demonstrating the use of the company's Tethadur technology to provide sustained release of Avastin. The data from preclinical studies concluded that long-term sustained release of antibodies such as Avastin is achievable with Tethadur, a form of pSivida's BioSilicon technology, and that the release of the antibodies is controllable over a wide range by adjusting the pore size and surface area of Tethadur. The study evaluated the effect of pore size in Tethadur on Avastin release over a period of three weeks. Want to know more? Visit pSivida's website.

  • STUDY REPORTS THAT HIGH-FREQUENCY ULTRASOUND CAN BE USED TO SCREEN EYES FOR DISEASE-SPECIFIC CONDITIONS AFTER DEATH. A new study from the Lions Eye Institute for Transplant & Research and the Eye Institute at the University of South Florida demonstrates that commonly used clinical techniques to image the anterior segment of the eye can be adapted to screen the posterior segment of post-mortem eyes for preclinical research. Investigators employed high-frequency ultrasound to successfully image retinal structures in post-mortem eyes, but this additional technique can be used to screen post-mortem eyes for disease-specific conditions. Optical coherence tomography imaging of the macula identified much of the anatomy seen in an in vivo scan, although post-mortem retinal changes imposed some limitations. A high-frequency (40 mHz) ultrasound biomicroscopy showed recognizable retinal landmarks in the posterior pole and correlated well with the pathology seen on the OCT images, such as epiretinal membranes causing macular puckering. The findings were presented at the recent 2014 Association for Research in Vision and Ophthalmology Annual Meeting.

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