Volume 14, Number 25
Monday, June 23, 2014

In this issue: (click heading to view article)
######### Changes in FAF Following Treatments for PCV
######### Fellow Eye Comparison of Corneal Thickness and Curvature in DMEK and DSAEK
######### Link Between PCV and History of CSC
######### Visual Acuity Following Cataract Surgery in Patients with AMD
######### Briefly

Changes in FAF Following Treatments for PCV

Japanese investigators evaluated changes in fundus autofluorescence after treatments for polypoidal choroidal vasculopathy.

A total of 36 eyes of 35 patients with treatment-naïve PCV underwent intravitreal injection of ranibizumab, photodynamic therapy or a combination of both treatments. The investigators compared FAF and indocyanine green angiography at baseline with those obtained 12 months later about the changes at the affected lesion.

In the 36 eyes, they detected 88 polyps on ICGA at baseline, and 65 (73.9%) of those showed centred hypoautofluorescence and a circumferential hyperautofluorescent ring on FAF. Twelve months later, ICGA revealed resolution of 42 of those 65 polyps, and of those 42 resolved polyps, 30 hyperautofluorescent rings (71.4%) were eliminated concurrently with the resolution of polyp. According to the study investigators, statistical analysis revealed that an elimination of the hyperautofluorescent ring was more frequently observed in association with the resolved polyps than with the persistent polyps (p<0.0001). They also noted that all of the hypoautofluorescent findings corresponding to branching vascular networks at baseline were unchanged during the follow-up period.

In conclusion, elimination of the hyperautofluorescent ring is highly associated with the resolution of the polyp on ICGA. The investigators propose that FAF has a potential as a noninvasive method of evaluating the therapeutic efficacy of treatments for PCV.

SOURCE: Yamagishi T, Koizumi H, Yamazaki T, Kinoshita S. Changes in fundus autofluorescence after treatments for polypoidal choroidal vasculopathy. Br J Ophthalmol. 2014;98(6):780–784.

Fellow Eye Comparison of Corneal Thickness and Curvature in DMEK and DSAEK

The following retrospective, case series comparative study included consecutive patients who underwent Descemet's stripping automated endothelial keratoplasty in one eye and Descemet's membrane endothelial keratoplasty in the fellow eye to compare posterior corneal curvature in the fellow eye of the same patients after these procedures. Each eye underwent corneal evaluation with Pentacam HR (Oculus); additionally, postoperative corneal curvature, corneal thickness and visual acuity were assessed.

Twenty eyes of 10 patients (five women and five men) aged 72.5 ± 13.5 (range, 42 to 87) years were included. No significant differences were observed between front flat Ks (43.01 ± 1.6 vs. 43.5 ± 0.9, p=0.27) and front steep Ks (44.17 ± 1.5 vs. 44.52 ± 0.7, p=0.39) in DMEK vs. DSAEK eyes, accordingly. It was noted that posterior curvature was statistically significantly flatter in DMEK compared with DSAEK eyes; back flat Ks (–6.30 ± 0.2 vs. –6.84 ± 0.6, p=0.012), back steep Ks (–6.64 ± 0.1 vs. –7.2 ± 0.3, p=0.03) and back Km (–6.45 ± 0.1 vs. –6.99 ± 0.4, p=0.005), accordingly. Furthermore, corneas in DMEK eyes were significantly thinner than in DSAEK eyes (541.0 ± 61 vs. 627.9 ± 70 µm, p=0.007).

Eyes that underwent DSAEK surgery have thicker corneas with steeper posterior corneal curvature than fellow eyes that underwent DMEK. This difference may explain the hyperopic shift commonly observed after DSAEK and should be considered when choosing an intraocular lens for cataract surgery.

SOURCE: Goldich Y, Artornsombidth P, Avni-Zauberman N, et al. Fellow eye comparison of corneal thickness and curvature in Descemet membrane endothelial keratoplasty and Descemet stripping automated endothelial keratoplasty. Cornea. 2014;33(6):547–550.


Link Between PCV and History of CSC

To evaluate the possible causative role of central serous chorioretinopathy in the development of exudative age-related macular degeneration, Japanese researchers conducted this cross-sectional study at an institutional setting.

They enrolled 150 control subjects who had senile cataract or nasolacrimal duct stenosis and who were older than 50 years. The researchers used the background data for 89 patients with typical AMD (tAMD) and 138 patients with polypoidal choroidal vasculopathy for comparison. They took their medical records for history of CSC, hypertension, systemic steroid use and smoking. They also evaluated the fundus for signs of atrophic retinal pigment epithelial tract and for focal photocoagulation scars in the macula.

After adjusting for age, gender, history of hypertension, systemic steroid use and smoking, history of CSC was significantly more frequent (p<0.0001) in patients with PCV (15 patients, 10.9%) compared with patients with tAMD (two patients, 2.2%) or control subjects (zero patients). On fundoscopy, the researchers observed an atrophic RPE tract (seven patients) or a focal photocoagulation scar (one patient) only in patients with PCV (eight patients, 5.8%), and the frequency was statistically significant compared with that with tAMD (p=0.0143) or control subjects (p=0.0143). The laterality of CSC and AMD involved the same eye in nine of 10 patients among those who had unilateral AMD and a reported unilateral CSC history.

To conclude, a history of CSC may be a predisposing factor for the development of PCV in the Japanese population.

SOURCE: Toyama T, Ohtomo K, Noda Y, Ueta T. Polypoidal choroidal vasculopathy and history of central serous chorioretinopathy. Eye. 2014;June 13. [Epub ahead of print].


Visual Acuity Following Cataract Surgery in Patients with AMD

The authors of this cohort study evaluated visual acuity outcomes after cataract surgery in persons with varying degrees of severity of age-related macular degeneration.

They included 1,232 eyes of 793 participants who underwent cataract surgery during the prospective, multicenter, randomized controlled Age-Related Eye Disease Study 2 of nutritional supplements for treatment of AMD.

The authors analyzed the pre- and postoperative characteristics of participants who underwent cataract extraction during the five-year trial and obtained both clinical data and standardized red-reflex lens and fundus photographs at baseline and annually. Photographs were graded by a centralized reading center for cortical and posterior subcapsular lens opacities and for AMD severity. Additionally, cataract surgery was documented at annual study visits or by history during the six-month telephone calls. Analyses were conducted using multivariate repeated-measures regression. Change in best-corrected visual acuity following cataract surgery compared with preoperative BCVA was the main outcome measure.

Adjusting for age at time of surgery, gender, interval between preoperative and postoperative visits, as well as type and severity of cataract, the mean changes in visual acuity were as follows: eyes with mild AMD (n=30) gained 11.2 letters (95% confidence interval [CI], 6.9 to 15.5); eyes with moderate AMD (n=346) gained 11.1 letters (95% CI, 9.1 to 13.2); eyes with severe AMD (n=462) gained 8.7 letters (95% CI, 6.7 to 10.7); eyes with noncentral geographic atrophy (n=70) gained 8.9 letters (95% CI, 5.8 to 12.1); and eyes with advanced AMD (central geographic atrophy, neovascular disease or both; n=324) gained 6.8 letters (95% CI, 4.9 to 8.8). The visual acuity gain across all AMD severity groups was statistically significant from preoperative values (p<0.0001), the authors reported.

They determined that mean visual acuities improved significantly after cataract surgery across varying degrees of AMD severity.

SOURCE: Age-Related Eye Disease 2 Research Group; Huynh N, Nicholson BP, Argrón E, et al. Visual acuity after cataract surgery in patients with age-related macular degeneration: Age-Related Eye Disease Study 2 Report Number 5. Ophthalmology. 2014;121(6):1229–1236.


  • KALA INITIATES TWO CLINICAL TRIALS FOR OPHTHALMIC PRODUCTS. Pharmaceuticals Inc. has initiated two clinical trials with its nanotechnology-based loteprednol etabonate mucus penetrating particle (LE-MPP) program, KPI-121. The company has initiated dosing in its Phase III, double-masked, randomized, controlled trial (KPI-121-C-001) to evaluate the safety and efficacy of LE-MPP in managing inflammation and pain associated with cataract surgery, as well as a Phase II, double-masked, randomized, controlled trial (KPI-121-C-002) with KPI-121 to investigate the safety and efficacy of low-dose LE-MPP in patients with dry-eye disease. Kala's proprietary MMP nanotechnology platform allows therapeutic agents to pass through the mucus layer of the tear film, facilitating penetration into deeper tissues of the eye. Find out more here.

  • VISIONIX UNVEILS NOVEL PRODUCT FOR REFRACTION. Visionix Inc., a company of Luneau Technology, released the VX 55, a new type of refraction product that offers effortless efficiency and technological advances that allow for connectivity among diagnostic devices in the practice and easy importation of measurement findings into EMR systems. According to the company, the VX 55 allows for freedom of movement and full control over the phoropter head and projection chart display at the touch of a finger, thanks to its ergonomic design. With little to no learning curve, physicians can use the VX 55 to digitalize their manual phoropters and control the entire refraction process from their tablets. For more information about the VX 55, visit www.visionix.comor call (800) 292-7468.

  • NICOX AND SEQUENOM ANNOUNCE NATIONAL BRAND LAUNCH OF RETNAGENE TEST PORTFOLIO IN THE UNITED STATES. Nicox S.A.'s subsidiary, Nicox Inc., is conducting a national brand launch to Sequenom Laboratories' RetnaGene portfolio of two laboratory-developed genetic tests in the United States. The portfolio includes RetnaGene AMD and RetnaGene LR, tests performed exclusively by Sequenom that assess an individual’s risk for advanced age-related macular degeneration. Sequenom granted Nicox exclusive promotion and marketing rights for its RetnaGene tests in January 2014, and Nicox has significantly strengthened its field force to support the national commercial launch of the portfolio, which is now available to U.S. customers. Practitioners can obtain additional information by calling (855) 696-4269 or by visiting www.mynicox.com.

  • INAUGURAL RECIPIENT OF BCLA INDUSTRY AWARD. Paul Rose, inventor of the Rose K family of lens designs for irregular cornea, has been named the first-ever recipient of the British Contact Lens Association Industry Award. Launched in 2013 to honor and recognize the entrepreneurial work being carried out by individuals working in contact lens science, research and technology, the 2014 BCLA Industry Award was bestowed on Dr. Rose during the BCLA’s Gala Dinner on June 7th.

  • VALEANT BEGINS EXCHANGE OFFER FOR ALLERGAN. In a recent news release, Valeant Pharmaceuticals International Inc. reported that it has commenced an exchange offer for the common stock of Allergan, taking its May 30th proposal directly to Allergan stockholders. Under the terms of the offer, Allergan stockholders would be able to elect to exchange each of their Allergan shares for $72.00 in cash and 0.83 Valeant common shares, or an amount of cash, or a number of Valeant common shares, in each case subject to proration. The amount of the all-cash and all-stock elections would be determined prior to the expiration of the exchange offer and would be set so that the implied value of all three elections would be the same based on the average closing prices of the Valeant common shares during an averaging period described in the offering documents. The offer is scheduled to expire on August 15, 2014, unless the offer is extended. Allergan's board of directors, consistent with its fiduciary duties and together with its financial and legal advisors, will carefully review and evaluate the exchange offer. Allergan stockholders have been advised to take no action at this time pending the review of the exchange offer by the board.

  • AVEDRO EXCLUSIVE GLOBAL SUPPLIER OF MEDIOCROSS RIBOFLAVIN FOR CORNEAL CROSS-LINKING. Avedro Inc. recently announced that it has entered into an exclusive agreement to purchase the MedioCross products of Medio-Haus-Medizinprodukte GmbH (Medio-Haus), Kiel, Germany. Medio-Haus has manufactured Avedro’s proprietary VibeX riboflavin products since 2010 and will now also provide all of its MedioCross riboflavin products exclusively through Avedro. Avedro's family of riboflavin products are used with Avedro's KXL System for performing Lasik Xtra and accelerated cross-linking for treating keratoconus and post-LASIK ectasia outside the United States. The MedioCross riboflavin products are currently used with a variety of cross-linking devices to treat keratoconus and post-LASIK ectasia and had previously been supplied to distributors through Peschke-Meditrade. Avedro will continue to offer the full line of Medio-Haus riboflavin products to prevent interruption of supply to the current customers of those products located outside of the United States.

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