Review of Ophthalmology Online

Volume 16, Number 51
Monday, December 19, 2016


In this issue: (click heading to view article)
######### Responses to Intravitreal Bevacizumab, Ranibizumab & Aflibercept Injections for nAMD
######### Goldmann & Pascal Relative to CCT and Corneal Curvature
######### Comparison of DR Classification Using FA and OCTA
######### New Bruch’s Membrane Opening: Improving OCT Specificity in Tilted Discs


Responses to Intravitreal Bevacizumab, Ranibizumab & Aflibercept Injections for nAMD

In a retrospective study, researchers examined 232 eyes of 232 individuals who received intravitreal anti-vascular endothelial growth factor injections due to treatment-naïve nAMD. All individuals, who were followed-up for at least one year, were treated with intravitreal injections monthly until three months, then as needed. Researchers evaluated the effects of intravitreal injections for treatment of nAMD using the central macular thickness, subretinal fluid, pigment epithelial detachment size and best-corrected visual acuity.

CMT, SRF, PED size and BCVA (LogMAR) significantly decreased after treatment with all three anti-VEGF agents. Overall, the bevacizumab, ranibizumab and aflibercept treatments showed no significant differences in responses. However, the aflibercept injections decreased PED size more quickly than bevacizumab injections (p=0.034).

Researchers concluded that bevacizumab, ranibizumab and aflibercept injections were effective for nAMD and had similar responses, although the number of injections of aflibercept was fewer than other anti-VEGF agents. They suggested that aflibercept injections may be a better choice than other anti-VEGF agents for cases of severe increases in PED height.

SOURCE: Park DH, Hae Sun HJ, Lee SJ, et al. A comparison of responses to intravitreal bevacizumab, ranibizumab, or aflibercept injections for neovascular age-related macular degeneration. Int Ophthalmol 2016; Nov 8. [Epub ahead of print].

Goldmann & Pascal Relative to CCT and Corneal Curvature

Investigators assessed the influence of central corneal thickness and corneal curvature in tonometry measurements taken by Goldmann applanation tonometry and Pascal dynamic contour tonometry.

The prospective study included 185 eyes from 97 subjects attending outpatient ophthalmology appointments who underwent intraocular pressure measurements by GAT and Pascal DCT. Investigators obtained CCT using ultrasound pachymetry and corneal curvature using Orbscan topography. They took measurements between 2009 and 2012. Apart from a descriptive and exploratory data analysis, the investigators also performed one-way analysis of variance and agreement analysis, estimated linear and intraclass correlation coefficients, and produced multiple scatter and Bland-Altman plots.

Mean IOP measurements obtained were 13.23 ±4.07 mmHg by GAT and 17.21 ±4.10 mmHg by DCT. Mean difference between GAT and DCT measurements was 3.88 ±2.8 mmHg. Mean CCT was 522.78 ±52 µm, and mean corneal curvature was 43.83 ±2.9823 D.

Investigators found that intraocular pressure measured by GAT was consistently lower when compared with DCT, and this difference was greatest with thinner CCT. Investigators determined that flat corneas appeared to influence GAT measurements compared with DCT.

SOURCE: Andreanos K, Koutsandrea C, Papaconstantinou D, et al. Comparison of Goldmann applanation tonometry and Pascal dynamic contour tonometry in relation to central corneal thickness and corneal curvature. Clin Ophthalmol 2016;10:2477-84.

Comparison of DR Classification Using FA & OCTA

Scientists analyzed and compared the classification of eyes with diabetic retinopathy using fluorescein angiography and optical coherence tomography angiography performed with AngioPlex (Carl Zeiss Meditec) or AngioVue (Optovue), as part of an observational, cross-sectional study of 50 eyes from 26 diabetic subjects. One of the investigators is an employee of Carl Zeiss Meditec.

Two independent graders classified the FA angiograms to assess the presence and severity of several characteristics according to the ETDRS Report 11; a similar evaluation was performed for each 3×3-mm OCTA image from the superficial retinal layer and for the full retina slab.

Percentages of non-gradable images for the outline of the foveal avascular zone in the central subfield were 29 percent for FA, 12 percent for AngioVue and 3 percent for AngioPlex. For capillary loss, percentages of non-gradable images in the CSF were 25 percent for FA, 11 percent for AngioVue and 0 percent for AngioPlex. For the inner ring, percentages of non-gradable images were 12.5 percent for FA, 11.5 percent for AngioVue and 0.5 percent for AngioPlex. Agreement between graders was substantial for the outline of the FAZ. For capillary loss, the agreement was fair for the CSF and moderate for the IR.

Scientists determined that OCTA allowed for better discrimination of the CSF and parafoveal macular microvasculature than FA, especially for FAZ disruption and capillary dropout, without requiring an intravenous injection of fluorescein. In addition, FA had a higher number of non-gradable images. Scientists advised that OCTA could replace the FA as a noninvasive and more sensitive procedure for detailed morphological evaluation of central macular vascular changes.

SOURCE: Soares M, Neves C, Pereira Marques I, et al. Comparison of diabetic retinopathy classification using fluorescein angiography and optical coherence tomography angiography. Br J Ophthalmol 2016; Dec. 7. [Epub ahead of print].

New Bruch’s Membrane Opening: Improving OCT Specificity in Tilted Discs

Scientists investigated and compared the false-positive diagnostic classification of the Bruch’s membrane opening (minimum rim width) and retinal nerve fiber layer thickness in healthy eyes with tilted optic disc.

Fifty healthy eyes of 30 participants with tilted optic disc underwent BMO-MRW and RNFL scanning using Spectralis and macular Cirrus optical coherence tomography scans.

The overall FP rate was significantly lower using BMO-MRW map compared with RNFL map by Spectralis (8 percent vs. 62 percent, respectively, p<0.001) and ganglion cell analysis map by Cirrus (8 percent vs. 50 percent, respectively, p<0.001). Specificity was significantly higher using BMO-MRW than RNFL in eyes with low myopia (89.7 percent vs. 41.4 percent, p<0.001) and moderate myopia (95.2 percent vs. 33.3 percent, p<0.001).

Scientists concluded that OCT-derived BMO-MRW analysis provided significantly greater specificity than RNFL in tilted disc, irrespective of the refractive error, and was more specific than GCA analysis in tilted disc with moderate myopia.

SOURCE: Rebolleda G, Casado A, Oblanca N, et al. The new Bruch’s membrane opening – minimum rim width classification improves optical coherence tomography specificity in tilted discs. Clin Ophthalmol 2016;10:2417-25.



  • Ophthotech Phase III Trials of Fovista: Primary Endpoint Not Met
    Ophthotech Corp. announced that the pre-specified primary endpoint of mean change in visual acuity at 12 months was not achieved in its two pivotal Phase III clinical trials investigating the superiority of Fovista (pegpleranib) anti-PDGF therapy in combination with Lucentis (ranibizumab) anti-VEGF therapy compared with Lucentis monotherapy for the treatment of wet age-related macular degeneration. The addition of Fovista to a monthly Lucentis regimen did not result in benefit, as measured by the mean change in visual acuity at the 12-month time point. The two clinical trials (OPH1002 and OPH1003) were international, multicenter, randomized, double-masked, controlled Phase III studies evaluating the safety and efficacy of 1.5 mg of Fovista administered in combination with Lucentis (Fovista combination therapy) compared with Lucentis monotherapy. Read more.

  • OCTA Module for Spectralis Available
    The Spectralis expandable diagnostic imaging platform can now be upgraded with an OCT angiography module to perform noninvasive, layer-by-layer examinations of flow in the vascular networks of the retina and choroid. The module can be added to new and existing upgradeable Spectralis devices with the OCT2 Module. The multimodal imaging platform enables clinicians to compare OCT angiographies to other modalities such as structural OCT and dye-based angiographies as well as infrared, MultiColor and BluePeak images, dependent on the model. Read more.

  • Philanthropists Donate $5 Million for Retinal Research
    Allergan founder Gavin Herbert and his wife, Ninetta, pledged $5 million to advance retinal research at UC Irvine Health Gavin Herbert Eye Institute, the academic eye care center named in his honor. The gift from the couple is dedicated to expanding the breadth and depth of research into the retina. Read more.

  • Mount Sinai Researcher Receives Prestigious Award
    Robert Ritch, MD, Shelley and Steven Einhorn Distinguished Chair in Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, was named the recipient of the 2017 Joanne G. Angle Service Award from the Association for Research in Vision and Ophthalmology. ARVO selected Dr. Ritch because of his track record of continuous service to the organization since 1991. One of his many achievements was leading the ARVO Host-a-Researcher Program initiative, which gives researchers from underdeveloped countries the opportunity to attend the association’s annual meeting, where they learn valuable information from fellow investigators, colleagues and mentors. Read more.

  • UAB Awarded $2 Million Grant
    The University of Alabama at Birmingham received a $2.94 million National Eye Institute Center Core Grant to support the 15 eligible R01 grants in the UAB School of Optometry and Department of Ophthalmology. UAB houses four cores devoted to the advancement of research in ocular disease, including molecular and cellular analysis, instrumentation, research programing, and computational analysis and ocular phenotyping. Vision research at UAB is focused on dry-eye disease, hereditary retinal degeneration, age-related macular degeneration, glaucoma, cataracts, myopia, brain visual pathways, traumatic brain injury and ocular imaging. Read more.

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