Review of Ophthalmology Online

FROM THE EDITORS OF REVIEW OF OPHTHALMOLOGY:







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Volume 18, Number 31
Monday, July 30, 2018
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JULY IS UV SAFETY MONTH



In this issue: (click heading to view article)
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######### Comparing Conventional & Accelerated Corneal Cross-linking
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######### Efficacy & Safety of Timolol Maleate Fixed Combinations on 24-hour IOP
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######### Segmentation Errors & Motion Artifacts in OCTA in Different Diseases
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######### Photodynamic Therapy with Intravitreal Ziv-Aflibercept & Aflibercept Injection in Chronic or Repeatedly Recurrent Acute CSC
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  Briefly

 

Comparing Conventional & Accelerated Corneal Cross-linking

Researchers retrospectively investigated the efficacy of corneal cross-linking on progressive keratoconus in a Japanese population and compared the outcomes of conventional and accelerated CXL, as part of a retrospective cohort study

They enrolled 108 consecutive eyes of 95 individuals (75 men; 21.9 ±6.2 years) with progressive keratoconus. The epithelium was ablated in all eyes. After presoaking the corneal stroma in riboflavin, UV-A at 3 mW/cm2 (conventional CXL) for 30 min was used to irradiate 23 eyes and 18 mW/cm2 UV-A was used for five minutes (accelerated CXL) on 85 eyes. Researchers evaluated best spectacle-corrected visual acuity, manifest refraction, keratometric value, corneal thickness, corneal endothelial cell density, intraocular pressure and complications at one, three, six and 12 months after the procedure.

BSCVA, manifest refraction, ECD and corneal thickness didn’t change significantly after both procedures. The keratometric value was significantly decreased from the preoperative value at 12 months (p<0.001). Progression to more than 1 D after CXL was observed in 10 eyes (9.3 percent). The change in Kmax was negatively associated with preoperative Kmax (p<0.001) and positively associated with preoperative thinnest corneal thickness (p<0.001). Both treatment modules showed no significant difference in all parameters.

Researchers concluded that CXL was as effective in treating keratoconus in Japanese individuals as in individuals of other ethnicities. They added that, overall, CXL could be performed using either the conventional or accelerated approach to halt the progression of keratoconus.

SOURCE: Kato N, Konomi K, Shinzawa M, et al. Corneal crosslinking for keratoconus in Japanese populations: One year outcomes and a comparison between conventional and accelerated procedures. Jpn J Ophthalmol 2018; Jul 10. [Epub ahead of print].





Efficacy & Safety of Timolol Maleate Fixed Combinations on 24-hour IOP

Investigators evaluated the effect of bimatoprost/timolol maleate (BTFC), latanoprost/timolol maleate (LTFC) and travoprost/timolol maleate (TTFC) fixed combinations on 24-hour intraocular pressure in open-angle glaucoma.

The prospective, observer-masked, randomized study included 50 individuals with primary open-angle glaucoma. All individuals were using hypotensive lipids and timolol maleate fixed-combination treatment for ≥4 weeks and had an IOP ≤21 mmHg. Group 1 (n=18) received BTFC, group 2 (n=14) received LTFC and group 3 (n=18) received TTFC. All individuals were hospitalized, and IOP was monitored for 24-hours (at 10:00, 14:00, 18:00, 22:00, 02:00 and 06:00). Mean diurnal IOP variation measurements were taken between 06:00 and 18:00, and mean nocturnal IOP variation measurements were taken between 22:00 and 02:00. Mean IOP and IOP variation in the three groups were compared.

• Mean 24-hour IOP didn’t differ significantly between the three groups (group 1: 14.6 ±2.9 mmHg; group 2: 14.1 ±3.7 mmHg and group 3: 15.8 ±2 mmHg; p> 0.05).
• Mean diurnal IOP variation was 4.6 ±2.3 mmHg in group 1, 5.8 ±2.4 mmHg in group 2, and 4.3 ±1.7 mmHg in group 3.
• Mean nocturnal IOP variation was 3.2 ±2.8 mmHg in group 1, 2.9 ±1.9 mmHg in group 2 and 3 ±1.6 mmHg group 3.
• Investigators found no significant differences in diurnal or nocturnal IOP variation between the three groups (p<0.05).

Investigators determined that all three fixed combinations effectively controlled IOP for 24 hours and had a similar effect on diurnal and nocturnal IOP variations.

SOURCE: Guven Yilmaz S, Degirmenci C, Karakoyun YE, et al. The efficacy and safety of bimatoprost/timolol maleate, latanoprost/timolol maleate, and travoprost/timolol maleate fixed combinations on 24-h IOP. Int Ophthalmol. 2018 Aug;38:4:1425-1431.



Segmentation Errors & Motion Artifacts in OCTA in Different Diseases

Scientists assessed the prevalence of segmentation errors and motion artifacts in optical coherence tomography angiography in different retinal diseases, as part of a retrospective analysis.

Multimodal retinal imaging, including OCTA, was performed in one eye of 57 healthy controls (50.96 ±22.4 years) and 149 individuals (66.42 ±14.1 years) affected by different chorioretinal diseases:
• early/intermediate age-related macular degeneration (n=26);
• neovascular AMD (n=22);
• geographic atrophy due to AMD (GA; n=6);
• glaucoma (n=28);
• central serous chorioretinopathy (n=14);
• epiretinal membrane (n=26);
• retinal vein occlusion (n=11); and
• retinitis pigmentosa (n=16).

Central 3 × 3 mm2 OCTA imaging was performed with active eye-tracking (AngioVue, Optovue). Best-corrected visual acuity and signal strength index were recorded. Images were independently evaluated by two graders using the OCTA motion artifact score (MAS; score of I to IV), as well as a newly introduced segmentation accuracy score (score I to IIB).

Mean SSI was 63.67 ±9.2 showing a negative correlation with increasing age (rSp=-0.42, p<0.001, n=206).

• In the healthy cohort, mean MAS was 1.45 ±0.8 and segmentation was accurate (SAS I) in all eyes. In eyes with retinal pathologies, mean MAS was 2.1 ±0.9 (p<0.001). The lowest MAS was observed in GA (2.67 ±0.5) and RVO (2.45 ±1.1).
• Compared with an accurate segmentation in 100 percent of healthy subjects, 34.2 percent (n=51) of all individuals showed highest segmentation quality (p<0.001).
• A total of 63.8 percent showed segmentation errors in more than 5 percent of all single B-scans in one (SAS IIA, n=58) or at least two (SAS IIB, n=40) segmentation boundaries. The highest percentage of inaccurate segmentation (SAS IIA or IIB) was observed in the nAMD group (90.1 percent). The inner plexiform layer was the segmentation boundary most prone to inaccurate segmentation in all pathologies compared with the inner limiting membrane and retinal pigment epithelium segmentation layer. Incorrect ILM segmentation was only seen in individuals with EM.

Scientists wrote that, prior to both qualitative and quantitative analysis, OCTA images must be carefully reviewed, as motion artifacts and segmentation errors in OCTA technology were frequent, particularly in pathologically altered maculas.

SOURCE: Lauermann JL, Woetzel AK, Treder M, et al. Prevalences of segmentation errors and motion artifacts in OCT-angiography differ among retinal diseases. Graefes Arch Clin Exp Ophthalmol 2018; July 7. [Epub ahead of print].




Photodynamic Therapy with Intravitreal Ziv-Aflibercept & Aflibercept Injection in Chronic or Repeatedly Recurrent Acute CSC

Researchers assessed the effect of off-label photodynamic therapy in combination with intravitreal off-label ziv-aflibercept or off-label aflibercept injections in individuals with chronic or repeatedly recurrent acute central serous chorioretinopathy.

The investigators retrospectively analyzed changes in best-corrected visual acuity, subfoveal subretinal fluid and maximum subretinal fluid in a single-center cohort study of 17 individuals (18 eyes) with persistent subretinal fluid for more than three months of duration of CSC. They measured treatment efficacy between injection and PDT at 30 ±15 days, 90 ±15 days and 180 ±30 days after PDT.

Researchers found significant reduction of sSRF and mSRF after therapy with ziv-aflibercept and aflibercept combined with PDT (p<0.001). The course of BCVA showed non-significant improvement within six months (p=0.065). They documented one case of allergic reaction after fluorescein angiography, and one case of ophthalmic migraine after ziv-aflibercept injection. One case of reversible vision loss occurred during the six-month period after combination therapy. No other adverse events or side effects were reported.

Researchers suggested that combination therapy of off-label ziv-aflibercept and aflibercept with PDT seemed to be beneficial, even in cases of chronic or repeatedly recurrent acute CSC. This included cases of CSC resistant to, or recurrent after, medical treatment, PDT alone or therapy with anti-vascular endothelial growth factor alone.

SOURCE: Doepfner JM, Michels S, Graf N, et al. Photodynamic therapy in combination with intravitreal ziv-aflibercept and aflibercept injection in patients with chronic or repeatedly recurrent acute central serous chorioretinopathy: A single-center retrospective study. Clin Ophthalmol 2018;12:1301-9.





  • GENENTECH UNVEILS POSITIVE PHASE II RESULTS FOR SUSTAINED-DELIVERY OF Ranibizumab
    Positive topline results from Genentech’s Phase II LADDER study evaluating the efficacy and safety of its investigational port delivery system with ranibizumab in people with wet age-related macular degeneration revealed that most PDS patients enrolled in the trial went six months or longer between the implantation of the device and the first refill. In addition, the company says that vision outcomes in the high-dose PDS group were similar to monthly ranibizumab injections and were maintained throughout the study period. The small, refillable eye implant, which is slightly longer than a grain of rice, is designed to allow people with wet AMD to go several months without needing to visit their ophthalmologist for treatment. Read more.



  • Apellis’ APL-2 on the Fast Track
    Apellis Pharmaceuticals announced that the U.S. FDA granted Fast Track designation to the company’s APL-2, a novel inhibitor of complement factor C3, as a next-generation monotherapy for the treatment of patients with geographic atrophy. Apellis plans to initiate a Phase III trial for patients with GA later this year which will consist of two identical, prospective, multicenter, randomized, double-masked, sham-injection controlled studies to assess the efficacy and safety of multiple intravitreal injections of APL-2 in patients with GA. Read more.



  • Alcon Unveils Next-generation Forceps for Retinal Surgery
    Alcon launched Finesse Sharkskin ILM Forceps at the American Society of Retina Specialists annual meeting in Vancouver, Canada. Alcon calls the forceps a “next-generation tool designed to provide increased surgical precision and enhance retina surgery outcomes.” The forceps have a large grasping platform and a textured tip surface, to help surgeons more easily grasp and peel the internal limiting membrane and minimize trauma to the retina in the process, Alcon says, adding that the forceps are designed to deliver an optimized grasping platform to minimize membrane shredding that can be caused by multiple grasping attempts. The laser-ablated micro-structures on the tip surface, which resemble the textured skin of a shark, increase friction between tissue and forceps to improve grip during ILM peeling, the company says. The conforming forceps also provide a 59 percent larger platform in 27 gauge to decrease the closing angle and increase the length of the grasping edge. The forceps are available in 23, 25+ and 27+ gauge sizes. Read more.

    Recently, Alcon also launched the new NGENUITY 3D Visualization System with DATAFUSION at the 2018 American Society of Retina Specialists annual meeting. Alcon says that the high-definition screen of the NGENUITY system provides retinal surgeons 3D visualization of the back of the eye with greater depth and detail during surgery than traditional microscopes and now, with the addition of the DATAFUSION software, the system also offers integration with the CONSTELLATION Vision System, the company's platform for vitreoretinal surgery. The company says that the integration of the systems lets surgeons to track key data parameters in real-time, such as intraocular pressure, flow rates, infusion pressure and laser power, on one screen. Read More.


  • FDA Accepts Aerie NDA Submission for Roclatan
    Aerie Pharmaceuticals received notification from the U.S. Food and Drug Administration that the FDA completed its initial 60-day review of the new drug application for the glaucoma drug Roclatan (netarsudil/latanoprost ophthalmic solution) 0.02%/0.005%, and determined that the application is sufficiently complete to permit a substantive review. The Prescription Drug User Fee Act goal date for the completion of the FDA’s review is set for March 14, 2019. Read more.


  • Eton Pharma Reports Positive Topline Results from Phase III EM-100 Trial
    Eton says that topline results from its Phase III study of EM-100 topical ophthalmic solution revealed that the drug is non-inferior to Zaditor (ketotifen fumarate ophthalmic solution 0.035%; Alcon/Novartis) in the treatment of ocular itching. Furthermore, the product demonstrated statistically significant superiority to placebo at all time points measured, with no adverse events. If approved, EM-100 would be the first topical, preservative-free formulation for the treatment of ocular itching associated with allergic conjunctivitis. Read more.


  • Topcon Introduces Augmented Reality App
    Topcon Medical Systems released a new app that makes use of augmented reality technology to provide another dimension to the company’s products and promotional materials. Topcon will roll out the app to support its Image of the Month ad campaign and then expand the app to include ISSOCT Conference, Maestro, Triton and Aladdin applications. Features include an augmented reality scanner and the ability to record, share and save AR experiences. The app is available for download from the Apple Store and Google Play.


  • Foundation Fighting Blindness Urges Congress to Pass Eye-Bonds Legislation
    The Foundation Fighting Blindness expressed strong support of a bipartisan bill introduced late July 18, 2018, in the U.S. House of Representatives that the Foundation says holds promise for saving and restoring the vision of the adults and children in the United States who are blind or have severely impaired vision from a variety of conditions, including inherited retinal diseases and age-related macular degeneration. The Faster Treatments and Cures for Eye Diseases Act, H.R. 6421 would allow for the creation of Eye-Bonds, and would fund translational research and advance treatments and cures for blindness and other causes of severe vision impairment. Eye-Bonds fill a critical need because many promising therapies never make it through the translational research process and into clinical trials because of a lack of funding. Eye-Bonds would finance packages of loans that would total $1 billion for new projects over four years in the pilot phase. Underwriters would determine how many projects they would fund and at what amount, not to exceed $250 million in any year. Read more.




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