Review Of Ophthalmology - June 11, 2018

Review of Ophthalmology Online

Volume 18, Number 24

Monday, June 11, 2018

JUNE IS HEALTHY VISION MONTH

In this issue: (click heading to view article)

		Rates of Endophthalmitis After PPV

		24-hour IOP Monitored With a CL Sensor & VF Progression in Older Glaucoma Subjects

		Viscocanalostomy & Phaco-viscocanalostomy Outcomes in Advanced Glaucoma

		Using OCTA to Assess Neovascularization Characteristics in Early PDR

		Briefly

Rates of Endophthalmitis After PPV

Researchers studied the incidence of endophthalmitis after pars plana vitrectomy, its causative organisms and visual acuity outcomes, in a retrospective, comparative study.

They reviewed the medical records of individuals with acute-onset postoperative endophthalmitis after PPV at Farabi Eye Hospital, Tehran, Iran, during a 12-year period between January 2004 and November 2015. They developed a control group by gathering the data from surgical records to compare the endophthalmitis cases with other cases that underwent PPV on the same day in the same operating room.

The incidence rate of post-vitrectomy endophthalmitis was 0.04 percent (16/39,783). The organisms identified in aqueous or vitreous cultures (culture positive: 44 percent) included Streptococcus pneumoniae (two individuals, 12.5 percent), Pseudomonas aeruginosa (two individuals, 12.5 percent), fungi (two individuals, 12.5 percent), and Streptococcus viridans (one individual, 6.25 percent). Visual acuity after treatment for endophthalmitis ranged from light perception (seven eyes) to hand motion (one eye), and evisceration was performed in eight eyes (50 percent). When comparing cases (individuals developing endophthalmitis) and controls (subjects with no complications operated on on the same day and at the same place as the case group), not using tamponade showed a statistically significant relationship with the occurrence of endophthalmitis (p=0.034).

Researchers determined a low incidence of endophthalmitis after PPV comparable with previous studies that had resulted in poor visual acuity. They speculated that the lack of a tamponade might have increased the risk of endophthalmitis among subjects.

SOURCE: Tabatabaei SA, Soleimani M, Vakili H, et al. The rate of endophthalmitis after pars plana vitrectomy and its risk factors. Int Ophthalmol 2018; May 11. [Epub ahead of print].

24-hour IOP Monitored With a CL Sensor & VF Progression in Older Glaucoma Subjects

Twenty-four-hour intraocular pressure patterns might provide more information regarding rates of visual field progression than office-hour measurements, investigators wrote. However, they added that little was known about the added value of 24-hour monitoring when stratifying glaucoma risk based on progression rates.

As such, they tested the hypothesis that 24-hour IOP-related patterns recorded with a contact lens sensor (CLS) correlated with prior rates of VF progression. Investigators conducted a multicenter, retrospective cohort study at 50 ophthalmology care centers in 13 countries. Participants included 445 individuals (445 eyes) with treated, manifest open-angle glaucoma. The study was conducted from November 8, 1999, to September 17, 2016.

A CLS system helped prospectively collect 24-hour recordings of IOP-related patterns. Investigators examined retrospective VF data of individuals who underwent at least three prior reliable VF tests. Main outcomes and measures included the association between CLS variables and rates of VF mean deviation change.

Of the 445 individuals included, 238 (53.5 percent) were women and 394 (88.5 percent) were white. The mean (SD) age and MD values at the time of CLS recording were 68.9 (11.2) years and -9 (7.0) dB. The mean rate of MD change was -0.46 (0.5) dB/y in 5.2 (three) years of follow-up. After adjusting for baseline MD severity, age and treatment, the following CLS variables were associated with fast VF progression:
• mean peak ratio while awake (β=-0.021; CI, -0.04 to -0.003);
• number of long peaks during sleep (β=0.036; CI, 0.005 to 0.067);
• night bursts ocular pulse frequency SD (β=0.027; CI, 0.004 to 0.051);
• and night bursts ocular pulse amplitude SD (β=19.739; CI, 1.333 to 38.145).
• Regression models including CLS variables fit better than Goldmann IOP when testing the association with rates of progression.

Investigators concluded that 24-hour CLS recordings might be associated with prior VF progression rates of glaucoma. They noted that this association appeared to be more accurate than Goldmann mean IOP when measured multiple times during office hours. Therefore, investigators wrote, CLS might be useful to assess the risk of future functional loss, even when historical VF information is insufficient.

SOURCE: De Moraes CG, Mansouri K, Liebmann JM, et al. Association between 24-hour intraocular pressure monitored with contact lens sensor and visual field progression in older adults with glaucoma. JAMA Ophthalmol 2018; May 24. [Epub ahead of print].

Viscocanalostomy & Phaco-viscocanalostomy Outcomes in Advanced Glaucoma

Scientists determined medium-term outcomes for individuals with advanced glaucoma undergoing viscocanalostomy.

They included all individuals with advanced glaucoma (MD -12 dB or above) and individuals with poor visual acuity secondary to advanced glaucoma precluding formal visual field assessment who underwent viscocanalostomy and phaco-viscocanalostomy between 2010 and 2014 under the care of a single surgical team. Intraocular pressure, visual acuity and VF outcomes were assessed from data prospectively collected and compiled into a surgical outcomes database. Success was defined at two IOP cutoff points: IOP ≤21 mmHg and ≤16 mmHg with (qualified) or without (complete) medications.

A total of 135 subjects were included. The results:
• Mean IOP changed from 23.6 ±6.4 mmHg preoperatively to 15.3 mmHg at one year (35 percent), 15.8 mmHg (33.5 percent) at two years and 14.8 mmHg at three years (39 percent).
• Qualified success for an IOP ≤21 mmHg was achieved in 95.66 percent of subjects at year one, 90.6 percent of subjects at year two and 80 percent of subjects at year three; complete success was achieved in 52.5 percent of subjects at year one, 48.6 percent at year two and 30.6 percent at year three.
• Qualified success for an IOP ≤16 mmHg was achieved in 66.6 percent at year one, 66.05 percent at year two and 60 percent at year three; complete success was achieved in 44.8 percent of cases at year one, 37.6 percent of cases at year two and 30.6 percent of cases at year three.
• The cumulative probability for achieving IOP ≤21 mmHg with or without drops was 86.1 percent of cases at 12 months, 81.4 percent of cases at 24 months and 81.4 percent of cases at 36 months.
• Eleven individuals (8.1 percent) failed to achieve adequate IOP control and needed further surgical intervention.
• Eleven individuals (8.1 percent) needed an intervention (YAG goniopuncture) following VC.
• Four individuals (2.9 percent) had postoperative complications, which resolved within two weeks following surgery.
• Nine subjects (6.7 percent) lost more than two Snellen lines.
• No significant change was determined in the MD across time points.

Scientists found that viscocanalostomy and viscocanalostomy combined with phacoemulsification were safe and effective methods of controlling IOP in the medium term in individuals with advanced glaucoma.

SOURCE: Tsagkataki M, Bampouras TM, Choudhary A, et al. Outcomes of viscocanalostomy and phaco-viscocanalostomy in patients with advanced glaucoma. Graefes Arch Clin Exp Ophthalmol 2018; May 22. [Epub ahead of print].

Using OCTA to Assess Neovascularization Characteristics in Early PDR

Researchers classified retinal neovascularization in untreated early stages of proliferative diabetic retinopathy based on optical coherence tomography angiography, as part of a cross-sectional study. Thirty-five eyes were included. They underwent color fundus photography, fluorescein angiography and OCTA exams. Researchers used OCTA to assess neovascularizations of the optic disc, neovascularizations elsewhere and intraretinal microvascular abnormalities. They evaluated the origin and morphology of NVD/NVE/IRMA on OCTA, and measured retinal nonperfusion areas using Image J software.

Researchers captured 35 NVDs, 75 NVEs and 12 IRMAs in 35 eyes, and identified three proposed subtypes of NVEs based on origins and morphological features.
• Type 1 (32 of 75, 42.67 percent) originated from retinal vein structures in a tree-like shape; type 2 (30 of 75, 40 percent) originated from capillary networks, with an octopus-like appearance; and type 3 (13 of 75, 17.33 percent) originated from the IRMAs, having a sea fan shape.
• NVDs originated from the retinal artery, retinal vein or choroid, and arose from the bending vessels near the rim of the optic disc.
• IRMAs originated from, and drained into, retinal venules extending into the retina.

The initial layer and affiliated NPAs were significantly different in the three subtypes of NVEs (all p<0.01).

Researchers wrote that OCTA enabled identification of the origins and morphological patterns of neovascularization in PDR. They added that the new classification of retinal neovascularization might be useful to better understand pathophysiological mechanisms and guide efficient therapeutic strategies.

SOURCE: Pan J, Chen D, Yang X, et al. Characteristics of neovascularization in early stages of proliferative diabetic retinopathy by optical coherence tomography angiography. Am J Ophthalmol 2018; May 26. [Epub ahead of print].

FDA Approves First Artificial Iris
The U.S. Food and Drug Administration approved the first standalone prosthetic iris in the United States, a surgically implanted device to treat adults and children whose iris is completely missing or damaged due to a congenital aniridia or other damage to the eye. The study found low rates of adverse events associated with the device. Complications included: device movement or dislocation; strands of device fiber in the eye; increased intraocular pressure; iritis; synechiae; and the need for secondary surgery to reposition, remove or replace the device. Read more.

BioTime Receives $1.9 Million Grant for Ongoing OpRegen Development
BioTime received a new grant of up to approximately $1.9 million from the Israel Innovation Authority for continued development of OpRegen. The company is currently in a Phase I/IIa clinical study, which in March 2018 received authorization from the Data Safety Monitoring Board to enroll cohort 4 based on safety observed throughout the first three cohorts. Read more.

Bausch + Lomb Enrolls First Patient in Envista Mx60ef Trifocal IOL Trial
Bausch + Lomb enrolled the first patient in a clinical trial studying the efficacy and safety of an investigational trifocal intraocular lens, the enVista MX60EF, to support an FDA pre-market approval application filing. The single-piece, ultraviolet-absorbing posterior chamber IOL is intended to be used in adults who desire improved uncorrected near, intermediate and distance vision, the company says. According to B+L, the lens features StableFlex technology for rapid optic recovery following delivery, an AccuSet haptics offset design, broad contact angle and a SureEdge continuous 360-degree square edge. Read more.

Drug-eluting Contact Lens to Provide Timed Drug Delivery
Alabama-based company OcuMedic says that a new, drug-eluting soft contact lens technology has been shown to deliver various drugs directly to the eye, and it has plans to begin clinical trials of the technology in the coming year. The extended-wear contact, developed by biomedical researchers at Rowan University and Auburn University, controls the release of anti-inflammatory, antibiotic and pain-reducing drugs delivered evenly over time. OcuMedic says the technology can potentially reduce recovery time and postoperative complications after eye surgery. Read more.
Adverum Presents Long-term Preclinical Data on ADVM-022 in Wet AMD
Adverum Biotechnologies announced additional long-term efficacy data from a preclinical study of ADVM-022 in wet age-related macular degeneration in a poster session at the American Society of Gene and Cell Therapy annual meeting in Chicago, including that ADVM-022:
• as a single intravitreal injection, was found to be safe and statistically significant (p<0.0001) in preventing development of grade IV lesions compared with the control group after 13 months;
• induced sustained intraocular expression of aflibercept for up to 16 months following a single intravitreal injection; and
• was well-tolerated, with no serious adverse events.
Read more.

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