Review of Ophthalmology Online


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Volume 18, Number 23
Monday, June 4, 2018
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JUNE IS HEALTHY VISION MONTH



In this issue: (click heading to view article)
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######### Vitreomacular Interface Abnormalities in DME & Implications for Anti-VEGF Therapy
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######### Evaluation of Corneal Biomechanics in Keratectasia Following LASIK
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######### Retinal Vessel Geometric Characteristics and DR Incidence & Progression
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######### Risk of Glaucoma Surgery After Corneal Transplant Surgery in Medicare Cases
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  Briefly

 

Vitreomacular Interface Abnormalities in DME & Implications for Anti-VEGF Therapy

Investigators aimed to determine whether the presence of vitreomacular interface abnormalities in individuals with diabetic macular edema would modify the response to ranibizumab.

They reviewed medical records and spectral-domain optical coherence tomography scans of consecutive cases with center-involving DME that received ranibizumab therapy between December 2013 and March 2014, at the Belfast Health and Social Care Trust. They identified individuals through an electronic database and recorded:
• demographics;
• systemic baseline characteristics;
• history of previous ocular surgery/laser;
• best-corrected visual acuity;
• central retinal thickness;
• stage of retinopathy at presentation;
• and BCVA, CRT and presence/absence of fluid at the last follow-up.
A masked investigator reviewed and graded OCT scans for the presence/absence of VMIAs at baseline and follow-up, and for changes in the posterior hyaloid face during follow-up.

A total of 146 eyes (100 people; mean age: 63.5 years) followed for a mean of nine months (range: two to 14 months) were included. In eyes with and without VMIAs, and in eyes without VMIAs with better levels of vision, higher frequency of macular laser and lower frequency of PRP, statistically significant differences were observed at baseline in:
• BCVA (p=0.007);
• previous macular laser and panretinal photocoagulation (p=0.006); and
• previous cataract surgery (p=0.01).
Multivariable regression analyses didn’t disclose statistically significant associations between VMIAs at baseline, changes in the posterior hyaloid face during follow-up, or in functional/anatomical outcomes following treatment.

Researchers determined that VMIAs were associated with worse presenting vision in individuals with DME. Furthermore, they added, that VMIAs or changes in the posterior hyaloid face during follow-up didn’t modify responses to ranibizumab.

SOURCE: Mikhail M, Stewart S, Seow F, et al. Vitreomacular interface abnormalities in patients with diabetic macular oedema and their implications on the response to anti-VEGF therapy. Graefes Arch Clin Exp Ophthalmol 2018; May 19. [Epub ahead of print].





Evaluation of Corneal Biomechanics in Keratectasia Following LASIK

Investigators evaluated the corneal biomechanics of eyes with keratectasia following LASIK, as part of a case control study. Included were 12 eyes with keratectasia after LASIK, 24 eyes with keratoconus, 17 eyes without keratectasia after LASIK and 34 eyes with normal corneas. Investigators evaluated corneal biomechanics of the four groups using a dynamic Scheimpflug analyzer.

Compared with normal eyes (7.06 ±0.54), the radius at the highest concavity (radius, mm) of eyes without keratectasia after LASIK (5.96 ±0.76), with keratectasia after LASIK (4.93 ±0.61) and with keratoconus (5.39 ±1.02) was significantly small. The deflection amplitude (HCDLA, mm) of normal eyes (0.94 ±0.07) was significantly lower than that of eyes with keratectasia after LASIK (1.11 ±0.10) and with keratoconus (1.06 ±0.16), and wasn’t significantly different from that of eyes without keratectasia after LASIK (0.98 ±0.07). Investigators reported significant differences between eyes with and without keratectasia after LASIK in radius and HCDLA (p<0.05), whereas eyes with keratectasia after LASIK and with keratoconus had no differences in these parameters.

Investigators wrote that corneal biomechanical features evaluated using the dynamic Scheimpflug analyzer in eyes with keratectasia, keratoconus and LASIK were different from those in normal eyes. They added that the biomechanics in eyes with keratectasia differed from those in LASIK eyes, but were similar to those in eyes with keratoconus.

SOURCE: Ueki R, Maeda N, Fuchihata M, et al. Evaluation of corneal biomechanics in patients with keratectasia following LASIK using dynamic Scheimpflug analyzer. Jpn J Ophthalmol 2018; Apr 26. [Epub ahead of print].



Retinal Vessel Geometric Characteristics and DR Incidence & Progression

Scientists examined the relationships between retinal vessel geometric, and incidence and progression of diabetic retinopathy, as part of an observational, prospective cohort study.

A total of 996 individuals with type 1 diabetes mellitus, and 1,370 people with type 2 diabetes mellitus at a baseline exam were eligible for follow-up exams at five-year intervals. A total of 3,846 person-interval data from these follow-ups were the basis for the analyses.

Scientists graded 30-degree stereoscopic color fundus photographs to assess DR and macular edema. They analyzed retinal vessel geometric characteristics using the Singapore I Vessel Assessment program from a digitized copy of one field 1 fundus photograph obtained at baseline and follow-up.

Main outcome measures included the five-year incidence of DR, progression of DR, incidence of proliferative DR and clinically significant macular edema in right eyes.

• Incident DR occurred in 45 percent of eyes, progression occurred in 32 percent, PDR was found in 10 percent and CSME was detected in 5 percent of eyes.
• While adjusting for glycated hemoglobin, duration of diabetes and other factors, retinal arteriolar simple tortuosity was associated significantly with the incidence of DR (OR, 1.17; CI, 1.01 to 1.35).
• Retinal venular branching angle was associated significantly with progression of DR (OR, 1.18; CI, 1.03 to 1.36).
• Retinal venular curvature tortuosity was associated significantly with incidence of PDR (OR, 1.15; CI, 1.01 to 1.30).
• Retinal venular branching angle (OR, 1.41; CI, 1.10 to 1.82) was associated significantly with the incidence of CSME.
• No significant associations of other RVGCs with DR outcomes in the full multivariate model were found.
• Inclusion of all possible RVGCs didn’t improve the predictive value of the models that already included retinal vessel diameter and baseline DR severity level.

Scientists found that retinal vessel geometric characteristics of retinal venules were associated with progression of DR. However, they also determined that most RVGCs measured from digitized fundus photographs added little to the assessment of risk of incidence and progression of DR when other risk factors were considered in type 1 diabetes mellitus and type 2 diabetes mellitus.

Source: Klein R, Lee KE, Danforth L, et al. The relationship of retinal vessel geometric characteristics to the incidence and progression of diabetic retinopathy. Ophthalmology 2018; May 17. [Epub ahead of print].




Risk of Glaucoma Surgery After Corneal Transplant Surgery in Medicare Cases

Researchers wrote that glaucoma is a well-documented complication of corneal transplants, contributing significantly to visual loss. Reported incidence of glaucoma following corneal transplants is highly variable, and definitions of post-transplant glaucoma are inconsistent, they added. In a retrospective cohort study, researchers used glaucoma surgery as an endpoint to compare rates following different corneal transplant surgeries.

Researchers obtained a 5-percent random sample of Medicare beneficiaries from 2010 to 2013, and identified individuals with Current Procedural Terminology codes for penetrating keratoplasty, endothelial keratoplasty, anterior lamellar keratoplasty and keratoprosthesis. They analyzed rates of glaucoma surgery within the same year following the abovementioned corneal transplants. Subgroup analyses included individuals who carried pre-existing glaucoma diagnoses prior to corneal transplant surgery.

A total of 3,098 individuals underwent corneal transplants during the study, including:
• 1,919 EK;
• 1,012 PK;
• 46 ALK;
• 32 KPro;
• and 89 PK and EK.
Rates of glaucoma surgery ranged from 6.1 percent to 9.4 percent in the corneal transplant groups, without statistically significant differences between groups. However, 10 percent of individuals with preexisting glaucoma required glaucoma surgery following any transplant surgery, compared with 5.3 percent of individuals without pre-existing glaucoma. This included 12.4 percent of PK cases with pre-existing glaucoma compared with 2.8 percent of PK cases without pre-existing glaucoma (p<0.01).

Despite literature suggesting that more angle-altering cornea surgeries confer higher risk of glaucoma incidence, researchers found no statistically significant differences between various transplant groups to support this concept. However, they found that individuals with pre-existing glaucoma had a higher risk of glaucoma surgery within the same year following corneal transplant surgery, which was especially pronounced in the PK group. These individuals required special care in considering long-term effects of corneal transplants, the researchers added.

SOURCE: Zheng C, Yu F, Tseng VL, et al. Risk of glaucoma surgery after corneal transplant surgery in Medicare patients. Am J Ophthalmol 2018; May 12. [Epub ahead of print].





  • PanOptica Doses First Patient with New PAN-90806 Formulation in Phase I/II Trial
    PanOptica dosed the first patient in a Phase I/II dose-ranging clinical trial of PAN-90806, a once-daily topical eye drop formulation of a small-molecule anti-vascular endothelial growth factor for the treatment of neovascular eye diseases. The company is investigating its new suspension formulation as monotherapy for up to three months in a masked study involving 60 individuals newly diagnosed with neovascular age-related macular degeneration randomized to one of three dose strengths at sites in the United States and the European Union. Read more.



  • Nidek Launches LSFG-RetFlow Laser Speckle Flowgraphy
    Nidek introduced the LSFG-RetFlow Laser Speckle Flowgraphy for noninvasive, real-time imaging and measurement of ocular blood flow, to aid in the clinical evaluation of glaucoma and retinochoroidal vascular disease. The technology provides 16 indices of the retinochoroidal vascular dynamics based on the Mean Blur Rate, which measures relative blood flow velocity and correlates to the actual rate of blood flow. The MBR is presented in a color-coded map for evaluation of the onset, progression and follow-up of disease. Practitioners can select indices that meet their clinical needs, and the instrument design is intended to ensure patient comfort, Nidek says. Read more.



  • Clearside Reveals Positive Topline Results from Phase II Trial of CLS-TA Used with Eylea for DME
    In TYBEE—a multicenter, randomized, masked, controlled Phase II trial—71 individuals who were treatment-naïve for diabetic macular edema were randomized 1:1 to receive quarterly treatments of suprachoroidal triamcinolone acetonide (CLS-TA) with intravitreal Eylea (months zero and three) or four monthly treatments of intravitreal Eylea plus a sham suprachoroidal procedure (months 0, one, two and three); individuals in both arms received intravitreal Eylea treatments at months four and five as needed. Clearside Biomedical announced the trial met its primary endpoint of mean improvement in best-corrected visual acuity from baseline over six months using the Early Treatment Diabetic Retinopathy Trial scale. Individuals in the combination arm gained an average of 12.3 ETDRS letters compared with 13.5 ETDRS letters in the Eylea-alone control arm (p=0.664). Read more.



  • Heidelberg’s Spectralis OCT2 Module Heads to International Space Station
    Heidelberg Engineering’s next-generation OCT2 Module will be installed on the International Space Station in late 2018. The device was onboard the Antares 230 Cygnus CRS OA-9, when it launched May 21, 2018, from Wallops Island, Va. Researchers will continue to study Space Flight Associated Neuro-Ocular Syndrome, as well as changes in posterior optic nerve head anatomy and choroidal blood supply to the retinal structures. Read more.



  • Prominent Optovue Employee Retires
    Optovue announced the retirement, effective July 1, of industry veteran John Hawley, the company’s senior vice president of global sales. Hawley will remain with Optovue in an advisory role. He started his tenure in 2008 as vice president of business development, as the company was beginning its entry into the ophthalmic and optometric OCT markets. Within six months, Hawley was heading the U.S. organization. He was promoted to senior vice president of global sales in 2016. Read more.



  • Envision Receives $300,000 for Workforce Innovation Center
    Envision received a $300,000 gift from The Sunderland Foundation for the construction of the William L. Hudson BVI Workforce Innovation Center. The center, to be housed in Envision’s headquarters, will be dedicated to training blind or visually impaired individuals, placing them into skilled positions and providing accessibility inclusion expertise to businesses around the United States. In addition, Envision kicked off a campaign to raise $1.5 million by Dec. 1 to receive a $750,000 challenge grant from the J.E. and L.E. Mabee Foundation. Read more.



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