Volume 16, Number 47
Monday, November 21, 2016


In this issue: (click heading to view article)
######### ODH Incidence in Ocular Hypertension Treatment Study: 13-Year Follow-up
######### Relationship Between Macular Thickness Measurement and Signal Strength on OCT
######### DMEK Comparing SF6 20% vs. 100% Air for Anterior Chamber Tamponade
######### OCT of Retinal Lesions in Infants With Congenital Zika Syndrome


ODH Incidence in Ocular Hypertension Treatment Study: 13-Year Follow-up

Researchers set out to determine the cumulative incidence of optic disc hemorrhage before and after development of primary open-angle glaucoma, determine the prognostic significance of ODH for the development of POAG and identify predictive factors for ODH, as part of a prospective cohort study.

Researchers evaluated ODHs in 3,236 eyes of 1,618 Ocular Hypertension Treatment Study participants annually using stereoscopic optic disc photographs. They determined incidence of ODH before and after the development of POAG, the risk of ODH for POAG and risk factors for ODH using a multivariate proportional hazards regression models.

After a median follow-up of 13 years, researchers detected one or more ODHs in 179 eyes of 169 participants. The incidence of ODH was 0.5 percent per year during an average of 13 years before the development of POAG and 1.2 percent per year during an average of six years after the development of POAG. The cumulative incidence of POAG in eyes with ODH was 25.6 percent compared to 12.9 percent in eyes without ODH. The occurrence of an ODH increased the risk of developing POAG 2.6-fold in the multivariate analysis (CI, 1.7 to 4.0; p<0.0001). Researchers identified randomization to the observation group, older age, thinner central corneal thickness, larger vertical cup-to-disc ratio, higher intraocular pressure and self-reported black race as risk factors for ODH.

They concluded that ODH was an independent predictive factor for the development of POAG in individuals with ocular hypertension and that the predictive factors for ODH are very similar to those for POAG in individuals with OHT.

SOURCE: Budenz DL, Huecker JB, Gedde SJ, et al. Thirteen-year follow-up of optic disc hemorrhages in the Ocular Hypertension Treatment Study. Am J Ophthalmol; Nov. 8. [Epub ahead of print].

Relationship Between Macular Thickness Measurement and Signal Strength on OCT

Investigators examined the relationship between signal strength and macular thickness as measured by Stratus optical coherence tomography’s fast macular thickness protocol in healthy subjects, as part of a prospective cross-sectional study.

Seventy-nine eyes of 42 healthy subjects were enrolled. Investigators recorded the age, gender and eye (right vs. left) of each subject. They used the Stratus OCT fast macular thickness scan protocol and the retinal thickness map analysis to measure macular thickness. Each eye was imaged at least six times to acquire images with signal strengths of 4 through 9 out of 10 via adjustment of the focusing knob. The OCT parameters included in the analysis were thickness in the central 1 mm and in the different quadrants in the 3-mm area.

Overall, 79 eyes of 42 cases with a mean age of 38.4 ±12.4 were included. Investigators found no significant difference between signal strength measurements obtained with different signal strengths in the central thickness (p=0.20). In the superior, nasal, inferior and temporal quadrants, a signal strength of 8 demonstrated up to 3 µm thicker measurements than a signal strength of 5 (p<0.05). In general linear regression analysis, after accounting for age and gender, signal strength didn’t remain a significant predictor of thickness in any quadrant.

Investigators determined that, when using fast map macular measurements, a signal strength of 5 is clinically as efficient as a signal strength of 8 in measuring macular thickness in all quadrants; as such, insisting on higher signal strength may not be necessary.

SOURCE: Segal O, Shapira Y, Gershoni A, et al. Relationship between macular thickness measurement and signal strength using Stratus optical coherence tomography. Clin Ophthalmol 2016;10:2259-64.

DMEK Comparing SF6 20% vs. 100% Air for Anterior Chamber Tamponade

Scientists analyzed one-year clinical outcomes and complication rates following Descemet’s membrane endothelial keratoplasty with sulfur hexafluoride 20% anterior chamber tamponade compared with conventional 100% air for primary graft attachment during DMEK surgery.

They retrospectively reviewed records of 1,112 consecutive DMEKs and grouped by anterior chamber tamponade used during DMEK surgery (SF620% vs. 100% air). Outcome measures included intraocular pressure, best spectacle-corrected visual acuity, endothelial cell density and central corneal thickness at one, three, six and 12 months after DMEK surgery. Scientists assessed complication rates, including intraoperative and postoperative complications, and graft detachment rate requiring rebubbling.

Of 854 cases included, in 105 (12.3 percent), DMEK was performed with SF620%, and in 749 cases (87.7 percent), 100% air was used for anterior chamber tamponade. Outcome results for IOP, BSCVA, ECD and CCT at all follow-up time points were comparable for anterior chamber tamponade groups without statistical significant differences (p≥0.05), but graft detachment rate requiring rebubbling was significantly lower in the SF620% group (p<0.001).

While SF620% anterior chamber tamponade did not appear to negatively affect the clinical outcome of DMEK surgery within the first postoperative year, scientists suggested that use of SF620% significantly reduced the rate of rebubblings.

SOURCE: Schaub F, Enders P, Snijders K, et al. One-year outcome after Descemet membrane endothelial keratoplasty (DMEK) comparing sulfur hexafluoride (SF6) 20% versus 100% air for anterior chamber tamponade. Br J Ophthalmol 2016; Nov. 11. [Epub ahead of print].

OCT of Retinal Lesions in Infants With Congenital Zika Syndrome

Researchers evaluated the affected retinal layers in infants with congenital Zika syndrome and associated retinal abnormalities using optical coherence tomography, as part of a cross-sectional, consecutive case series including eight infants (age range: 3 to 5.1 months) with CZS.

Researchers obtained OCT images in the affected eyes of seven infants with CZS who had undergone previous ophthalmologic examinations on March 17, 2016, and in one infant on January 1, 2016. They performed an IgM antibody-capture enzyme-linked immunosorbent assay for ZIKV on the cerebrospinal fluid samples of seven of the eight infants (88 percent), and other congenital infections were ruled out.

Among the eight infants (three male, five female, mean [SD] age at exam, 4.1 [0.7] months), seven who underwent cerebrospinal fluid analysis for ZIKV had positive findings for IgM antibodies. Eleven of the 16 eyes (69 percent) of the eight infants had retinal alterations, and researchers performed OCT imaging in nine (82 percent) of them, along with OCT in one unaffected eye. The main OCT findings in the affected eyes included discontinuation of the ellipsoid zone and hyperreflectivity underlying the retinal pigment epithelium in nine eyes (100 percent), retinal thinning in eight eyes (89 percent), choroidal thinning in seven eyes (78 percent); and colobomatous-like excavation involving the neurosensory retina, retinal pigment epithelium and choroid in four eyes (44 percent).

Researchers wrote that Zika virus can cause severe damage to the retina, including the internal and external layers, and the choroid. They added that the colobomatous-like finding seen in OCT images related to the excavated chorioretinal scar observed clinically.

SOURCE: Ventura CV, Ventura LO, Bravo-Filho V, et al. Optical coherence tomography of retinal lesions in infants with congenital Zika syndrome. JAMA Ophthalmology 2016; Nov. 10. [Epub ahead of print].



  • Ocular Therapeutix Announces Positive Topline Results from Phase III Trial
    Ocular Therapeutix announced positive topline results from its Phase III clinical trial of Dextenza (dexamethasone insert) 0.4 mg for the treatment of post-surgical ocular inflammation and pain. Dextenza is a product candidate administered by a physician as a bioresorbable intracanalicular insert and designed for drug release to the ocular surface for up to 30 days. The trial successfully met its two primary efficacy endpoints for inflammation and pain, achieving statistically significant differences between the treatment group and the placebo group for the absence of inflammatory cells on day 14 and the absence of pain on day eight, respectively. A total of 52.3 percent of individuals treated with Dextenza showed an absence of inflammatory cells in the anterior chamber of the study eye on day 14 compared with 31.1 percent of those receiving the placebo vehicle control punctum plug (p<0.0001). Read more.

  • Report Explores Gap Between Managed Care & ECPs
    The Eye Care Trend Report, Volume II, supported by Allergan, is a 40-page report that examines and compares the perspectives of managed care organizations, ophthalmologists and optometrists on current eye-care issues. Findings from three surveys are analyzed along with commentary from an independent Editorial Advisory Panel of 10 managed-care and eye-care experts. A total of 83 MCOs, 65 ophthalmologists and 127 optometrists completed the three surveys. Findings include: MCOs name the rising cost of care as the leading challenge in eye care, while ophthalmologists and optometrists cite decreasing reimbursements as the top challenge; and approximately three-quarters of ophthalmologists (n=64) and optometrists (n=127) agree that a patient’s health plan formulary has a great or moderate influence on prescribing decisions. Read more.

  • MediNiche Introduces Updated OcuDerma Eye Gel
    OcuDerma Eye Gel, which its maker MediNiche describes as a smooth, non-oily and non-sticky gel containing advanced technology peptides to help reduce under-eye bag volume by decreasing capillary permeability, improving lymphatic circulation and improving firmness and elasticity, now has a new formula. The formula is designed to prevent the clouding of lenses or irritation, and contains no fragrances, artificial dyes, parabens, sensitizers or pore-clogging agent. MediNiche says OcuDerma also contains a blend of extracts, locust bean and hyaluronate to make the skin around the eyes feel tighter and look firmer, help lift the upper eyelid, reduce the appearance of “crow’s feet” and diminish puffiness. New packaging includes an airless pump bottle in a box and features a "Sani-Dose" pump dispenser that’s designed to deliver the eye gel in a way that reduces the risk of contamination. Read more.

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