An interventional comparative study of refractive error in infants who underwent a single intravitreal bevacizumab injection for treatment of threshold retinopathy of prematurity suggests that, compared to conventional retinal laser coagulation, bevacizumab is helpful therapy leading to less myopization and less astigmatism.
The study group included 12 infants (23 eyes; mean birth weight: 622 ±153 g; gestational age: 25.2 ±1.6 weeks) who received a single injection of intravitreal bevacizumab (0.375 mg or 0.625 mg) for threshold ROP in fundus zone one or zone two. The control group included 13 infants (26 eyes; birth weight: 717 ±197 g; gestational age: 25.3 ±1.8 weeks) who had previously undergone retinal argon laser therapy of ROP. The groups did not differ significantly in birth age, weight or follow-up. The follow-up examination included refractometry under cycloplegic conditions.
At the end of follow-up at 11.4 ±2.3 months after birth, refractive error was less myopic in the study group than the control group (-1.04 ±4.24 vs. -4.41 ±5.50; p=0.03). Prevalence of moderate myopia (17 percent ±8 percent vs. 54 percent ±10 percent; p=0.02) and high myopia (9 percent ±6 percent vs. 42 percent ±10 percent; p=0.01) was significantly lower in the bevacizumab group. Refractive astigmatism was also significantly lower in the study group (-1.0 ±1.04 D vs. 1.84 ±1.41 D; p=0.03). In multivariate analysis, myopic refractive errors were significantly associated with laser therapy vs. bevacizumab therapy.
Am J Ophthalmol 2013;155:1119-1124.
Harder B, Schlichtenbrede F, Von Baltz S, Jendritza W, et al.
Glaucomatous Progression in Patients with Ocular Hypertension
Researchers at the Devers Eye Institute longitudinally followed 168 individuals (336 eyes) with ocular hypertension or early glaucoma to determine clinical features of optic disc progression. Their results indicate that eye-care providers should pay particular attention to increased excavation and neuroretinal rim thinning in these patients–especially in the inferotemporal quadrant.
Two glaucoma specialists independently graded the baseline and most recent optic disc photographs for optic disc progression, as well as location of changes. Optic disc progression was defined as: new or increased neuroretinal rim thinning (two or more clock hours); notching (one clock hour or less of thinning of the neuroretinal rim); excavation (undermining of the neuroretinal rim or disc margin); and nerve fiber layer defect(s).
Of the 336 eyes, 92 (27.4 percent) showed optic disc progression after a median of 6.1 years. Of those with progression, excavation occurred in 89 percent of eyes; rim thinning occurred in 54 percent of eyes; and notching occurred in 16 percent of eyes. In the cohort, 56 percent had two or more features of progression. The inferotemporal quadrant was the most common location for progression, but more than one location of progression occurred in at least 30 percent of eyes.
J Glaucoma 2013;22:343-348.
Lloyd M, Mansberger S, Fortune B, Nguyen, Torres R.
Safety Testing Results for Epimacular Brachytherapy
Epimacular brachytherapy did not produce deleterious effects on macular function or choroidal perfusion, tested using microperimetry and indocyanine green angiography. Wet AMD areas receiving higher doses of radiation showed greater improvement in retinal sensitivity. The presence of a dose-response suggests the positive effect of epimacular brachytherapy related more to beta irradiation than vitrectomy.
A prospective intervention case series of 12 participants with neovascular AMD requiring frequent ranibizumab underwent vitrectomy and epimacular brachytherapy. The Strontium 90/Yttrium 90 source delivered a single 24-Gy dose at the center of the treatment zone. The dose attenuated with increasing distance from the source. Microperimetry and indocyanine green angiography were performed at baseline and at 12 months. The main outcome measures were mean sensitivity and choroidal nonperfusion. A linear mixed model was used to assess the association between the dose of radiation and the change in mean sensitivity.
Mean visual acuity remained within one letter of baseline at 12 months (-0.33 ±13.2 letters). There was no statistically significant change in mean sensitivity within the neovascular AMD lesion area (gain of 0.95, ±3.25 dB; p=0.0339) or in neighboring unaffected retina (0.66 ±4.14 dB; p=0.594), defined using fluorescein angiography. Within the lesion area, mean sensitivity improved by an average of 0.23 ±0.16 dB (p=0.006) for every additional gray of radiation received. Indocyanine green angiography failed to demonstrate any choroidal nonperfusion or radiation damage at 12 months after the treatment.
Petrarca R, Richardson M, Douri A, Nau J, et al.
Kamra Corneal Inlay Implant to Treat Presbyopia After LASIK
Six-month results evaluating visual outcomes after the implantation of a Kamra small-aperture corneal inlay into a femtosecond-created corneal pocket to treat presbyopia in patients who had previous LASIK suggest that the implant improves near vision with minimal effect on distance vision. This results in high patient satisfaction and less dependence on reading glasses, researchers say.
The study enrolled 223 eyes of 223 post-LASIK presbyopic patients with a mean age of 53.6 years (r: 44 to 65 years) and a mean manifest spherical equivalent of -0.18 D (r: -1.0 to +0.5 D). The inlay was implanted into a corneal pocket created by a femtosecond laser at a depth of 200 μm, a minimum of 80 μm below the previous LASIK flap interface, in the nondominant eye. Uncorrected and corrected distance visual acuities, near visual acuity, and a patient questionnaire on satisfaction, the use of reading glasses and visual symptoms were evaluated.
The mean uncorrected distance visual acuity in the operated eye decreased one line from 20/16 preop to 20/20 six months postop (p<0.001). The mean uncorrected near visual acuity improved four lines from Jaeger 8 to J2 (p<0.001). At six months, significant improvements were observed in patient dependence on reading glasses and patient satisfaction of vision without reading glasses.
J Cataract Refract Surg 2013;39:898-905.
Tomita M, Kanamori T, Waring G, Nakamura T, et al.