Results of a cross-sectional analysis of 1,038 participants in the 2005 to 2008 National Health and Nutrition Examination survey suggest that there is a greater burden of diabetic macular edema among non-Hispanic blacks, individuals with high levels of hemoglobin A1C and those with longer duration of diabetes.
Patients selected for this analysis were over 40 years of age, diagnosed with diabetes and had valid fundus photographs. Of the 1,038 participants, 55 had DME for an overall weighted prevalence of 3.8 percent (95 percent confidence interval, 2.7 percent to 4.9 percent) or approximately 746,000 persons in the United States population aged 40 years or older. Researchers identified no differences in the prevalence of DME by age or sex. Multivariable logistical regression analysis showed that the odds of having DME were higher for non-Hispanic blacks than for non-Hispanic whites (odds ratio, 2.64; 95 percent CI, 1.19 to 5.84; p=0.02). Elevated levels of glycosylated hemoglobin A1c (OR, 1.47; 95 percent CI, 1.26 to 1.71 for each one percent; p<0.001) and longer duration of diabetes (OR, 8.51; 95 percent CI, 3.7 to 19.54 for ≥10 vs. <10 years; p<0.001) were also associated with DME prevalence.
JAMA Ophthalmol 2014;132:1334-1340.
Varma R, Bressler N, Doan W, Gleeson M, et al.
Poor Bevacizumab Response Possible Sleep Apnea Indicator
A case-controlled prospective study from the University of Louisville in Kentucky indicates that patients with exudative age-related macular degeneration or diabetic macular edema who have poor response to anti-vascular growth factor therapy with bevacizumab have a significantly higher risk of obstructive sleep apnea compared with age-matched controls. Poor responders to bevacizumab should be screened to assess their risk for OSA.
Patients with AMD (n=103) were categorized into nonexudative (n=56; 54.37 percent) and exudative (n=47; 45.63 percent) groups. The DME group (n=77) included patients with nonproliferative diabetic retinopathy and cystoid macular edema (n=30; 37.66 percent). Patients were categorized based on the number of intravitreal injections of bevacizumab received. All groups were compared with age-matched controls and completed a screening questionnaire to assess the risk for OSA, the main outcome measure.
Within the exudative AMD group, 14 (29.79 percent) had poor response exudative AMD, as defined by persistent subretinal fluid on OCT after at least three anti-VEGF consecutive monthly injections, and were at significantly higher risk of OSA (p<0.05). Of the DME patients with cystoid macular edema, four (19 percent) received one injection, 18 (81.82 percent) received two or more consecutive injections and 16 (72.73 percent) received three or more consecutive injections. The risk for OSA increased significantly with the number of injections (p<0.05).
Nesmith B, Ihnen M, Schaal S.
Effects of Topical Diquafosol on Intraoperative Corneal Wetting
Four-week pretreatment with diquafosol 3.0% ophthalmic solution in cataract patients was effective in enhancing the intraoperative corneal surface wetting property, which suggests improved optical clarity during surgery.
After a two-week washout period, patients with senile cataract at the Miyake Eye Hospital in Nagoya, Japan, were randomly assigned to receive one drop of diquafosol 3.0% ophthalmic solution or artificial tears six times a day for four weeks prior to surgery. The main outcome measure, termed the corneal wetting property, was the time between when a clear image of the operating microscope light source appeared just after the corneal surface was irrigated with a balanced salt solution and the time at which that image began to blur.
The study enrolled 51 patients (76 eyes). The mean time to corneal wetting was 50.1 seconds ±10.8 (standard deviation) in the diquafosol group and 45.3 ±9.2 seconds in the artificial tears group. The difference between the two groups was statistically significant (p<0.029).
J Cataract Refract Surg 2014; 40:1682-1688.
Miyake G, Ota I, Miyake K, Zako M, et al.
A Changing Pattern of Cataract Surgery Indications
A five-year trend in national data sets from the Netherlands, Sweden and Malaysia shows a decreasing visual threshold for cataract surgery as well as decreasing surgical complication rates and increasing visual outcomes regardless of the initial preoperative visual level. Cataract surgery on eyes with poor preoperative visual acuity was related to surgical complications and cataract surgery on eyes with excellent preoperative visual acuity was related to adverse visual results.
A multinational team of researchers analyzed preoperative, surgical and postoperative data of patients undergoing cataract extraction between 2008 and 2012 from two databases: the European Registry of Quality Outcomes for Cataract and Refractive Surgery, which contains complete data from the national cataract registries in the Netherlands and Sweden, and the Malaysian National Cataract Registry. The researchers’ analysis examined preoperative and postoperative corrected distance visual acuity, preoperative ocular comorbidity in the surgery eye and capsule complications during surgery.
There were substantial differences in indication for surgery between the three national data sets. The percentage of eyes with a preop BCVA of 20/200 or worse varied from 7.1 percent to 72 percent. In all three data sets, the visual thresholds for cataract surgery decreased over time by 6 percent to 28 percent of the baseline values. The frequency of capsule complications varied between the three data sets, as well, from 1.1 percent to 3.7 percent in 2008 and from 0.6 percent to 2.7 percent in 2012. An increasing postop VA was also seen for all three data sets. A high frequency of capsule complication was related significantly to poor preop VA and a high frequency of decreased visual acuity after surgery was related significantly to excellent preop VA.
Lundström M, Henry Y, Salowi M, Barry P, et al.
Evaluation of Compounded Bevacizumab Prepared for IVI
Researchers at Weill Cornell Medical College found that intravitreal preparations of bevacizumab acquired from compounding pharmacies were negative for microbial contaminants and endotoxin, but had significant variations in protein concentrations. These variations appeared, in general, to be lower than in bevacizumab acquired directly from Genentech. The clinical implications of these variable protein levels remain uncertain.
The study, conducted at a university-based, good manufacturing practice facility and academic ophthalmology practice, was a prospective in vitro study of 21 syringes of compounded bevacizumab from 11 compounding pharmacies. Of these samples, 17 (81 percent) had lower protein concentrations (mean [standard deviation], 22.2 [4.9] mg/mL; range: 19.2 to 24.5 mg/mL) compared with bevacizumab acquired directly from Genentech (25 mg/mL; p<0.05). In three of the 10 compounding pharmacies where more than one sample was available, there were statistically significant differences in the protein concentration between samples from the same compounding pharmacy. No microbial contaminants or endotoxin were detected in any samples.
JAMA Ophthalmol 2015;133:32-39.
Yannuzzi N, Klufas M, Quach L, Beatty L, et al.