Volume 17, Number 7July 2021THE LATEST PUBLISHED RESEARCH Welcome to Review of Ophthalmology's Retina Online newsletter. Each month, Medical Editor Philip Rosenfeld, MD, PhD, and our editors provide you with this timely and easily accessible report to keep you up to date on important information affecting the care of patients with vitreoretinal disease. INSIDE THIS ISSUE:
SS-OCTA Characteristics of Treatment-naïve Nonexudative MNV in AMD Prior to ExudationInvestigators assessed the characteristics of treatment-naïve nonexudative macular neovascularization in age-related macular degeneration before the onset of exudation, using swept-source optical coherence tomography angiography. They evaluated the following measurements at two visits prior to exudation: MNV area; choriocapillaris (CC) flow deficits; vessel area density (VAD); vessel skeleton density (VSD); retinal pigment epithelial detachment (PED) volume; mean choroidal thickness (MCT); and choroid vascularity index (CVI). They compared measurements made at the second visit and the rate of change between visits in eyes with and without exudation. The differences in these parameters between eyes with and without subsequent exudation were summarized with 95 percent confidence intervals. Twenty-one eyes with nonexudative MNV were identified and followed. Here are some of the findings: Investigators concluded that the onset of exudation was correlated with lesions having less vascularity and smaller PED volume measurements, but measurements of MNV area, CC flow deficits, MCT and CVI weren’t correlated with near-term exudation. They added that investigations are ongoing to further explore these and other anatomic changes as harbingers of near-term exudation. SOURCE: Shen M, Zhang Q, Yang J, et al. Swept-source OCT angiographic characteristics of treatment-naïve nonexudative macular neovascularization in AMD prior to exudation. Invest Ophthalmol Vis Sci 2021;3;62:6:14. nAMD Managed by a Treat-Extend-Stop ProtocolInvestigators assessed vision, injection quantity, initial lesion size and final anatomic status in patients with nAMD completing the treat-extend-stop protocol. Patients with nAMD received ≥3 monthly anti-VEGF injections followed by one- to two-week injection interval extensions, with intra-/subretinal fluid resolution on SD-OCT to 12 weeks. With quiescent disease and two quarterly injections, patients were monitored alone beginning at four weeks extending by one- to two-week intervals until quarterly monitoring. Eighty-eight of 143 eyes with nAMD completed the TES protocol without disease recurrence. Here are some of the findings: Investigators wrote that central GA or FV was associated with worse visual outcomes (as opposed to rCNV) after cessation of therapy. They added that anti-VEGF therapy may not affect the rate of GA expansion and that final anatomic character and location are key determinants of final vision. SOURCE: Adrean SD, Chaili S, Pirouz A, et al. Results of patients with neovascular age-related macular degeneration managed by a treat-extend-stop protocol without recurrence. Graefes Arch Clin Exp Ophthalmol 2021; Jul 12 [Epub ahead of print].
Predicting Short-term Anti-VEGF Treatment Effects in nAMDResearchers predicted short-term anti-vascular endothelial growth factor treatment responders/non-responders for neovascular age-related macular degeneration patients based on optical coherence tomography images. A total of 4,944 OCT scans from 206 patients with nAMD were the basis of a responder/non-responder prediction method for the short-term effect of anti-VEGF therapy. A deep learning architecture named a “sensitive structure-guided network (SSG-Net)” was created for prediction using pre- and post-treatment images. To verify its clinical efficiency, two deep learning methods and four experienced ophthalmologists evaluated the performance of the developed model. Here are some of the findings: Researchers wrote that the proposed SSG-Net was effective in predicting the short-term efficacy of anti-VEGF treatment for nAMD patients. They noted that the technique could possibly help clinicians explain the necessity of anti-VEGF treatment to potential responders and avoid unnecessary treatment for non-responders. SOURCE: Zhao X, Zhang X, Lv B, et al. Optical coherence tomography-based short-term effect prediction of anti-vascular endothelial growth factor treatment in neovascular age-related macular degeneration using sensitive structure guided network. Graefes Arch Clin Exp Ophthalmol 2021; Jun 7. [Epub ahead of print].
Effect of Residual Retinal Fluid on Visual Function in Ranibizumab-treated nAMDResearchers looked at the relationship between retinal fluid and vision in ranibizumab-treated patients with neovascular age-related macular degeneration, as part of a clinical cohort study using a post hoc analysis of clinical trial data. Within the HARBOR Phase III, randomized, controlled trial, 917 patients ages ≥50 years with subfoveal nAMD associated with subretinal (SRF) and/or intraretinal fluid (IRF) at baseline, screening or week one were treated with intravitreal ranibizumab 0.5 or 2.0 mg (all treatment arms pooled). Main outcome measures included mean best-corrected visual acuity and BCVA change from baseline at months (M)12/24 evaluated by presence/absence of SRF and/or IRF. Here are some of the findings:
Researchers reported that vision outcomes (adjusted for baseline BCVA) through M24 were better in ranibizumab-treated eyes with residual vs. resolved SRF, and worse with residual vs. resolved IRF. They added that presence of residual retinal fluid requires a complex and nuanced assessment and interpretation in the context of nAMD management. SOURCE: Holekamp NM, Sadda S, Sarraf D, et al. Effect of residual retinal fluid on visual function in ranibizumab-treated neovascular age-related macular degeneration. Am J Ophthalmol 2021; July 17 [Epub ahead of print].Predominantly Persistent Subretinal Fluid in CATTInvestigators described predominantly persistent subretinal fluid in eyes receiving ranibizumab or bevacizumab for neovascular age-related macular degeneration and compared visual acuity to eyes with non-persistent SRF, as part of a cohort within the randomized Comparison of Age-related Macular Degeneration Treatments Trials (CATT) clinical trial. The participants included CATT patients assigned to a pro re nata treatment. Reading center graders evaluated optical coherence tomography scans at baseline and monthly follow-up visits for SRF. Predominantly persistent SRF through week 12 was defined as SRF at baseline, weeks four, eight and 12. Predominantly persistent SRF through one or two years was defined as SRF in ≥80 percent of visits by year one or two, respectively. Adjusted mean VA score and VA change from baseline were compared between eyes with predominantly persistent SRF and eyes with non-persistent SRF over the same duration using linear regression models, including baseline predictors of VA and predominantly persistent intraretinal fluid (IRF). Primary outcome measures included predominantly persistent SRF through year one, adjusted VA score and VA change, and SRF thickness at the foveal center. Here are some of the findings: Investigators found that eyes with predominantly persistent and non-persistent SRF through week 12, year one or year two had similar VA outcomes after adjustment for baseline covariates and persistent IRF. At the foveal center, predominantly persistent SRF was most commonly absent or present in small quantities. SOURCE: Core JQ, Pistilli M, Daniel E, et al; Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group. Predominantly persistent subretinal fluid in the comparison of age-related macular degeneration treatments trials (CATT). Ophthalmol Retina 2021; Jun 11. [Epub ahead of print]. Differentiating Exudative Macular Degeneration and PCV Using OCT B-scanAlthough polypoidal choroidal vasculopathy is best diagnosed with indocyanine green angiography, ICGA is often unavailable or not ordered. Optical coherence tomography is widely available, and OCT B-scans can visualize polypoidal lesions diagnostic of PCV as inverted U-shaped elevations of the retinal pigment epithelium with heterogeneous reflectivity and sometimes ring-shaped lesions within the polypoidal lesion. This study aimed to differentiate findings between eyes diagnosed with PCV or typical exudative age-related macular degeneration using ICGA, and then compared findings noted on the OCT B-scan line scan in each group. The retrospective chart review compared clinical features of PCV eyes and typical exudative AMD based on ICGA. Eyes with PCV were evaluated for inverted U-shaped polypoidal lesions, which are the main differentiating finding of PCV from typical exudative AMD. Data collected included: presence of subretinal fluid (SRF); macular edema or intraretinal edema (ME); subretinal hyperreflective material (SHRM); and retinal pigment epithelial detachment (RPED). These findings were evaluated at baseline and after six to nine months of antiangiogenic therapy. Additionally, analysis was performed for the presence of polypoidal lesions before and after treatment. A total of 112 eyes of 106 patients were included. The researchers found the following: Investigators wrote that a characteristic inverted U-shaped elevation was present in more than half of eyes with polypoidal choroidal vasculopathy on OCT B-scan at baseline, but it disappeared following antiangiogenic therapy in 56.4 percent of cases. They added that subretinal fluid was more prevalent in PCV eyes than non-PCV AMD eyes. Investigators suggested that, if PCV is suspected in an anti-vascular endothelial growth factor-resistant case of exudative AMD, it's important in the absence of ICGA availability to look at the baseline B-scan OCT prior to therapy for evidence of polypoidal lesions. SOURCE: Kokame GT, Omizo JN, Kokame KA, et al. Differentiating exudative macular degeneration and polypoidal choroidal vasculopathy using optical coherence tomography B-scan. Ophthalmol Retina 2021 May 19. [Epub ahead of print].
GA Incidence and Progression Following Intravitreal Injections of Anti-VEGF Agents for AMDSince geographic atrophy can occur in advanced neovascular age-related macular degeneration, researchers sought to estimate the incidence and progression of GA following intravitreal injections of anti-vascular endothelial growth factor agents in eyes with nAMD. The investigators searched Ovid MEDLINE, Embase and Cochrane Central from inception to May 2020. They included studies that reported on the progression or development of GA in eyes with nAMD following anti-VEGF therapy. They found 31 articles consisting of 4,609 study eyes (4,501 patients). Eyes received a mean of 17.7 injections over 35.2 months. Here are some of the findings: Investigators found an association between the frequency and number of treatments with anti-VEGF agents and the development of GA in nAMD. They suggested that future studies should clarify risk factors, population characteristics, and the relative contributions of treatment and disease progression on GA development in this context. SOURCE: Eshtiaghi A, Issa M, Popovic MM, et al. Geographic atrophy incidence and progression following intravitreal injections of anti-vascular endothelial growth factor agents for age-related macular degeneration: A meta-analysis. Retina 2021; May 17. [Epub ahead of print].
Intravitreal Application of Epidermal Growth Factor in Non-Exudative AMDResearchers assessed the safety of intravitreally applied epidermal growth factor (EGF). The clinical interventional, prospective, single-center case series study included patients with age-related macular degeneration-related geographic atrophy, in whom the eye with the worse best-corrected visual acuity underwent a single, or repeated, intravitreal injection of EGF (0.75 µg in 50 µL). At baseline and afterwards, the eyes underwent ophthalmological exams. The study included seven patients (mean age: 70.0 ±12.2 years (range: 54 to 86 years), with five patients receiving a single injection and two patients receiving two intravitreal injections in an interval of four weeks. Here are some of the findings: Researchers reported that, with the exception of one eye with temporary, self-resolving cystoid macular edema, single and repeated intravitreal applications of EGF (0.75 µg) in patients with GA didn’t lead to intraocular inflammations or any observed intraocular side effect. SOURCE: Bikbov MM, Khalimov TA, Panda-Jonas S, et al. Intravitreal application of epidermal growth factor in non-exudative age-related macular degeneration. Br J Ophthalmol 2021; Jul 14. [Epub ahead of print].
Comparing Treatment Outcomes Between Subthreshold Micropulse Laser and Aflibercept for DMEResearchers compared two-year treatment outcomes of subthreshold micropulse (577 nm) laser and aflibercept for diabetic macular edema, as part of a retrospective case-control study. A total 164 eyes in 164 DME patients treated with either micropulse laser (86 eyes) or intravitreal aflibercept monotherapy (78 eyes) were recruited. Main outcome measures included at least five Early Treatment Diabetic Retinopathy Study letters' improvement from baseline at six, 12 and 24 months. Here are some of the findings: Researchers found that aflibercept achieved faster and higher rates of anatomical and functional improvement than micropulse laser in DME patients, though long-term efficacy of treatment didn’t result in significant differences between aflibercept monotherapy and micropulse laser. Researchers suggested that micropulse laser potentially could serve as primary treatment with deferred aflibercept rescue without reducing the chance of visual improvement in DME eyes. SOURCE: Lai FHP, Chan RPS, Lai ACH, et al. Comparison of two-year treatment outcomes between subthreshold micropulse (577 nm) laser and aflibercept for diabetic macular edema. Jpn J Ophthalmol 2021; Jun 14. [Epub ahead of print].Incidence & Risk Factors for Macular Edema After Primary RRD SurgeryResearchers assessed the incidence of cystoid macular edema diagnosed using spectral-domain optical coherence tomography after primary rhegmatogenous retinal detachment surgery. From April 2016 to October 2017, 150 eyes of 150 patients presenting with primary RRD were included consecutively in this prospective, single-center study. Patients with any of the following characteristics were excluded: previous vitreoretinal surgery; combined cataract surgery; preoperative presentation with any intraocular or systemic inflammatory condition; or visible macular edema or epiretinal membrane on funduscopy. SD-OCT (Spectralis, Heidelberg Engineering) was performed three and six weeks after surgery. A total of 128 of the 150 patients completed the study. Here are some of the findings: Researchers reported that postoperative CME was a frequent complication after RRD surgery; they identified ERM and macula-off RRD as potential risk factors. They wrote that, since CME potentially delays visual recovery, postoperative follow-ups should include SD-OCT. SOURCE: Gebler M, Pfeiffer S, Callizo J, et al. Incidence and risk factors for macular oedema after primary rhegmatogenous retinal detachment surgery: A prospective single-centre study. Acta Ophthalmol 2021; Jun 16. [Epub ahead of print]. Outlook Completes Patient Dosing in Phase III NORSE TWO Trial Outlook Therapeutics administered the final dose to the last patient enrolled in its NORSE TWO safety and efficacy study evaluating ONS-5010 (bevacizumab-vikg) for treatment of wet age-related macular degeneration. The trial enrolled 228 wet AMD patients at 39 U.S. clinical trial sites, who are being treated for 12 months. The primary endpoint is the difference in the proportion of patients who gain at least 15 letters in best-corrected visual acuity at 11 months for ONS-5010 dosed on a monthly basis compared to Lucentis, which is being dosed quarterly per the PIER regimen. Read more.
NGM Completes Enrollment in Phase II CATALINA Study NGM Biopharmaceuticals completed enrollment in the Phase II CATALINA study, which is evaluating the safety and efficacy of intravitreal injections of NGM621 in patients with geographic atrophy secondary to age-related macular degeneration. Read more.
SOURCE: NGM Biopharmaceuticals, July 2021
More OpRegen Data in Patients with Dry AMD with GA Released Lineage Cell Therapeutics reported updated interim results from its ongoing, 24-patient Phase I/IIa clinical study of its lead product candidate, OpRegen. OpRegen is an investigational cell therapy consisting of allogeneic retinal pigment epithelium cells, administered one time to the subretinal space, for the treatment of dry age-related macular degeneration with geographic atrophy. Read more.
Regenerative Patch Technologies Announces Results from Phase I/IIa Trial
SOURCE: Regenerative Patch Technologies, June 2021
Adverum Halts Development of ADVM-022 in DME After Additional Adverse Reactions
Nanoscope Announces First Patient Dosed in Phase IIb Trial Nanoscope Therapeutics announced the first patient was dosed in its Phase IIb clinical trial of MCO-010, an ambient-light activatable optogenetic monotherapy to restore vision in patients with retinitis pigmentosa. Based on preliminary evidence from the company's Phase I/IIa study, MCO-010 has received FDA orphan drug designations for RP and Stargardt’s disease. Read more. Atsena Receives FDA Orphan Drug Designation for Gene Therapy Atsena Therapeutics announced the FDA granted orphan drug designation for its investigational gene therapy product for the treatment of GUCY2D-associated Leber’s congenital amaurosis. The safety and efficacy of the therapy are being evaluated in a Phase I/II clinical trial, which is currently enrolling patients. Read more.
SOURCE: Atsena Therapeutics, June 2021 Dexycu to Get New Category III CPT Code EyePoint Pharmaceuticals announced that the American Medical Association’s Current Procedural Terminology Editorial Panel accepted the addition of a new Category III CPT code, 0X78T, for the administration of a drug into the posterior chamber of the anterior segment of the eye, effective January 1, 2022, which EyePoint says provides an opportunity for a reimbursement pathway for the administration of Dexycu, the company’s single dose, sustained-release, intracameral steroid for the treatment of postoperative inflammation. Read more. Amydis Receives $3 Million Grant for Novel Amyloid Beta Retinal Tracer Amydis announced an award of a $3 million grant from the National Institute of Aging at the National Institutes of Health. The two-year Commercialization Readiness Pilot Program award will provide additional funding toward a clinical trial to test Amydis’ small-molecule retinal tracer targeting the biomarker amyloid beta for the diagnosis of amyloid angiopathy. Read more. Recycling of the Eye’s Light Sensors is Faulty in Progressive Blindness University of Maryland School of Medicine researchers have found the process that removes the eye’s old photoreceptors is disrupted in age-related macular degeneration, according to the findings published June 23 in Nature Communications. The team compared healthy mouse eyes to those from a mouse engineered without the CIB2 protein, which is needed for vision, and found the CIB2 mutant mice weren’t getting rid of their old photoreceptors like healthy mouse eyes did. They identified several components in a photoreceptor recycling process, including mTORC1 proteins, that clean up cellular debris. The proteins were overactive in CIB2 mutant mice and in human eye tissue samples from individuals with AMD. The researchers say the findings suggest that drugs against mTORC1 might be effective treatments for the most common type of AMD. Learn more. SOURCE: University of Maryland School of Medicine, June 2021 Protein Tenascin-C Plays Key Role in Retinal Ischemia Researchers from Ruhr-Universität Bochum, Germany studying the role of the protein tenascin-C, an extracellular matrix component, in retinal ischemia, showed tenascin-C plays a crucial role in damaging the cells responsible for vision following ischemia. The results were published in the May 20 online edition Frontiers in Neuroscience. The research team showed in mice that retinal cells express increased levels of tenascin-C at a very early stage following ischemia, before the quantity of the protein gradually reduces again as damage to the retina progresses. The researchers also conducted electroretinogram analyses and found that retinal ischemia impairs the function of rod-photoreceptors and bipolar cells. Based on this knowledge, researchers say that future therapy approaches could be developed to improve the treatment of ischemia. Read more.
SOURCE: Ruhr-Universität Bochum, May 2021
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