Volume 19, Number 34Monday, August 26, 2019AUGUST IS CHILDREN’S EYE HEALTH/SAFETY MONTH In this issue: (click heading to view article)Choriocapillaris Impairment in Eyes with CNV Secondary to AMDResearchers developed an optical coherence tomography angiography-based framework for quantitatively analyzing the spatial distribution of choriocapillaris (CC) impairment around choroidal neovascularization secondary to age-related macular degeneration.In a retrospective, cross-sectional study, they quantitatively analyzed 400-kHz swept-source OCTA images from seven eyes of six individuals with CNV secondary to AMD using custom software. Researchers developed a lesion-centered zonal OCTA analysis technique, which portioned the field-of-view into zones relative to CNV boundaries, to quantify the spatial dependence of CC flow deficits. Quantitative, lesion-centered zonal analysis of CC OCTA images revealed the highest flow-deficit percentages near CNV boundaries, decreasing in zones farther from the boundaries. OCTA using shorter interscan times (1.5 ms) revealed more severe flow deficits than OCTA using longer interscan times (3 ms); however, spatial trends were similar for both interscan times. Researchers provided a detailed description of the OCTA processing steps and parameters to elucidate their influence on quantitative measurements. Researchers determined that CC impairment, assessed by flow-deficit percentages, was most prominent near CNV boundaries. The lesion-centered zonal analysis technique enabled quantitative CC measurements relative to focal lesions. Researchers wrote that understanding how processing steps, imaging/processing parameters and artifacts can affect quantitative CC measurements is important for longitudinal, OCTA-based studies of disease progression and treatment response. SOURCE: Moult EM, Alibhai AY, Rebhun C, et al. Spatial distribution of choriocapillaris impairment in eyes with choroidal neovascularization secondary to age-related macular degeneration: A quantitative OCT angiography study. Retina 2019; Aug 13. [Epub ahead of print].
Real-time PCR & Sequencing for Diagnosing Bacterial KeratitisInvestigators evaluated the efficacy of real-time PCR for 16S ribosomal DNA (16S r-DNA) sequencing to diagnose microbial keratitis in 272 eyes of 272 individuals with keratitis.
Ranibizumab in Asian Patients with BRVO: BLOSSOM StudyScientists evaluated the efficacy and safety profile of intravitreal ranibizumab 0.5 mg in Asian patients with visual impairment due to macular edema secondary to branch retinal vein occlusion, as part of a 12-month, Phase III, double-masked study.A total of 283 individuals with BRVO participated. Individuals ages ≥18 years were randomized (2:1) to receive either ranibizumab 0.5 mg or sham. The ranibizumab group received a minimum of three monthly intravitreal injections until stable maximal visual acuity was achieved. This was followed by an individualized, VA stabilization, criteria-driven, pro re nata regimen. Patients in the sham group received sham injections up to month five and could receive ranibizumab 0.5 mg PRN from month six. Main outcome measures included the mean average change in best-corrected VA from baseline to month one through month six, and safety up to month 12. Here were some of the findings: • At baseline, patients’ mean BCVA was 57.4 ±11.7 letters and mean central subfield thickness (CSFT) was 525 ±193.4 μm. • Compared with sham, ranibizumab treatment resulted in superior VA gains. • The least squares (LS) mean average change in BCVA from baseline to month one to month six was +12.5 letters in the ranibizumab group and +5 letters in the sham group (LS mean difference between ranibizumab vs. sham: +7.5 letters [CI, 5.5 to 9.5], one-sided p<0.001). • The LS mean change from baseline at month 12 in the ranibizumab vs. sham group in BCVA was +16.4 (14.9, 17.8) vs. +11.4 (9.3, 13.5) letters; and in CSFT was -280 (-291.6, -268.4) vs. -269.7 (-286.2, -253.1) μm. • The mean number of injections over 12 months was 7 (±2.55 in the ranibizumab group and 3.6 ±1.60 in the sham with ranibizumab group. • No new safety findings were reported. Scientists found that individualized PRN ranibizumab treatment was statistically superior to sham at month six and led to early visual gains that were maintained up to 12 months. They added that results from the sham group indicated the importance of early treatment in achieving optimal visual outcomes in BRVO. Furthermore, the scientists wrote, the safety of ranibizumab in the study was consistent with the drug’s well-established safety profile. SOURCE: Wenbin W, Weisberger A, Zhu L, et al. Efficacy and safety of ranibizumab in Asian patients with branch retinal vein occlusion: Results from the Randomized BLOSSOM study. Opthalmology Retina 2019; Aug. 13. [Epub ahead of print]. Corneal Biomechanics & VF Progression in Eyes with Seemingly Well-controlled IOPResearchers looked at the incidence and risk factors for glaucomatous visual field progression in eyes with well-controlled intraocular pressure, as part of a prospective cohort.A total of 460 eyes of 334 glaucoma patients under treatment were included. Study subjects had mean follow-up of 4.3 ±0.8 years. They were classified as well-controlled if all IOP measurements were under 18 mmHg. Rates of VF progression were calculated using ordinary least squares linear regression of standard automated perimetry mean deviation values over time. Progression was defined as a significantly negative slope of the mean deviation (α=0.05). Main outcome measures included: rates of change in SAP mean deviation, mean and peak IOP, IOP fluctuation, corneal biomechanics, corneal hysteresis, central corneal thickness and corneal index. Here were some of the findings: • Of the 179 eyes with well-controlled IOP, 42 (23.5 percent) demonstrated VF progression. • Researchers found no statistically significant difference between progressing and stable individuals in baseline MD (-6.4 ±7.1 vs. -6 ±6.2 dB; p=0.346), mean IOP (11.7 ±2 vs. 12.1 ±2.3 mmHg; p=0.405), IOP fluctuation (1.6 ±0.6 vs. 1.6 ±0.5 mmHg; p=0.402) or peak IOP (14.3 ±1.9 vs. 14.6 ±2.1 mmHg; p=0.926). • Progressing eyes, compared with stable eyes, had significantly lower CH (8.6 ±1.3 vs. 9.4 ±1.6 mmHg; p=0.014) and thinner CCT (515.1 ±33.1 vs. 531.1 ±42.4 μm; p=0.018). • In the multivariate analysis, a 1 SD lower corneal index, a summation of normalized versions of CH and CCT, resulted in a 68 percent higher risk of progression (OR: 1.68; CI, 1.08 to 2.62; p=0.021). Researchers deduced that approximately one-quarter of eyes with well-controlled IOP might show VF progression over time. They added that thin corneas and low CH were the main risk factors. Source: Susanna BN, Ogata NG, Jammal AA, et al. Corneal biomechanics and visual field progression in eyes with seemingly well-controlled intraocular pressure. Opthalmology 2019; Aug 9. [Epub ahead of print]. BRIEFLY New World Medical Launches New Glaucoma Drainage Device FDA Approves Eylea (Aflibercept) Injection Prefilled Syringe Alcon to Launch Precision1 Daily Disposable Contact Lenses Aerie Initiates First-in-human Trial of AR-13503 Sustained Release Intravitreal Implant Prevent Blindness Creates Educational Resource for Diabetes
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