From the editors of Review of Ophthalmology:
JANUARY IS GLAUCOMA AWARENESS MONTH
In this issue: (click heading to view article)
Age-related Differences in Prevalence of nAMD Subtypes in the First Diagnosed Eye
Researchers evaluated age-related differences in the prevalence of subtypes of neovascular age-related macular degeneration in the first diagnosed eye, as part of a retrospective, observational study of 1,099 cases diagnosed with neovascular AMD.
The neovascular AMD cases were classified into three subtypes: typical neovascular AMD; polypoidal choroidal vasculopathy; and type 3 neovascularization. Subjects were divided into four groups, according to age: >50 and <60 years; ≥60 and <70 years; ≥70 and <80 years; and ≥80 years. Difference in the prevalence of three AMD subtypes was evaluated among the four age groups. Here are some of the findings:
• In the >50 and <60 years age group, 34 (25 percent) subjects were diagnosed with typical nAMD and 102 individuals (75 percent) were diagnosed with PCV.
• In the ≥60 and <70 years age group, 90 (28.1 percent) were diagnosed with typical nAMD, 206 (64.4 percent) were diagnosed with PCV and 24 individuals (7.5 percent) were diagnosed with type 3 neovascularization.
• In the ≥70 and <80 years age group, 200 (41.9 percent) were diagnosed with typical nAMD, 197 (41.3 percent) were diagnosed with PCV and 80 (16.8 percent) were diagnosed with type 3 neovascularization.
• In the ≥80 years age group, 83 (50 percent) were diagnosed with typical nAMD, 39 (23.5 percent) were diagnosed with PCV and 44 (26.5 percent) were diagnosed with type 3 neovascularization.
• A significant difference was observed in the prevalence of the subtypes of neovascular AMD among the four age groups (chi-square test, p<0.001).
Researchers concluded that subtype prevalence in newly diagnosed neovascular AMD differed significantly according to age. They added that this suggested that different pathophysiology might be involved in the development of neovascular AMD subtypes.
SOURCE: Kim JH, Chang YS, Kim JW, et al. Age-related differences in the prevalence of subtypes of neovascular age-related macular degeneration in the first diagnosed eye. Graefes Arch Clin Exp Ophthalmol 2019; Jan. 7. [Epub ahead of print].
Cannula-assisted Technique to Unfold DMEK Grafts
Investigators described the use of irrigating single-port cannulas to unfold Descemet’s membrane endothelial keratoplasty grafts when traditional tapping techniques are challenging, as part of a retrospective, comparative, non-randomized, interventional case series that included 143 DMEKs performed between February 2014 and November 2015.
All eyes were divided into two groups: 48 cases that underwent DMEK using tap techniques only; and 30 cases that used irrigating cannulas to unfold the graft as a secondary approach. Investigators assessed intraocular manipulation time and total graft manipulation time. They evaluated uncorrected visual acuity, best spectacle-corrected visual acuity and endothelial cell count at six and 12 months postoperatively. They also reviewed DMEK procedures performed between December 2015 and January 2017 to evaluate the use of irrigating cannulas to unfold the graft. Here’s some of the results:
• All grafts were clear.
• A statistically significant improvement was found in uncorrected visual acuity and best-corrected visual acuity at six and 12 months postoperatively in both groups (p<0.01).
• Endothelial cell loss at 12 months was 32.10 percent in the cannula group and 32.11 percent in the tapping DMEK group (p>0.05).
• Total graft manipulation time was three minutes in the cannula DMEK group and three minutes in the tapping DMEK group (p<0.01).
• Irrigating cannulas were used as a secondary approach in a smaller percentage of cases between December 2015 and January 2017 (26.2 percent) compared with DMEK performed during this study (38.5 percent).
Investigators wrote that the use of cannulas was useful and effective without negatively affecting postoperative endothelial cell count when surgeons face obstacles unscrolling the endothelium with the Descemet’s membrane graft while using only tap techniques.
SOURCE: Sarnicola C, Sabatino F, Sarnicola E, et al. Cannula-assisted technique to unfold graft in Descemet membrane endothelial keratoplasty. Cornea 2018; Dec 18. [Epub ahead of print].
Macular Atrophy in nAMD
Scientists determined optical coherence tomography signs associated with macular atrophy in eyes with neovascular age-related macular degeneration and pigment epithelial detachments treated with vascular endothelial growth factor inhibitors.
They analyzed OCT scans from a subgroup of the PED cohort of the HARBOR study for MA. Two groups were formed based on MA presence/absence at month 24. Then, scientists graded OCT scans from each baseline visit with standard reading center grading parameters including ellipsoid zone disruption, intraretinal cysts, subretinal fluid, and MA or nascent MA in study and fellow eyes. Twenty-eight eyes were included in the analysis. The following are some of the results:
• Fourteen eyes had OCT-based MA at month 24 and 14 did not.
• Macular atrophy at month 24 was significantly associated with MA/nascent MA at baseline (p=0.0136); intraretinal cysts at baseline (p=0.0048); and collapse of PEDs in study eyes (p=0.0025).
• Macular atrophy wasn’t associated with ellipsoid zone disruption or subretinal fluid in the study eye at baseline.
Scientists determined that some OCT findings in eyes of individuals with nAMD were present before the start of anti-vascular endothelial growth factor therapy and might predict the development of MA.
SOURCE: Rebhun CB, Moreira-Neto C, Gune S, et al. Macular atrophy in neovascular age-related macular degeneration: A pilot post hoc analysis of patients with pigment epithelial detachments. Retina 2018; Dec 24. [Epub ahead of print].
Parapapillary Deep-layer Microvasculature Dropout and VF Progression in Glaucoma
Researchers evaluated the association between optical coherence tomography angiography-derived parapapillary deep-layer microvasculature dropout and glaucomatous visual field progression, as part of a retrospective, cohort study.
A total of 138 eyes of 138 individuals with primary open-angle glaucoma (mean follow-up: 5.5 years) with ≥5 VFs prior to OCTA imaging were included. VF progression was defined as a guided progression analysis-based “likely progression” event or a significant VF index slope. Microvasculature dropout was defined as parapapillary deep-layer microvasculature dropout based on a qualitative analysis of OCTA. Researchers compared prevalence of dropout between eyes with and without VF progression. Here are some of the findings:
• Fifty-five eyes (39.9 percent) demonstrated VF progression.
• A higher proportion of eyes with dropout progressed than those without dropout (50/84 eyes [59.5 percent] vs. 5/54 eyes [9.3 percent]; p<0.001).
• In multivariable logistic regression analyses, mean and standard deviation intraocular pressure, optic disc hemorrhage, focal lamina cribrosa defects and dropout were significantly associated with prior VF progression (p<0.05).
• The VFI progression rate was significantly faster in eyes with dropout (-2.23 ±3.22 percent/year) than in those without dropout (-0.05 ±1.24 percent /year)(p<0.001), and the location of dropout and VF progression were spatially correlated.
Researchers reported that eyes with parapapillary deep-layer microvasculature dropout detected by OCTA had a significantly higher rate of VF progression than eyes without dropout. They wrote that these findings implicated dropout as a structural parameter suggestive of past glaucomatous VF progression, but added that prospective, longitudinal studies were needed to clarify the role of deep-layer microvasculature damage in the pathogenesis of glaucoma.
SOURCE: Kwon JM, Suh MH, Weinreb RN, et al. Parapapillary deep-layer microvasculature dropout and visual field progression in glaucoma. Am J Ophthalmol 2018; Dec 19. [Epub ahead of print].
Gemini Initiates CLARITY Disease Registry & Natural History Study of Dry AMD Subjects
Gemini Therapeutics announced the initiation of CLARITY, a disease registry and natural history study designed to identify and characterize disease progression in subjects with non-central geographic atrophy secondary to dry AMD, who are carriers of high-risk genetic variants. CLARITY will genetically screen thousands of subjects and enroll hundreds based on genetic criteria. Subjects will be separated into one of two studies. Read more.
Oculis In-licenses Novel Phase II Anti-TNF Alpha Antibody Fragment
Oculis entered into an agreement to in-license a novel topical anti-TNF alpha antibody from Novartis. The compound, named LME 636, which will be renamed OCS-02, is based on a proprietary single-chain antibody fragment technology designed for topical delivery. Efficacy and safety were evaluated in three clinical trials including controlled studies under IND by Novartis Institute of Biomedical Research. The company says the studies demonstrated a promising profile for treating inflammatory conditions of the anterior segment of the eye, including dry-eye disease. Read more.
Atlantic Street Capital Forms Advancing Eyecare Holdings With Lombart and Marco Partnership
Atlantic Street Capital announced it would form Advancing Eyecare Holdings with the partnership of its portfolio company Lombart Instrument, a U.S. distributor of ophthalmic instruments to ophthalmologists and optometrists, and Marco Ophthalmic, a high-tech instrumentation supplier. The transaction is expected to be completed in the first quarter of 2019. Marco is well-known for its focus on optimizing the refraction lane. Lombart offers products such as chairs, stands, slit lamps, refractors, tonometers, keratometers, eye projectors, perimeters and more. Read more.
First Patient Treated With Dompé’s Oxervate Eye Drops for Neurotrophic Keratitis
Dompé announced the first patient was treated with Oxervate eye drops (cenegermin-bkbj) in the United States. Oxervate was approved by the FDA in August 2018 as the first drug specifically indicated to treat neurotrophic keratitis. Dompé offers a patient support program called Dompé Connect to Care, which will provide educational resources on NK and Oxervate for patients and physicians. DC2C also provides financial assistance to eligible patients through the Oxervate Co-pay Card Program and the Dompé Patient Assistance Program. Read more.
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