From the editors of Review of Ophthalmology:
JANUARY IS GLAUCOMA AWARENESS MONTH
In this issue: (click heading to view article)
Vessel Density Measurements Using OCTA
Researchers analyzed the values of retinal vessel density (VD) in the three retinal capillary plexuses, the foveal avascular zone area and retinal layer thickness in a cohort of healthy subjects. They analyzed the optical coherence tomography angiography maps of 148 eyes of 84 healthy subjects, ages 22 to 76 years, to measure VD of the retinal capillary plexuses using a projection artifact removal algorithm. In addition, they evaluated foveal avascular zone metrics, and studied the relationship between OCTA findings and age, sex and image quality.
- The deep capillary plexus showed the lowest VDs (31.6 ± 4.4 percent) in all macular areas and age groups compared with the superficial vascular plexus (47.8 ±2.8 percent) and intermediate capillary plexus (45.4 ±4.2 percent).
- The mean VDs decreased yearly by 0.06 percent in the superficial vascular plexus, 0.06 in the intermediate capillary plexus and 0.08 percent in the deep capillary plexus.
- The mean FAZ area density was 0.25 ±0.1 mm2, the FAZ acircularity index was 1.1 ±0.05 and the capillary density in a 300-µm area around the FAZ was 50.8 ±3.4 percent.
- The yearly increase in FAZ area was 0.003 mm2 (p<0.001).
Researchers determined that the deep capillary plexus had the lowest VD, which they wrote was a significant finding that might be used to evaluate retinal vascular diseases. They added that VD decreased with age in the three capillary plexuses.
SOURCE: Lavia C, Bonnin S, Maule M, et al. Vessel density of superficial, intermediate, and deep capillary plexuses using optical coherence tomography angiography. Retina 2018; Dec. 6. [Epub ahead of print].
Choroidal Microvascular Dropout in POAG
Investigators studied the prevalence and factors associated with the presence of choroidal microvascular dropout (CMvD) in primary angle-closure glaucoma eyes compared with primary open-angle glaucoma eyes, as part of a cross-sectional study.
Thirty-six POAG eyes and 28 PACG eyes underwent optical coherence tomography angiography. Presence of CMvD was evaluated on choroidal OCTA slabs. VF defects in the glaucoma eyes were classified into initial nasal defects, initial parafoveal scotomas, and combined nasal and parafoveal defects. Investigators evaluated the association between type of VF defect and CMvD. Their findings included:
- CMvD was detected in 21 POAG (58.3 percent) and 10 PACG (35.7 percent) eyes (p=0.07).
- CMvD in POAG eyes was associated with pretreatment intraocular pressure (OR=0.91 mmHg higher IOP; p=0.06), visual field mean deviation (OR=0.75 dB higher MD; p=0.007), retinal nerve fiber layer thickness (OR=0.92 μm increase in thickness; p=0.02) and peripapillary vessel density (OR=0.80 unit increase in density; p=0.01).
- CMvD in PACG eyes was associated with visual field mean deviation (OR=0.90 dB higher MD; p=0.05).
- Within glaucoma subject eyes (64), CMvD was significantly associated with POAG (OR>3.5; p<0.05) after accounting for glaucoma severity.
- CMvD was seen in six of seven eyes with initial parafoveal scotomas and one of 13 with initial nasal defects in the POAG group (p<0.05), and one of two eyes with initial parafoveal scotomas and zero of 10 with initial nasal defects in the angle-closure group (p<0.05).
Investigators concluded that the prevalence of choroidal microvascular dropout was significantly lower in PACG compared with POAG. They added that CMvD in PACG (as in POAG) was associated with advanced VF damage and with IPFS on VFs.
SOURCE: Rao HL, Sreenivasaiah S, Riyazuddin M, et al. Choroidal microvascular dropout in primary angle closure glaucoma. Am J Ophthalmol 2018; Dec. 12. [Epub ahead of print].
Choroidal Thickness Changes in Wet AMD
Scientists assessed choroidal thickness changes during an exudative recurrence of age-related macular degeneration as part of a prospective, non-interventional study conducted between November 2016 and July 2017 in consecutive patients with exudative AMD.
CT was measured manually in both eyes based on enhanced-depth imaging spectral-domain optical coherence tomography at follow-up visits scheduled in the morning. A total of 134 individuals were included. Ninety-five patients presented with at least one episode, defined by a follow-up visit under controlled conditions (dry retina) followed by a visit for exudative recurrence. A total of 119 episodes were analyzed.
The mean CT change in the treated eye was +8.45 ±13.52 μm (p<0.001) in the subfoveal area and +5.62 ±14.77 μm (p=0.009) in the nasal area. No significant changes in CT were observed in the fellow eyes. No significant associations between CT changes and treatments, number of intravitreal injections and blood pressure were observed.
Scientists wrote that CT increased mildly, but significantly in cases of exudative recurrence of neovascular AMD. Thus, they suggested, CT could be used as a monitoring criterion, similar to central retinal thickness in AMD management.
SOURCE: Bouteleux V, Kodjikian L, Mendes M, et al. Increased choroidal thickness: a new feature to monitor age-related macular degeneration recurrence. Graefes Arch Clin Exp Ophthalmol 2018; Dec. 16. [Epub ahead of print].
Wavefront-guided PRK for Astigmatism Post-PK or DALK
Researchers reported the outcomes of wavefront-guided photorefractive keratectomy in the treatment of high astigmatism following keratoplasty. They conducted a retrospective, interventional analysis on individuals with high astigmatism following penetrating keratoplasty or deep anterior lamellar keratoplasty who underwent WG-PRK.
Thirteen eyes of 12 individuals (10 males) ages 35.1 ±5.9 years were included. Preoperative astigmatism ranged between 3 D and 5 D. Average follow-up time was 14 ±6.2 months.
- Uncorrected distance visual acuity improved from 0.97 ±0.58 logMAR (Snellen equivalent ∼20/187) preoperatively to 0.13 ±0.15 logMAR (Snellen equivalent ∼20/27) at six months (p=0.001) and 0.14 ±0.16 logMAR (Snellen equivalent ∼20/28) at the final follow-up (p=0.002).
- UDVA ≥20/40 increased from one eye (7.7 percent) preoperatively to 13 eyes (100 percent) at six months and 12 eyes (92.3 percent) at the final follow-up (p<0.001 for both).
- UDVA ≥20/25 increased from one eye (7.7 percent) preoperatively to six eyes (46.2 percent) at six months and the final follow-up (p=0.027 for both).
- Mean astigmatism improved from -3.98 ±0.75 D to -1.27 ±0.82 D and -1.40 ±1.04 D at six months and at the last follow-up, respectively (p=0.001 for both).
- Preoperative astigmatism was ≥3 D in all eyes and was reduced to ≤2.50 D at six months postoperatively; seven eyes (63.6 percent) had ≤1 D of astigmatism at six months and the final follow-up.
Researchers found that WG-PRK was safe and effective in the treatment of high and regular post-keratoplasty astigmatism.
SOURCE: Sorkin N, Kreimei M, Einan-Lifshitz A, et al. Wavefront-guided photorefractive keratectomy in the treatment of high astigmatism following keratoplasty. Cornea 2018; Dec. 14. [Epub ahead of print].
Carl Zeiss Meditec Completes Acquisition of IanTECH
Carl Zeiss Meditec completed its acquisition of IanTECH, a privately held company focused on technology solutions for micro-interventional cataract surgery. Carl Zeiss will integrate the IanTECH technology into its portfolio of surgical solutions for cataract surgery. Current products include the miLoop Lens Fragmentation Device, which is the first in a line of ophthalmic tools engineered by IanTECH for its micro-interventional cataract surgery platform. Designed with microthin, self-expanding nitinol filament technology, the miLoop device is intended to offer cataract surgeons the ability to achieve full-thickness lens fragmentation for any grade cataract, while minimizing intraocular ultrasonic vibrations and phaco power.
Alcon Acquires Tear Film Innovations
Alcon acquired Tear Film Innovations, a privately held company and manufacturer of the iLux Device, used to treat meibomian gland dysfunction. Handheld and portable, the iLux enables eye-care professionals to target a patient's blocked meibomian glands and provide therapy through an in-office treatment. A practitioner can warm the eyelids via disposable silicone pads to address blocked meibomian glands through the application of light-based heating. Read more.
Clearside Submits New Drug Application for Xipere
Clearside Biomedical submitted a New Drug Application for Xipere to the FDA for the treatment of macular edema associated with uveitis. Macular edema is the leading cause of vision loss and blindness in uveitis patients and can occur from uveitis affecting any anatomic location—anterior, intermediate, posterior or pan. If approved, Xipere would be the first therapy for macular edema associated with uveitis. Read more.
ProQR Receives FDA Fast Track Designation for QR-421a
ProQR Therapeutics received the FDA’s Fast Track designation for QR-421a, a first-in-class, investigational, RNA-based oligonucleotide designed to address the underlying cause of vision loss associated with Usher syndrome type 2 and non-syndromic retinitis pigmentosa due to mutations in exon 13 of the USH2A gene. Fast Track designation is granted by the FDA to drugs that are under development for serious conditions and have the potential to fulfill an unmet medical need. Read more.
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