Volume 20, Number 32Monday, July 27, 2020JULY IS UV SAFETY MONTH
In this issue: (click heading to view article)
Short- and Long-term Variability of IOP Measured with an Intraocular Telemetry SensorResearchers evaluated the short- and long-term variability of intraocular pressure in eyes with primary open-angle glaucoma in 22 individuals who had previously been implanted with a sulcus-based IOP sensor (EyeMate, Implandata). Two of the authors are consultants for Implandata. The participants were requested to obtain at least four IOP measurements per day. Data were grouped according to the eye and medication so that an eye treated with a particular medication was considered as one group, and the same eye treated with a different medication during the observation period was considered a different group. A day was divided in seven periods:
Short-term variability at a particular period was defined as the variability in IOP measurements obtained during that period on different days within three months of each other. Long-term variability was defined as the variability in IOP measurements obtained during a particular period on different days over a time period of at least one year. Variability was assessed using intraclass correlation coefficients (ICCs). The mean age of study participants was 67.8 ±6.8 years; 36.4 percent were female. The mean follow-up duration was 19.2 ±21.3 months (median: 9, range: 1 to 58). Here were some of the findings:
Researchers wrote that continual IOP monitoring showed that IOP had moderate short-term and high long-term variability in glaucoma patients. They added that the findings demonstrated that single IOP measurements don’t characterize day-to-day variations in IOP. Moreover, researchers wrote, the findings showed the importance of continual IOP monitoring in glaucoma patients. SOURCE: Mansouri K, Rao HL, Weinreb RN, et al. Short-term and long-term variability of intraocular pressure measured with an intraocular telemetry sensor in patients with glaucoma. Ophthalmology 2020; July 11. [Epub ahead of print].Efficacy & Safety of Epimacular Brachytherapy for Previously Treated nAMD: The MERLOT TrialAlthough anti-vascular endothelial growth factor treatment offers better outcomes than the natural history of neovascular age-related macular degeneration, investigators wrote that a less burdensome, less expensive and more durable treatment is needed. They assessed the efficacy and safety of epimacular brachytherapy (EMB) for chronic, active, neovascular nAMD. The Macular Epiretinal Brachytherapy vs Ranibizumab (Lucentis) Only Treatment (MERLOT) device trial was conducted at 24 National Health Service hospitals across the UK. Individuals who had nAMD and received intravitreal ranibizumab were enrolled between November 10, 2009, and January 30, 2012. Eligible individuals were randomized 2:1 and stratified by lens status and angiographic lesion type to receive either EMB plus as-needed ranibizumab, or just as-needed ranibizumab monotherapy. Participants were followed up monthly for 24 months and then assessed at final visits at month 36. Masking of participants and clinicians wasn’t possible, but best-corrected visual acuity and imaging were analyzed by masked assessors. Analyses followed the intent-to-treat approach. Interventions included pars plana vitrectomy with 24 Gy EMB plus as-needed ranibizumab vs. as-needed ranibizumab monotherapy. Coprimary outcomes were the number of as-needed ranibizumab injections and the mean change in Early Treatment Diabetic Retinopathy Study BCVA with a noninferiority margin of -5 ETDRS letters. Secondary outcomes were the percentage of participants losing fewer than 15 ETDRS letters and gaining 0 or more, or 15 or more ETDRS letters and the mean change in angiographic total lesion size, choroidal neovascularization size and foveal thickness on optical coherence tomography. Of 363 participants, 329 (90.6 percent) completed 24 months of follow-up (222 participants in the EMB group and 107 in the ranibizumab group). The mean age of the combined groups was 76.5 ±7.4 years. Here were some of the findings:
Investigators reported that the MERLOT trial found that, despite the acceptable safety of EMB, it didn’t reduce the number of ranibizumab injections and was actually associated with worse visual acuity than anti-VEGF treatment alone. They added that these results don’t support EMB use as an adjunctive treatment for chronic, active nAMD. SOURCE: Jackson TL, Soare C, Petrarca C, et al. Evaluation of month-24 efficacy and safety of epimacular brachytherapy for previously treated neovascular age-related macular degeneration: The MERLOT randomized clinical trial. JAMA Ophthalmol 2020; July 09. [Epub ahead of print].Lower Corneal Haze & Aberrations in DMEK vs. DSAEK in Fellow Eyes for Fuchs’Scientists evaluated the long-term corneal changes in patients with Fuchs’ endothelial corneal dystrophy contributing to superior postoperative visual outcomes after Descemet’s membrane endothelial keratoplasty compared with Descemet’s stripping automated endothelial keratoplasty. Using retrospective analysis, scientists evaluated nine individuals with FECD who underwent DSAEK in one eye and DMEK in the fellow eye. Individuals were genotyped for the triplet repeat expansion in the TCF4 gene and imaged using optical coherence tomography, Scheimpflug imaging and in vivo confocal microscopy through focusing. Here were some of the findings:
Scientists determined that DSAEK resulted in higher total stromal backscattering (haze) compared with DMEK because of the addition of stromal tissue. They added that lower higher-order aberrations of the posterior cornea and lower total stromal backscattering (haze) may both contribute to superior visual outcomes after DMEK vs. DSAEK. SOURCE: Waldrop WH, Gillings MJ, Robertson DM, et al. Lower corneal haze and aberrations in Descemet membrane endothelial keratoplasty versus Descemet stripping automated endothelial keratoplasty in fellow eyes for Fuchs endothelial corneal dystrophy. Cornea 2020; July 6. [Epub ahead of print].Macular Vessel Density in Diabetes and DR with SS-OCTAResearchers wrote that previous studies on the association between macular vessel density and diabetic retinopathy have had conflicting conclusions. So they assessed the alterations of macular vessel density and other factors in diabetic patients, using swept-source optical coherence tomography angiography in a large-scale sample from Chinese communities. Patients with type 2 diabetes without histories of ocular treatment were recruited from 2017 to 2018. The average and quadrant parafoveal vessel densities (PVDs) were obtained with a commercial SS-OCTA device (Triton, Topcon). The univariate and multivariate linear regression was used to analyze the correlation of PVD with diabetic retinopathy, diabetic macular edema, HbA1c and other factors. A total of 919 individuals were included in the final statistical analysis. Here were some of the findings:
Researchers found that reduced PVD was independently associated with more severe DR, older age, higher HbA1c level and the presence of DME. They wrote that the findings suggested that macular vessel alterations in DR warrant further evaluation in longitudinal studies. Source: Xie N, Tan Y, Liu S, et al. Macular vessel density in diabetes and diabetic retinopathy with swept-source optical coherence tomography angiography Graefes Arch Clin Exp Ophthalmol 2020; July 13. [Epub ahead of print].BRIEFLY Genentech Releases Phase III Data of PDS Alcon Upgrades Ngenuity Viewing System Numab and Boehringer Ingelheim to Develop Multi-specific Antibody Therapeutics Araim’s Cibinetide Shows Potential for Efficacy in DME Iveric Adds Dr. Blumenkranz to Board Review of Ophthalmology® Online is published by the Review Group, a Division of Jobson Medical Information LLC (JMI), 11 Campus Boulevard, Newtown Square, PA 19073. |