Volume 19, Number 30Monday, July 29, 2019JULY IS UV SAFETY MONTH In this issue: (click heading to view article)
Prognostic Implications of Hyperreflective Crystalline Deposits in Non-neovascular AMDResearchers explored patterns of disease progression in non-neovascular age-related macular degeneration associated with hyperreflective crystalline deposits (HCDs) in the subretinal pigment epithelium-basal laminar space, as part of a retrospective medical records review of multimodal imaging; longitudinal eye-tracked, near-infrared reflectance (NIR); and optical coherence tomography spanning ≥2 years.NIR/OCT images were analyzed with ImageJ software to identify HCD morphology and location. Researchers reviewed associated macular complications from HCD detection to the most recent follow-up, using NIR/OCT. Thirty-three eyes with HCDs from 33 individuals (mean age: 72 ±7.5 years) had 46.7 months (CI, 33.7, 59.6) of serial eye-tracked NIR/OCT follow-up. Here are some of the findings: • Baseline best-corrected visual acuity was 0.44 logMAR (Snellen equivalent 20/55). • At a mean of 11.3 months (3.1, 19.6) after HCD detection, 31/33 (93.9 percent) eyes had developed macular complications including de novo areas of complete retinal pigment epithelium and outer retinal atrophy (cRORA) in 21/33 (64 percent) eyes, enlargement of preexisting cRORA in 4/33 (12 percent) eyes and incident macular neovascularization in 3/33 (9 percent) eyes. • Movement and clearance of HCDs in 9/33 (27 percent) eyes was associated with enlargement of preexisting cRORA (r=0.44, p=0.02). BCVA at the last follow-up visit had decreased to 0.72 logMAR (20/105). Researchers concluded that eyes with non-neovascular AMD demonstrating HCDs were at risk for vision loss due to macular complications, particularly when movement and clearance of such structures appeared on multimodal imaging. They added that HCD reflectivity and dynamism might be amenable to automated recognition and analysis to assess cellular activity related to drusen end stages. SOURCE: Fragiotta S, Fernández-Avellaneda P, Breazzano MP, et al. The fate and prognostic implications of hyperreflective crystalline deposits in nonneovascular age-related macular degeneration. Invest Ophthalmol Vis Sci. 2019;60:8:3100-9.
Pseudodrusen and the Development of Late AMD in the Fellow Eye Investigators evaluated whether the development of late age-related macular degeneration in fellow eyes with pseudodrusen was associated with the pseudodrusen pattern in individuals with unilateral exudative AMD, as part of a retrospective, observational study.
SOURCE: Sakurada Y, Sugiyama A, Kikushima W, et al. Pseudodrusen pattern and development of late age-related macular degeneration in the fellow eye of the unilateral case. Jpn J Ophthalmol 2019; Jul 2. [Epub ahead of print].
Treatment of Severe Keratoconus HydropsScientists reported on the successful management of severe corneal hydrops by corneal optical coherence tomography guidance and intracameral application of eye platelet-rich plasma (E-PRP) in a case of a patient with Down syndrome.A 36-year-old woman with Down syndrome presented with acute vision loss, pain, photophobia and corneal edema in the left eye. Clinical examination revealed keratoconus in the right eye and extreme keratoconus with severe corneal hydrops in the left eye. Anterior segment OCT (MS-39, Costruzione Strumenti Oftalmici) showed intrastromal cystic fluid collection, and a ruptured and detached Descemet’s membrane. After medical treatment and intracameral sulfur hexafluoride injection failed, a sterile 0.3 mL of E-PRP was injected into the anterior chamber. Clinical and anatomical improvements began from the first postoperative day, and corneal edema totally resolved at one week. Postoperatively, no significant side effects were noted with the exception of an early, transient, moderate (28 mmHg) intraocular pressure peak. Anterior segment-OCT demonstrated dramatic normalization in corneal morphology with total disappearance of fluid in the cystic intracorneal space, closure of the DM rupture and DM reattachment. The individual was stable during the six-month follow-up. Scientists wrote that, in this case, intraocular E-PRP was a promising, apparently safe and effective treatment option for the management of corneal hydrops when conventional approaches failed. They added that this was the first case in the literature to describe the OCT appearance of corneal hydrops and intracameral use of E-PRP for the resolution of DM rupture in acute corneal hydrops. SOURCE: Alio JL, Toprak Ibrahim, Rodriguez AE. Treatment of severe keratoconus hydrops with intracameral platelet-rich plasma injection. Cornea 2019; Jun 22. [Epub ahead of print]. Longitudinal Analysis of Bruch’s Membrane Opening Morphometry in Myopic GlaucomaResearchers assessed longitudinal changes in morphological characteristics of the Bruch’s membrane opening in control and glaucomatous subjects.They followed 53 myopic eyes (17 controls, six suspects, 20 with stable glaucoma and 10 with progressing glaucoma) for an average of 4.2 ±1.4 years, and imaged them at baseline and two follow-up appointments using a 1,060 nm swept-source optical coherence tomography system. They segmented Bruch’s membrane and Bruch’s membrane opening, and measured four morphometric BMO parameters (area, ellipse ratio, non-planarity and depth). Here are some of the findings: • There were no significant changes in the BMO area or ellipse ratio for all groups. • BMO non-planarity was shown to increase in the glaucoma groups. • BMO depth relative to BM increased in all groups except the suspects (controls: 8.1 µm/y, p=0.0001; stable glaucoma group: 3.5 µm/y, p=0.0001; progressing glaucoma group: 14 µm/y, p=0.0026). • In linear mixed-model analysis, axial length was positively associated with the BMO area in all groups except for progressing glaucoma and with BMO non-planarity in stable glaucoma; it wasn’t a significant factor in of BMO parameter slopes in the ANCOVA analysis of slopes. Researchers reported that, longitudinally, Bruch’s membrane opening increased in non-planarity in glaucoma eyes, and its axial position relative to Bruch’s membrane became more posterior in control and glaucoma eyes. Source: Bhalla M, Heisler M, Han S, et al. Longitudinal analysis of Bruch’s membrane opening morphometry in myopic glaucoma. J Glaucoma 2019; July 19. [Epub ahead of print]. BRIEFLY B+L Introduces 23-Gauge Bi-Blade Dual Port Vitrectomy Cutter for Stellaris Elite Genentech/Roche Complete Enrollment in Archway Allegro to Present Results of Phase II Risuteganib Intermediate Dry AMD Study IVERIC bio Advances LCA10 Minigene Program & Expands Orphan Gene Therapy Portfolio J-Code Roundup First, CMS confirmed its preliminary decision to assign a permanent product-specific J-code for Omeros’ Omidria (phenylephrine and ketorolac intraocular solution) 1% / 0.3%. Omidria is a commercial drug that can be used during cataract surgery to prevent miosis and reduce postoperative pain, which the company says can improve patient outcomes and safety. The new J-code for Omidria—J1097—will become effective October 1, 2019. Read more. Augmented-reality Contact Lens Advances in Studies New Products from Alcon
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