Review of Ophthalmology Online



Vol. 22, #24  •   Monday, June 14, 2021


In this Issue:


Identification of Peripheral Anterior Synechia Using AS-OCT

Researchers created a model that evaluates the presence and extent of peripheral anterior synechia based on anterior segment optical coherence tomography.

The extent of PAS involvement in the eyes of individuals with angle closure was assessed by indentation gonioscopy, and the part of non-PAS and PAS were assigned into two groups: NPAS and PAS. Anterior chamber angles were then imaged by AS-OCT with light-emitting diode irradiation directly into the pupils, leading to pupillary constriction and increasing anterior chamber angle width. Parameters, including the angle opening distance at 750 μm anterior to the scleral spur (AOD750) and trabecular-iris space area at 750 μm anterior to the scleral spur (TISA750), were then measured. The differences before and after LED irradiation of AOD750 and TISA750 were calculated and used to generate a PAS model based on binary logistic regression.

A total of 258 AS-OCT images in 14 eyes were assigned to the modeling data, and 120 were assigned to the validation data. Here are some of the findings:
• No differences were found in AOD750 and TISA750 in the dark between NPAS and PAS (PAOD750=0.258, PTISA750=0.486).
• After LED light exposure, TISA750light was larger in NPAS than in PAS (p=0.047).
• The light-dark differences of both parameters showed significant differences between the two groups (PAOD750dif=0.019, PTISA750dif <0.001).
• The area under the curve of the model performance was 0.841, and the overall correct rate was 80.8 percent based on the validation data.

Researchers wrote that the AS-OCT-based PAS model could be useful in identifying the presence of synechial angle closure and evaluating the extent of PAS in a single eye.

SOURCE: Dai Y, Zhang S, Shen M, et al. Identification of peripheral anterior synechia with anterior segment optical coherence tomography. Graefes Arch Clin Exp Ophthalmol. 2021; May 11. [Epub ahead of print].




SS-OCTA Characteristics of Treatment-naïve Nonexudative MNV in AMD Prior to Exudation

Investigators assessed the characteristics of treatment-naïve nonexudative macular neovascularization in age-related macular degeneration before the onset of exudation, using swept-source optical coherence tomography angiography.

They evaluated the following measurements at two visits prior to exudation: MNV area; choriocapillaris (CC) flow deficits; vessel area density (VAD); vessel skeleton density (VSD); retinal pigment epithelial detachment (PED) volume; mean choroidal thickness (MCT); and choroid vascularity index (CVI). They compared measurements made at the second visit and the rate of change between visits in eyes with and without exudation. The differences in these parameters between eyes with and without subsequent exudation were summarized with 95 percent confidence intervals.

Twenty-one eyes with nonexudative MNV were identified and followed. Here are some of the findings:
• Nine eyes developed exudation, and 12 eyes didn’t.
• Differences between these groups of eyes for all parameters tended to be small, and the 95 percent CIs largely ruled out any substantial differences.
• Overall, eyes with exudation had:
   o 24 percent smaller VAD;
   o 20 percent smaller VSD; and
   o 33 percent smaller PED volume measurements.
• No noteworthy differences were observed for MNV area, CC flow deficits, MCT or CVI measurements.

Investigators concluded that the onset of exudation was correlated with lesions having less vascularity and smaller PED volume measurements, but measurements of MNV area, CC flow deficits, MCT and CVI weren’t correlated with near-term exudation. They added that investigations are ongoing to further explore these and other anatomic changes as harbingers of near-term exudation.

SOURCE: Shen M, Zhang Q, Yang J, et al. Swept-source OCT angiographic characteristics of treatment-naïve nonexudative macular neovascularization in AMD prior to exudation. Invest Ophthalmol Vis Sci 2021;3;62:6:14.


Complimentary CME Education Videos


Effect of Six-month Postoperative ECD on Graft Survival After DMEK

Scientists analyzed whether endothelial cell density at six months affected long-term ECD outcome and graft survival five years after Descemet’s membrane endothelial keratoplasty in eyes with Fuchs’ endothelial corneal dystrophy, as part of a retrospective cohort study.

A total of 585 DMEK eyes (443 patients) that underwent surgery for Fuchs’ were included. The study group was divided into four groups based on six-month ECD quartiles: group 1 (n=146) with 313 to 1,245 cells/mm2; group 2 (n=148) with 1,246 to 1,610 cells/mm2; group 3 (n=145) with 1,611 to 1,938 cells/mm2; and group 4 (n=146) with 1,939 to 2,760 cells/mm2. Group 1 was further split into subgroup 1a (n=36) with six-month ECD of ≤828 cells/mm2; subgroup 1b (n=37) with 829 to 1,023 cells/mm2; subgroup 1c (n=37) with 1,024 to 1,140 cells/mm2; and subgroup 1d (n=36) 1,141 to 1,245 cells/mm2.

The intervention was DMEK, and the main outcome measures included long-term ECD, graft survival probability and postoperative complication rates.

Here are some of the findings:
• The mean preoperative donor ECD of the overall group decreased from 2,543 (±185) cells/mm2 preoperatively to 1,584 (±479) cells/mm2 at six months postoperatively (-38 [±18] percent).
• For group 1, ECD decreased from 951 (±233) cells/mm2 (n=146) at six months to 735 (±216) cells/mm2 (n=99) at five years postoperatively.
• For group 1 graft survival probability was 0.95 (CI, 0.91 to 0.99) at five years postoperatively, which was significantly lower than for groups 2 to 4 (p=0.001).
• Five-year graft survival in subgroup 1a (six-month ECD ≤828 cells/mm2) was 0.79 (CI, 0.67 to 0.94), which was significantly lower than in subgroups 1b to 1d (p=0.001).
• Preoperative ECD didn’t influence graft survival (p=0.393), while higher six-month ECD values were associated with lower rates of graft failure (hazard ratio 0.994 [CI, 0.99 to 1.00][p=0.001]).

Scientists wrote that six-month ECD was associated with DMEK graft survival. High early cell loss after DMEK negatively affected long-term ECD outcome and graft survival, and grafts in the subgroup with ECD ≤828 cells/mm2 at six months were at higher risk of failure within five years after DMEK.

SOURCE: Vasiliauskaitė I, Quilendrino R, Baydoun L, et al. Effect of six-month postoperative endothelial cell density on graft survival after Descemet membrane endothelial keratoplasty. Ophthalmology 2021; May 22. [Epub ahead of print].


Outer Retinal Layer Thickening Predicts Onset of Exudative nAMD

Researchers assessed changes in outer retinal layer (ORL) thickness before the development of exudative macular neovascularization in eyes with age-related macular degeneration, as part of a retrospective observational case series.

They enrolled AMD eyes that eventually developed exudative MNV and were followed with sequential optical coherence tomography for at least two years before the exudation occurred. ORL thickness was automatically calculated by OCT software for each sector of the Early Treatment Diabetic Retinopathy Study map at each follow-up visit. The ORL thickness change from baseline to the day when the exudative MNV developed was compared between sectors that eventually developed exudative MNV and those that didn’t.

Forty-seven eyes (47 patients) were included. Here are some of the findings:
• At baseline (24 ±3 months before exudative MNV), mean ORL thickness of sectors that eventually developed exudative MNV was similar to that of sectors that didn’t (85.2 ±8.2 µm vs. 86.8 ±5.7 µm; p=0.08).
• ORL thickness significantly increased in sectors that developed exudative MNV compared to those that didn’t (+5.8 ±10.4 µm vs. -2.8 ±3.6 µm; p<0.01).
• The regression model based on the data predicted an increase in ORL thickness from baseline of +4.2 percent 55 days, and +11.1 percent 30 days before exudative MNV was detected.
• The ORL thickness of areas that didn’t develop exudative MNV didn’t change.

Researchers found that thickening of the ORL began in the area where exudative MNV developed long before the exudation, accelerating significantly in the last two months. They added that the occurrence of exudative MNV could be predicted by two months using this analysis.

SOURCE: Invernizzi A, Parrulli S, Monteduro D, et al. Outer retinal layer thickening predicts the onset of exudative neovascular age related macular degeneration. Am J Ophthalmol 2021; May 27. [Epub ahead of print].




Industry News

Outlook Completes Patient Dosing in Phase III NORSE TWO Trial

Outlook Therapeutics administered the final dose to the last patient enrolled in its NORSE TWO safety and efficacy study evaluating ONS-5010 (bevacizumab-vikg) for treatment of wet age-related macular degeneration. The trial enrolled 228 wet AMD patients at 39 U.S. clinical trial sites, who are being treated for 12 months. The primary endpoint is the difference in the proportion of patients who gain at least 15 letters in best-corrected visual acuity at 11 months for ONS-5010 dosed on a monthly basis compared to Lucentis, which is being dosed quarterly per the PIER regimen. Read more.

B+L and Lochan to Develop Next Generation of Eyetelligence Software

Bausch + Lomb entered into an agreement with software-development company Lochan to develop the next-generation of Bausch + Lomb’s eyeTELLIGENCE clinical decision support software. Using its existing cloud-based infrastructure, B+L says that the analytical software will allow surgeons to integrate all aspects of the cataract, retinal and refractive surgery processes to maximize practice efficiency. The companies expect to launch the initial phase of this next-generation software in 2022. Read more.

Noveome Announces Preliminary Results of Phase I Trial

Noveome Biotherapeutics announced preliminary results of a Phase I open-label clinical trial to establish the safety of ST266 when delivered intranasally in glaucoma suspects. The company says that the device used in the trial is able to deliver ST266 to the cribriform plate at the back of the upper nasal cavity where is able to reach the optic nerve, eye and brain, bypassing the blood-brain barrier. Read more.


Optomed Launches Tabletop Fundus Cameras

Optomed USA now offers two tabletop fundus imaging cameras for the U.S. market. The Optomed Polaris, a small, stationary device, has a fully automatic, non-mydriatic fundus camera; it requires minimal training and provides sharp 45-degree images of the retina, the company says. The Optomed Halo, with a lightweight design and small footprint, offers a fully automatic, portable, non-mydriatic retinal camera. Social distancing is possible with the Optomed Halo because the controlling computer can be located up to 25 feet away from the camera or behind a glass wall, Optomed says. Learn more.


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