Review of Ophthalmology Online


Volume 18, Number 40
Monday, October 1, 2018


In this issue: (click heading to view article)
######### Diurnal Variation of Choroidal Thickness in POAG
######### Changes in DR Severity When Treating DME With Ranibizumab: Protocol
######### DWEK vs. DMEK to Treat Fuchs’ Endothelial Corneal Dystrophy
######### Long-term Low-dose Aspirin and nAMD


Diurnal Variation of Choroidal Thickness in POAG

Researchers analyzed pattern and magnitude of diurnal variations of macular choroidal thickness (mCT) in primary open-angle glaucoma and healthy subjects, as part of a prospective study.

Twenty-one POAG and 17 healthy subjects underwent mCT, systemic blood pressure and intraocular pressure measurements during the daytime at five time points (8 a.m., 11 a.m., 2 p.m., 5 p.m. and 8 p.m.). Researchers used swept-source optical coherence tomography to determine the mCT.

• In healthy subjects, the mean mCT was 233.63 ±50.98 μm at 8 a.m., which decreased gradually until 2 p.m. (206.02 ±45.91, p=0.015) and increased in the evening (8 p.m.; 228.12 ±51.69, p=0.030).
• In POAG subjects, the mean mCT at 8 a.m.—246.50 ±48.94 μm— decreased to 226.77 ±51.48 at 2 p.m. (p=0.027) but didn’t increase in the evening (229.07 ±50.87; p=0.566).
• The overall diurnal variation of the mean mCT wasn’t statistically significant in either group (p=0.179 [POAG subjects] and 0.164 [healthy subjects]).
• The systolic BP, diastolic BP and mean ocular perfusion pressure of the POAG group had a peak value at 8 a.m. and a trough value at 8 p.m. (p=0.001, 0.002 and <0.001).

Researchers found that the mCT in POAG subjects didn’t increase in the evening compared with the healthy subjects’ pattern, although diurnal mCT values measured in all subjects weren’t statistically significant.

SOURCE: Baek SU, Kim J-S, Kim Y, et al. Diurnal variation of choroidal thickness in primary open-angle glaucoma. J Glaucoma 2018; Sep 18. [Epub ahead of print].

Changes in DR Severity When Treating DME With Ranibizumab: Protocol

Investigators assessed five-year changes from baseline in diabetic retinopathy severity among eyes treated with ranibizumab for diabetic macular edema. They looked at DR severity from study visits and annual fundus photographs among participants in Protocol I (, and estimated the proportion of eyes that improved at annual exams and the cumulative probability of worsening through five years. Here are some of the investigators’ findings:

• Among 235 participants with nonproliferative DR at baseline, the following percentage of eyes had retinopathy improvement: 29 percent at one year, 28 percent at three years and 32 percent at five years.
• Among 111 participants with proliferative DR, improvement percentages were 38 percent at one year, 35 percent at three years and 23 at five years.
• The five-year cumulative probability of worsening was 18 percent (CI, 14 to 25 percent) among NPDR eyes and 31 percent (CI: 23 to 42 percent) among PDR eyes (p=0.01).
• In year one, the mean number of ranibizumab injections was 8.1 ±2.5 for NPDR eyes and 9 ±2.8 for PDR eyes; in year three, it was 2.2 ±2.6 for NPDR eyes and 2.3 ±2.9 for PDR eyes; and in year five, the mean was 1.8 ±2.6 for NPDR eyes, and 1.7 ±2.6 for PDR eyes.

Investigators concluded that individuals receiving ranibizumab therapy for DME might have favorable changes in DR severity during a five-year period concomitant with sequential reduction in anti-vascular endothelial growth factor therapy.

SOURCE: Bressler SB, Odia I, Glassman AR, et al. Changes in diabetic retinopathy severity when treating diabetic macular edema with ranibizumab: protocol i 5-year report. Retina 2018; Sept. 18. [Epub ahead of print].

DWEK vs. DMEK to Treat Fuchs’ Endothelial Corneal Dystrophy

Scientists compared the visual outcomes and associated morbidity of patients with Fuchs’ endothelial corneal dystrophy treated with Descemet’s membrane endothelial keratoplasty or descemetorhexis without endothelial keratoplasty.

The retrospective, comparative cohort study included 27 eyes with mild-to- moderate Fuchs’ dystrophy (with corneal guttae/edema limited to the central cornea with relatively clear periphery) treated at the University of Pittsburgh Medical Center from 2015 to 2017, with either DMEK (n=15) or DWEK (n=12). Descemetorhexis was performed by removing the central 4 mm of diseased Descemet’s membrane at the end of phacoemulsification for cataract surgery. Visual acuity was measured using the Snellen chart and then converted to logMAR for analysis. Some of the scientists’ findings were as follows:

• The average postoperative pinhole VA was 20/25 − 1 (logMAR 0.16 ±0.09) for DMEK eyes and 20/30 + 1 (logMAR 0.13 ±0.10) for DWEK eyes (p=0.44).
• The average time to 20/40 vision for DMEK was 2.2 ±2.8 weeks compared with 7.1 ±2.7 weeks for DWEK (p<0.01).
• In the DMEK group, eight individuals (53 percent) had adverse events, including increased intraocular pressure (n=7), anterior chamber inflammation (n=1), and graft nonadherence (n=1), with one individual requiring anterior chamber paracentesis (6.7 percent) and one person requiring a rebubbling procedure (6.7 percent).
• The DWEK group had no adverse events (p<0.01).

Scientists found that DWEK effectively treated select individuals with mild-to-moderate Fuchs’ dystrophy with equivalent visual outcomes compared with the current standard of care, i.e., DMEK. They wrote that DWEK cases had reduced adverse events and need for additional procedures and didn’t require long-term immunosuppression or donor corneal tissue, although recovery time could be longer.

SOURCE: Huang MJ, Kane S, Dhaliwal DK. Descemetorhexis without endothelial keratoplasty versus DMEK for treatment of Fuchs endothelial corneal dystrophy. Cornea 2018; Sep 14. [Epub ahead of print].

Long-term Low-dose Aspirin and nAMD

Researchers wrote that the association between long-term cardioprotective aspirin use and neovascular age-related macular degeneration is controversial. They performed a retrospective, population-based study using a nationwide cohort from clinics and hospitals in South Korea in an effort to estimate the risk of nAMD with long-term regular use of low-dose aspirin.

Researchers identified nonregular aspirin users and regular aspirin users under the country’s national health insurance, age ≥45 years, who were followed from 2010 through 2015. They estimated nAMD incidence per 10,000 person-years. Long-term regular use of low-dose aspirin was defined as sustained intake of ≤100 mg aspirin with ≥1,044 days-prescription between 2005 and 2009. Nonregular aspirin users included occasional users or nonusers. The analyses included: a propensity score-adjusted analysis in a large, randomly selected, unmatched whole cohort (n=482,613); propensity score-matched analysis in a matched cohort (n=74,196); and maximally adjusted analysis in the unmatched whole cohort (n=482,613). Main outcome measures included incidence of newly developed nAMD using the registration code for intractable disease under national health insurance.

The incidence of nAMD was 3.5 among nonregular aspirin users and 7.2 among regular aspirin users, per 10,000 person-years in the unmatched whole cohort. However, propensity score-adjusted analyses revealed no association between aspirin use and nAMD (adjusted HR, 0.98; CI, 0.73 to 1.30). Similarly, propensity score-matched analyses showed no association; incidences of nAMD were 7.5 among nonregular aspirin users and 7.1 among regular aspirin users (crude HR, 0.94; CI, 0.70 to 1.28). A maximally adjusted model—including age, sex, income, residential area and history of 100 randomly selected types of generic drugs— showed no association (adjusted HR, 0.95; CI, 0.71 to 1.28).

Researchers found no association between regular use of low-dose aspirin for five years and future incidence of nAMD. As such, their findings suggested that regular, long-term use of low-dose aspirin appeared to be safe with respect to the new development of nAMD.

SOURCE: Rim TH, Tae Keun Yoo, Jiyong Kwak, et al. Long-term regular use of low-dose aspirin and neovascular age-related macular degeneration: National sample cohort 2010–2015. Ophthalmology 2018; Sep 18. [Epub ahead of print].

  • ASCRS Issues Preliminary CyPass Withdrawal Consensus Statement
    The American Society of Cataract and Refractive Surgery CyPass Withdrawal Task Force recently released its Preliminary ASCRS CyPass Withdrawal Consensus Statement. The task force was charged with reviewing data from the COMPASS-XT study and related research, and developing an independent physician guidance document associated with the voluntary withdrawal of the CyPass Micro-Stent. The statement includes diagnostic monitoring options, and considerations/recommendations for intervention and device revision. Further details on the results of the five-year follow-up study of the CyPass Micro-Stent along with additional resources are available on Alcon’s website. Read more.

  • Avedro Announces Cigna Coverage
    Following Cigna’s recent announcement that it’s now covering the Photrexa drug formulations and the KXL System used in the treatment of progressive keratoconus, Avedro reported that 50 commercial insurance plans cover the FDA-approved corneal cross-linking procedure. Patients can find an updated list of plans at with coverage policies. Read more.

  • Oculis Appoints Dugel
    Oculis appointed Pravin U. Dugel, MD as chairman of its scientific advisory board. Dr. Dugel is managing partner of Retinal Consultants of Arizona, a founding member of the Spectra Eye Institute and clinical professor at the department of ophthalmology at the Keck School of Medicine, University of Southern California. He served as principal investigator for more than 100 multicenter clinical trials for emerging and FDA-approved therapies for wet age-related macular degeneration including Fovista, Lucentis and Eylea. The Becker Institute recently named him “one of the best 35 ophthalmologists in the United States.” Dr. Dugel serves on the Orbis International board of directors and on scientific advisory boards for MacuSight, Alcon Surgical, Genentech and Novartis. Read more.

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