Volume 19, Number 37Monday, September 16, 2019SEPTEMBER IS HEALTHY AGING MONTH In this issue: (click heading to view article)
Macular Atrophy in nAMD: Ranibizumab vs. Aflibercept (The RIVAL Study)In the Novartis-sponsored RIVAL study, researchers evaluated differences in development of macular atrophy and other efficacy outcomes over 24 months between treat-and-extend (T&E) ranibizumab and aflibercept in individuals with neovascular age-related macular degeneration.As part of the Phase IV, randomized, partially masked, multicenter study, individuals ages ≥50 years diagnosed with active, treatment-naive subfoveal choroidal neovascularization secondary to nAMD with baseline best-corrected visual acuity of ≥23 logMAR letters were included. Patients were randomized 1:1 to receive either intravitreal injections of ranibizumab 0.5 mg or aflibercept 2 mg, and treated according to the same reading center-guided T&E regimen following three initial monthly injections. The primary outcome was mean change in square root area of MA from baseline to month 24. Key secondary outcomes included number of injections and mean change in BCVA from baseline to months 12 and 24. A total of 278 individuals were included in the analysis (ranibizumab 0.5 mg, n=141; aflibercept 2.0 mg, n=137). Here were some of the findings: • Mean (CI) change in square root area of MA from baseline to month 24 was +0.36 mm (0.27, 0.45) for ranibizumab and +0.28 mm (0.19, 0.37) for aflibercept; treatment difference: +0.08 mm (-0.05, 0.21; p=0.24). • The proportion of individuals with MA increased from 7 percent (10/141) to 37 percent (43/117) for ranibizumab and from 6 percent (8/137) to 32 percent (35/108) for aflibercept from baseline to month 24. • The average number of injections received per year (CI) was similar between both groups: 9.6 (9.2, 10) for ranibizumab and 9.5 (9.1, 9.9) for aflibercept. • The mean change in BCVA (CI) from baseline to month 24 was +6.6 letters (4.7, 8.5) for the ranibizumab group and +4.6 letters (2.7, 6.6) for the aflibercept group, treatment difference (CI): 2 letters (-0.7, 4.6; p=0.15). • Rates of adverse events (AEs) were similar between both groups. Researchers observed no significant differences in the rate of growth and development of MA over 24 months between ranibizumab and aflibercept in nAMD treated using an identical T&E regimen. They found that ranibizumab and aflibercept resulted in similar visual acuity improvements over 24 months with similar number of injections and AEs. Source: Gillies MC, Hunyor AP, Arnold JJ, et al. Macular atrophy in neovascular age-related macular degeneration: A randomized clinical trial comparing ranibizumab and aflibercept (the RIVAL study). Ophthalmology 2019; Aug 27. [Epub ahead of print]. Using OCTA to Identify Impact of Slab Selection on Quantification of Choriocapillaris Flow DeficitsInvestigators assessed the impact of slab selection on quantitative measurements of choriocapillaris (CC) flow deficits using swept-source optical coherence tomography angiography, as part of a cross-sectional study.
Refractive Outcomes Using Conventional vs. Total Keratometry for IOL CalculationScientists compared the refractive outcomes following cataract surgery using conventional keratometry (K) and total keratometry (TK) for intraocular lens calculations in the SRK/T, HofferQ, Haigis, and Holladay 1 and 2, as well as Barrett and Barrett TK Universal II formulas. One of the authors received honoraria from Carl Zeiss, maker of the TK system in the IOLMaster.Sixty eyes of 60 individuals from Siriraj Hospital, Thailand, were prospectively enrolled in this comparative study. Scientists assessed eyes using the IOLMaster 700. They recorded posterior keratometry, K, TK, central corneal thickness, anterior chamber depth, lens thickness, axial length and white-to-white corneal diameter. They calculated emmetropic IOL power using K and TK in all formulas, in addition to selected IOL power and predicted refractive outcomes. Furthermore, they measured postoperative manifest refraction three months postoperatively. Finally, they calculated mean absolute errors (MAEs), median absolute errors (MedAEs) and the percentage of eyes within ±0.25, ±0.50 and ±1D of the predicted refraction for all formulas in both groups. Here were some of the findings: • Mean difference between K and TK was 0.03 D (44.56 ±1.18 vs. 44.59 ±1.22 D), showing excellent agreement (ICC=0.99, all p<0.001). • Emmetropic IOL powers in all formulas for both groups were very similar, with a trend toward lower MAEs and MedAEs for TK when compared with K. • The Barrett TK Universal II formula demonstrated the lowest MAEs. • The proportion of eyes within ±0.25, ±0.50 and ±1 D of predicted refraction were slightly higher in the TK group. Scientists reported that conventional K and TK for IOL calculations showed strong agreement. They suggested that the same IOL constant could be used for both K and TK. SOURCE: Srivannaboon S, Chirapapaisan C. Comparison of refractive outcomes using conventional keratometry or total keratometry for IOL power calculation in cataract surgery. Graefes Arch Clin Exp Ophthalmol 2019; Sep 5. [Epub ahead of print]. Mitomycin C-augmented Phacotrabeculectomy vs. Phacoemulsification in PACGResearchers aimed to compare the efficacy and safety of phacotrabeculectomy using releasable sutures and adjunctive mitomycin C vs. phacoemulsification alone in the management of primary angle-closure glaucoma.In total, 63 eyes of 63 individuals with PACG were randomized to undergo either mitomycin C-augmented phacotrabeculectomy with tight scleral flap closure using releasable sutures aiming at no flow, or phacoemulsification alone. The primary outcomes were success rates and complications. Secondary outcomes were IOP and glaucoma medications. Here were some of the findings: • The IOP and glaucoma medications were significantly reduced at one, three, six and 12 months postoperatively in both groups (p<0.001). • No statistically significant difference was found in IOP, IOP reduction, success rates or survival times between both groups. • Glaucoma medications were only significantly lower in the phacotrabeculectomy group at one and three months. • Rates of postoperative interventions and complications were higher in the phacotrabeculectomy group. • Complete success, defined as an IOP of 6 to 21 mmHg on no medications and with no signs of glaucoma progression, was achieved in 58 percent in the phacotrabeculectomy group, compared with 62 percent in the phacoemulsification group (p=0.9). • Only two eyes (6 percent) in the phacoemulsification group required a subsequent trabeculectomy. Researchers concluded that trabeculectomy didn’t seem to add an advantage when combined with phacoemulsification in PACG patients and was associated with more postoperative interventions. They added that, despite the use of releasable sutures to allow titration of the IOP postoperatively, the rate of hypotony and other complications was higher in the phacotrabeculectomy group. SOURCE: El Sayed YM, Elhusseiny AM, Albalkini AS, et al. Mitomycin c-augmented phacotrabeculectomy versus phacoemulsification in primary angle-closure glaucoma: A randomized controlled study. J Glaucoma 2019; Aug 29. [Epub ahead of print]. BRIEFLY First Trifocal IOL Approved in United States J&J Vision Showcases Latest Data & Solutions at ESCRS Annual Meeting AAO & Verana Health Launch Verana Practice Insights Boost Epi-On Corneal Cross-Linking Data to Be Presented at ESCRS 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. |