From the editors of Review of Ophthalmology:
Monday, September 21, 2019
SEPTEMBER IS HEALTHY AGING MONTH
In this issue: (click heading to view article)
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Automated Macular Segmentation with SD-OCT in Fellow Eyes with Unilateral RVO
Researchers assessed changes in the macular layers in the fellow eyes of unilateral retinal vein occlusion patients and evaluated whether certain layers were more impacted, based on RVO type.
The retrospective study included 87 fellow eyes of individuals with unilateral RVO (26 central, 61 branch) and 105 eyes of 105 subjects without RVO. Researchers used spectral-domain optical coherence tomography for automatized retinal segmentation. They documented thicknesses of ganglion cells, retinal pigment epithelium; and retinal nerve fiber, inner plexiform, inner nuclear, outer plexiform, outer nuclear, photoreceptor and overall inner retinal layers. Here were some of the findings:
• The inner plexiform layer was thinner in the inferior sector in the RVO group compared with the control group ( p=0.047).
• The subgroup analysis showed that the retina was thinner in the RVO group compared with controls without systemic diseases in some sectors of the following layers: inferior retinal; RNFL; ganglion cell; inner plexiform; inner retinal and RPE ( p<0.05).
• Retinal thickness was decreased in the fellow eyes of the branch RVO group compared with the thickness in the fellow eyes of the central RVO group in same sectors ( p<0.05).
Researchers found that the fellow eyes of unilateral RVO patients didn’t show major structural differences compared with controls; however, they revealed significant sectoral thinning in many retinal layers when compared with the eyes of healthy subjects without systemic diseases. They also determined that the central maculas were thinner in fellow eyes with branch RVO compared with those in fellow eyes with central RVO.
Source: Cetin EN, Bozkurt K, Parca O, et al. Automated macular segmentation with spectral domain optical coherence tomography in the fellow eyes of patients with unilateral retinal vein occlusion. Int Ophthalmol 2019;39:9:2049-56.
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DMEK Using Peripherally-trephinated Donor Tissue in FECD
Investigators evaluated the clinical outcomes and endothelial cell density after Descemet’s membrane endothelial keratoplasty using peripherally trephinated donor tissue (DMEK-pD) and compared them with DMEK using centrally trephinated donor tissue (DMEK-cD) in patients with Fuchs’ endothelial corneal dystrophy.
The prospective, comparative, interventional case series included 125 eyes of 110 individuals with Fuchs’ and cataract who underwent either DMEK-pD (n=60) or DMEK-cD (n=65) combined with phacoemulsification, between June 2016 and November 2018. Investigators recorded preoperative and postoperative best-spectacle-corrected visual acuity and ECD at six months and one year. Here were some of the findings:
• All eyes had visually symptomatic Fuchs’ and cataract, with a preoperative mean BSCVA of 1.03 logMAR in both groups.
• Baseline donor mean ECD was 2,944 ±201 cells/mm2 in the DMEK-pD and 2,907 ±173 cells/mm2 in the DMEK-cD group (p=0.12).
• BSCVA improvement was comparable at six months (p=0.23) and one year (p=0.34).
• Mean ECD recorded was significantly higher in the DMEK-pD group than in the DMEK-cD group after six months (2,508 ±201 vs. 2,084 ±298 cells/mm2) (p<0.01); and after one year (2,338 ±256 vs. 1,907 ±339 cells/mm2)(p<0.01).
• Complication rates were similar in both groups.
Investigators reported that DMEK-pD exhibited similar clinical outcomes with higher ECD compared with conventional DMEK-cD after six months and one year. However, they added that the possibility of transplanting peripherally trephinated donor tissue in DMEK with more endothelial cells would need to be explored further in the future.
SOURCE: Basak SK, Basak S. Clinical outcomes and endothelial cell density after Descemet membrane endothelial keratoplasty using peripherally-trephinated donor tissue (DMEK-pD) in Fuchs’ endothelial corneal dystrophy. Am Cornea 2019; Sep 10. [Epub ahead of print].
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Using Projection-resolved OCTA to Assess Reduced Retinal Vessel Density in GA Secondary to AMD
Scientists compared retinal vessel density in eyes with geographic atrophy secondary to age-related macular degeneration to age-matched healthy eyes using projection-resolved optical coherence tomography angiography (PR-OCTA), as part of a prospective, cross-sectional study.
Study participants underwent macular 3-mm 2 OCTA scans with spectral-domain OCTA. Reflectance-compensated retinal vessel densities were calculated on projection-resolved superficial vascular complex (SVC), intermediate capillary plexus (ICP) and deep capillary plexus (DCP). Quantitative analysis using normalized deviation compared the retinal vessel density in GA regions, 500 μm GA rim regions and non-GA regions to similar macular locations in control eyes.
Ten eyes with GA and 10 control eyes were studied. Here were some of the findings:
• Eyes with GA had significantly lower vessel density in the SVC (54.8 ±2.4 percent vs. 60.8 ±3.1 percent, p<0.001); ICP (34 ±1.5 percent vs. 37.3 ±1.7 percent, p=0.003); and DCP (24.4 ±2.3 percent vs. 28 ±2.3 percent, p<0.001) compared with control eyes.
• Retinal vessel density within the GA region decreased significantly in SVC, ICP and DCP.
• Retinal vessel density in the GA rim region decreased in the SVC and ICP, but not in the DCP.
• The non-GA region didn’t significantly deviate from normal controls.
• Eyes with GA had significantly reduced photoreceptor layer thickness, but similar ganglion cell complex thickness; and similar nerve fiber, inner nuclear and outer plexiform thickness.
Scientists wrote that GA eyes had reduced retinal vessel density in SVC, ICP and DCP compared with controls. They added that loss was greatest within GA regions. Furthermore, they wrote, vessel density might be more sensitive than retinal layer thickness measurements in detecting inner retinal changes in eyes with GA.
SOURCE: You QS, Wang J Yukun Guo Y, et al. Detection of reduced retinal vessel density in eyes with geographic atrophy secondary to age-related macular degeneration using projection-resolved optical coherence tomography angiography. Am J Ophthalmol 2019; Sep 14. [Epub ahead of print].
Treatment Outcomes Following Resident-performed Non-valved (Baerveldt 350) Glaucoma Drainage Device Implantation
Researchers reviewed the outcomes of resident-performed Baerveldt implantation through one year of postoperative management in a resident-run clinic at the Durham Veterans Affairs Medical Center.
They searched the medical records of all veterans at the center to identify those including Baerveldt implantation performed by resident physicians between July 1, 2007, and June 30, 2017. Exclusion criteria included previous glaucoma tube or concurrent surgical intervention, including cataract extraction. They reviewed all postoperative visits and collected clinical data. Failure was defined as two consecutive visits, starting at postoperative month (POM) three, with intraocular pressure ≤5 mmHg or >21 mmHg, <20 percent IOP reduction from baseline, reoperation for glaucoma or loss of light perception.
A total of 48 eyes were included with the following mean IOPs and the following number of medications:
• baseline: 23.1 ±6.7 mmHg on 3.7 ±1 medications;
• postoperative day 1: 20.5 ±11.7 mmHg on no medications;
• postoperative week one: 14.3 ±6.9 mmHg and 1.9 ±1.7 medications;
• POM1: 16.7 ±6.4 mmHg and 2.2 ±1.5 medications;
• POM3: 15.1 ±5.2 mmHg and 2.1 ±1.6 medications;
• POM6: 12.8 ±4.9 mmHg and 2.8 ±1.3 medications; and
• POM12: 13 ±4 mmHg and 2.8 ±1.4 medications.
Here were some of the findings:
• IOP decreased at all time intervals ( p<0.01) but postoperative day one ( p=0.15) while the medication burden was reduced at every visit ( p<0.01).
• Through 12 months, eight patients (17 percent) failed, with a time to failure of 9.2 ±0.3 months.
• No patients underwent additional glaucoma surgical interventions or lost light perception.
Researchers concluded that residents could safely and effectively perform Baerveldt implantation in the operating room and clinic.
Rothman AL, Rosdahl JA, Hunter TG, et al. Treatment outcomes following resident performed nonvalved (Baerveldt 350) glaucoma drainage device implantation. J Glaucoma 2019; Sep 5. [Epub ahead of print].
Glaucoma Drainage Device Debuts
New World Medical has announced the availability of a new option for glaucoma surgeons performing tube shunt surgery as a means to lower intraocular pressure: the Ahmed ClearPath Drainage Device. The valveless ClearPath has a flexible plate contoured to conform to the curvature of the eye. Its suture points are positioned more anteriorly than those of other valveless drainage devices to make them easier to visualize and access during surgery, the company says. The ClearPath is available in two sizes, 350 mm2 and 250 mm2. The model 350 plate surface is positioned more posteriorly to avoid muscle attachment points, and the 250 mm2 is designed to be a true single-quadrant implant that fits between the muscles. Both models come with an optional pre-threaded ripcord and a 23-ga. needle. Learn more.
New Fundus Camera from Essilor
Essilor Instruments now offers the Retina800 Next-Generation Fundus Camera, which the company says is designed to help streamline retinal screening in your practice. Essilor says the unique optical design allows fast, fully automatic, high-quality image capture without human intervention; operator training is minimal. The Retina800 captures 45-degree, true-color images in a few seconds with the press of a button, even if the patient has opacities or a pupil as small as 2.5 mm. Ninety-degree mosaic imaging is easily accomplished, the company adds.
Other features include:
• an intuitive user interface;
• image quality validation before storage;
• direct connection to a DICOM server;
• a space-saving, compact footprint; and
• an intuitive tablet interface.
Learn more.
Canon Xephilio OCT-A1 OCT Device Receives FDA 510(k) Clearance
Canon announced its Xephilio OCT-A1 optical coherence tomography device is now approved. The device, which features automated acquisition functionality, is indicated for the in vivo imaging and measurement of the retina, retinal nerve fiber layer and optic disc. It has a scanning speed of 70,000 A-scans per second, with optical depth resolution of approximately 3 µm. With its integrated scanning laser ophthalmoscopic and real-time retinal tracking technology, the system automatically retains the scan position and scan protocol for each patient from one exam to the next. The positioning of the components enables the operator and patient to sit side-by-side to help personalize the interaction, the company says. Learn more.
Zeiss Showcases Advances at ESCRS 2019
During the 2019 European Society of Cataract and Refractive Surgery annual meeting in Paris, Zeiss Medical Technology Segment presented new digital and imaging technologies to help doctors maximize clinical efficiency and performance. Here were some of the highlights:
• The company introduced the Zeiss EQ Workplace for the Zeiss Cataract Suite, offering surgeons a digital solution to streamline the refractive cataract workflow. Zeiss estimates the system will be available in the U.S. by the end of 2019.
• The company expanded its Cirrus optical coherence tomography portfolio with the launch of its new Cirrus 6000, the next-generation 100kHz system, with image acquisition of 100,000 A-scans per second. The Cirrus 6000 is slated to be available in the United States at the end of October, the company says.
• The company unveiled its slit-lamp SL 800, designed for visualization with high-contrast and resolution. The slit lamp should be available to U.S. physicians at the end of September, according to Zeiss.
• The Zeiss ARTEVO 800, the first digital microscope in ophthalmic surgery, recently received the CE mark. Read more.
Myco Granted a Preliminary Injunction Against BlephEx and CEO
A Michigan federal judge barred BlephEx from making allegations of patent infringement and threatening litigation against customers of Myco Industries regarding Myco's AB Max. U.S. District Judge Gershwin A. Drain issued a preliminary injunction on Aug. 27, enjoining BlephEx and CEO James Rynerson from making allegations of patent infringement and threatening litigation against potential customers of Myco. BlephEx's product and its related patent are used on the inner edge of the eyelid, whereas Myco's AB Max is applied on the front edge of the eyelid, which Judge Drain stated makes them sufficiently different. Read more.
Alfred W. Bressler Vision Science Symposium & Pisart Seminar Will Honor Award Recipients
The Lighthouse Guild will host the Alfred W. Bressler Vision Science Symposium and Pisart Seminar, and present the Bressler Prize and Pisart Award at The University Club of New York on October 5. Vladimir Kefalov, PhD, is the recipient of the 2019 Bressler Prize, and Tiffany Schmidt, PhD, is the Pisart Award honoree. Dr. Kefalov is a retinal scientist and professor in the Department of Ophthalmology & Visual Sciences, and Department of Neuroscience, at Washington University School of Medicine in St. Louis. His work has generated new insights into mechanisms of multiple human vision disorders, including the causes of photoreceptor dysfunction and degeneration, which are spurring treatments for vision loss.
Dr. Schmidt is an assistant professor in the Department of Neurobiology and associate director of the Neurobiology Master's Program at Northwestern University in Evanston, Illinois. She’s being recognized for her contributions in sensory research and circadian biology, which is advancing the understanding of adult retinal function and retinal development. Read more.
Vertical Pharmaceuticals to Present Phase III RVL-1201 Clinical Trial Data in Acquired Blepharoptosis
Vertical Pharmaceuticals announced that Phase III clinical trial results for RVL-1201 (oxymetazoline hydrochloride ophthalmic solution, 0.1%) would be presented at multiple global congresses in October and November. RVL-1201 is a novel first-in-class pharmacologic agent in development for the treatment of
acquired blepharoptosis. If approved, RVL-1201 (a direct-acting, α-adrenergic agent) will be a noninvasive therapy administered topically to the eye. Read more.
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