New Imaging Modalities in Retina

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New Imagings Modalities in Retina – Fariba Ghasemi MD – 1399.12.18

Journal club – 17-4-2021

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Ophthalmology

. 2021 Mar 9;S0161-6420(21)00195-0. doi: 10.1016/j.ophtha.2021.03.009. Online ahead of print.

Ocular Findings in Infants with Congenital Toxoplasmosis Following a Toxoplasmosis Outbreak

Aline Reetz Conceição ۱, Lilian Missio ۱, Deisi Nara Belucik ۱, Luiz Gustavo Brenner Reetz ۱, Matheus Henrique Monteiro Leber ۱, Kleber Silva Ribeiro ۲, Deise Fialho Costa ۲, Maria Clara da Silva Valadão ۱, Alessandra Gonçalves Commodaro ۲, João Rafael de Oliveira Dias ۳, Rubens Belfort Jr ۲Affiliations expand

Abstract

Purpose: We investigated the prevalence of ocular abnormalities in infants vertically exposed to Toxoplasma gondii infection during an outbreak in Santa Maria City, Brazil.

Design: Consecutive case series.

Participants: A total of 187 infants were included in this study.

Methods: The infants were recruited from January 2018 to November 2019. All mothers were screened for syphilis and human immunodeficiency virus before delivery. Toxoplasmosis infection was confirmed in all mothers and infants based on the presence of serum anti-T. gondii immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies. All infants underwent an ophthalmologic examination; ocular abnormalities were documented using a wide-field digital imaging system. Neonatal cranial sonography and/or head computed tomography were performed in 181 infants, and the cerebrospinal fluid (CSF) was screened for anti-T. gondii IgG and IgM antibodies in 159 infants. Peripheral blood samples from nine infants and their mothers were analyzed for the presence of T. gondii DNA by real-time polymerase chain reaction.

Main outcomes measures: Ocular abnormalities associated with congenital toxoplasmosis.

Results: A total of 187 infants were examined. Twenty-nine infants (15.5%) had congenital toxoplasmosis, of whom 19 (10.2%) infants had ocular abnormalities, including retinochoroiditis in 29 of 38 (76.3%) eyes, optic nerve abnormalities in five (13.2%) eyes, microphthalmia in one (2.6%) eye, and cataract in two (5.3%) eyes. Bilateral retinal choroidal lesions were found in 10 of 19 (52.6%) infants. Nine eyes of six infants had active lesions, with retinal choroidal cellular infiltrates at the first examination. Thirteen (7.2%) of 181 infants screened presented with cerebral calcifications. Eighty-three percent of the screened infants were positive for anti-T. gondii IgG and negative for IgM antibodies in the CSF. Congenital toxoplasmosis was higher in mothers infected during the third pregnancy trimester, and maternal treatment during pregnancy was not associated with a lower rate of congenital toxoplasmosis.

Conclusions: High prevalence rates of clinical manifestations were observed in infants with congenital toxoplasmosis after a waterborne toxoplasmosis outbreak, the largest yet described. Cerebral calcifications were higher in infants with ocular abnormalities and maternal infection during the third pregnancy trimester was associated with a higher rate of congenital toxoplasmosis independent of maternal treatment.

Ophthalmology. 2021 Jan 12doi: ۱۰.۱۰۱۶/j.ophtha.2021.01.007 [Epub ahead of print]PMCID: PMC7801188PMID: ۳۳۴۴۴۶۶۰

Face Masks and Bacterial Dispersion Toward the Periocular Area

Joseph J. Raevis, MD,۱Genti Gjyzeli, BS,۲Mihai Mititelu, MD, MPH,۱Jeremy Rogers, PhD,۳Michael Lasarev, MS,۴ and Jonathan S. Chang, MD۱,∗

JAMA Ophthalmol

. 2021 Mar 18;e210221. doi: 10.1001/jamaophthalmol.2021.0221. Online ahead of print.

Intravitreal Aflibercept Injection vs Sham as Prophylaxis Against Conversion to Exudative Age-Related Macular Degeneration in High-risk Eyes: A Randomized Clinical Trial

Jeffrey S Heier ۱, David M Brown ۲, Sumit P Shah ۳, Namrata Saroj ۴, Sabin Dang ۵, Nadia K Waheed ۶, Charles C Wykoff ۷, Jonathan L Prenner ۸, David S Boyer ۹Affiliations expand

Abstract

Importance: Anti-vascular endothelial growth factor (VEGF) agents may provide a prophylactic effect in high-risk eyes with intermediate dry age-related macular degeneration (AMD) against conversion to exudative AMD (eAMD), lowering the risk of vision loss.

Objective: To evaluate intravitreal aflibercept injection (IAI) as prophylaxis against the conversion to eAMD in high-risk eyes at 24 months.

Design, setting, and participants: This single-masked, sham-controlled, randomized clinical trial performed at 4 US clinical sites enrolled patients with intermediate AMD in 1 eye (study eye), defined as presence of more than 10 medium drusen (≥۶۳ to <125 μm), at least 1 large druse (≥۱۲۵ μm), and/or retinal pigmentary changes, and eAMD in the fellow eye. Patients were treated from June 23, 2015, to March 13, 2019.

Interventions: Intravitreal aflibercept injection (2 mg) or sham quarterly injection for 24 months (1:1 randomization).

Main outcomes and measures: The primary end point was the proportion of patients with conversion to eAMD at month 24 characterized by development of choroidal neovascularization, as assessed by leakage on fluorescein angiography and fluid on spectral-domain optical coherence tomography by an independent masked reading center.

Results: Of 128 patients enrolled, 127 (63 in the IAI group and 64 in the sham group) were included in the primary analysis (68 men [53.5%]; mean [SD] age, 76.5 [8.1] years). Baseline demographic and clinical characteristics were balanced between the groups. By month 24, 6 patients (9.5%) in the IAI group and 7 (10.9%) in the sham group developed eAMD (P = .98). Patients with a history of eAMD for longer than 2 years in their fellow eye at baseline showed a lower rate of conversion to eAMD in the study eye compared with those with a history of eAMD for 2 years or less in the fellow eye. Safety was consistent with previous studies involving intravitreal anti-VEGF injections.

Conclusions and relevance: In this evaluation of quarterly anti-VEGF exposure as prophylaxis to reduce conversion of eyes with high-risk dry AMD to eAMD, the rates of conversion were not lower in the IAI group compared with the sham treatment group at month 24. Understanding the mechanism of conversion to eAMD and therapies that could prevent this event remains an important unmet need.

Trial registration: ClinicalTrials.gov Identifier: NCT02462889.

JAMA Ophthalmol

. 2021 Mar 30. doi: 10.1001/jamaophthalmol.2021.0606. Online ahead of print.

Effect of Intravitreous Anti-Vascular Endothelial Growth Factor vs Sham Treatment for Prevention of Vision-Threatening Complications of Diabetic Retinopathy: The Protocol W Randomized Clinical Trial

Raj K Maturi ۱, Adam R Glassman ۲, Kristin Josic ۲, Andrew N Antoszyk ۳, Barbara A Blodi ۴, Lee M Jampol ۵, Dennis M Marcus ۶, Daniel F Martin ۷, Michele Melia ۲, Hani Salehi-Had ۸, Cynthia R Stockdale ۲, Omar S Punjabi ۳, Jennifer K Sun ۹, DRCR Retina NetworkAffiliations expand

Abstract

Importance: The role of anti-vascular endothelial growth factor injections for the management of nonproliferative diabetic retinopathy (NPDR) without center-involved diabetic macular edema (CI-DME) has not been clearly established.

Objective: To determine the efficacy of intravitreous aflibercept injections compared with sham treatment in preventing potentially vision-threatening complications in eyes with moderate to severe NPDR.

Design, setting, and participants: Data for this study were collected between January 15, 2016, and May 28, 2020, from the ongoing DRCR Retina Network Protocol W randomized clinical trial, conducted at 64 US and Canadian sites among 328 adults (399 eyes) with moderate to severe NPDR (Early Treatment Diabetic Retinopathy Study severity level, 43-53), without CI-DME. Analyses followed the intent-to-treat principle.

Interventions: Eyes were randomly assigned to 2.0 mg of aflibercept injections (n = 200) or sham (n = 199) given at baseline; 1, 2, and 4 months; and every 4 months through 2 years. Between 2 and 4 years, treatment was deferred if the eye had mild NPDR or better. Aflibercept was administered in both groups if CI-DME with vision loss (≥۱۰ letters at 1 visit or 5-9 letters at 2 consecutive visits) or high-risk proliferative diabetic retinopathy (PDR) developed.

Main outcomes and measures: Development of CI-DME with vision loss or PDR through May 2020, when the last 2-year visit was completed.

Results: Among the 328 participants (57.6% men [230 of 399 eyes]; mean [SD] age, 56 [11] years), the 2-year cumulative probability of developing CI-DME with vision loss or PDR was 16.3% with aflibercept vs 43.5% with sham. The overall hazard ratio for either outcome was 0.32 (97.5% CI, 0.21-0.50; P < .001), favoring aflibercept. The 2-year cumulative probability of developing PDR was 13.5% in the aflibercept group vs 33.2% in the sham group, and the 2-year cumulative probability of developing CI-DME with vision loss was 4.1% in the aflibercept group vs 14.8% in the sham group. The mean (SD) change in visual acuity from baseline to 2 years was -0.9 (5.8) letters with aflibercept and -2.0 (6.1) letters with sham (adjusted mean difference, 0.5 letters [97.5% CI, -1.0 to 1.9 letters]; P = .47).

Conclusions and relevance: In this randomized clinical trial, among eyes with moderate to severe NPDR, the proportion of eyes that developed PDR or vision-reducing CI-DME was lower with periodic aflibercept compared with sham treatment. However, through 2 years, preventive treatment did not confer visual acuity benefit compared with observation plus treatment with aflibercept only after development of PDR or vision-reducing CI-DME. The 4-year results will be important to assess longer-term visual acuity outcomes.

Ophthalmology

. 2021 Jan 8;S0161-6420(21)00001-4. doi: 10.1016/j.ophtha.2020.12.036. Online ahead of print.

Age Effect on Treatment Responses to 0.05%, 0.025%, and 0.01% Atropine: Low-Concentration Atropine for Myopia Progression Study

Fen Fen Li ۱, Yuzhou Zhang ۱, Xiujuan Zhang ۱, Benjamin Hon Kei Yip ۲, Shu Min Tang ۳, Ka Wai Kam ۴, Alvin L Young ۴, Li Jia Chen ۵, Clement C Tham ۶, Chi Pui Pang ۷, Jason C Yam ۸Affiliations expand

Abstract

Purpose: To investigate the effect of age at treatment and other factors on treatment response to atropine in the Low-Concentration Atropine for Myopia Progression (LAMP) Study.

Design: Secondary analysis from a randomized trial.

Participants: Three hundred fifty children aged 4 to 12 years who originally were assigned to receive 0.05%, 0.025%, or 0.01% atropine or placebo once daily, and who completed 2 years of the LAMP Study, were included. In the second year, the placebo group was switched to the 0.05% atropine group.

Methods: Potential predictive factors for change in spherical equivalent (SE) and axial length (AL) over 2 years were evaluated by generalized estimating equations in each treatment group. Evaluated factors included age at treatment, gender, baseline refraction, parental myopia, time outdoors, diopter hours of near work, and treatment compliance. Estimated mean values and 95% confidence intervals (CIs) of change in SE and AL over 2 years also were generated.

Main outcome measures: Factors associated with SE change and AL change over 2 years were the primary outcome measures. Associated factors during the first year were secondary outcome measures.

Results: In 0.05%, 0.025%, and 0.01% atropine groups, younger age was the only factor associated with SE progression (coefficient of 0.14, 0.15, and 0.20, respectively) and AL elongation (coefficient of -0.10, -0.11, and -0.12, respectively) over 2 years; the younger the age, the poorer the response. At each year of age from 4 to 12 years across the treatment groups, higher-concentration atropine showed a better treatment response, following a concentration-dependent effect (Ptrend <0.05 for each age group). In addition, the mean SE progression in 6-year-old children receiving 0.05% atropine (-0.90 diopter [D]; 95% CI, -0.99 to -0.82) was similar to that of 8-year-old children receiving 0.025% atropine (-0.89 D; 95% CI, -0.94 to -0.83) and 10-year-old children receiving 0.01% atropine (-0.92 D; 95% CI, -0.99 to -0.85). All concentrations were well tolerated in all age groups.

Conclusions: Younger age is associated with poor treatment response to low-concentration atropine at 0.05%, 0.025%, and 0.01%. Among concentrations studied, younger children required the highest 0.05% concentration to achieve similar reduction in myopic progression as older children receiving lower concentrations.

Retina

. 2021 Apr 1;41(4):761-767. doi: 10.1097/IAE.0000000000002952.

COMPARISON OF SCLERAL FIXATION OF INTRAOCULAR LENS: Sutureless Intrascleral Fixation Versus Conventional Sutured Scleral Fixation

Kyu Hwan Jang ۱, Mingui Kong ۱ ۲, Byung Gil Moon ۳, Gisung Son ۱ ۲Affiliations expand

Abstract

Purpose: To compare the clinical outcomes of sutured scleral and sutureless intrascleral fixations of the intraocular lens.

Methods: Medical records of patients who underwent sutureless intrascleral fixation (sutureless group) and the conventional sutured scleral fixation (sutured group) were retrospectively reviewed. Patient demographics and the clinical outcomes of the two techniques were compared before and 1, 3, and 6 months after surgery.

Results: Seventy patients were followed up for 6 months after the surgery: 25 patients in the sutureless group (25 eyes) and 45 in the sutured group (45 eyes). Surgery time was shorter in the sutureless group than that in the sutured group (73.00 ± ۱۵.۶۸ vs. 107.39 ± ۲۵.۳۰ minutes, P < 0.001). The visual acuity gradually improved throughout the postoperative period in both groups, and a faster visual acuity recovery was observed in the sutureless group. The cylindrical error at 6 months after the surgery was significantly lower in the sutureless group than that in the sutured group (-1.33 ± ۰.۵۵ vs. -2.29 ± ۱.۱۹ diopter, P < 0.001).

Conclusion: Sutureless intrascleral fixation is an effective and reliable surgical technique that provides more favorable visual and refractive outcomes than the conventional sutured scleral fixation method.

Journal Club 4-10-2021

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Characterizing New-Onset Exudation in the Randomized Phase 2 FILLY Trial of Complement Inhibitor Pegcetacoplan for Geographic Atrophy

Charles C Wykoff, Philip J Rosenfeld, Nadia K Waheed, Rishi P Singh, Nick Ronca, Jason S Slakter, Giovanni Staurenghi, Jordi Monés, Caroline R Baumal, Namrata Saroj, Ravi Metlapally, Ramiro Ribeiro

Free article

Abstract

Objective: Evaluate clinical characteristics of eyes that developed investigator-determined new-onset exudative age-related macular degeneration (eAMD) during the FILLY trial.

Design: Post-hoc analysis of the phase 2 study of intravitreal pegcetacoplan in geographic atrophy (GA).

Subjects: ۲۴۶ subjects with GA secondary to AMD.

Intervention: Either 15 mg intravitreal pegcetacoplan or sham given monthly or every other month (EOM) for 12 months followed by a 6-month off-treatment period.

Main outcome measures: Time of onset of new eAMD in the study eye; history of eAMD in the fellow eye; presence of double layer sign (DLS) on structural optical coherence tomography (OCT) in the study eye; changes in retinal anatomy by structural OCT and fluorescein angiography (FA); and changes in visual acuity.

Results: Exudation was reported in 26 study eyes across all treatment groups over 18 months. Mean time to diagnosis of eAMD was 256 days (range: 31 to 555). Overall, a higher proportion of subjects with a history of eAMD in the fellow eye (P=0.016) and a DLS in the study eye at baseline (P=0.0001) developed eAMD. Among study eyes that developed eAMD, 18/26 (69%) had a history of fellow eye eAMD and 19/26 (73.1%) had a DLS at baseline, compared to 72/217 (33%) (P=0.0003) and 70/215 (32.5%) (P<0.0001)respectively, of study eyes that did not develop eAMD. All 21 subjects with structural OCT imaging at the time of eAMD diagnosis had subretinal fluid and/or intraretinal cysts, consistent with exudation. Among 17 subjects who received FA at the time of eAMD diagnosis, 10 had detectable MNV, all occult lesions. Development of eAMD did not appear to have an appreciable impact on visual acuity, and all subjects responded to anti-VEGF therapy.

Conclusions: Intravitreal injections of pegcetacoplan slowed the rate of GA growth and were associated with an unexpected dose-dependent increased incidence of eAMD with no temporal clustering of onset. eAMD appeared to be associated with the presence of baseline eAMD in the contralateral eye and a DLS, suggestive of nonexudative MNV, in the study eye. The safety profile of pegcetacoplan was acceptable to proceed to phase 3 studies without adjustments to enrollment criteria.

Retinopathy of transcobalamin II deficiency: long-term stability with treatment

Sarah Chorfi ۱, Grant A Mitchell ۲, Cynthia X Qian ۱Affiliations expandPMID: ۳۳۴۷۶۶۴۵

DOI: ۱۰.۱۰۱۶/j.ophtha.2021.01.015

COVID-19 and Use of Teleophthalmology (CUT Group): Trends and Diagnoses

David S Portney ۱, Ziwei Zhu ۲, Evan M Chen ۳, Emma Steppe ۲, Priyanka Chilakamarri ۴, Maria A Woodward ۵, Chad Ellimoottil ۶, Ravi Parikh ۷Affiliations expand

Fundus Pigmentation in the Diagnosis and Treatment of Retinopathy of Prematurity

Kenneth C Fan ۱, Sarah P Read ۲, Nimesh A Patel ۱, Elizabeth A Vanner ۱, Hasenin Al-Khersan ۱, Diana M Laura ۱, Parastou Pakravan ۱, Catherin I Negron ۱, Audina M Berrocal ۳Affiliations expand

Patient Harm due to Diagnostic Error of Neuro-Ophthalmologic Conditions

Leanne Stunkel ۱, Rahul A Sharma ۲, Devin D Mackay ۳, Bradley Wilson ۴, Gregory P Van Stavern ۱, Nancy J Newman ۵, Valérie Biousse ۶Affiliations expand

Abstract

Objective: To prospectively examine diagnostic error of neuro-ophthalmic conditions and resultant harm at multiple sites.

Design: Prospective cross-sectional study.

Subjects: ۴۹۶ consecutive adult new patients seen at three university-based neuro-ophthalmology clinics in the United States in 2019-2020.

Methods: Collected data regarding demographics, prior care, referral diagnosis, final diagnosis, diagnostic testing, treatment, patient disposition, and impact of the neuro-ophthalmologic encounter. For misdiagnosed patients, we identified the cause of error using the Diagnosis Error Evaluation and Research (DEER) taxonomy tool, and whether the patient suffered harm due to the misdiagnosis.

Main outcome measures: The primary outcome was whether patients who were misdiagnosed prior to neuro-ophthalmology referral suffered harm as a result of the misdiagnosis. Secondary outcomes included appropriateness of referrals, misdiagnosis rate, interventions undergone prior to referral, and the primary type of diagnostic error.

Results: Referral diagnosis was incorrect in 49% of cases. Misdiagnosed patients suffered harm in 26%, which could have been prevented by earlier referral to neuro-ophthalmology in 97%. Patients experienced inappropriate laboratory testing, diagnostic imaging, or treatment prior to referral in 23%, with higher rates for patients misdiagnosed prior to referral (34% of patients compared to 13% with a correct referral diagnosis, p<0.0001). Seventy-six percent of inappropriate referrals were misdiagnosed, compared to 45% of appropriate referrals (p<0.0001). The most common reasons for referral were optic neuritis or optic neuropathy (21%), papilledema (18%), diplopia or cranial nerve palsies (16%), and unspecified vision loss (11%). The most common sources of diagnostic error were the physical examination (36%), generation of a complete differential diagnosis (24%), history taking (24%), and utilization or interpretation of diagnostic testing (13%). In 489/496 (99%) patients, neuro-ophthalmologic consultation impacted patient care. In 2% of cases, neuro-ophthalmology directly saved the patient’s life or vision, in an additional 10% harmful treatment was avoided or appropriate urgent referral was provided, and in an additional 48% neuro-ophthalmology provided a diagnosis and direction to the patient’s care.

Conclusions: Misdiagnosis of neuro-ophthalmic conditions, mismanagement prior to referral, and preventable harm are common. Early appropriate referral to neuro-ophthalmology may prevent patient harm.

Comparison of the myopic progression before, during and after COVID-19 lockdown

Pingjun Chang ۱, Bing Zhang ۱, Li Lin ۱, Ruru Chen ۱, Siping Chen ۱, Yune Zhao ۲, Jia Qu ۳Affiliations expand

Health and Vision-Related Quality of Life in a Randomized Controlled Trial Comparing Methotrexate and Mycophenolate Mofetil for Uveitis

Nicole K Kelly ۱, Aheli Chattopadhyay ۱, S R Rathinam ۲, John A Gonzales ۳, Radhika Thundikandy ۲, Anuradha Kanakath ۴, S Bala Murugan ۵, R Vedhanayaki ۲, Dean Cugley ۶, Lyndell L Lim ۶, Eric B Suhler ۷, Hassan A Al-Dhibi ۸, Caleb D Ebert ۱, Elyse J Berlinberg ۱, Travis C Porco ۹, Nisha R Acharya ۱۰, FAST Research GroupAffiliations expand

Abstract

Objective: To evaluate changes in health-related and vision-related quality of life (QoL) among patients with noninfectious uveitis who were treated with antimetabolites.

Design: Secondary analysis of a randomized controlled trial.

Participants: Patients with noninfectious uveitis from India, the United States, Australia, Saudi Arabia, and Mexico.

Methods: From 2013-2017, 216 participants were randomized to receive 25 mg weekly oral methotrexate or 1.5 g twice daily oral mycophenolate mofetil. Median changes in QoL were measured using Wilcoxon signed rank tests, and differences between treatment groups were measured using linear mixed models, adjusting for baseline QoL score, age, sex, and site. Among Indian patients, vision-related QoL scores from a general scale (NEI-VFQ) and a culturally specific scale (IND-VFQ) were compared using Pearson correlation tests.

Main outcome measures: Vision-related (NEI-VFQ and IND-VFQ) and health-related (PCS (physical component score) and MCS (mental component score) SF-36v2) QoL was measured at baseline, the primary endpoint (6 months or treatment failure before 6 months), and the secondary endpoint (12 months or treatment failure between 6-12 months).

Results: Among 193 participants who reached the primary endpoint, vision-related QoL increased from baseline by a median of 12.0 points (interquartile range (IQR)=1.0-26.1, NEI-VFQ scale), physical health-related QoL increased by a median of 3.6 points (IQR=-1.4-14.9, PCS SF-36v2), and mental health-related QoL increased by a median of 3.0 points (IQR=-3.7-11.9, MCS SF-36v2). These improvements in NEI-VFQ, SF-36v2 PCS, and SF-36v2 MCS scores were all significant (p<0.01). The linear mixed models showed that QoL did not differ between treatment groups for each QoL assessment (NEI-VFQ, IND-VFQ, PCS SF-36v2, and MCS SF-36v2; p > 0.05 for all). NEI-VFQ and IND-VFQ scores for Indian participants were highly correlated at baseline and the primary and secondary endpoints (correlation coefficient=0.87, 0.80, 0.90, respectively).

Conclusions: Among patients treated with methotrexate or mycophenolate mofetil for uveitis, vision-related and health-related QoL significantly improved over the course of one year and did not differ by treatment allocation. These findings suggest that antimetabolites could improve overall patient well-being and daily functioning.

Journal Club 27-2-2021

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Gene therapy for neovascular age-related macular degeneration: rationale, clinical trials and future directions

Thales Antonio Cabral de Guimaraes ۱ ۲, Michalis Georgiou ۱ ۲, James W B Bainbridge ۱ ۲, Michel Michaelides ۳ ۲Affiliations expand

Free PMC article

Abstract

Age-related macular degeneration (AMD) is one of the leading causes of irreversible blindness in the developed world. Antivascular endothelial growth factor therapy has transformed the management and outcome of neovascular AMD (nAMD), although the need for repeated intravitreal injections-even lifelong-and the related complications, high drug costs, frequent clinic visits and repeated imaging have resulted in an enormous burden both to healthcare systems and patients. The application of gene therapy approaches for sustained delivery of a range of antiangiogenic proteins has the promise of helping to address these aforementioned challenges. A number of early phase clinical trials of gene therapy in nAMD have provided encouraging results, with many more ongoing or anticipated. There remain significant areas of controversy, including regarding the optimal treatment targets, routes of administration and potential safety concerns. In this review we aim to provide an update of the current status of gene therapy for nAMD and briefly discuss future prospects.

Long-term outcomes of treat-and-extend ranibizumab with and without navigated laser for diabetic macular oedema: TREX-DME 3-year results

John F Payne ۱, Charles C Wykoff ۲, W Lloyd Clark ۳, Beau B Bruce ۴, David S Boyer ۵, David M Brown ۶, TREX-DME Study GroupCollaborators, Affiliations expand

Abstract

Background/aims: To evaluate the long-term effects of treat-and-extend dosing of ranibizumab with and without navigated focal laser for diabetic macular oedema (DME).

Methods: This is a multicentre, randomised clinical trial where 150 eyes were randomised into three cohorts; Monthly (n=30), TReat and EXtend without macular laser photocoagulation (TREX; n=60), and treat and extend with angiography-GuIded macular LAser photocoagulation (GILA; n=60). During the first 2 years, eyes either received ranibizumab 0.3 mg every 4 weeks or underwent treat-and-extend ranibizumab with or without angiography-guided laser therapy. In the third year, all eyes were treated as needed with ranibizumab for >5 letters vision loss or if the central retinal thickness (CRT) was >325 µm, and all eyes were eligible to receive focal laser.

Results: ۱۰۹ eyes (73%) completed the 3-year end-point. At week 156, mean best-corrected visual acuity (BCVA) and CRT improved by 6.9, 9.7, 9.5 letters (p=0.60) and 129, 138, 165 µm (p=0.39), in the Monthly, TREX and GILA cohorts, respectively. These improvements were reached prior to week 104 and no significant changes occurred from week 104 to week 156 (BCVA: p=0.34; CRT: p=0.36). The mean number of injections in the third year was 3.0, 3.1, and 2.4 in the Monthly, TREX and GILA cohorts, respectively (p=0.56). 86 eyes (79%) required at least one ranibizumab injection in the third year.

Conclusion: The improvements achieved after 2 years of treat-and-extend ranibizumab for DME were maintained in the third year with a mean of 3 intravitreal injections.

Trial registration number: FDA IND 119146, NCT01934556.

Long-term natural history of visual acuity in eyes with choroideremia: a systematic review and meta-analysis of data from 1004 individual eyes

Liangbo L Shen ۱, Aneesha Ahluwalia ۱, Mengyuan Sun ۲, Benjamin K Young ۱, Holly K Grossetta Nardini ۳, Lucian V Del Priore ۴Affiliations expand

Abstract

Background/aims: Best-corrected visual acuity (BCVA) is the most common primary endpoint in treatment trials for choroideremia (CHM) but the long-term natural history of BCVA is unclear.

Methods: We searched in seven databases to identify studies that reported BCVA of untreated eyes with CHM. We sought individual-level data and performed segmented regression between BCVA and age. For eyes followed longitudinally, we introduced a horizontal translation factor to each dataset to account for different ages at onset of a rapid BCVA decline.

Results: We included 1004 eyes from 23 studies. BCVA of the right and left eyes was moderately correlated (r=0.60). BCVA as a function of age followed a 2-phase decline (slow followed by rapid decline), with an estimated transition age of 39.1 years (95% CI 33.5 to 44.7). After the introduction of horizontal translation factors to longitudinal datasets, BCVA followed a 2-phase decline until it reached 0 letters (r۲=۰.۹۰). The BCVA decline rate was 0.33 letters/year (95% CI -0.38 to 1.05) before 39 years, and 1.23 letters/year (95% CI 0.55 to 1.92) after 39 years (p=0.004).

Conclusion: BCVA in eyes with CHM follows a 2-phase linear decline with a transition age of approximately 39 years. Future trials enrolling young patients may not be able to use BCVA as a primary or sole endpoint, but rather, may need to employ additional disease biomarkers that change before age 39. BCVA may still have utility as a primary endpoint for patients older than 39 years who have measurable BCVA decline rates.

OCT-A characterisation of recurrent type 3 macular neovascularisation

Riccardo Sacconi ۱ ۲, Marco Battista ۱ ۲, Enrico Borrelli ۱ ۲, Alexandra Miere ۳, Eleonora Corbelli ۱ ۲, Vittorio Capuano ۳, Lea Querques ۲, Eric H Souied ۳, Francesco Bandello ۱ ۲, Giuseppe Querques ۴ ۲Affiliations expand

Abstract

Purpose: To investigate optical coherence tomography angiography (OCT-A) findings in recurrent type 3 macular neovascularisation (MNV).

Methods: In this retrospective cohort study, consecutive patients with type 3 MNV secondary to age-related macular degeneration underwent OCT-A at three different time points: baseline, after anti-vascular endothelial growth factor treatment with complete resolution of the exudative signs (ie, non-exudative stage) and at the recurrence of exudation (ie, recurrence stage). Demographics and clinical findings were analysed, including OCT-A features of type 3 MNV recurrence.

Results: Twelve eyes (12 patients, mean age 78±۷ years) were included. Using OCT-A, at baseline all type 3 MNVs showed the presence of detectable flow downgrowing from the deep vascular complex (DVC) to the retinal pigment epithelium (RPE)/sub-RPE space. 6/12 eyes (50%) showed anomalous flow under the RPE, while the other 6 eyes showed flow reaching the RPE without anomalous flow in the sub-RPE space. At the non-exudative stage (after treatment), BCVA and CMT significantly improved (p=0.004 and p=0.036), and flow inside the retinal lesions reduced; interestingly the connection to the RPE/sub-RPE space regressed. At the time of recurrence, all type 3 MNVs showed the presence of intra/sub-retinal exudation with restoration of the flow deepening from the DVC to the RPE/sub-RPE space.

Conclusions: Detectable flow deepening from the DVC to the RPE/sub-RPE space using OCT-A is mandatory to have a new exudation secondary to recurrent type 3 MNV. Early detection of type 3 MNV recurrence by OCT-A characterisation may prompt retreatment and potentially prevent progression to late stages of the disease.

Retinal light sensitivity as outcome measure in recessive Stargardt disease

Maximilian Pfau ۱ ۲, Frank G Holz ۱ ۳, Philipp L Müller ۴ ۳ ۵Affiliations expand

Abstract

Background/aims: To evaluate the applicability of mesopic light sensitivity measurements obtained by fundus-controlled perimetry (FCP, also termed ‘microperimetry’) as clinical trial endpoint in Stargardt disease (STGD1).

Methods: In this retrospective, monocentre cohort study, 271 eyes of 136 patients (age, 37.1 years) with STGD1 and 87 eyes of 54 healthy controls (age, 41.0 years) underwent mesopic FCP, using a pattern of 50 stimuli (achromatic, 400-800 nm) centred on the fovea. The concurrent validity of mesopic FCP testing using the MAIA device (CenterVue, Italy), the retest variability and its determinants, and the progression of sensitivity loss over time were investigated using mixed-model analyses. The main outcomes were the average pointwise sensitivity loss in dependence of patients’ demographic, functional and imaging characteristics, the intrasession 95% coefficient of repeatability, and the pointwise sensitivity loss over time.

Results: Pointwise sensitivity loss was on average (estimate (95% CI)) 13.88 dB (12.55 to 15.21) along the horizontal meridian and was significantly associated with the electrophysiological subgroup, presence/absence of foveal sparing, best-corrected visual acuity and disease duration. The 95% coefficient of repeatability was 12.15 dB (10.78 to 13.38) and varied in dependence of the underlying mean sensitivity and local sensitivity slope. The global progression rate for the sensitivity loss was 0.45 dB/year (0.13 to 0.78) and was higher for the central and inner ETDRS subfields compared with more peripheral regions.

Conclusions: Mesopic light sensitivity measured by FCP is reliable and susceptible for functional changes. It constitutes a potential clinical outcome for both natural history studies as well as future interventional studies in patients with STGD1.

Prognostic value of intermediate age-related macular degeneration phenotypes for geographic atrophy progression

Sarah Thiele ۱, Jennifer Nadal ۲, Maximilian Pfau ۳ ۴, Marlene Saßmannshausen ۳, Monika Fleckenstein ۳, Frank G Holz ۳, Matthias Schmid ۲, Steffen Schmitz-Valckenberg ۳Affiliations expand

Free PMC article

Abstract

Background: To characterise early stages of geographic atrophy (GA) development in age-related macular degeneration (AMD) and to determine the prognostic value of structural precursor lesions in eyes with intermediate (i) AMD on the subsequent GA progression.

Methods: Structural precursor lesions for atrophic areas (lesion size at least 0.5 mm² in fundus autofluorescence images) were retrospectively identified based on multimodal imaging and evaluated for association with the subsequent GA enlargement rates (square-root transformed, sqrt). A linear mixed-effects model was used to account for the hierarchical nature of the data with a Tukey post hoc test to assess the impact of the local precursor on the subsequent GA progression rate.

Results: A total of 39 eyes with GA of 34 patients with a mean age of 74.4±۶.۷ (±SD) years were included in this study. Five precursor lesions (phenotypes 1-5) preceding GA development were identified: large, sub-retinal pigment epithelial drusen (n=19), reticular pseudodrusen (RPD, n=10), refractile deposits (n=4), pigment epithelial detachment (n=4) and vitelliform lesions (n=2). Precursor lesions exhibited a significant association with the subsequent (sqrt) GA progression rates (p=0.0018) with RPD (phenotype 2) being associated with the fastest GA enlargement (2.29±۰.۵۲ (±SE) mm/year.

Conclusions: The results indicate the prognostic relevance of iAMD phenotyping for subsequent GA progression highlighting the role of structural AMD features across different AMD stages.

Ocular toxoplasmosis: phenotype differences between toxoplasma IgM positive and IgM negative patients in a large cohort.

British Journal of Ophthalmology ( IF ۳.۶۱۱ ) Pub Date : ۲۰۲۱-۰۲-۰۱, DOI: ۱۰.۱۱۳۶/bjophthalmol-2019-315522
Sofia Ajamil-Rodanes,Joshua Luis,Rabia Bourkiza,Benedict Girling,Angela Rees,Catherine Cosgrove,Carlos Pavesio,Mark Westcott

Purpose To investigate the differences in demographics and clinical characteristics of patients diagnosed with ocular toxoplasmosis according to their IgM status. Methods Retrospective case note analysis was carried out on patients who tested positive for serum Toxoplasma gondii -specific IgM antibodies (IgM+) as well as a comparator group who tested negative for serum IgM (IgM-), but positive for serum IgG. Patient demographics and clinical features were compared between the two groups to evaluate for any significant differences. Results One hundred and six patients were included in the study between March 2011 and June 2018, consisting of 37 in the IgM +group and 69 in the IgM- group. Patients in the IgM +group were significantly older (51.1 vs 34.1 years, p<0.0001), more likely to present with central macular lesions (32% vs 12%, p=0.012), and more likely to develop rhegmatogenous retinal detachment (11% vs 1%, p=0.049). In contrast, patients in the IgM- group were more likely present with pain (20% vs 3%, 0.017) and exhibit more severe inflammation of the anterior chamber and vitreous (p<0.05). Overall, retinal lesions were more likely to be superotemporal (55%) and superonasal (31%). Furthermore, age was associated with larger (p=0.003) and more peripheral lesions (p=0.007). Conclusions This study demonstrated significant differences in clinical characteristics of ocular toxoplasmosis according to serum IgM status. IgM+ patients were older, less likely to report pain, had lower levels of intraocular inflammation, but were more likely to have macular involvement. We also found age to be correlated with larger and more peripheral lesions.

Journal Club 20-2-2021

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IMPLICATIONS OF THE MORPHOLOGIC PATTERNS OF TYPE 1 MACULAR NEOVASCULARIZATION ON MACULAR ATROPHY GROWTH ON PATIENTS UNDER ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT

Diogo Cabral ۱ ۲ ۳, Florence Coscas ۳ ۴, Telmo Pereira ۲, Rita Laiginhas ۵, Catarina Rodrigues ۱, Catherine Français ۳, Vanda Nogueira ۱, Manuel Falcão ۵, Alexandra Miere ۴, Marco Lupidi ۶, Gabriel Coscas ۳ ۴, Eric Souied ۴Affiliations expand

Abstract

Purpose: To evaluate the correspondence between macular atrophy (MA) progression and Type 1 macular neovascularization morphology during long-term anti-vascular endothelial growth factor treatment for exudative neovascular age-related macular degeneration.

Methods: Retrospective review of consecutive patients with complete retinal pigment epithelium and outer retina atrophy overlying or in the proximity of macular neovascularization. The assessment of MA was based on spectral domain optical coherence tomography, en-face near infra-red imaging and fundus autofluorescence. Macular neovascularization blood flow morphology was evaluated by swept-source optical coherence tomography-angiography. Qualitative features were categorized per ETDRS sector as: immature, mature; and hypermature pattern. An automatic analysis was designed in MATLAB coding language to compute MA per ETDRS. Measurements were compared between the baseline and the last follow-up visit.

Results: Twenty eyes from 20 patients were included; the mean age was 85.4 (8.3) years. The median follow-up was 1.85 (1.0-2.4) years and the median anti-vascular endothelial growth factor injection rate during follow-up was 4.0 (2.0-5.0) injections/year. During follow-up, sectors with persistence of an immature blood flow pattern had a lower MA growth rate than sectors with mature macular neovascularization flow patterns (P = 0.001).

Conclusion: The presence of an immature blood flow pattern on optical coherence tomography-angiography is associated with a lower progression rate of MA.

ASSOCIATION OF SERUM VASOGENIC AND PROINFLAMMATORY FACTORS WITH CLINICAL RESPONSE TO ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR FOR DIABETIC MACULAR EDEMA

Pedro S Brito ۱ ۲, Jorge V Costa ۱, Catarina Barbosa-Matos ۲ ۳, Sandra M Costa ۲ ۳, Jorge Correia-Pinto ۲ ۳, Rufino M Silva ۴ ۵ ۶Affiliations expand

Abstract

Purpose: To study the role of serum biomarkers as prognostic factors for qualitative and quantitative response to anti-vascular endothelial growth factor injections for diabetic macular edema (DME).

Methods: Sixty-seven eyes with DME were treated with intravitreal bevacizumab during a 12-month follow-up period. All cases underwent a baseline workup consisting of 12 inflammatory, metabolic and prothrombotic factors. The following outcomes were evaluated at 3-month intervals until 1 year of follow-up: visual acuity, central subfield thickness (CST), macular volume (MV), % of change from baseline in CST, occurrence of a CST change < 10%, a CST change >20%, and a CST <330 µm, achieving an improvement ≥۲ lines of visual acuity, achieving visual acuity ≥۲۰/۴۰.

Results: A significant improvement in CST and visual acuity was seen from third month onwards. Twenty-eight (48.1%) cases were classified as “early responders,” 24 (35.8%) as “late responders”, and 15 (22.4%) as “poor responders.” Serum vascular endothelial growth factor-A levels were significantly lower in “poor responders” (P = 0.006). C-reactive protein (hsCRP) was associated with a limited anatomic response (<10% CST change) (P = 0.002, OR = 1.845, cutoff value of hsCRP = 1.84 mg/L). hsCRP was also negatively associated with obtaining a final CST <330 µm (P = 0.04, r2 = 0.112, OR = 0.643). Baseline visual acuity was significantly associated with 12th month visual acuity (P < 0.001, r2 = 0.602) and also with an improvement ≥۲ visual acuity lines (P = 0.009, OR = 20.54).

Conclusion: Increased high-sensitivity C-reactive protein was associated with limited anatomic response to anti-vascular endothelial growth factor treatment and persistent DME. Poor responders had significantly lower values of serum vascular endothelial growth factor-A, suggesting an alternative pathogenic pathway for persisting DME.

VISUAL OUTCOME OF EARLY VITRECTOMY AND INTRAVITREAL ANTIBIOTICS IN ACUTE POSTSURGICAL AND POSTINTRAVITREAL INJECTION ENDOPHTHALMITIS: European Vitreo-Retinal Society Endophthalmitis Study Report Two

Mohamed Kamel Soliman ۱, Giampaolo Gini ۲, Ferenc Kuhn ۳, Barbara Parolini ۴, Sengul Ozdek ۵, Ron A Adelman ۶, Ahmed B Sallam ۷, European Vitreo-Retinal Society (EVRS) Endophthalmitis Study GroupAffiliations expand

Abstract

Purpose: To evaluate the visual outcome associated with intravitreal antibiotics (IVA) and pars plana vitrectomy (PPV) for acute postprocedure endophthalmitis.

Methods: Data from 237 eyes presenting with acute postprocedure endophthalmitis were collected from 57 retina specialists in 28 countries. All eyes were treated with IVA on the day of presentation. We classified eyes according to the method of treatment used as IVA and early PPV (IVA + PPV within 1 week of presentation) groups.

Results: After exclusion of ineligible eyes, data from 204 eyes were analyzed. The mean (SD) age of patients was 62.7 (21.8) years and 69.3 (12.7) years in the IVA and PPV groups, respectively (P = 0.18). Endophthalmitis secondary to cataract, intravitreal injections, PPV, and other intraocular procedures represented 64.2%, 16.2%, 13.7%, and 5.9% of cases, respectively. Intravitreal antibiotics alone were administered in 55 eyes (27.0%), and early PPV was performed in 149 eyes (73.0%). No difference was found between groups in the final visual acuity of ≥۲۰/۶۰ (۴۳.۶%, ۶۵ eyes vs. 34.5%, 19 eyes) and ≤counting fingers (30.9%, 46 eyes vs. 36.4%, 20 eyes) for IVA versus early PPV groups, respectively. Vision of light perception (odds ratio = 12.2; 95% confidence interval: 2.0-72.6) and retinal detachment (odds ratio = 7.7; 95% confidence interval: 1.5-409) at baseline were predictive of vision of ≤counting fingers. Retinal detachment at baseline (odds ratio = 20.4; 95% confidence interval: 1.1-372.1) was predictive of final retinal detachment status.

Conclusion: The current retrospective multicenter cohort of eyes with acute postprocedure endophthalmitis reports similar outcomes after treatment with IVA alone when compared with IVA and early PPV within 1 week of presentation.

ASSOCIATION BETWEEN PLATELET INDICES AND RETINAL VEIN OCCLUSION: A Systematic Review and Meta-Analysis

Zhengyang Liu ۱ ۲ ۳ ۴, Luke A Perry ۱, Thomas L Edwards ۲ ۳ ۴Affiliations expand

Abstract

Purpose: Platelet count, mean platelet volume, platelet distribution width, and plateletcrit are standard indices of platelet activation that have been studied in retinal vein occlusion (RVO) and its subtypes: branch retinal vein occlusion and central retinal vein occlusion. This systematic review and meta-analysis aimed to assess the association between these platelet parameters and RVO.

Methods: We searched for studies investigating the association between these platelet indices and RVO in multiple online databases from inception to August 2020. Mean differences and the associated confidence intervals were obtained and calculated for each included study and pooled using random-effects inverse variance modeling. Meta-regression was used to explore interstudy and intrastudy heterogeneity.

Results: Thousand three hundred and twenty-five unique studies were screened, from which 24 studies encompassing 2,718 patients were included. Mean platelet volume and platelet distribution width were significantly elevated in RVO, with pooled mean differences of 0.45 fL (95% CI 0.24-0.66, P < 0.0001) and 1.43% (95% CI 0.57-2.29, P = 0.0011), respectively. Platelet count and plateletcrit were not significantly associated with RVO. Mean platelet volume was also independently elevated in branch retinal vein occlusion and central retinal vein occlusion.

Conclusion: Mean platelet volume and platelet distribution width are significantly elevated in RVO. Further research is required to explore the independence and potential prognostic significance of these associations.

COMPARATIVE EFFECTIVENESS OF PROTON BEAM VERSUS PHOTODYNAMIC THERAPY TO SPARE THE VISION IN CIRCUMSCRIBED CHOROIDAL HEMANGIOMA

Thibaud Mathis ۱ ۲, Célia Maschi ۳, Carlo Mosci ۴, Charlotte A Espensen ۵, Laurence Rosier ۶, Catherine Favard ۷, Sarah Tick ۸, Charles-Henry Remignon ۱, Paolo Ligorio ۴, Nicolas Bonin ۹, Joël Gambrelle ۱۰, Anh-Minh Nguyen ۱, Carsten Faber ۵, Laurent Meyer ۱۱, Frederic Mouriaux ۱۲, Joël Herault ۱۳, Stéphanie Baillif ۳, Jens-Folke Kiilgaard ۵, Laurent Kodjikian ۱ ۲, Jean-Pierre Caujolle ۳, Julia Salleron ۱۴, Juliette Thariat ۱۵Affiliations expand

Abstract

Purpose: The aim of this study was to compare the functional and anatomical effectiveness of photodynamic therapy (PDT) versus proton beam therapy (PBT) in a real-life setting for the treatment of circumscribed choroidal hemangioma.

Methods: A total of 191 patients with a diagnosis of circumscribed choroidal hemangioma and treated by PBT or PDT were included for analyses.

Results: The 119 patients (62.3%) treated by PDT were compared with the 72 patients treated by PBT. The final best-corrected visual acuity did not differ significantly between the two groups (P = 0.932) and final thickness was lower in the PBT compared with the PDT group (P = 0.001). None of the patients treated by PBT needed second-line therapy. In comparison, 53 patients (44.5%) initially treated by PDT required at least one other therapy and were associated with worse final best-corrected visual acuity (P = 0.037). In multivariate analysis, only an initial thickness greater than 3 mm remained significant (P = 0.01) to predict PDT failure with an estimated odds ratio of 2.72, 95% confidence interval (1.25-5.89).

Conclusion: Photodynamic therapy and PBT provide similar anatomical and functional outcomes for circumscribed choroidal hemangioma ≤۳ mm, although multiple sessions are sometimes required for PDT. For tumors >۳ mm, PBT seems preferable because it can treat the tumor in only 1 session with better functional and anatomical outcomes.

PHOTORECEPTOR OUTER SEGMENT IS EXPANDED IN THE FELLOW EYE OF PATIENTS WITH UNILATERAL CENTRAL SEROUS CHORIORETINOPATHY

Enrico Borrelli ۱, Marco Battista ۱, Francesco Gelormini ۱, Maria C Gabela ۱ ۲, Flavia Pennisi ۱, Alberto Quarta ۱, Mario Pezzella ۱, Riccardo Sacconi ۱, Lea Querques ۱, Francesco Bandello ۱, Giuseppe Querques ۱Affiliations expand

Abstract

Purpose: To quantitatively evaluate the photoreceptor structural changes in the fellow unaffected eyes of patients with unilateral central serous chorioretinopathy (CSC).

Methods: This is a retrospective cross-sectional study. We analyzed data from patients with diagnosis of unilateral CSC, as based on clinical examination and multimodal imaging, who had structural optical coherence tomography obtained. An additional group of age-matched healthy patients was included for comparison. Main outcome measures were as follows: (1) the foveal photoreceptor outer segment lateral surface and (2) the foveal choroidal thickness.

Results: One hundred and sixty fellow unaffected eyes of 160 unilateral CSC patients and 50 age-matched controls (50 eyes) were included. The mean ± SD age was 51.6 ± ۱۱.۱ years (range 28-80 years) in the unilateral CSC group and 52.8 ± ۱۰.۸ years (range 31-74 years) in the control group (P = 0.511). The foveal photoreceptor outer segment lateral surface was significantly increased in the unaffected eyes with CSC in the fellow eye (0.068 ± ۰.۰۰۷ mm2) as compared with control eyes (0.060 ± ۰.۰۰۵ mm2, P < 0.0001). The mean ± SD foveal choroidal thickness was 368.0 ± ۱۰۵.۷ µm in the unilateral CSC group and 302.9 ± ۹۲.۲ µm in control patients (P < 0.0001). In the Pearson correlation test, the photoreceptor outer segment lateral surface correlated with the choroidal thickness in the CSC group (R = 0.166, P = 0.016) but not in the control group (R = -0.025, P = 0.864).

Conclusion: Our results corroborate the hypothesis that retinal and choroidal changes affect both eyes of patients with acute/history of unilateral disease. These structural changes could be intended as an imaging evidence of reduced photoreceptor outer segment turnover secondary to retinal pigment epithelium and choroid dysfunction.

OPTICAL COHERENCE TOMOGRAPHY BIOMARKERS FOR REDUCTION OF DRUSENOID PIGMENT EPITHELIUM DETACHMENT

Mirinae Kim ۱ ۲, Yeo Jin Lee ۱, Wookyung Park ۱ ۲, Young-Gun Park ۱ ۲, Young-Hoon Park ۱ ۲Affiliations expand

Abstract

Purpose: To identify the optical coherence tomography biomarkers that can collectively predict the probability of collapse or reduction of drusenoid pigment epithelium detachment (PED).

Methods: This consecutive observational case series reviewed the clinical data of 24 eyes with non-neovascular drusenoid PED. Among the study population, 17 eyes showed collapse or reduction of drusenoid PED. The mean follow-up duration was 44.8 ± ۲۴.۶ months. Optical coherence tomography-derived parameters were analyzed at baseline, at the last available visit before reduction of PED, at the first available visit after reduction of PED, and at the final visit.

Results: The mean subfoveal choroidal thickness showed a significant decrease after PED reduction and at the most recent visit (P = 0.015). Migration of retinal pigment epithelium cells was detected in 15 (88.2%) after PED reduction; however, there was no significance in the frequency of migration of retinal pigment epithelium cells at each time point (P = 0.392). Non-neovascular subretinal fluid was detected in 7 (41.2%) before PED reduction, 2 (11.8%) after PED reduction, and 2 (11.8%) at the final visit. Interestingly, subretinal fluid appeared more frequently just before reduction of PED (P = 0.029).

Conclusion: We found evidence of non-neovascular subretinal fluid and choroidal thinning before reduction in PED. This finding might be useful for detection and prediction of the progression of drusenoid PED.

Journal Club 13-2-2021

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Special Thanks to Dr Amini and Dr Bazvand

EFFECT OF PANRETINAL PHOTOCOAGULATION ON CORNEAL SENSATION AND TEAR FUNCTION IN PATIENTS WITH DIABETIC RETINOPATHY

Hossein Jamali ۱, Jamshid Eslami ۲, Farid Kalashipour ۳, Mohammad Hossein Nowroozzadeh ۱Affiliations expand

Abstract

Purpose: To evaluate the early effects of panretinal photocoagulation (PRP) on corneal sensation and dry eye signs in patients with diabetic retinopathy.

Methods: Fifty patients with Type 2 diabetes mellitus and very severe nonproliferative or non-high-risk proliferative diabetic retinopathy who required PRP for the treatment of their retinal condition were enrolled. All patients were treated using a pattern PRP device. Esthesiometry, tear breakup time test, Schirmer test, and corneal staining pattern were evaluated at baseline and 2 months after the last session of PRP.

Results: Data from 88 eyes of 50 patients (41 right eyes and 47 left eyes) were analyzed. The mean tear breakup time test (right eyes) was decreased from 9.51 at baseline to 7.66 seconds after PRP (P < 0.001). The post-PRP eyes showed more advanced grades of corneal staining than pre-PRP assessment (P < 0.001). The average value of Schirmer test was 14.39 versus 12.29 mm (without anesthesia; P < 0.001) and 8.17 versus 7.15 mm (with anesthesia, P < 0.001) for baseline versus post-PRP measurements, respectively. The corneal sensation also showed decrease after laser therapy (4.93 versus 4.31 cm; P < 0.001).

Conclusion: This study demonstrates that decreased corneal sensation and signs of dry eye are more common immediately after PRP for diabetic retinopathy. These conditions should be discussed with the patient preoperatively and managed postoperatively.

THE INCIDENCE OF NEOVASCULARIZATION IN CENTRAL SEROUS CHORIORETINOPATHY BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY

M Cristina Savastano ۱ ۲, Marco Rispoli ۳, Bruno Lumbroso ۴Affiliations expand

Free PMC article

Abstract

Purpose: To evaluate the incidence of neovascularization (NV) secondary to central serous chorioretinopathy (CSC)-a condition belonging to the spectrum of pachychoroid disorders by means of optical coherence tomography angiography.

Methods: One hundred and seventy five eyes with CSC were evaluated in this retrospective observational study. The eyes with acute or chronic CSC with no NV were included in Group 1, and those with NV were evaluated in Group 2. Only eyes that had undergone structural optical coherence tomography and optical coherence tomography angiography were included. Age, best-corrected visual acuity, and subfoveal choroidal thickness were evaluated in all eyes. In Group 2, the type and morphology of NV and the occurrence of exudation were considered.

Results: Of a total of 175 eyes with CSC, 86 had the acute form and 89 the chronic. Approximately 140 belonged to Group 1 (80%) and 35 to Group 2 (20%). Approximately 39.2% of all patient with chronic CSC developed NV. Mean age in Groups 1 and 2 was 53.3 years (±۱۰.۹) and 66.6 years (±۱۰.۲), respectively. Mean best-corrected visual acuity in Groups 1 and 2 was 45.7 (±۱۱.۷) and 30.9 (±۱۷.۹) early treatment diabetic retinopathy study letters, respectively. Mean CCT in Group 1 and 2 was 417.5 µm (±۱۲۳) and 344.2 µm (±۱۶۵.۹), respectively. In Group 2, all patients had Type 1 NV (100%); 29 eyes (83%) had filamentous feature, and 6 eyes (17%) had irregular shape. Silent nonexudative NV was observed in 7 eyes (20%), all belonging to Group 2.

Conclusion: The use of optical coherence tomography angiography in everyday clinical practice allows for the accurate analysis of the chorioretinal vascular setting, with the identification of new vessels that could remain misdiagnosed.

VISUAL IMPAIRMENT AND MACULAR VASCULAR REMODELING SECONDARY TO RETROGRADE MACULOPATHY IN RETINAL DETACHMENT TREATED WITH SILICON OIL TAMPONADE

Lea Dormegny ۱, Ludovic C Jeanjean ۲, Xuanli Liu ۱ ۳, Arnaud Messerlin ۱, Tristan Bourcier ۱, Arnaud Sauer ۱, Claude Speeg-Schatz ۱, David Gaucher ۱Affiliations expand

Abstract

Purpose: To assess the frequency of macular cysts (MCs) in retinal detachment treated with silicone oil and evaluate their impact on visual acuity and macular vascularization using optical coherence tomography-angiography.

Methods: Forty-three eyes of 41 patients treated with silicone oil for retinal detachment were retrospectively studied. Best-corrected visual acuity and 6- × ۶-mm optical coherence tomography-angiography examination at least 3 months after silicone oil removal were reviewed. In eyes with MCs, cyst area was measured on the en face optical coherence tomography-angiography image using ImageJ. Density of superficial capillary plexus and area of superficial foveal avascular zone were generated by the optical coherence tomography-angiography. Density of deep capillary plexus and deep foveal avascular zone area were measured using ImageJ.

Results: Twenty-five eyes (58%) presented with MCs. Cysts were exclusively located in the inner nuclear layer in 60% of cases. Mean best-corrected visual acuity in the MC group was lower than that of the non-MC group (P = 0.012). Macular cyst area negatively correlated with best-corrected visual acuity (P = 0.0201). Density of superficial capillary plexus was higher in the MC group (P < 0.0001), whereas area of superficial foveal avascular zone was lower (P < 0.0001). Macular cyst area negatively correlated with density of deep capillary plexus (P < 0.001).

Conclusion: The incidence of INL-MCs after silicone oil removal is high. These are associated with impaired vision and macular vascular remodeling. We highlight their similarity with the “retrograde maculopathy” phenomenon.

EN FACE IMAGING OF OUTER RETINAL PATHOLOGY AFTER RETINAL DETACHMENT

Vilde M Thomseth ۱, David H Engelsvold ۱, Anastasia Ushakova ۲, Vegard A Forsaa ۱Affiliations expand

Abstract

Purpose: To explore the potentials of multicolor (MC) confocal scanning laser ophthalmoscopy (cSLO) to detect structural retinal pathology after macula-off rhegmatogenous retinal detachment (RRD) and to describe their appearances.

Methods: Thirty MC cSLO images of 30 eyes after RRD repair were prospectively studied for the presence of RRD-related pathology. All MC cSLO findings were verified using swept source optical coherence tomography. Positive percent agreements were calculated using swept source optical coherence tomography as reference.

Results: Eight RRD-related structural pathologies were identified and characterized: ellipsoid zone (EZ) disruption, foveal EZ rosette, outer retinal fold, retinal detachment line, subretinal fluid blebs, subretinal fluid layer, retinal striae, and intraretinal cysts. Multicolor cSLO positive percent agreements were as follows: EZ disruption: 79%, foveal EZ rosette: 73%, outer retinal fold: 67%, retinal detachment line: 84%, subretinal fluid blebs: 0.70%, subretinal fluid layer: 50%, intraretinal cysts: 60%, and retinal striae: 100%.

Conclusion: En face MC cSLO imaging detected and delineated RRD-related structural pathology in high agreement with cross-sectional swept source optical coherence tomography and can supplement optical coherence tomography in the documentation and monitoring of outer retinal remodeling processes after macula-off RRD. Foveal EZ rosette is a new finding of the foveal EZ.

Trial registration: ClinicalTrials.gov NCT03187613.

FINGERPRINT SIGN OF THE HENLE FIBER LAYER

Shane M Griffin ۱, H Richard McDonald ۲ ۳, Robert N Johnson ۲ ۳, J Michael Jumper ۲ ۳, Arthur D Fu ۲ ۳, Emmett T Cunningham Jr ۲ ۳ ۴ ۵, Lee Kiang ۱, Caleb C Ng ۲ ۳, Brandon J Lujan ۱ ۲Affiliations expand

Abstract

Purpose: To describe the appearance of concentric, fingerprint-like waves within the Henle fiber layer (HFL) using en face optical coherence tomography in patients with tractional pathologies of the retina.

Methods: Retrospective analysis of six eyes of six patients imaged by optical coherence tomography with volumetric slabs positioned at the level of the HFL.

Results: Optical coherence tomography data from six patients with tractional vitreoretinal pathology were reviewed. Concentric, fingerprint-like microwaves were visualized through en face optical coherence tomography in all six study eyes at the level of the HFL. This finding resembled the finding of HFL waves previously noted histopathologically from force exerted on this layer.

Conclusion: In retinal pathologies in which specific physical forces act on the retina, volumetric optical coherence tomography may permit visualization of en face concentric, fingerprint-like hyperreflective rings within the HFL. This “fingerprint sign” may represent a biomechanical consequence of traction on the retina and allow clinical decision making based on improved recognition of the existence of such traction.

OCRIPLASMIN FOR VITREOMACULAR TRACTION IN CLINICAL PRACTICE: The INJECT Study

David H W Steel ۱, Niall Patton ۲, Theodor Stappler ۳, Niral Karia ۴, Hans Hoerauf ۵, Nishal Patel ۶, Joachim Wachtlin ۷, Thomas Raber ۸, Petra Kozma-Wiebe ۸, INJECT study investigatorsAffiliations expand

Free PMC article

Abstract

Purpose: Randomized clinical trials have demonstrated the safety and efficacy of ocriplasmin in patients with vitreomacular traction (VMT), including those with macular hole (MH). The INJECT study prospectively evaluated ocriplasmin in the setting of clinical practice.

Methods: INJECT was a Phase 4, multicenter, prospective observational study. Patients were followed up for 12 months. Assessments included nonsurgical VMT resolution, nonsurgical MH closure, best-corrected visual acuity, occurrence of vitrectomy, and adverse events.

Results: The efficacy population (N = 395) received an ocriplasmin injection and had optical coherence tomography-confirmed VMT at baseline. At Day 28, the rate of nonsurgical VMT resolution was 40.7% in the overall group, and the rate of nonsurgical MH closure was 36.0% in the VMT with MH group. At Month 12, the rate of ≥۲-line best-corrected visual acuity gain (irrespective of vitrectomy) was 36.8% in the overall group and 59.6% in the VMT with MH group. The percentage of patients who underwent vitrectomy in the study eye was 29.1% in the overall group and 55.6% in the VMT with MH group. Photopsia (9.8%) and vitreous floaters (6.8%) were the most frequent adverse events.

Conclusion: The INJECT study showed that ocriplasmin is effective in a clinical setting in patients with VMT, with or without MH. No new safety signals were identified from this large and surgeon-selected patient group, although the significant limitations of the study design without an image reading center and scheduled study visit timings should be noted.

Journal Club – 2-6-2021

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Journal Club – 2-6-2021 Special Thanks to Dr Fadakar and Dr Bazvand

Journal Club – 30-1-2021

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Challenging Presentations of CSC

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Weekly Case Presentation

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Special Thanks to Dr Mahdizad and Dr Ebrahimi-Adib

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