Meta-Analysis of Postoperative Outcome Parameters Comparing Descemet Membrane Endothelial Keratoplasty Versus Descemet Stripping Automated Endothelial Keratoplasty

Analysis,Postoperative,Descemet Membrane Endothelial Keratoplasty, Descemet Stripping Automated Endothelial Keratoplasty
2017 Sep 26. doi: 10.1097/ICO.0000000000001384. [Epub ahead of print]

Meta-Analysis of Postoperative Outcome Parameters Comparing Descemet Membrane Endothelial Keratoplasty Versus Descemet Stripping Automated Endothelial Keratoplasty.

Abstract

PURPOSE:

This meta-analysis compares Descemet membrane endothelial keratoplasty (DMEK) with Descemet stripping automated endothelial keratoplasty (DSAEK) to evaluate their strength and weakness profiles.

DESIGN:

Meta-analysis.

METHODS:

We performed a meta-analysis and searched the peer-reviewed literature in PubMed, Cochrane Library, Web of Science, and Embase following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Prospective and retrospective trials performing and comparing DMEK and DSAEK were included. Effects were calculated as odds ratios or standardized mean differences.

RESULTS:

A total of 11 studies with a total of 723 eyes (350 DMEK and 373 DSAEK) were included. No significant difference was found regarding the total detachment rate, graft failure, and rejection. One of 340 eyes undergoing DMEK showed total detachment and 5 of 363 eyes undergoing DSAEK showed total detachment (P = 0.28). Six of 280 eyes undergoing DMEK showed graft failure; 1 of 313 eyes undergoing DSAEK developed this complication (P = 0.18). No rejection was observed in 158 eyes undergoing DMEK; 4 cases of rejection occurred in 196 eyes undergoing DSAEK (P = 0.37). No significant difference was found regarding endothelial cell loss (P = 0.48). There was a significantly higher partial detachment rate with DMEK: 88 of 340 eyes undergoing DMEK showed partial detachment; 16 of 363 eyes undergoing DSAEK showed this complication (P < 0.00001). DMEK was superior in best-corrected visual acuity after 6 months (P < 0.001), subjective evaluation of visual acuity (P = 0.001), patient satisfaction (P < 0.001), and was the method preferred by patients (P = 0.001).

CONCLUSIONS:

DMEK and DSAEK have a similar complication profile. However, the superiority in the visual outcome and patient satisfaction makes DMEK the preferred option for most patients.

Analysis,Postoperative,Descemet Membrane Endothelial Keratoplasty, Descemet Stripping Automated Endothelial Keratoplasty

 

PMID:
28957976
DOI:
10.1097/ICO.0000000000001384

LONG-TERM OUTCOMES OF RANIBIZUMAB TREATMENT OF MYOPIC CHOROIDAL NEOVASCULARIZATION IN EAST-ASIAN PATIENTS FROM THE RADIANCE STUDY

OUTCOMES,RANIBIZUMAB,MYOPIC,CHOROIDAL NEOVASCULARIZATION, ASIAN,RADIANCE STUDY

2017 Sep 27. doi: 10.1097/IAE.0000000000001858. [Epub ahead of print]

LONG-TERM OUTCOMES OF RANIBIZUMAB TREATMENT OF MYOPIC CHOROIDAL NEOVASCULARIZATION IN EAST-ASIAN PATIENTS FROM THE RADIANCE STUDY.

Abstract

PURPOSE:

To evaluate long-term efficacy and safety of ranibizumab for treatment of myopic choroidal neovascularization (mCNV) in clinical practice.

METHODS:

Noninterventional, retrospective cohort study of East-Asian patients previously treated with ranibizumab during the RADIANCE trial. Forty-one patients who completed the RADIANCE trial were followed-up for up to 48 months (post-RADIANCE observation period). Outcome measures were best-corrected visual acuity changes from baseline (assessed at RADIANCE trial initiation), mCNV recurrences, and ocular adverse events.

RESULTS:

Mean visual gain from baseline best-corrected visual acuity (56.5 ± 12.1 letters) (20/80) was significant at 12 months (+14.3 ± 11.4 letters, n = 40, P < 0.0001), 24 months (+10.4 ± 22.3 letters, n = 31, P = 0.0143), 30 months (+11.0 ± 22.4 letters, n = 29, P = 0.0134), 42 months (+12.9 ± 20.9 letters, n = 25, P = 0.0051), and 48 months (+16.3 ± 18.7, n = 16, P = 0.0034). Of the 16 patients who completed 48 months of follow-up, 63% gained ≥10 letters and 13% lost ≥10 letters. Over the post-RADIANCE observation period, 83% of patients required no further treatment for mCNV, 10% experienced mCNV recurrences, and 12% experienced a nonserious ocular adverse event. Patients who required additional treatment for mCNV received a mean of 5.0 (SD 5.9, range 1.0-18.0) ranibizumab injections.

CONCLUSION:

Best-corrected visual acuity gained at the end of the RADIANCE trial was sustained over additional 36 months of follow-up. Few patients required further treatment and no new safety concerns were observed.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

OUTCOMES,RANIBIZUMAB,MYOPIC,CHOROIDAL NEOVASCULARIZATION, ASIAN,RADIANCE STUDY
PMID:
28961671
DOI:
10.1097/IAE.0000000000001858
OUTCOMES,RANIBIZUMAB,MYOPIC,CHOROIDAL NEOVASCULARIZATION, ASIAN,RADIANCE STUDY

Drugs Avastin and Lucentis.

Biocompatibility of intraocular lens power adjustment using a femtosecond laser in a rabbit model

Biocompatibility, intraocular lens, power adjustment, femtosecond laser

2017 Aug;43(8):1100-1106. doi: 10.1016/j.jcrs.2017.05.040.

Biocompatibility of intraocular lens power adjustment using a femtosecond laser in a rabbit model.

Abstract

PURPOSE:

To evaluate the biocompatibility (uveal and capsular) of intraocular lens (IOL) power adjustment by a femtosecond laser obtained through increased hydrophilicity of targeted areas within the optic, creating the ability to build a refractive-index shaping lens within an existing IOL.

SETTING:

John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.

DESIGN:

Experimental study.

METHODS:

Six rabbits had phacoemulsification with bilateral implantation of a commercially available hydrophobic acrylic IOL. The postoperative power adjustment was performed 2 weeks after implantation in 1 eye of each rabbit. The animals were followed clinically for an additional 2 weeks and then killed humanely. Their globes were enucleated and bisected coronally just anterior to the equator for gross examination from the Miyake-Apple view to assess capsular bag opacification. After IOL explantation for power measurements, the globes were sectioned and processed for standard histopathology.

RESULTS:

Slitlamp examinations performed after the laser treatments showed the formation of small gas bubbles behind the lenses that disappeared within a few hours. No postoperative inflammation or toxicity was observed in the treated eyes, and postoperative outcomes and histopathological examination results were similar to those in untreated eyes. The power measurements showed that the change in power obtained was consistent and within ±0.1 diopter of the target.

CONCLUSIONS:

Consistent and precise power changes can be induced in the optic of commercially available IOLs in vivo by using a femtosecond laser to create a refractive-index shaping lens. The laser treatment of the IOLs was biocompatible.

 

Biocompatibility, intraocular lens, power adjustment, femtosecond laser

 

PMID:
28917413
DOI:
10.1016/j.jcrs.2017.05.040

Outcomes of Ahmed Glaucoma Valve Revision in Pediatric Glaucoma.

Outcomes, Ahmed Glaucoma Valve, Revision, Pediatric, Glaucoma

2017 Sep 13. pii: S0002-9394(17)30392-6. doi: 10.1016/j.ajo.2017.09.015. [Epub ahead of print]

Outcomes of Ahmed Glaucoma Valve Revision in Pediatric Glaucoma.

Abstract

PURPOSE:

Encapsulation of the Ahmed glaucoma valve (AGV) plate is a common cause for postoperative elevation of intraocular pressure, especially in children. Many reports have described the outcomes of AGV revision in adults. However, the outcomes of AGV revision in children are poorly documented. The aim of this study was to determine the outcomes of AGV revision in children.

DESIGN:

Retrospective cross sectional study METHODS: A retrospective chart review of patients less than 15 years of age who underwent AGV revision with a minimum postoperative follow-up of six months was conducted. Outcome measures included: reduction in intraocular pressure from baseline, survival analysis and reduction in the number of anti-glaucoma medications. Postoperative complications were also noted. Complete success was defined as an IOP of 21 mmHg or less without medications, while qualified success was defined as having an IOP of 21 mmHg or less with medications.

RESULTS:

A total of 44 eyes met the inclusion criteria. Primary congenital glaucoma was present in 39 eyes (88.6%), aphakic glaucoma in 4 eyes (9.1%), and Peters anomaly associated glaucoma in 1 eye (2.3%). The mean number of previous surgeries was 1.4, and the mean age was 6.7 years (range 1.9 – 13 years) with a median follow up of 12 months (range; 6 to 24 months). The IOP was reduced from a preoperative mean of 30.4 (±10.3) to 24.9 (±10.6) mmHg at 6 months postoperatively. Kaplan-Meier analysis showed that the complete success at 1 month was 100% followed by a rapid decline at 6 months to 38.6%, 27.7% at one year and 5.5% at 2 years. Qualified success was 100% at 1 month followed by a six-month and 1 year survival rate of approximately 50%, and a two-year survival rate of approximately 16%. The median survival time was 14 months. No specific risk factors for failure were identified. Visual acuity remained unchanged following revision. The most common complication was recurrence of encapsulation with elevated IOP (15.9%). Other complications included hyphema (n=3; 6.8%), endophthalmitis (n=1; 2.3%) wound leak (n=1; 2.3%) and choroidal detachment (n=2; 4.5%).

CONCLUSION:

Although the short-term success rate of AGV revision in children is high, with longer follow-up the success rate decreases significantly.

Outcomes, Ahmed Glaucoma Valve, Revision, Pediatric, Glaucoma

PMID:
28918060
DOI:
10.1016/j.ajo.2017.09.015

Quantitative Assessment of Microstructural Changes of the Retina in Infants With Congenital Zika Syndrome

Microstructural Changes, Retina, Infants, Congenital Zika Syndrome

2017 Sep 7. doi: 10.1001/jamaophthalmol.2017.3292. [Epub ahead of print]

Quantitative Assessment of Microstructural Changes of the Retina in Infants With Congenital Zika Syndrome.

Abstract

IMPORTANCE:

A better pathophysiologic understanding of the neurodevelopmental abnormalities observed in neonates exposed in utero to Zika virus (ZIKV) is needed to develop treatments. The retina as an extension of the diencephalon accessible to in vivo microcopy with spectral-domain optical coherence tomography (SD-OCT) can provide an insight into the pathophysiology of congenital Zika syndrome (CZS).

OBJECTIVE:

To quantify the microstructural changes of the retina in CZS and compare these changes with those of cobalamin C (cblC) deficiency, a disease with potential retinal maldevelopment.

DESIGN, SETTING, AND PARTICIPANTS:

This case series included 8 infants with CZS and 8 individuals with cblC deficiency. All patients underwent ophthalmologic evaluation at 2 university teaching hospitals and SD-OCT imaging in at least 1 eye. Patients with cblC deficiency were homozygous or compound heterozygotes for mutations in the methylmalonic aciduria and homocystinuria type C (MMACHC) gene. Data were collected from January 1 to March 17, 2016, for patients with CZS and from May 4, 2015, to April 23, 2016, for patients with cblC deficiency.

MAIN OUTCOMES AND MEASURES:

The SD-OCT cross-sections were segmented using automatic segmentation algorithms embedded in the SD-OCT systems. Each retinal layer thickness was measured at critical eccentricities using the position of the signal peaks and troughs on longitudinal reflectivity profiles.

RESULTS:

Eight infants with CZS (5 girls and 3 boys; age range, 3-5 months) and 8 patients with cblC deficiency (3 girls and 5 boys; age range, 4 months to 15 years) were included in the analysis. All 8 patients with CZS had foveal abnormalities in the analyzed eyes (8 eyes), including discontinuities of the ellipsoid zone, thinning of the central retina with increased backscatter, and severe structural disorganization, with 3 eyes showing macular pseudocolobomas. Pericentral retina with normal lamination showed a thinned (<30% of normal thickness) ganglion cell layer (GCL) that colocalized in 7 of 8 eyes with a normal photoreceptor layer. The inner nuclear layer was normal or had borderline thinning. The central retinal degeneration was similar to that of cblC deficiency.

CONCLUSIONS AND RELEVANCE:

Congenital Zika syndrome showed a central retinal degeneration with severe GCL loss, borderline inner nuclear layer thinning, and less prominent photoreceptor loss. The findings provide the first, to date, in vivo evidence in humans for possible retinal maldevelopment with a predilection for retinal GCL loss in CZS, consistent with a murine model of the disease and suggestive of in utero depletion of this neuronal population as a consequence of Zika virus infection.

Microstructural Changes, Retina, Infants, Congenital Zika Syndrome

 

PMID:

Association Between Eyelid Laxity and Obstructive Sleep Apnea

Eyelid Laxity, Sleep Apnea

2017 Sep 7. doi: 10.1001/jamaophthalmol.2017.3263. [Epub ahead of print]

Association Between Eyelid Laxity and Obstructive Sleep Apnea.

Abstract

IMPORTANCE:

While much has been reported on the relationship between floppy eyelid syndrome and obstructive sleep apnea (OSA), the diagnostic criteria of floppy eyelid syndrome are often subjective and vague.

OBJECTIVE:

To evaluate the association between OSA and quantitative markers of eyelid laxity or secondary ocular surface disease in a sleep clinic population.

DESIGN, SETTING, AND PARTICIPANTS:

This investigation was a cross-sectional observational study at the Center for Sleep Medicine at Icahn School of Medicine at Mount Sinai. Participants were individuals referred for overnight polysomnography from March 1 to August 30, 2015.

MAIN OUTCOMES AND MEASURES:

Eyelid laxity and ocular surface disease were assessed on bedside ophthalmologic examination. The presence and severity of OSA were determined from polysomnography results. Initial correlation between OSA and ocular surface and eyelid markers was calculated through bivariate linear regression analysis, and the association between ocular symptoms was obtained through bivariate ordered logistic regression. Analysis was repeated adjusting for known associations between OSA and sex, age, body mass index, and medical comorbidities through multivariable analysis.

RESULTS:

In total, 201 individuals (402 eyes) were enrolled in the study. Their mean (SD) age was 53.2 (13.5) years, 43.3% (n = 87) were female, 56.7% (n = 114) were of white race/ethnicity, 26.9% (n = 54) were black/African American, 4.0% (n = 8) were Asian, 8.0% (n = 16) were multiracial or other, and 4.5% (n = 9) were of unknown race/ethnicity, with 21.9% (n = 44) of all individuals self-identifying as Hispanic and 75.1% (n = 151) self-identifying as non-Hispanic. After adjustment, no association was observed between OSA severity and an eyelid laxity score (regression coefficient, 0.85; 95% CI, -0.33 to 0.62; P = .40) or an ocular surface score (regression coefficient, 1.09; 95% CI, -0.32 to 0.29; P = .93). Through subset analysis, male sex was associated with a higher ocular surface score, while older age and diabetes were associated with a higher eyelid laxity score. Only one patient (0.5%) exhibited findings of floppy eyelid syndrome.

CONCLUSIONS AND RELEVANCE:

Among individuals referred for overnight polysomnography, quantitative markers of eyelid laxity were not associated with the presence or severity of OSA. Subset analysis suggests that prior studies may have been limited by confounding variables or the technique of identifying eyelid laxity.

Eyelid Laxity, Sleep Apnea

 

PMID:

Association of Disease Location and Treatment With Survival in Diffuse Large B-Cell Lymphoma of the Eye and Ocular Adnexal Region

Survival, Diffuse, B-Cell Lymphoma,  Eye, Ocular, Adnexal Region

2017 Sep 7. doi: 10.1001/jamaophthalmol.2017.3286. [Epub ahead of print]

Association of Disease Location and Treatment With Survival in Diffuse Large B-Cell Lymphoma of the Eye and Ocular Adnexal Region.

Abstract

IMPORTANCE:

Primary diffuse large B-cell lymphoma (DLBCL) of the ocular region is rare, and the utility of surgery and radiation therapy remains unresolved.

OBJECTIVE:

To explore the clinical characteristics and determine factors associated with overall survival in primary vitreoretinal lymphoma (PVRL) and ocular adnexal (OA)-uveal DLBCL.

DESIGN, SETTING, AND PARTICIPANTS:

This retrospective analysis included 396 patients with ophthalmic DLBCL from January 1, 1973, through December 31, 2014, using the Surveillance, Epidemiology, and End Results database. The median follow-up was 39.0 months (interquartile range, 5.1-72.9 months). All patients diagnosed with primary DLBCL of the eye or retina (PVRL) or the eyelid, conjunctiva, choroid, ciliary body, lacrimal gland, or orbit (OA-uveal lymphoma) were included. Patients diagnosed at autopsy or with additional neoplastic disease were excluded.

MAIN OUTCOMES AND MEASURES:

Patient demographic characteristics, disease location, treatment modalities, and overall survival.

RESULTS:

Forty-seven patients with PVRL (24 women [51.1%] and 23 men [48.9%]) and 349 with OA-uveal DLBCL (192 women [55.0%] and 157 men [45.0%]) had a similar mean (SD) age at diagnosis (69.6 [12.3] vs 66.1 [17.7] years). No difference in the use of surgery or radiation therapy by location was found. For all PVRL and OA-uveal DLBCL, a Cox proportional hazards regression model affirmed that age older than 60 years was associated with increased risk for death (hazard ratio [HR], 2.7; 95% CI, 1.9-4.0; P < .001). Gross total resection was associated with a decreased risk for death (HR, 0.5; 95% CI, 0.3-0.9; P = .04), whereas radiation therapy was not. The 5-year overall survival among patients with PVRL was 41.4% (SE, 8.6%); among those with OA-uveal DLBCL, 59.1% (SE, 2.8%; Mantel-Cox test, P = .007). Median overall survival was lower in PVRL (38.0 months; 95% CI, 14.2-61.8 months) than in OA-uveal DLBCL (96.0 months; 95% CI, 67.3-124.7 months; Mantel-Cox test, P = .007). In addition, median overall survival in ophthalmic-only disease was higher (84.0 months; 95% CI, 63.2-104.8 months) than that in primary DLBCL that occurred outside the central nervous system and ophthalmic regions (46.0 months; 95% CI, 44.4-47.6 months; Mantel-Cox test, P < .001).

CONCLUSIONS AND RELEVANCE:

The 5-year survival in PVRL vs OA-uveal DLBCL differed by 17.7%, and overall survival was greater in ophthalmic DLBCL than in DLBCL located outside the central nervous system and ophthalmic regions. Younger age (≤60 years) and gross total resection were associated with increased survival.

Survival, Diffuse, B-Cell Lymphoma,  Eye, Ocular Adnexal Region
PMID:
28880986
DOI:
10.1001/jamaophthalmol.2017.3286

Performance of an iPad Application to Detect Moderate and Advanced Visual Field Loss in Nepal

iPad, Application, Visual Field Loss

2017 Aug 24. pii: S0002-9394(17)30341-0. doi: 10.1016/j.ajo.2017.08.007. [Epub ahead of print]

Performance of an iPad Application to Detect Moderate and Advanced Visual Field Loss in Nepal.

Abstract

PURPOSE:

To evaluate the accuracy and efficiency of Visual Fields Easy (VFE), a free iPad app, for performing suprathreshold perimetric screening.

METHODS:

We performed screening visual fields using a calibrated iPad 2 with the VFE application on 206 subjects (411 eyes): 210 normal (NL), 183 glaucoma (GL) and 18 diabetic retinopathy (DR) at Tilganga Institute of Ophthalmology, Kathmandu, Nepal. We correlated the results with a Humphrey Field Analyzer using 24-2 SITA Standard tests on 273 of these eyes (198 NL, 160 GL, 15 DR) RESULTS: The number of missed locations on the VFE correlated with Mean Deviation (MD, r=0.79), Pattern Standard Deviation (PSD, r = 0.60), and number of locations that were worse than the 95% confidence limits for Total Deviation (r=0.51) and Pattern Deviation (r=0.68) using SITA Standard. iPad suprathreshold perimetry was able to detect most visual field deficits with moderate (MD of -6 to -12 dB) and advanced (MD worse than -12 dB) loss, but had greater difficulty in detecting early (MD better than -6 dB) loss, primarily due to an elevated false positive response rate. The average time to perform the Visual Fields Easy test was 3 minutes 18 seconds (s.d = 16.88 seconds).

iPad, Application, Visual Field Loss

DISCUSSION:

The Visual Fields Easy test procedure is a portable, fast, effective procedure for detecting moderate and advanced visual field loss. Improvements are currently underway to monitor eye and head tracking during testing, reduce testing time, improve performance and eliminate the need to touch the video screen surface.

KEYWORDS:

Abstract: 249; Design: Prospective; Word Count: Manuscript: 2928; cross sectional; diabetic retinopathy; glaucoma; iPad; tablet display; validation study; visual field screening; visual impairment

PMID:
28844641
DOI:
10.1016/j.ajo.2017.08.007

 

Optical Coherence Tomography Predictors of Risk for Progression to Non-Neovascular Atrophic Age-Related Macular Degeneration

Optical Coherence Tomography, Progression, Non-Neovascular, Atrophic, Age-Related Macular Degeneration

2017 Aug 25. pii: S0161-6420(16)32460-5. doi: 10.1016/j.ophtha.2017.06.032. [Epub ahead of print]

Optical Coherence Tomography Predictors of Risk for Progression to Non-Neovascular Atrophic Age-Related Macular Degeneration.

Abstract

PURPOSE:

Appearance of geographic atrophy (GA) on color photography (CP) is preceded by specific features on spectral-domain optical coherence tomography (SD OCT). We aimed to build SD OCT-based risk assessment models for 5-year new onset of GA and central GA on CP.

DESIGN:

Prospective, longitudinal study.

PARTICIPANTS:

Age-Related Eye Disease Study 2 Ancillary SD OCT study participants with age-related macular degeneration (AMD) with bilateral large drusen or noncentral GA and at least 1 eye without advanced disease (n = 317).

METHODS:

For 1 eye per participant, qualitative and quantitative SD OCT variables were derived from standardized grading and semiautomated segmentation, respectively, at baseline. Up to 7 years later, annual outcomes were extracted and analyzed to fit multivariate logistic regression models and build a risk calculator.

MAIN OUTCOME MEASURES:

New onset of CP-visible GA and central GA.

RESULTS:

Over a follow-up median of 4.0 years and among 292 AMD eyes (without advanced disease at baseline) with complete outcome data, 46 (15.8%) developed central GA. Among 265 eyes without any GA on baseline CP, 70 (26.4%) developed CP-visible GA. Final multivariate models were adjusted for age. In the model for GA, the independent predicting SD OCT factors (P < 0.001-0.03) were: hyperreflective foci and retinal pigment epithelium (RPE) layer atrophy or absence, followed by choroid thickness in absence of subretinal drusenoid deposits, photoreceptor outer segment loss, RPE drusen complex volume, and RPE drusen complex abnormal thinning volume. For central GA, the factors (P < 0.001) were RPE drusen complex abnormal thinning volume, intraretinal fluid or cystoid spaces, hyperreflective foci, and RPE layer atrophy or absence. The models yielded a calculator that computes the probabilities of CP-visible, new-onset GA and central GA after 1 to 5 years.

CONCLUSIONS:

For AMD eyes with large drusen and no advanced disease, we built a novel risk assessment model-based on age and SD OCT segmentation, drusen characteristics, and retinal pathology-for progression to CP-visible GA over up to 5 years. This calculator may simplify SD OCT grading and with future validation has a promising role as a clinical prognostic tool.

PMID:
28847641
DOI:
10.1016/j.ophtha.2017.06.032