Comparative evaluation of progression rate in keratoconus before and after collagen crosslinking

Posted Posted in cornea

progression, keratoconus, collagen, crosslinking

2017 Nov 9. pii: bjophthalmol-2017-311017. doi: 10.1136/bjophthalmol-2017-311017. [Epub ahead of print]

Comparative evaluation of progression rate in keratoconus before and after collagen crosslinking.

Abstract

PURPOSE:

To compare the rate of disease progression in keratoconus before and after corneal collagen crosslinking (CXL).

METHODS:

145 eyes were followed without CXL (no-CXL group) for a median duration of 31 months whereas 45 eyes were followed up for 41 months before (pre-CXL) and after (post-CXL) accelerated, epithelium-off crosslinking. Progression was defined based on significant slope found in linear mixed effect models against time. Swept-source optical coherence tomography was used for measurement of anterior steep keratometry, anterior flat keratometry (Ant Kf), anterior average keratometry (Ant Avg K); posterior steep keratometry, posteriorflat keratometry (Post Kf), posterior average keratometry (Post Avg K) and corneal thickness.

RESULTS:

The patients in pre-CXL group were significantly younger (26.3±5.48 years) compared with the patients in no-CXL group (32.7±10.24 years) (P=0.004). Significant differences were observed during baseline examination for all parameters (P≤0.035) between pre-CXL and no-CXL groups except Ant Cyl and Post Cyl. During observation period, statistically significant differences were noted between pre-CXL and no-CXL groups in the progression rate of Ant Kf, Ant Avg K, Post Kf and Post Avg K (P≤0.045). After CXL, the progression rate in post-CXL group was comparable to that in no-CXL group. All corneal parameters remained stable in no-CXL group throughout the follow-up period.

CONCLUSIONS:

Serial tomographic examination is useful to document disease progression before and after CXL. In our study, a decrease in progression rate of corneal parameters was noted after CXL. In cases with stable corneal parameters over time, careful monitoring can be considered instead of collagen crosslinking.

progression, keratoconus, collagen, crosslinking:

cornea; imaging; treatment other

PMID:
29122823
DOI:
10.1136/bjophthalmol-2017-311017

Effect of Cornea Preservation Time on Success of Descemet Stripping Automated Endothelial Keratoplasty: A Randomized Clinical Trial

Posted Posted in cornea

Cornea Preservation, Descemet Stripping Automated Endothelial Keratoplasty

2017 Nov 10. doi: 10.1001/jamaophthalmol.2017.4989. [Epub ahead of print]

Effect of Cornea Preservation Time on Success of Descemet Stripping Automated Endothelial Keratoplasty: A Randomized Clinical Trial.

Abstract

IMPORTANCE:

Demonstrating that success of Descemet stripping automated endothelial keratoplasty is similar across donor cornea preservation times (PTs) could increase the donor pool.

OBJECTIVE:

To determine whether the 3-year rate of graft success using corneal donor tissue preserved 8 to 14 days is noninferior to that of donor tissue preserved 7 days or less.

DESIGN, SETTING, AND PARTICIPANTS:

A multicenter, double-masked, randomized noninferiority clinical trial was conducted from April 16, 2012, to June 5, 2017, at 40 clinical sites (70 surgeons) in the United States, with donor corneas provided by 23 US eye banks. A total of 1090 individuals (1330 study eyes) underwent Descemet stripping automated endothelial keratoplasty (1255 eyes [94.4%] for Fuchs endothelial corneal dystrophy).

INTERVENTIONS:

Descemet stripping automated endothelial keratoplasty with random assignment of a donor cornea with a PT of 7 days or less (0-7d PT) or 8 to 14 days (8-14d PT).

MAIN OUTCOMES AND MEASURES:

Graft success at 3 years.

RESULTS:

Of the 1090 participants (1330 study eyes; 60.2% women and 39.8% men; median age at enrollment, 70 years [range, 42-90 years]), the 3-year cumulative probability of graft success was 95.3% (95% CI, 93.6%-96.9%) in the 0-7d PT group and 92.1% (95% CI, 89.9%-94.2%) in the 8-14d PT group (difference, 3.2%). The upper limit of the 1-sided 95% CI on the difference was 5.4%, exceeding the prespecified noninferiority limit of 4%. The difference was mostly owing to more primary donor failures in the 8-14d PT group, with the conditional probability of failure after the first month being 2.4% in the 0-7d PT group and 3.1% in the 8-14d PT group. In preplanned secondary analyses, longer PT was associated with a lower rate of graft success (unadjusted hazard ratio for graft failure per additional day of PT, 1.10; 95% CI, 1.03-1.18; P = .008 [PT analyzed as days]), with success rates of 96.5% (95% CI, 92.3%-98.4%) for PT of 4 days or less, 94.9% (95% CI, 92.5%-96.6%) for PT of 5 to 7 days, 93.8% (95% CI, 91.0%-95.8%) for PT of 8 to 11 days, and 89.3% (95% CI, 84.4%-92.7%) for PT of 12 to 14 days (P = .01 [PT analyzed as categorical variable]).

CONCLUSIONS AND RELEVANCE:

The 3-year success rate in eyes undergoing Descemet stripping automated endothelial keratoplasty was high irrespective of PT. However, the study was unable to conclude that the success rate with donor corneas preserved 8 to 14 days was similar to that of corneas preserved 7 days or less with respect to the prespecified noninferiority limit. Although longer PT was associated with a lower success rate, the difference in rates was small when PT was less than 12 days.

Cornea Preservation, Descemet Stripping Automated Endothelial Keratoplasty REGISTRATION:

clinicaltrials.gov Identifier: NCT01537393.

PMID:
29127431
DOI:
10.1001/jamaophthalmol.2017.4989

Oxygen venular saturation correlates with a functional loss in primary open-angle glaucoma and normal-tension glaucoma patients

Posted Posted in glaucoma

Oxygen, saturation, open-angle glaucoma, normal-tension glaucoma

2017 Nov 1. doi: 10.1111/aos.13575. [Epub ahead of print]

Oxygen venular saturation correlates with a functional loss in primary open-angle glaucoma and normal-tension glaucoma patients.

Abstract

PURPOSE:

To investigate whether there are differences in retinal oxygen saturation in upper and lower visual field hemispheres in primary open-angle glaucoma (POAG) and in normal-tension glaucoma (NTG).

METHODS:

This study enrolled POAG and NTG patients exhibiting differences between the upper and lower total deviation (TD) that were either more than 10 or <5 dB. Retinal oxygen saturation measurements in these patients with glaucoma were performed by a non-invasive spectrophotometric retinal oximeter. The Student’s t-test was used for statistical analysis.

RESULTS:

Evaluations of the worse and better hemifields in the patients with POAG who exhibited differences in the upper and lower hemifield TD that was <5 dB (n = 25) showed that there were no statistically significant differences for the retinal venous saturation of oxygen (SaO2 ). However, there was a higher mean SaO2 in the worse (57.0 ± 7.5%) versus the better (54.3 ± 7.0%) hemifield in the patients with NTG (n = 22; p = 0.007). Evaluations of the patients with more than a 10-dB difference in the upper and lower hemifield TD showed statistically significant differences for the retinal venous SaO2 in the venous vessels between the POAG (n = 19) and the NTG (n = 26) patients.

CONCLUSION:

Although there was no significant difference in retinal SaO2 in the venules between the better and worse hemifield when the difference between the better and worse hemifield in the patients with POAG was <5 dB, there was a higher SaO2 in the venous vessels in the worse hemifield in the patients with NTG.

 

Oxygen, saturation, open-angle glaucoma, normal-tension glaucoma

 

KEYWORDS:

normal-tension glaucoma; oxygen saturation; primary open-angle glaucoma; visual field defect

Changes in oxygen saturation and the retinal nerve fibre layer in patients with optic neuritis

Posted Posted in Retina

oxygen saturation, retinal nerve fibre layer, optic neuritis

2017 Nov 1. doi: 10.1111/aos.13571. [Epub ahead of print]

Changes in oxygen saturation and the retinal nerve fibre layer in patients with optic neuritis – a pilot study.

Abstract

PURPOSE:

Assessment of retinal oxygen saturation, thickness of a retinal nerve fibre layer (RNFL) and functional changes in the optic nerve during optic neuritis (ON) in patients with multiple sclerosis (MS).

METHODS:

Thirty-two patients with ON due to MS within 3 months of onset of symptoms were enrolled [22 females, 10 males, age 34 ± 9 years, median 32.5 years, 22 patients with the clinically isolated syndrome (CIS), 10 patients with relapsing-remitting from of MS (RRMS)]. All patients were examined using optical coherence tomography (OCT model 4000, Carl Zeiss Meditec, Dublin, CA, USA), automatic optical oximetry (Oxymap ehf, Reykjavik, Iceland) and using visual evoked potentials (VEP) (Metronic Keypoint® , Minneapolis, MN, USA).

RESULTS:

Arterio-venous difference (AVD) was increased in patients ON affected eye compared to patients’ unaffected eye (PUE) [34.2 ± 4.7 versus 31.3 ± 4.6, p = 0.044 (mean ± standard deviation)]. No statistically significant difference was found in vessel oxygen saturation as well as in RNFL thickness in ON affected eyes when compared to unaffected MS eyes and healthy individuals. Significantly lower optic nerve conduction velocity was found in the affected eye when compared to unaffected MS eye and healthy (p < 0.0001 for both comparisons). No correlation between oxygen saturation values and VEP was observed in patients with MS.

CONCLUSION:

The AVD in oxygen saturation is altered in patients with acute ON. In the early stage of ON, AVD could reflect inflammatory and metabolic changes in the affected eye. Therefore, oximetry could be used as another diagnostic method in MS patients in suspicion of ON. This result would be promising for future investigation in this field.

KEYWORDS oxygen saturation, retinal nerve fibre layer, optic neuritis:

multiple sclerosis; optic neuritis; optical coherence tomography; oximetry

DIFFERENCE IN TREATMENT OUTCOMES ACCORDING TO OPTICAL COHERENCE TOMOGRAPHY-BASED STAGES IN TYPE 3 NEOVASCULARIZATION (RETINAL ANGIOMATOUS PROLIFERATION)

Posted Posted in Retina

Optical Coherence Tomography, Neovascularization , Retinal Angiomatous Proliferation

2017 Oct 10. doi: 10.1097/IAE.0000000000001876. [Epub ahead of print]

DIFFERENCE IN TREATMENT OUTCOMES ACCORDING TO OPTICAL COHERENCE TOMOGRAPHY-BASED STAGES IN TYPE 3 NEOVASCULARIZATION (RETINAL ANGIOMATOUS PROLIFERATION).

Abstract

PURPOSE:

To compare 12-month treatment outcomes of Type 3 neovascularization among its different stages as classified using an optical coherence tomography-based method.

METHODS:

This retrospective observational study included 40 patients (40 eyes) who were newly diagnosed with Type 3 neovascularization. The patients were initially administered 3 monthly anti-vascular endothelial growth factor injections. Repeat treatment was performed when recurrence of fluid was noted. Disease staging was classified using the optical coherence tomography-based method. The best-corrected visual acuity at diagnosis and at 12 months and degree of change in best-corrected visual acuity were compared among the different stages of the disease. In addition, incidence of progression in the disease stages was estimated.

RESULTS:

Among the 40 patients, 14 (35.0%) were classified as Stage 2 and 26 (65.0%) were classified as Stage 3. The best-corrected visual acuity values at diagnosis and at 12 months were 0.61 ± 0.31 (20/81 Snellen equivalents) and 0.46 ± 0.30 (20/57) in the Stage 2 group and 0.67 ± 0.42 (20/93) and 0.70 ± 0.49 (20/100) in the Stage 3 group, respectively. There was a significant difference in best-corrected visual acuity change between the two groups (P = 0.036). During the follow-up period, 3 retinal pigment epithelium tears and 2 submacular hemorrhages had developed in the Stage 3 group. Progression of the disease from Stage 2 to Stage 3 was noted in 2 patients (14.3%).

CONCLUSION:

The visual outcome was worse in Stage 3 than in Stage 2, and adverse events that may lead to abrupt visual deterioration developed only in Stage 3. Further studies are needed to reveal whether anti-vascular endothelial growth factor therapy can suppress the progression of the disease stages.

Optical Coherence Tomography, Neovascularization , Retinal Angiomatous Proliferation

PMID:
29019795
DOI:
10.1097/IAE.0000000000001876

Comparison of central corneal thickness with four different optical devices

Posted Posted in cornea

corneal thickness, optical devices

2017 Oct 11. doi: 10.1007/s10792-017-0736-7. [Epub ahead of print]

Comparison of central corneal thickness with four different optical devices.

Abstract

BACKGROUND:

To compare the consistency between the average scores of the contact central corneal thickness measurements from ultrasound pachymetry devices still gold standard, such as iPac® and Echoscan US-500, and noncontact measurements via Pentacam HR and Sirius topography.

METHODS:

This prospective study, subsequently admitted to the ophthalmology department, 76 healthy individuals were performed. The measurements were repeated three times for each eye, and average scores were statistically analyzed on the same day and almost at the same time. While measuring the eyes, Pentacam HR, Sirius topography, iPac®, and Echoscan US-500 were used, respectively. The inter-rater agreement of measurements from the devices was assessed with intraclass correlation coefficient, and 95% Confidence Interval and p values demonstrating statistically significance were also presented. In the graphical assessment of the agreement, the Bland-Altman graph was used.

RESULTS:

Among 76 study participants, 43 (56.6%) were composed of women, and age level was 38.6 ± 12.5 years, ranging between 18 and 69. It was observed that the highest agreement was between the measurements obtained from Echoscan US-500 and iPac® devices, but the agreement between the measurements of different devices was higher than 0.90. Bland-Altman graphics were also investigated; the results of four different devices were seen to be consistent with one another.

CONCLUSIONS:

Therefore, the devices we compared in the study can be used as alternatives to one another due to the higher consistency between CCT measurements provided with through UP devices of Echoscan US-500 and iPac®, and Pentacam HR and Sirius topography devices.

CLINICAL TRIAL REGISTRATION NUMBER:

2016/112.

corneal thickness, optical devices

KEYWORDS:

Central corneal thickness; ,®

PMID:
29022163
DOI:
10.1007/s10792-017-0736-7

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

Posted Posted in cornea
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

Posted Posted in Retina

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

Posted Posted in Cataracts and Cataract Surgery

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.

Posted Posted in 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