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

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.

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

Comparison of Clinical Trial and Systematic Review Outcomes for the 4 Most Prevalent Eye Diseases

Posted Posted in eye health

Clinical Trial,Review, Outcomes,  Eye Diseases

2017 Aug 3. doi: 10.1001/jamaophthalmol.2017.2583. [Epub ahead of print]

Comparison of Clinical Trial and Systematic Review Outcomes for the 4 Most Prevalent Eye Diseases.

Abstract

IMPORTANCE:

Suboptimal overlap in outcomes reported in clinical trials and systematic reviews compromises efforts to compare and summarize results across these studies.

OBJECTIVES:

To examine the most frequent outcomes used in trials and reviews of the 4 most prevalent eye diseases (age-related macular degeneration [AMD], cataract, diabetic retinopathy [DR], and glaucoma) and the overlap between outcomes in the reviews and the trials included in the reviews.

DESIGN, SETTING, AND PARTICIPANTS:

This cross-sectional study examined all Cochrane reviews that addressed AMD, cataract, DR, and glaucoma; were published as of July 20, 2016; and included at least 1 trial and the trials included in the reviews. For each disease, a pair of clinical experts independently classified all outcomes and resolved discrepancies. Outcomes (outcome domains) were then compared separately for each disease.

MAIN OUTCOMES AND MEASURES:

Proportion of review outcomes also reported in trials and vice versa.

RESULTS:

This study included 56 reviews that comprised 414 trials. Although the median number of outcomes per trial and per review was the same (n = 5) for each disease, the trials included a greater number of outcomes overall than did the reviews, ranging from 2.9 times greater (89 vs 30 outcomes for glaucoma) to 4.9 times greater (107 vs 22 outcomes for AMD). Most review outcomes, ranging from 14 of 19 outcomes (73.7%) (for DR) to 27 of 29 outcomes (93.1%) (for cataract), were also reported in the trials. For trial outcomes, however, the proportion also named in reviews was low, ranging from 19 of 107 outcomes (17.8%) (for AMD) to 24 of 89 outcomes (27.0%) (for glaucoma). Only 1 outcome (visual acuity) was consistently reported in greater than half the trials and greater than half the reviews.

CONCLUSIONS AND RELEVANCE:

Although most review outcomes were reported in the trials, most trial outcomes were not reported in the reviews. The current analysis focused on outcome domains, which might underestimate the problem of inconsistent outcomes. Other important elements of an outcome (ie, specific measurement, specific metric, method of aggregation, and time points) might have differed even though the domains overlapped. Inconsistency in trial outcomes may impede research synthesis and indicates the need for disease-specific core outcome sets in ophthalmology.

Clinical Trial,Review, Outcomes,  Eye Diseases

Clinical Trial, Review, Outcomes,  Eye Diseases

PMID:
28772305
DOI:
10.1001/jamaophthalmol.2017.2583

Clinical Trial, Review, Outcomes,  Eye Diseases

Modern laser in situ keratomileusis outcomes.

Posted Posted in lasik
Modern, lasik, keratomileusis, outcomes
J Cataract Refract Surg. 2016 Aug;42(8):1224-34. doi: 10.1016/j.jcrs.2016.07.012.

Modern laser in situ keratomileusis outcomes.

Abstract

Laser in situ keratomileusis (LASIK) articles published between 2008 and 2015 that contain clinical outcomes data were reviewed and graded for quality, impression, and potential bias. All 97 relevant articles (representing 67 893 eyes) provided a positive or neutral impression of LASIK. Industry bias was not evident. The aggregate loss of 2 or more lines of corrected distance visual acuity was 0.61% (359/58 653). The overall percentage of eyes with uncorrected distance visual acuity better than 20/40 was 99.5% (59 503/59 825). The spherical equivalent refraction was within ±1.0 diopter (D) of the target refraction in 98.6% (59 476/60 329) of eyes, with 90.9% (59 954/65 974) within ±0.5 D. In studies reporting patient satisfaction, 1.2% (129/9726) of patients were dissatisfied with LASIK. Aggregate outcomes appear better than those reported in summaries of the safety and effectiveness of earlier laser refractive surgery systems approved by the U.S. Food and Drug Administration. Modern results support the safety, efficacy, and patient satisfaction of the procedure.

J Cataract Refract Surg. 2016 Aug;42(8):1224-34. doi: 10.1016/j.jcrs.2016.07.012.

Modern laser in situ keratomileusis outcomes.

Abstract

Laser in situ keratomileusis (LASIK) articles published between 2008 and 2015 that contain clinical outcomes data were reviewed and graded for quality, impression, and potential bias. All 97 relevant articles (representing 67 893 eyes) provided a positive or neutral impression of LASIK. Industry bias was not evident. The aggregate loss of 2 or more lines of corrected distance visual acuity was 0.61% (359/58 653). The overall percentage of eyes with uncorrected distance visual acuity better than 20/40 was 99.5% (59 503/59 825). The spherical equivalent refraction was within ±1.0 diopter (D) of the target refraction in 98.6% (59 476/60 329) of eyes, with 90.9% (59 954/65 974) within ±0.5 D. In studies reporting patient satisfaction, 1.2% (129/9726) of patients were dissatisfied with LASIK. Aggregate outcomes appear better than those reported in summaries of the safety and effectiveness of earlier laser refractive surgery systems approved by the U.S. Food and Drug Administration. Modern results support the safety, efficacy, and patient satisfaction of the procedure.

Extent of Internal Limiting Membrane Peeling and Its Impact on Macular Hole Surgery Outcomes: A Randomized Trial

Posted Posted in Retina
Internal Limiting Membrane, Peeling, Macular Hole, Surgery, Outcomes
Am J Ophthalmol. 2016 Jul 5. pii: S0002-9394(16)30315-4. doi: 10.1016/j.ajo.2016.06.041. [Epub ahead of print]

Extent of Internal Limiting Membrane Peeling and Its Impact on Macular Hole Surgery Outcomes: A Randomized Trial.

Abstract

PURPOSE:

To identify whether and how outcomes of macular hole (MH) surgery are influenced by the extent of internal limiting membrane (ILM) peeling.

DESIGN:

Randomized clinical trial.

METHODS:

This study involved 65 eyes from 65 patients who underwent surgery for idiopathic MH. ILM was peeled with a radius of either 0.75-disc diameter (small extent group, SEG) or 1.5-disc diameter (large extent group,LEG), according to the randomization. Anatomical success, visual acuity, and metamorphopsia score (M-score) were measured at two and six month postoperative visits. The distance between the foveal center and the parafoveal edge of the outer plexiform layer on optical coherence tomography was measured in four directions, and further distance increases in certain directions were defined as asymmetric elongation of foveal tissue.

RESULTS:

Complete closure of the MH was observed after initial operation in 97.0% of eyes in both groups. The mean visual improvement at six months after surgery was 20.4±12.8 and 19.1±10.8 ETDRS letters in SEG and LEG, respectively (P= .452). The mean amount of improvement in M-score was 0.26±0.55 in SEG and 0.50±0.53 in LEG (P= .039). There was a difference of the mean degree of asymmetric elongation between the two groups (22.5±10.8% in SEG vs 13.4±5.8% in LEG, P= .001). And there was inverse correlation between the mean degree of asymmetric elongation and the amount of improvement in M-score at six months postoperatively (P< .001).The mean amount of improvement in M-score was 0.26±0.55 in SEG and 0.50±0.53 in LEG (P= .039). There was a difference of the mean degree of asymmetric elongation between the two groups (22.5±10.8% in SEG vs 13.4±5.8% in LEG, P= .001). And there was inverse correlation between the mean degree of asymmetric elongation and the amount of improvement in M-score at six months postoperatively (P< .001)

CONCLUSION:

Larger extent of ILM peeling during MH surgery is beneficial with respect to reduction of metamorphopsia, alleviating asymmetric elongation of foveal tissue.