EW Weekly, October 28, 2016

October 28, 2016
Volume 21 , Number 39

Dropless therapy reduces needfor supplemental postop meds

An investigator-sponsored retrospective review on a series of patients receiving cataract surgery and eligible for a transzonular injection of compounded Tri-Moxi-Vanc (3.0 mg triamcinolone acetonide, 0.2 mg moxifloxacin, 2.0 mg vancomycin; Imprimis Pharmaceuticals, San Diego) found nearly 92% of cases (n=1,413/1,541) did not need supplemental medication after surgery. Sydney Tyson, MD, reviewed the medical records of 922 patients who underwent cataract surgery followed by an injection of Tri-Moxi-Vanc from November 2013 through December 2014. The primary analysis consisted of 1,541 surgical cases performed at a single-specialty ambulatory center (SurgiCenter of Vineland, Vineland, New Jersey). Cases were evaluated preoperatively and at postoperative days 1, 14-21, and 90 for visual acuity, IOP, and presence of endophthalmitis, inflammation and cystoid macular edema (CME). Among the findings: no postop endophthalmitis, no major intraoperative complications, rates of infection and inflammation reported appear similar to reported rates with alternative prophylactic therapies such as topical drops, and the rate of breakthrough inflammation was 9.2% (n=132/1,429).

First patients dosed intopical studies on DME, AMD

The first patients have been dosed in Phase 1/2 trials of SF0166 topical ophthalmic solution for the treatment of diabetic macular edema (DME) and age-related macular degeneration (AMD), developer SciFluor Life Sciences (Lexington, Massachusetts) said. Clinical study SF0166-C-001 is a multicenter, randomized Phase 1/2 trial being conducted in the United States to evaluate the safety and preliminary efficacy of SF0166 for the treatment of patients with DME. A separate multicenter, randomized, Phase 1/2 trial of SF0166 has been initiated in patients with wet AMD. Each trial has two dose groups of up to 20 patients with an aim to collect safety and tolerability data as well as to record changes in retinal thickness and visual acuity.

Mediterranean diet may cut AMD risk by 33%

People who closely follow the Mediterranean diet, especially by eating fruit, may be more than a third less likely to develop age-related macular degeneration (AMD), according to Rufino Silva, MD, University of Coimbra, Portugal. His group studied 883 people age 55 or older who lived in the central region of the country between 2013 and 2015. Of those, 449 had AMD in its early stages before vision loss, and 434 did not have AMD. Researchers assessed their diets based on a questionnaire asking how often they ate foods associated with the Mediterranean diet. The more they ate foods associated with the diet, the higher the score, from 0-9. Those who closely followed the diet scored a 6 or greater; the higher the score, the lower the AMD risk. Of those who did not closely follow the diet (scored below a 6), 50% had AMD. Of those who did closely follow the diet (scored 6 or above), only 39% had AMD, representing a 35% lower risk compared to those who did not adhere to the diet. Dr. Silva presented results earlier this month at the American Academy of Ophthalmology meeting.

First patient implanted with Orion I prosthesis

The first successful implantation and activation of a wireless visual cortical stimulator in a human subject provided the initial human proof of concept for the ongoing development of the Orion I Visual Cortical Prosthesis, developer Second Sight (Sylmar, California) said in a press release. According to Second Sight, a 30-year-old patient was implanted with a wireless multichannel neurostimulation system on the visual cortex and was able to perceive and localize individual phosphenes or spots of light with no significant adverse side effects. The Orion I program was designed to treat patients "who cannot benefit from the Argus II Retinal Prosthesis (designed for people with severe to profound outer retinal degeneration such as retinitis pigmentosa)," the company said.

Sun Pharma to buy Ocular Technologies

Sun Pharma (Mumbai, India) will buy Auven Therapeutics, developers of Seciera (topical cyclosporine 0.09%) for $40 million upfront, the company said. Seciera is in a Phase 3 confirmatory clinical trial for the treatment of dry eye. Seciera is a patented, novel, proprietary formulation of cyclosporine A. In a Phase 2b/3 study (N=455), Seciera "demonstrated a rapid onset of action and was well tolerated by the study population. Based on the published data in literature, the efficacy and safety endpoints in these trials compared favorably to other formulations of cyclosporine A."


  • Patients with glaucoma may have unsatisfactory refractive outcomes after cataract surgery if they have a large lens vault, according to a new study. Y.C. Kim and colleagues retrospectively evaluated refractive outcomes after cataract surgery between patients with closed-angle (n=29) and open-angle (n=94) glaucoma. At a postoperative 6-month evaluation, the mean absolute error (MAE) predicted by the SRK-II and SRK-T formulae was 0.67±0.61 D and 0.81±0.66 D, respectively. The overall predictability of achieving within ±1.0 D of target was 76.92% and 72.73%, respectively. At a cutoff value of 1.0 D for MAE, there was no statistical significant difference in refractive outcome between the two groups. Logistic regression modeling showed that large lens vault was a significant predictor of unsatisfactory refractive outcome after cataract surgery in patients with glaucoma. The study is published in BMC Ophthalmology.
  • Descemet's membrane endothelial keratoplasty (DMEK)-only procedures are more likely to require air removal than those combined with cataract surgery, which suggests that decreased zonular flexibility may prevent the air bubble from taking a more spherical shape and more easily allow occlusion of iridotomy, according to A. Gonzalez and colleagues. They retrospectively reviewed 368 consecutive DMEK cases performed to treat Fuchs' dystrophy, bullous keratopathy, or failed keratoplasty. Using an air management algorithm, slit lamp assessment 1 hour after DMEK identified complete air fill in 80/368 eyes (22%). This spontaneously resolved in 45 eyes. Air was removed from 35 eyes (9%). Eyes that required air removal were more likely to have occluded iridotomy than did eyes in which the full air fill spontaneously resolved (23% vs. 6.6%, respectively, P=0.05). Although full air fill was more likely after DMEK combined with cataract surgery (P=0.001), air removal was more likely after DMEK-only procedures (P=0.01). Eyes that underwent air removal tended to have lower rebubble rates, although this did not reach statistical significance (P=0.06). No cases of pupillary block glaucoma occurred, and full air fill did not significantly affect 6-month postoperative vision or endothelial cell density. The study is published in Cornea.
  • Both topography-guided LASIK and wavefront-optimized LASIK produce excellent results, but topography-guided LASIK was associated with better contrast sensitivity, lower induction of higher-order aberrations (HOAs), and a smaller amount of tissue ablation, according to Arun Kumar Jain, MD, and colleagues. In their prospective contralateral eye case study, 35 patients had topography-guided LASIK in one eye and wavefront-optimized LASIK in the contralateral eye using the Customized Refractive Surgery Master software and Mel 80 excimer laser (Carl Zeiss Meditec, Jena, Germany). Uncorrected distance visual acuity (UDVA) was 0.0 logMAR or better, and the postoperative residual MRSE was ±0.50 D in 94.29% of eyes in the topography-guided group and 85.71% of eyes in the wavefront-optimized group (P=.09). More eyes in the topography-guided group than in the wavefront-optimized group had a UDVA of −0.1 logMAR or better (P=.04). Topography-guided LASIK was associated with less deterioration of mesopic contrast sensitivity at higher spatial frequencies (12 cycles per degree [cpd] and 18 cpd) and lower amounts of induced coma (P=.04) and spherical aberration (P=.04). Less stromal tissue was ablated in the topography-guided group (mean 61.57±16.23 μm) than in the wavefront-optimized group (mean 79.71±14.81 μm) (P<.001). The study is published in the Journal of Cataract & Refractive Surgery.


  • Topcon (Tokyo) launched the IMAGEnet Connect, a "vendor neutral ophthalmic workflow, image and data management system that seamlessly connects eyecare devices and systems" for use in clinics to streamline data management.

EYEWORLD WEEK Online is edited by Stacy Majewicz and Michelle Dalton.

EyeWorld Week Online (ISSN 1089-0319), a digital publication of the American Society of Cataract and Refractive Surgery and the American Society of Ophthalmic Administrators, is published every Friday, distributed by email, and posted live on Friday.

Medical Editors: Eric Donnenfeld, MD, chief medical editor; Rosa Braga-Mele, MD, cataract editor; Clara Chan, MD, cornea editor; Nathan Radcliffe, MD, glaucoma editor; and Vance Thompson, MD, refractive editor.

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