EW Weekly, April 7, 2017

April 7, 2017
Volume 22 , Number 14

Breast cancer drug could help cure retinal diseases

Tamoxifen, a drug commonly used for breast cancer patients, unexpectedly was found to offer protective effects against photoreceptor degeneration in a recent study, reported Xu Wang, PhD, and co-investigators. They speculated that the drug may be worthy of further clinical studies as a potential treatment for retinitis pigmentosa and atrophic AMD. Investigators used two separate mouse models in their discoveries. "In a light-induced degeneration model, tamoxifen prevented onset of photoreceptor apoptosis and atrophy and maintained near-normal levels of electroretinographic responses," the investigators wrote. "Rescue effects were correlated with decreased microglial activation and inflammatory cytokine production in the retina in vivo, and a reduction of microglia-mediated toxicity to photoreceptors in vitro, indicating a microglia-mediated mechanism of rescue." The results seem to contradict previous findings that linked tamoxifen to the occurrence of retinal toxicity. The work is published in the Journal of Neuroscience.

Phase 1b trial commences for drug to treat primary ocular melanoma

The first patient was enrolled in a Phase 1b trial late last month for AU-011 (Aura Biosciences, Cambridge, Massachusetts), an investigational therapy in development for the treatment of ocular melanoma, according to an Aura press release. Trial researchers will evaluate the safety of two dose levels of AU-011 to treat small-to-medium primary ocular melanoma in up to 12 adult patients at Wills Eye Hospital, Philadelphia, and other ocular oncology centers around the U.S. Patients will be followed up for a 2-year observation period. Aura Biosciences also announced that the U.S. Food and Drug Administration (FDA) has granted AU-011 a fast-track designation to treat primary ocular melanoma. This allows Aura to have more interaction with the FDA during the drug development process and have priority review of its New Drug Application.

Study: Ethnicity plays a role in the visual function of AMD

Among a group of Asian patients from different ethnicities, Chinese study participants had more negative vision-specific functioning (VSF) effects from early and late age-related macular degeneration (AMD) compared with Malay and Indian patients. The findings suggest a possible ethnic influence with the disease and VSF and the possible need for ethnicity-based strategies to delay AMD onset or progression, according to Eva K. Fenwick, PhD, and co-investigators. The population-based study included 9,962 Chinese, Malay, and Indian adults in Singapore. Investigators used gradable fundus images and Visual Function Index data to analyze patients. Data were collected from January 2004 to December 2011. Chinese participants with late AMD had a 19.1% loss of VSF, which was clinically significant. This differed from the Malay group, with a 13.5% VSF drop and no VSF loss in the Indian group. Screening for early detection and management of AMD could help minimize the effects of VSF, the investigators concluded. The study is published in JAMA Ophthalmology.


  • The drug rituximab, commonly used for autoimmune diseases and some cancers, was efficacious and well tolerated for the treatment of ocular cicatricial pemphigoid (OCP) in a retrospective study. Investigators, led by Caiyun You, MD, PhD, reviewed 32 patient records (61 eyes) at a tertiary referral center with biopsy for patients who had confirmed OCP and who presented between 2006 and 2016. Patients received treatment with rituximab monotherapy or rituximab with additional immunomodulatory treatment. Twenty-six patients achieved clinical remission and had an average sustained remission of 24.5 months (range, 9 to 84 months). Adverse events that occurred included leukopenia in three patients (9.4%), anemia in two patients (6.2%), liver enzyme elevation in three patients (9.4%) who also used a concomitant immunomodulatory drug, and Epstein-Barr virus infection and sinus infection in one patient each (3.1%). Future studies are needed to further clarify the role of rituximab therapy for OCP, including optimum dose and duration of administration, the investigators concluded. The study is published in Graefe's Archive for Clinical and Experimental Ophthalmology.
  • Both femtosecond laser-assisted LASIK and PRK had similar effects on the ocular surface in a prospective, comparative, observational study. Led by Paola Sauvageot, MD, PhD, investigators included 44 patients (44 eyes; 22 in each group) with myopia. They analyzed tear osmolarity, the Ocular Surface Disease Index questionnaire, Schirmer I test results, corneal sensitivity, tear breakup time, and corneal fluorescein staining preoperatively and at 3, 6, and 12 months postoperatively. In the LASIK and PRK group, corneal sensitivity decreased after 3 months (P = .002 and P = .02, respectively) and 6 months (P = .03 and P = .04, respectively) compared with preoperative evaluation. Tear osmolarity was slightly higher after a year, but mean values remained in a normal range (P = .01 and P = .04, respectively). Investigators found the only difference between the two groups was a lower corneal sensitivity in the LASIK group after 3 months (P = .02). "The ocular surface condition could be considered clinically unaltered after 1 year in both groups," the investigators concluded. The study appears in the Journal of Cataract & Refractive Surgery.
  • Surgeons and their clinical staff can try to help improve the patient experience of AMD treatment, according to Hugo Senra, PhD, and coinvestigators. That's because their work finds that anti-vascular endothelial growth factor (VEGF) treatment for AMD often has some associated anxiety, and clinical levels of depression seem to be more common in patients at the early stages of treatment. Their study aimed to look at clinically significant levels of depression, anxiety, and posttraumatic stress among AMD patients and the level of burden among their caregivers. Among 300 patients and 100 caregivers recruited for the study, 56% of patients (n = 132) reported anxiety related to anti-VEGF treatment, with the most common fear being blindness from intravitreal injections and concerns about the effectiveness of treatment. Seventeen percent (n = 52) of patients had clinical levels of anxiety, and 12% (n = 36) had clinical levels of depression. Depression was significantly higher in patients receiving up to three injections compared with patients receiving four to 12 injections and compared with patients receiving more than 12 injections. The research is published in the American Journal of Ophthalmology.
  • The prognosis for repeat keratoplasty was excellent after failed deep anterior lamellar keratoplasty (DALK) in a retrospective study led by Sepehr Feizi, MD, MSc, and coinvestigators. Outcomes with secondary grafts were comparable to those of primary DALK grafts. Still, the rejection rate with secondary groups was high and required close follow-up after penetrating keratoplasty (PK) and repeat DALK performed for failed DALK. Investigators reviewed patients with keratoconus who had DALK and were followed up for 1 year or more. Of 382 consecutive eyes with keratoconus who had DALK over 9 years, graft failure was observed in 14 eyes for reasons included nonhealing epithelial defects, pseudoanterior chamber, patient dissatisfaction with vision, interface opacification, high astigmatism, and recurrence of keratoconus in the graft. Twelve of these 14 eyes had PK or repeat DALK. All regrafts were clear at the most recent exam, performed at a mean of 49.7 months after the secondary graft. "There was no significant difference between eyes with clear first grafts and eyes that underwent PK or repeat DALK in visual outcomes at the final examination," the investigators wrote. "Graft rejection was the most common complication, which was encountered in 75% of regrafts." The study is published in Cornea.


  • The Stellaris Elite vision enhancement system (Bausch + Lomb, Bridgewater, New Jersey) has received 501(k) clearance from the FDA. Stellaris Elite will be the first phacoemulsification platform on the market to offer Adaptive Fluidics and the Attune energy management system, according to a company press release. The company plans to launch Stellaris Elite for retina applications this summer, allowing for retina and cataract use in one machine.

This issue of EyeWorld Weekly Update was edited by Amy Goldenberg and Vanessa Caceres.

EyeWorld Weekly Update (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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