EyeWorld Weekly Update, June 16, 2017

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June 16, 2017
Volume 23 , Number 22

Primary efficacy endpoints reached in posterior segment uveitis Phase 3 study

A second Phase 3 trial for the sustained-released treatment Durasert (pSivida, Watertown, Massachusetts) for posterior segment uveitis achieved the trial's primary endpoint, according to a company press release. The study included 153 patients, and the primary endpoint was the prevention of posterior uveitis recurrence at 6 months. Patients were followed for 36 months. "Durasert 3-year insert demonstrated a significant reduction in the recurrence of posterior segment uveitis through 6 months; 21.8% of Durasert-treated patients had a recurrence compared to 53.8% of patients in the sham group," the press release reported. The IOP elevation was 2.4 mm Hg and 1.3 mm Hg at 6 months compared with baseline for Durasert and the sham, respectively. During the first 6 months of follow-up, 41.6% of Durasert patients required IOP-lowering therapy in the Durasert group compared with 34.6% in the sham group. The company expects to submit a European Marketing Authorization Application by the end of this month and a New Drug Application with the U.S. Food and Drug Administration in the fourth quarter of this year, pSivida reported. The Durasert insert is a treatment that can last 2 to 3 years.

June is Cataract Awareness Month

June is Cataract Awareness Month, and there are several online resources for physicians to help patients better understand what cataracts are and how to prevent them or seek treatment for them. The National Eye Institute "Facts About Cataract" page, , explains what causes cataracts and has links to cataract research news. There is also a short video that patients can watch. Prevent Blindness addresses what cataracts are, symptoms, and risk factors at . There is also a PDF resource on the site that covers certain myths about cataracts, such as "Cataract can be treated with eye drops" and "It can take months to recover from cataract surgery." A site from Alcon (Fort Worth, Texas), , includes information for patients such as lens options and steps to plan for surgery.

Computer model shows how OCT can identify drusen connected to AMD

A new computer model developed by Hrvoje Bogunovic, Department of Ophthalmology, Medical University of Vienna, Austria, can be used with OCT to predict whether drusen will survive or disappear. The researchers used artificial intelligence technology to develop their computer model, which calculates the risk of drusen disappearing. Their research, presented at the 2017 Association for Research in Vision and Ophthalmology meeting, analyzed 38 patients and discovered 944 drusen, of which 249 (26%) disappeared, according to a press release. "Our findings are a promising step toward image-guided prediction of the progress of age-related macular degeneration. Our model enables us to compile a drusen atlas ... which we can then use to predict, in the case of each individual patient, which are at higher risk for disappearing," Bogunovic said in the press release. Further analysis is underway.

RESEARCH BRIEFS

  • Capsulotomies created by a femtosecond laser with a contact lens interface were as strong as manual capsulorhexes, according to Thomas Chan, MB BS, and co-researchers. Their study focused on the breaking force required to tear an explanted capsule after femtosecond laser-assisted cataract surgery (FLACS) in the worse eye and manual cataract surgery in the contralateral eye. The prospective nonrandomized case study used paired samples from 78 eyes (39 patients). There was no significant difference in mean breaking force between manual and femtosecond laser capsulorhexes. Additionally, the breaking strain for samples from the two groups were not that different. In five patients in the femtosecond group the capsules required less force to break than capsules in the manual group. Scanning electronic microscopy images of the latter patients did not show specific laser imperfections. The research is published in the Journal of Cataract & Refractive Surgery.
  • Tip designs in advanced phacoemulsification systems are a crucial factor in increasing efficacy in cataract surgery, according to Milena Pahlitzsch, MD, and co-researchers. Their prospective randomized study included 343 eyes from 343 patients having cataract surgery (196 patients had femtosecond laser-assisted cataract surgery, and 147 had manual phacoemulsification). The Intrepid balanced tip (Alcon) and Kelman tapered tip (Alcon) were tested with FLACS and manual phaco. The main outcome measures were cumulative dissipated energy, balanced salt solution volume, total longitudinal energy, and torsional amplitude. There were lower cumulative dissipated energy values in the FLACS group compared with manual phaco. A significant difference was seen in cumulative dissipated energy in the FLACS balanced tip group compared with the FLACS tapered tip group as well as between the FLACS balanced tip group and manual tapered tip group. The balanced tip was able to conserve more energy than the tapered tip, the authors reported. The research is published in Clinical & Experimental Ophthalmology.
  • Phacoemulsification can lower IOP in patients with primary open-angle glaucoma (POAG) and reduce dependency on topical glaucoma medications, according to a meta-analysis led by James Armstrong, HBSc. The study was spurred by a lack of guidance as to whether cataract extraction and traditional filtering surgery should be performed as a staged or combined procedure in patients with both cataract and POAG, according to the authors. They identified 32 studies (1,826 subjects) in their database search. "A 12%, 14%, 15%, and 9% reduction in IOP from baseline occurred 6, 12, 24, and 36 months after phacoemulsification," the researchers wrote. "A mean reduction of 0.57, 0.47, 0.38, and 0.16 medications per patient of glaucoma medication occurred 6, 12, 24, and 36 months after phacoemulsification." The effects of phaco appear to last at least 3 years, but the researchers noted a gradual loss of the initial effect after 2 years. More research is needed to identify the populations that appear to experience a greater reduction in IOP. The research is published in the Journal of Glaucoma.
  • Excellent clinical outcomes were achieved for up to 2 years after Descemet membrane endothelial keratoplasty (DMEK) in an evaluation of 500 consecutive cases. The 500 cases (393 patients) had DMEK for Fuchs' endothelial corneal dystrophy, bullous keratopathy, failed corneal transplants, and other reasons. Researchers, led by Jorge Peraza-Nieves, MD, found that 81% of eyes had a best corrected visual acuity (BCVA) of 20/25 or better at 12 months postoperatively; 49% had a BCVA of 20/20 or better, and 15% had a BCVA of 20/18 or better and remained stable up to 2 years. The mean postoperative endothelial corneal cell density decreased by 37%, 40%, and 45% at 6, 12, and 24 months, respectively. Eyes with Fuchs' dystrophy and attached grafts had better BCVA outcomes and higher endothelial corneal cell density. Retransplantation was performed in 32 eyes (6.4%) during the study period; the main long-term complications were secondary graft failure (1.4%) and allograft rejection (1.4%). The research is published in Cornea.

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; Reay Brown, MD, glaucoma editor; and Vance Thompson, MD, refractive editor.

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