EW Weekly, January 31, 2020

Use protection for mouth, nose, and eyes when treating potential coronavirus cases
A novel coronavirus (2019-nCoV) could possibly cause conjunctivitis, and there is the potential for it to spread through aerosol contact with the conjunctiva, according to the American Academy of Ophthalmology (AAO), which cited anecdotal reports. 2019-nCoV emerged in Wuhan, China, with the first known human infection in December 2019. Its numbers have since grown into the thousands in China and patients with confirmed infection have been reported in other countries around the globe, including the U.S. AAO recommends the use of mouth, nose, and eye protection when caring for patients who may be infected with the coronavirus. “Affected patients frequently present to eye clinics or emergency departments. That increases the likelihood ophthalmologists may be the first providers to evaluate patients possibly infected with 2019-nCoV,” AAO reported in a press release. When identifying possible coronavirus cases, ophthalmologists should ask 1) if the patient is presenting for conjunctivitis, 2) if they also have respiratory symptoms, 3) if they have traveled internationally recently, and 4) if their travel includes a recent trip to China or if they have family members recently back from China.

Ocuphire enters agreement to in-license oral, small-molecule drug candidate for DR, DME
Ocuphire Pharma has entered into an agreement with Apexian Pharmaceuticals to grant Ocuphire a worldwide sublicense for Apexian’s Ref-1 Inhibitor program, according to an Ocuphire press release. This includes Apexian’s drug candidate APX3330, an orally administered, small-molecule drug that targets and inhibits reduction-oxidation effector factor-1 protein, which is an upstream regulator of critical transcription factors that control inflammatory and angiogenesis pathways connected to diabetic retinopathy (DR) and diabetic macular edema (DME). APX3330, according to Ocuphire, may improve eye health in patients with diabetes by lowering inflammation, hypoxia signaling, and abnormal angiogenesis. In Phase 1 and 2 trials, APX3330 has been given twice daily to more than 400 subjects and has clinical data that supports chronic administration. Trial work for APX3330 is still underway.

First single-cell analysis of uveal melanoma announced
The first single-cell analysis of uveal melanoma was announced by researchers at Bascom Palmer Eye Institute, Miami, Florida, led by J. William Harbour, MD. Part of the key findings were an enrichment of T cells that expressed the checkpoint molecule LAG3 instead of PD1 and CTLA4 molecules, which have been the focus of most checkpoint inhibitor therapy. LAG3 may be a new target for immunotherapy in uveal melanoma, reported Dr. Harbour and colleagues. Their findings were published in Nature Communications.

DEXYCU to be developed, commercialized in mainland China and other countries
EyePoint Pharmaceuticals and Ocumension Therapeutics have announced an exclusive license agreement to develop and commercialize DEXYCU (dexamethasone intraocular suspension) 9% to treat postop inflammation after ocular surgery in mainland China, Hong Kong, Macau, and Taiwan. In the U.S., DEXYCU is marketed by EyePoint. EyePoint maintains the worldwide development and commercialization rights outside of the territories that are licensed to Ocumension.

Research briefs
  • In a retrospective consecutive case series comparing the accuracy of new and updated methods of IOL power calculation against those of established methods, the Kane formula was the most accurate, reported Kieren Darcy, BM, and coresearchers. They included the newer Kane, Hill-RBF 2.0, and Holladay 2 (with new axial length adjustment) formulas and the established Barrett Universal II, Olsen, Haigis, Holladay 1, Hoffer Q, and SRK/T formulas. Researchers included 10,930 eyes from 10,930 patients, and all patients had uneventful cataract surgery and the insertion of one of four IOL types. The Kane formula had the lowest mean absolute prediction error (P<.001 in all cases). This was followed by Hill 2.0, Olsen, Holladay 2, Barrett Universal II, Holladay 1, SRK/T, Haigis, and the Hoffer Q. With the Kane formula, 72% of eyes were predicted within ±0.5 D, followed by 71.2% with the Hill 2.0 and 70.6% with the Olsen formula. For each IOL subtype analyzed and the short, medium, and long axial length subgroups, the Kane formula had the lowest mean absolute prediction error. The study appears in the Journal of Cataract & Refractive Surgery.
  • In a prospective, comparative case series comparing dry eye syndrome after Müller’s muscle-conjunctival resection for ptosis and an upper blepharoplasty, ptosis surgery led to an increase in subjective dry eye feelings as well as dry eye signs, reported Ofira Zloto, MD, and coresearchers. This same increase was not noticed after blepharoplasty surgery. Among the blepharoplasty group (23 patients) were adult patients with dermatochalasis. The ptosis group (31 patients) included adult patients with dermatochalasis and ptosis who demonstrated significant improvement after phenylephrine 10% instillation. At baseline and at postop day 90, Ocular Surface Disease Index (OSDI) results, Schirmer’s test 2, tear breakup time, fluorescein staining, and lissamine green staining were compared. The postop OSDI score was significantly higher after ptosis surgery compared with preop results (25.38 vs. 17.24). Physicians should be aware of the risk for dry eye after ptosis surgery, discuss it with patients, and carefully examine for dry eye during follow-up, the researchers concluded. The study is published in the American Journal of Ophthalmology.
  • A neural feedback mechanism driven by intracranial pressure appears to regulate conventional outflow facility in rats and may protect the eye from translaminar pressure swings, according to Kayla Ficarrotta, PhD, and coresearchers. This may offer a new target for glaucoma researchers, they wrote. Their study tested the role of intracranial pressure and its modulation of IOP by cannulating the anterior chamber and lateral ventricle of 18 anesthetized Brown Norway rats. They were connected to a programmable pump and saline reservoir, and the intracranial pressure was manipulated by varying reservoir height. Eye outflow facility was determined from the pump flow rate required to hold the IOP at different levels. The eye outflow facility was 22 nl/min/mm Hg at resting intracranial pressure and 13 nl/min/mm Hg when the intracranial pressure was raised 15 mm Hg, which was a 13% reduction. The outflow facility decrease was independent of blood pressure, reversible, scaled with intracranial pressure elevation, and correlated with rises in resting IOP. The research is published in the Journal of Physiology.
  • More rapid visual recovery occurred with Descemet membrane endothelial keratoplasty (DMEK) and nanothin Descemet stripping automated endothelial keratoplasty (DSAEK) compared with thicker DSAEK, according to Moïse Tourabaly and coresearchers. However, final vision quality was not influenced by graft thickness. The study analyzed 150 endothelial keratoplasties performed in eyes with corneal endothelial disorders and no other ocular comorbidities. Eyes were classified into five groups: DMEK, nanothin DSAEK, ultrathin DSAEK, thin DSAEK, and conventional DSAEK. The majority of the eyes (92.7%) had been diagnosed with Fuchs dystrophy. The mean graft thickness after graft deswelling was 74 µm. Mean follow-up was 32 months. The mean spectacle-corrected logMAR visual acuity improved from 0.76 to 0.14. In the DMEK and nanothin DSAEK groups, the time to reach 20/40 vision was significantly shorter. A better preop visual acuity and a thinner graft were factors associated with a shorter time to reach 20/40 visual acuity. A higher final vision improvement was associated with poorer preop visual acuity, and higher postop higher order aberrations were associated with poorer preop visual acuity. The research appears in the British Journal of Ophthalmology.

This issue of EyeWorld Weekly was edited by Stacy Jablonski and Vanessa Caceres.

EyeWorld Weekly (ISSN 1089-0319), a digital publication of the American Society of Cataract and Refractive Surgery (ASCRS), 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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