Category: Peer-reviewed

Author reply – Corrected Proof

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Beaumont et al and Ueta raise concerns about the systemic safety of aflibercept for intravitreal injection, particularly regarding cerebrovascular risk and stroke, based on their analysis of safety data from the VIEW studies comparing aflibercept to r…

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Clinical Manifestations of Patients with Intraocular Inflammation and Positive QuantiFERON–TB Gold In-Tube Test in a Country Non-endemic for Tuberculosis – Accepted Manuscript

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Abstract: Purpose: To evaluate clinical manifestations of patients with uveitis and scleritis of unknown origin and positive QuantiFERON–TB test Gold In-Tube (quantiferon) in a country not endemic for tuberculosis.Design: Multicentre retrospective co…

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Descemet’s Membrane Endothelial Keratoplasty: Clinical Results of Single Versus Triple Procedures (Combined with Cataract Surgery) – Corrected Proof

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Purpose: To compare the outcomes of triple Descemet’s membrane endothelial keratoplasty (DMEK) versus DMEK alone in pseudophakic eyes.Design: Retrospective, comparative, interventional case series.Participants: Patients with Fuchs’ endothelial dystrophy, secondary corneal edema, and prior failed endothelial keratoplasty with or without prior cataract extraction.Methods: Outcomes of 492 DMEK procedures performed between April 2010 and August 2012 were reviewed; 292 pseudophakic eyes underwent DMEK (group 1) and 200 eyes had concurrent cataract surgery with DMEK (group 2).Main Outcome Measures: Corrected distance visual acuity, endothelial cell loss, immediate and early postoperative complications.Results: The mean age at the time of surgery was 70 years (range, 47–94 years) in group 1 and 64 years (range, 46–90 years) in group 2 (P < 0.0001). At 6 months, the median corrected distance visual acuity was 20/25 (range, 20/16–20/80; n = 164) in group 1 and 20/20 (range, 20/16–20/100; n = 121) in group 2 (P < 0.0001), excluding 21 eyes with retinal or optic nerve problems. The DMEK graft failed to clear in 9 eyes (3.1%) in group 1 and 7 eyes (3.5%) in group 2 (P = 0.34); all were regrafted successfully with DMEK. No further graft failures occurred during the follow-up period. The air reinjection rate was 30% in group 1 and 29% in group 2 (P = 0.69). The air reinjection rate dropped significantly in both groups, from 45% to 16%, after use of viscoelastic was eliminated during the tissue insertion step. The median endothelial cell loss at 3 to 6 months did not differ significantly between groups (26% in both).Conclusions: Triple DMEK was not associated with any higher risk of complications than DMEK alone. Compared with sequential management of patients with concomitant cataract and endothelial dysfunction, triple DMEK is an effective strategy in rapid visual rehabilitation and offers the advantage of a 1-stage procedure, with reduced risks and costs.Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

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Macular Morphology in Patients with Optic Nerve Head Drusen and Optic Disc Edema – Corrected Proof

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Purpose: In this study we investigated macular morphology, including individual retinal layers, in patients with optic nerve head drusen (ONHD) and optic disc edema (ODE) compared with healthy participants, using high-resolution spectral domain optical coherence tomography (OCT).Design: Prospective, cross-sectional, observational study.Participants: A total of 67 patients with ONHD, 36 patients with ODE, and 57 healthy participants.Methods: High-resolution spectral domain OCT (Copernicus [OPTOPOL Technology S.A., Zawiercie, Poland] 3-μm resolution, 7×7×2-mm volumetric scans) was used to image macula morphology. Average retinal nerve fiber layer (RNFL) thickness was measured using a semiautomated method with manual correction of the internal limiting membrane, RNFL, and retinal pigment epithelium (RPE). Retinal and RNFL thicknesses were measured and analyzed in 3 circular zones (Early Treatment Diabetic Retinopathy Study protocol). Individual retinal layers at the macula were quantified by analyzing tomograms using ImageJ (http://rsbweb.nih.gov/ij/; Accessed June 1, 2013).Main Outcome Measures: Average retinal and individual retinal layer thickness in patients with ODE or ONHD, and healthy controls.Results: Patients with ONHD had thicker retinae in the inner annulus compared with patients with ODE and controls (significant in the temporal segment compared with those with ODE [P = 0.013] and in the superior segment compared with controls [P = 0.05]). Patients with ONHD had a significantly thinner inner plexiform layer (IPL) (P = 0.02), nerve fiber layer (P = 0.05), and RPE (P = 0.0001), and thicker ganglion cell layer (P = 0.003) and outer plexiform layer (OPL) (P < 0.001) compared with controls. Patients with ODE demonstrated the thickest retina and RNFL in the outer annulus (significant in the inferior segment compared with controls, P = 0.02 for both) with significant thickening in the IPL (P = 0.004), OPL (P < 0.003), and outer segment layer (P ≤ 0.02), and severe ganglion cell loss (P = 0.004) and RPE (P = 0.0001) thinning compared with healthy volunteers.Conclusions: Our study shows that optic nerve diseases are associated with selective changes in different retinal layers in patients with ODE and ONHD. These findings may be of diagnostic value and could be taken into consideration in assessing patients and studying the pathogenesis of these conditions.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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A Multicenter, Open-Label, 52-Week Study of 2% Rebamipide (OPC-12759) Ophthalmic Suspension in Patients with Dry Eye – Accepted Manuscript

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Abstract: Purpose: To investigate the efficacy and safety of 2% rebamipide ophthalmic suspension administered 4 times daily for 52 weeks in patients with dry eye.Design: Multicenter (17 sites), open-label single-arm study.Methods: A total of 154 patients with dry eye were enrolled in this study. After a 2-week screening period, patients received 2% rebamipide, instilled as 1 drop in each eye, 4 times daily for 52 weeks. The signs and symptoms measures were assessed at baseline, at weeks 2 and 4, and at every 4 weeks thereafter. The objective signs were fluorescein corneal staining score, lissamine green conjunctival staining score, and tear film break-up time, while subjective symptoms were dry eye-related ocular symptoms (foreign body sensation, dryness, photophobia, eye pain, and blurred vision). The safety variable was the occurrence of adverse events.Results: For all objective signs and subjective symptoms, the scores significantly improved at week 2 compared with at baseline (P < .001, paired t-test). Interestingly, further improvements of those scores were observed at every visit up to week 52. No deaths were reported, yet serious adverse events which were not thought to be drug-related were observed in 6 patients. Incidence of any of the adverse events did not markedly increase throughout the 52-week treatment period.Conclusion: The results of this study show that 2% rebamipide was effective in improving both the objective signs and subjective symptoms of dry eye patients for at least 52 weeks. In addition, 2% rebamipide treatment was generally well-tolerated.

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A Method to Estimate the Amount of Neuroretinal Rim Tissue in Glaucoma: Comparison with Current Methods for Measuring Rim Area – Accepted Manuscript

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Abstract: Purpose: To test whether the minimum rim area assessed by spectral domain optical coherence tomography (SD-OCT), based on the shortest distance from Bruch’s Membrane Opening (BMO) to the inner limiting membrane, corresponds more closely to retinal nerve fiber layer (RNFL) thickness and visual field mean deviation (MD) than current rim measures in early glaucoma.Design: Prospective cross-sectional study.Methods: 221 participants with non-endstage glaucoma or high-risk ocular hypertension performed standard automated perimetry, and received SD-OCT and confocal scanning laser ophthalmoscopy (CSLO) scans, on the same day. Rim area measured by CSLO was compared with three SD-OCT rim measures from radial B-scans: horizontal rim area between BMO and ILM within the BMO plane; mean minimum rim width (BMO-MRW); and minimum rim area (BMO-MRA) optimized within sectors and then summed. Correlations between these measures and either MD from perimetry or RNFL thickness from SD-OCT were compared using Steiger’s test.Results: RNFL thickness was better correlated with BMO-MRA (r=0.676) or BMO-MRW (r=0.680) than with either CSLO Rim Area (r=0.330, p<0.001) or Horizontal Rim Area (r=0.482, p<0.001).MD was better correlated with BMO-MRA (r=0.534) or BMO-MRW (r=0.546) than with either CSLO Rim Area (r=0.321, p<0.001) or Horizontal Rim Area (0.403, p<0.001). The correlation between MD and RNFL thickness was r=0.646.Conclusions: Minimum rim measurements from SD-OCT are significantly better correlated to both RNFL thickness and MD than rim measurements within the BMO plane, or based on the clinical disc margin. They provide new structural parameters for both diagnostic and research purposes in glaucoma.

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Imaging the Posterior Segment of the Eye using Swept-Source Optical Coherence Tomography in Myopic Glaucoma Eyes: Comparison with Enhanced-Depth Imaging – Accepted Manuscript

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Abstract: Purpose: To compare the detection rates of identifying the posterior border of the sclera and lamina cribrosa and measurement reproducibility of scleral and laminar thicknesses using enhanced depth imaging (EDI) of Heidelberg Spectralis optic…

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Impact of Crystalline Lens Opacification on Effective Phacoemulsification Time in Femtosecond Laser-Assisted Cataract Surgery – Corrected Proof

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Purpose: To compare effective phacoemulsification time in cataract surgery performed by manual phacoemulsification vs femtosecond laser-assisted lens fragmentation.Design: Retrospective, consecutive, nonrandomized, comparative case series.Methods: The setting was the Department of Ophthalmology, Goethe-University, Frankfurt, Germany. The study population included 150 eyes of 86 patients with senile cataract. In the intervention, 88 eyes (group 1) underwent femtosecond laser-assisted surgery (corneal incisions, capsulotomy, lens fragmentation) using the LenSx platform (Alcon) and residual lens work-up with pulsed ultrasound energy (Infiniti Vision System; Alcon). In 62 eyes (group 2), complete cataract removal was performed with phacoemulsification only, using pulsed ultrasound energy with the same device (Infiniti). Nucleus staging (Pentacam nucleus staging; PNS) was evaluated using Pentacam HR (Oculus); endothelial cell density was measured using specular microscopy (NonCon Robo). The main outcome measures were as follows. Mean preoperative PNS staging was assessed using an automatic ordinal scaling (PNS-O, grades 0–5) and a manually defined density grid derived from Scheimpflug imaging (PNS-P [%]). Effective phacoemulsification time and endothelial cell loss were evaluated in both groups.Results: Preoperative PNS-O and PNS-P showed no significant difference between groups (P = 0.267). Overall mean effective phacoemulsification time was significantly lower in group 1 (1.58 ± 1.02 seconds) compared to 4.17 ± 2.06 seconds in group 2 (P = 0.001). Effective phacoemulsification time was significantly lower in group 1 for all PNS-O stages (P < 0.001). With increasing preoperative PNS-P, effective phacoemulsification time increased in both groups; however, this gain was noticeably, but not significantly, lower in group 2. Endothelial cell loss was significantly lower in group 1 (P = 0.02).Conclusions: Femtosecond laser-assisted cataract surgery allows a significant reduction in effective phacoemulsification time, which correlates positively with the preoperative lens opacity.

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