One-Year Results of Aflibercept Treatment of AMD
Oishi et al. conducted a prospective, nonrandomized, interventional case-series study to evaluate the efficacy of aflibercept treatment in three subtypes of age-related macular degeneration (AMD). They also assessed predictive factors for visual outcome.
A total of 98 patients with AMD were recruited from a clinic at Kyoto University in Japan. Of these, 46 had typical AMD, 42 had polypoidal choroidal vasculopathy (PCV), and 10 had retinal angiomatous proliferation (RAP). Patients received aflibercept injections monthly for three months, followed by once every two months for eight months. The logMAR acuity at 12 months and improvement of vision from baseline were compared among patients with PCV, RAP, and typical AMD. Overall mean logMAR improved from 0.36 to 0.21 in 12 months.
While there was no difference in visual improvement between typical AMD and PCV, final logMAR was better in PCV (0.32 ± 0.09 vs. 0.08 ± 0.04, p = .016). The authors also assessed polypoidal lesions in 39 PCV patients who had follow-up angiography and found that polyps regressed in 27 cases (69 percent).
Multiple regression analysis showed that the factors associated with better visual outcome with aflibercept were the presence of external limiting membrane, a smaller greatest linear dimension, and the presence of polypoidal lesions.
Effect of Pupil Dilation on Biometry
Adler et al. conducted a prospective observational case-series study to evaluate the effect of pupil dilation on biometric measurements and intraocular lens (IOL) power calculation with the IOLMaster. They concluded that pupil dilation has no clinically significant impact on IOLMaster measurements.
Two consecutive optical biometry measurements, before and after pupil dilation, were obtained using the IOLMaster on 318 eyes of 214 patients prior to cataract surgery. The parameters compared were axial length, corneal power, cylinder, and the corresponding IOL power, which was calculated using the SRK/T formula. The study found no statistically significant difference before and after dilation in axial length, corneal power, or calculated IOL power. There was, however, a statistically significant difference in cylinder measurements.
Risk Factors for Progressive Myopia With Atropine Therapy
In the Atropine for the Treatment of Myopia Study, a small group of children experienced myopic progression despite therapy. Loh et al. sought to determine the factors that contributed to such progression.
In this cohort study, 200 of 400 children were randomized to receive atropine 1 percent in one eye only. Children were followed up with cycloplegic autorefraction every four months over two years. Children whose myopia worsened by more than 0.5 D in the atropine-treated eye at one year were classified as progressors.
Among the 182 children still in the study at one year, 22 (12 percent) were progressors. Univariate analysis suggested that these children tended to be younger, to have higher myopic spherical equivalent at baseline, and to have two myopic parents. In children classified as nonprogressors, myopic progression at one year was less in the atropine-treated eye than in the untreated fellow eye; in contrast, among progressors, the myopic change was more similar between treated and untreated eyes.
Regression analysis showed that the risk of being a progressor was 40 percent lower with each year of increased age, 43 percent lower for every 1 D less in myopia at baseline, and 59 percent lower for every 1 D less in myopic change in the untreated eyes over the first year.
Ocriplasmin for Vitreomacular Traction and Macular Holes
Sharma et al. analyzed the effect of ocriplasmin on vitreomacular traction (VMT) and the rate of VMT release, full-thickness macular hole (MH) closure, and best-corrected visual acuity (BCVA) changes.
In this retrospective study, 58 eyes with VMT, defined as persistent attachment of the vitreous at the macula causing anatomic distortion of the fovea, were treated with ocriplasmin. VMT release, full-thickness MH closure, visual acuity changes, and anatomic characteristics on spectral-domain optical coherence tomography were analyzed.
VMT resolved in 29 of 58 eyes (50 percent), and nonsurgical closure of full-thickness MH was achieved in four of 15 eyes (27 percent). Mean logMAR BCVA among all treated eyes improved from 0.51 (20/65) at baseline to 0.36 (20/46) at final follow-up, with a mean follow-up of 8.7 months. In comparison to eyes without VMT release, eyes with successful VMT release had a better pretreatment BCVA (20/48 vs. 20/89) and final follow-up BCVA (20/31 vs. 20/68). Improvement in BCVA was significant in eyes with VMT release. Transient ellipsoid zone changes were noted in 15 treated eyes (26 percent), of which 14 had successful VMT release; mean time to resolution of these changes was within 38 days. Transient subfoveal fluid accumulation was noted in all patients with VMT release.
American Journal of Ophthalmology summaries are edited by Thomas J. Liesegang, MD.
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