Pazopanib Eyedrops for Choroidal Neovascularization
Published online Nov. 25, 2014
Csaky et al. evaluated whether daily-dosed pazopanib eyedrops could maintain or possibly improve vision while reducing the continued need for intravitreal ranibizumab in patients with active subfoveal choroidal neovascularization secondary to age-related macular degeneration. They found that the drops had no treatment benefit beyond that obtained from dosing with intravitreal ranibizumab alone.
For this study, 510 patients were randomized to one of four treatment groups: placebo eyedrops instilled four times per day; pazopanib 5 mg/mL drops instilled three or four times per day; pazopanib 10 mg/ mL drops instilled two, three, or four times per day; or an intravitreal injection of ranibizumab given once every four weeks. In addition, open-label ranibizumab was administered to all groups as needed.
At the one-year mark, treatment with the pazopanib eyedrops was found to be safe and well tolerated. However, their use neither reduced the number of as-needed ranibizumab injections nor provided added anatomic or visual acuity benefits compared with the ranibizumab-only group.
Choroidal Melanoma Recurrence After Transpupillary Thermotherapy
Mashayeki et al. evaluated the long-term outcome of patients with small choroidal melanomas treated with transpupillary thermotherapy (TTT). They found a direct correlation between a larger number of high-risk tumor features and higher rates of tumor recurrence after TTT treatment. As a result, they recommended that small choroidal melanomas with multiple risk factors be treated with other measures.
For this retrospective review, the researchers evaluated 391 patients treated between 1995 and 2012 at Wills Eye Hospital (mean follow-up, 82 months). Patients were analyzed by date of treatment, with 311 treated from 1995 to 2000 and 80 treated from 2001 to 2012. The two groups had similar demographic features, but the latter group had a lower rate of ocular symptoms (27 percent) than did the former (56 percent).
Tumor recurrence rates at three, five, and 10 years were 19.1 percent, 28.7 percent, and 42.1 percent, respectively, for those treated from 1995 to 2000, while recurrence rates were 8.6 percent, 11.4 percent, and 14.9 percent, respectively, for those treated from 2001 to 2012. However, when recurrence rates were analyzed by tumor feature, a different pattern emerged. The 10-year recurrence rate was 18 percent in those with one or two risk factors, 35 percent in those with three to five risk factors, and 55 percent in those with six or seven risk factors.
On multivariate analysis, features predictive of tumor recurrence included presence of symptoms, shorter distance between the tumor and the optic disc, subretinal fluid, thickness of residual tumor scar, and elevation of residual tumor scar. The presence of orange pigment before TTT and extraocular tumor extension were predictive of tumor metastasis. The only factor predictive of extraocular tumor extension was intraocular tumor recurrence after additional TTT treatment.
The researchers concluded that primary TTT of high-risk small choroidal melanocytic lesions should be performed cautiously. Moreover, patients who receive TTT for high-risk lesions should be counseled regarding the risk of vision loss, the need for long-term observation, and the possible need for more treatment, ranging from additional TTT to enucleation.
Overnight Orthokeratology for Myopic Children
Swarbrick et al. investigated the effect of overnight orthokeratology (OK) contact lens wear on axial length growth in East Asian children with progressive myopia. They found that the overnight use of the OK lens was more effective at inhibiting axial eye growth and myopia progression than daytime wear of a conventional rigid gas-permeable (GP) lens.
For this prospective study, the researchers employed a contralateral-eye crossover design. The 26 children in the study were fitted with an OK lens in one eye for overnight wear and a GP lens in the contralateral eye for daytime wear. This protocol was followed for six months. After a two-week washout period, the lens/eye combination was reversed, and the lenses were worn for an additional six months.
GP lens–wearing eyes showed progressive axial length growth throughout the study. After the first six months of lens wear, axial length had increased by 0.04 ± 0.06 mm in the GP eyes but did not change in the OK eyes. In the second six-month period, OK eyes again showed no change in axial length, while axial length increased by 0.09 ± 0.08 mm in the GP eyes.
Ophthalmology summaries are written by Jean Shaw and edited by Susan M. MacDonald, MD.
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