Intravitreal ranibizumab (Lucentis®) for the treatment of myopic choroidal neovascularization

Background  Macular choroidal neovascularization (CNV) is one of the most vision-threatening complications of myopia, which can lead to severe vision loss. The purpose of this study was to evaluate the safety and efficacy of intravitreal ranibizumab in the treatment of myopic CNV. Methods  We conducted a prospective, consecutive, interventional study of patients with subfoveal or juxtafoveal CNV secondary to pathologic myopia (PM) treated with intravitreal injection of ranibizumab in the Jules Gonin University Eye Hospital from June 2006 to February 2008. Best-corrected visual acuity (BCVA), optical coherence tomography (OCT), and fluorescein angiography (FA) were performed at baseline and monthly for all patients. Indications for retreatment were loss in BCVA associated either with persistent leakage from CNV shown on FA, and/or evidence of CNV activity on OCT. Results  The study included 14 eyes of 14 patients. The mean spherical equivalent refractive error was −12.5 (range, −8.0 D to −16.0 D). Mean time of follow-up was 8.4 months (range from 3 to 16 months, SD: 3). The mean number of intravitreal injections administered for each patient was 2.36 (SD 1.5). The mean initial visual acuity (VA) was 0.19 decimal equivalent (logMAR: 0.71, SD: 0.3). A statistically significant improvement to a mean VA of 0.48 decimal equivalent (log-MAR:0.32, SD: 0.25) was demonstrated at the final follow-up. VA improved by a mean of 3.86 (SD 2.74) lines. Nine patients (64%) demonstrated a gain of 3 or more lines. Mean central macular thickness (CMT) measured with OCT was 304 μm (SD: 39) at the baseline, and was reduced significantly at the final follow-up to 153 μm (SD: 23). Average CMT reduction was 170 μm (SD: 57). No injection complications or drug-related side effects were noted during the follow-up period. Conclusions  In this small series of eyes with limited follow-up, intravitreal ranibizumab was a safe and effective treatment for CNV secondary to PM, resulting in functional and anatomic improvements. Financial Support: None     

Anti-vascular endothelial growth factor treatment for choroidal neovascularization secondary to angioid streaks in pseudoxanthoma elasticum：a case report and systemic review

The present study reports a case of a patient with choroidal neovascularization (CNV) associated with pseudoxanthoma elasticum (PXE). We observed the functional and anatomical improvement of the patient treated with intravitreal vascular endothelial growth factor (VEGF) inhibitor bevacizumab. The study also systematically searched the database for similar cases to provide a literature review. Data concerning the clinical features, treatment strategies and outcomes were extracted and analyzed. Retrospective interventional case report and systematic literature review. A 56-year-old healthy Chinese woman with CNV secondary to PXE was reported. Examinations included best corrected visual acuity (BCVA), biomicroscopy, optical coherence tomography (OCT), lfuorescein and indocyanine green angiography and digital fundus photography. The patient managed with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections (bevacizumab 1.25 mg/0.05 mL). The Cochrane Library, PubMed, OVID, and UpToDate databases were searched using the term pseudoxanthoma elasticum or Gr?nblad-Strandberg syndrome with the limits English. Articles that predated the databases were gathered from current references. Fundus examination revealed angioid streaks bilaterally and CNV in left eye (LE). After the patient underwent three intravitreal injections of bevacizumab, the LE showed absorption of the subretinal lfuid and shrinkage of the CNV. Visual acuity (VA) was improved in her treated LE. Bevacizumab treatment was well tolerated with no adverse events reported. Approximately ten articles about 45 patients (49 eyes) describing CNV secondary to angioid streaks in PXE treated with anti-VEGF were found in the literature search. In the present case, bevacizumab of an initial three injection loading dose, achieved maintenance of visual function in the treatment of CNV associated with angioid streaks in PXE. Literature articles concluded that the intravitreal application of anti-VEGF is highly efifcient for improving and stabilizing the lesion as well as the eyesight. So we believe that anti-VEGF therapy can be a great choice of treatment for CNV secondary to angioid streaks related PXE.     

Rhegmatogenous retinal detachment after LASIK for myopia of up to –10 diopters: 10 years of follow-up

Background

The aim of this work was to characterize rhegmatogenous retinal detachment (RRD) in over 22,000 eyes after laser-assisted in situ keratomileusis (LASIK) for the correction of myopia ≤ –10.00 diopters (D), its characteristics, and its frequency at 10?years of follow-up.

Methods

This is a retrospective single-center interventional non-comparative case series. A total of 22,296 myopic eyes that underwent surgical correction of myopia ≤ –10.00 D were included. LASIK for the correction of myopia was performed in all eyes. Patients were followed for 10?years after LASIK. The clinical charts of patients that developed rhegmatogenous retinal detachment (RRD) after LASIK were reviewed.

Results

A total of 11,594 (52%) eyes came back for follow-up after LASIK at 10?years. Twenty-two eyes (19 patients) developed a RRD after LASIK at 10?years. Rhegmatogenous retinal detachments occurred between 1?month and 10?years (mean: 31.6?±?39.3?months) after LASIK. Eyes that developed a RRD had from –1.50 to –9.75 D of myopia (mean: –4.81?±?2.2 D) before LASIK. The frequency of RRD after LASIK determined in our study was 0.05% (11/22,296) at 1?year, 0.15% (18/11,371) at 5?years, and 0.19% (22/11,594) at 10?years.

Conclusions

Rhegmatogenous retinal detachment after LASIK for the correction of myopia ≤ –10.00 D is infrequent. The risk of RRD after LASIK is very low if you screen patients, and do prophylactic treatment as performed in this study. RRD, if managed promptly, will result in good vision. We recommend that patients scheduled for refractive surgery undergo a very thorough dilated indirect funduscopy with scleral depression and treatment of any retinal lesion predisposing to the development of a RRD before LASIK surgery should be performed.     

【In Press】Autophagy: a potential target for the treatment of intraocular neovascularization

The formation of neovascularization is a common pathological feature of many ocular vascular diseases, and is an important cause of vision loss in patients. Neovascularization can cause retinal hemorrhage, vitreous hemorrhage, and other serious complications, leading to loss of vision. The treatment of intraocular neovascularization is the focus of Ophthalmology research. In recent years, some studies have found that autophagy is closely related to vascular endothelial growth factor (VEGF) and the formation of neovascularization. Autophagy is expected to become a new target for the treatment of intraocular neovascularization. Therefore, this article reviews the research on autophagy and the formation of intraocular neovascularization.     

Is there a hyperopic shift in myopic eyes during the presbyopic years?

Background : Studies of age-related changes in myopia during the presbyopic years have produced contradictory results. Some studies have shown that myopic eyes undergo a hyperopic shift after the age of 40 or 45 years, whereas others have provided evidence for a myopic shift. In this paper, we report the results of both a cross-sectional study and a retrospective longitudinal study of age-related changes in refraction during the presbyopic years. Methods : In the cross-sectional study, refractive error data were tabulated for the right eyes of 559 patients over the age of 45 years, who had been examined during a 17-month period in an established optometric practice. In the longitudinal study, we tabulated refractive error data on 100 myopes, 100 hyperopes and 100 emmetropes, who had been examined for periods varying from 10 to 26 years after age 40, all of whom had 6/6 visual acuity at all examinations. Results : In the cross-sectional study, the prevalence of myopia during the later presbyopic years was found to be greater when eyes with all visual acuities were included than when only eyes with acuity of 6/6 or better were considered. In the longitudinal study, it was found that almost all hyperopic and emmetropic eyes showed an age-related hyperopic shift; but only a small proportion of myopic eyes shifted toward hyperopia, with others remaining relatively stable and still others increasing in myopia. Discussion and conclusions : We suggest that when healthy myopic, hyperopic, or emmetropic eyes shift in the hyperopic direction, it is because of an age-related decrease in the gradient index of the lens; but when healthy myopic eyes shift in the myopic direction, it is because of axial elongation that more than compensates for the decrease in the gradient index of the lens. Another possible cause of a myopic shift, even for eyes having 6/6 visual acuity, is the presence of early, sub-clinical nuclear sclerosis.     

Is there a general trait of susceptibility to simultaneous contrast?

Individuals differ in their susceptibility to simultaneous contrast. Are the underlying differences in neural machinery conserved across different stimulus dimensions? We measured the extent to which 101 subjects perceived simultaneous contrast on the dimensions of luminance, colour, luminance contrast, colour contrast, orientation, spatial frequency, motion and numerosity. Individual differences showed re-test reliability for each dimension (0.32 ? ICC(c,1) ? 0.78, p ? 0.05), but susceptibility to simultaneous contrast, with a few exceptions, was not correlated across dimensions. Either susceptibility to contrast arises empirically from an individual’s interactions with the environment, or it is genetically determined but independently for different dimensions.     

Is age relevant for the success of treatment of anisometropic amblyopia?

A prospective cohort study of 200 anisometropic amblyopes was conducted. The patients were classified into two groups. Group A: Patients less than 12 years of age. This consisted of 144 (72%) patients, the average age being 7.77 years (+/-2.34, range 1 to 12). Group B: Patients more than 12 years of age. This comprised 56 (28%) patients, the average age being 19.8 years (+/-5.47, range 12 to 30). Criterion for success was defined as best corrected visual acuity of 20/40 (0.5 logMAR equivalent) or better. The Chi-square test was used to compare baseline characteristics and success rates. There were no significant differences in the baseline characteristics between the two groups ( P =0.07). The treatment was successful in 108 (75%) in Group A and in 34 (60.7%) in Group B ( P = 0.07). There was no statistically significant change in the success rate of treatment of anisometropic amblyopia, even beyond 12 years of age.     

Is the observed lowering of intraocular pressure due to treatment?

Objective:

Use Bayes'' theorem to estimate the intraocular pressure (IOP) lowering effect of medical treatment initiated for glaucoma and determine if IOP comparisons to the baseline IOP of the same eye is clinically useful.

Materials and Methods:

The probability that treatment with prostaglandin is responsible for an observed 20% decrease in IOP with prostaglandin treatment was calculated using Bayes'' theorem using the following available information: the probability of a 20% decrease in IOP given treatment with prostaglandin, the probability of a treatment effect using prostaglandin and the overall probability of a 20% decrease in IOP. The calculations were repeated to account for a possible 2 mmHg overestimation of effect caused by measurement error in performing applanation tonometry.

Results:

The probability that treatment is responsible for an observed 20% decrease in IOP following initiation of treatment with a prostaglandin was 99%. After adjusting for measurement error this probability was 98%. Obtaining two IOP measurements marginally increased the probability.

Conclusion:

Following initiation of treatment with prostaglandin, Bayes'' theorem allows us to infer that treatment effect is the most likely explanation for an observed 20% decrease in IOP from the baseline; this inference remains even after adjusting for known measurement error. The high probability of a treatment effect is due to the high prior odds of treatment effect and the high likelihood ratio for prostaglandin producing such an effect. If data is available, similar calculations can be used for other percentage decreases, other medications and for the monocular trial.     

Beyond AREDS: is there a place for antioxidant therapy in the prevention/treatment of eye disease?

Age-related macular degeneration (AMD), the major cause of blindness in adults (65 years of age and older), and diabetic retinopathy, the major cause of blindness in working adults, are chronic, progressive diseases with multifaceted etiologies that are not fully understood. Progression and lack of treatment of both diseases may lead to the advanced stage with neovascularization. Although the detailed cellular mechanisms leading to the development of AMD and diabetic retinopathy remain elusive, oxidative damage to the retina and its pigment epithelium are considered to be involved. Clinical studies have shown that the progression of AMD can be slowed down by nutritional antioxidants, but trials with antioxidants for diabetic retinopathy (very limited in number) have been inconclusive. Long-term administration of the AREDS antioxidants, the same nutritional antioxidants that have been demonstrated to slow the progression of AMD, have yielded exciting results in preventing the pathogenesis of retinopathy in diabetic rodents. These results suggest the merit of testing the AREDS antioxidants in a clinical trial to prevent the development and/or progression of diabetic retinopathy, with the possibility of reducing the impact of this common vision-threatening disease.     

Quality of life after wearing multifocal contact lenses for myopia control for 2 weeks in the BLINK Study

Purpose

To validate Pediatric Refractive Error Profile 2 (PREP2) subscales that can be used to evaluate contact lens wearers and compare vision-specific quality of life measurements between children wearing multifocal and single vision contact lenses for 2 weeks.

Methods

Two hundred and ninety-four myopic children aged 7–11 years (inclusive) were enrolled in the 3-year, double-masked Bifocal Lenses In Nearsighted Kids (BLINK) Study. Participants completed the PREP2 survey after having worn contact lenses for 2 weeks. The Vision, Symptoms, Activities and Overall PREP2 subscales were used to compare participants' subjective assessment while wearing +1.50 or +2.50 D add multifocal or single vision contact lenses. Rasch analysis was used to validate each subscale and to compare participants' subjective assessment of contact lens wear.

Results

Item fit to the Rasch model was good for all scales, with no individual items having infit mean square statistics outside the recommended range (0.7–1.3). Response category function was acceptable for all subscales, with ordered category thresholds. Measurement precision, assessed by the Rasch person reliability statistic, was less than ideal (≥0.8) for three of the subscales, but met the minimum acceptable standard of 0.5. Scores for the Vision subscale differed by treatment assignment (p = 0.03), indicating that participants with the highest add power reported statistically worse quality of vision, although the difference was only 3.9 units on a scale of 1–100. Girls reported fewer symptoms than boys (p = 0.006), but there were no other differences between boys and girls.

Conclusions

Rasch analysis demonstrates that the PREP2 survey is a valid instrument for assessing refractive error-specific quality of life. These results suggest that vision-related quality of life is not meaningfully affected by 2 weeks of soft multifocal contact lens wear for myopia control.