The RELATION study: efficacy and safety of ranibizumab combined with laser photocoagulation treatment versus laser monotherapy in NPDR and PDR patients with diabetic macular oedema

Purpose

To assess efficacy and safety of intravitreal ranibizumab 0.5 mg plus laser (COMBI) versus laser monotherapy (LASER) in patients with visual impairment due to diabetic macular oedema (DME) in either nonproliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) and to analyse the relevance of inner versus outer retinal thickness.

Methods

In this double‐masked, multicentre phase IIIb study, patients (N = 128) were randomized (2:1) to receive COMBI (n = 85) versus LASER (n = 43). Patients received four initial monthly injections of ranibizumab 0.5 mg (COMBI) or sham (LASER) followed by pro re nata (PRN) injections. In both groups, patients received laser at baseline and additional laser at 3 monthly intervals, as needed. The study was started in 2010 and was prematurely terminated due to approval of ranibizumab for DME.

Results

The least squares (LS) mean change in mean best‐corrected visual acuity (BCVA) from baseline to month 12 was higher in the COMBI (6.5) versus LASER (2.3) group (LS mean difference: 4.2 [95% CI 0.9; 7.4] letters, p = 0.01, primary end‐point). There was also a tendency in the same direction for the subgroup of 26 patients with PDR (LS mean difference 14.7, p = 0.11). Mean central retinal thickness decreased by 107.3 μm in the COMBI group and by 80.3 μm in the LASER group from baseline to month 12 (p = 0.28). Ranibizumab was well tolerated.

Conclusion

This study showed that ranibizumab plus laser is a valuable treatment option for the management of DME. Patients with DME in PDR might also benefit from combined therapy compared to laser alone.     

Axial length growth and the risk of developing myopia in European children

Purpose

To generate percentile curves of axial length (AL) for European children, which can be used to estimate the risk of myopia in adulthood.

Methods

A total of 12 386 participants from the population‐based studies Generation R (Dutch children measured at both 6 and 9 years of age; N = 6934), the Avon Longitudinal Study of Parents and Children (ALSPAC) (British children 15 years of age; N = 2495) and the Rotterdam Study III (RS‐III) (Dutch adults 57 years of age; N = 2957) contributed to this study. Axial length (AL) and corneal curvature data were available for all participants; objective cycloplegic refractive error was available only for the Dutch participants. We calculated a percentile score for each Dutch child at 6 and 9 years of age.

Results

Mean (SD) AL was 22.36 (0.75) mm at 6 years, 23.10 (0.84) mm at 9 years, 23.41 (0.86) mm at 15 years and 23.67 (1.26) at adulthood. Axial length (AL) differences after the age of 15 occurred only in the upper 50%, with the highest difference within the 95th percentile and above. A total of 354 children showed accelerated axial growth and increased by more than 10 percentiles from age 6 to 9 years; 162 of these children (45.8%) were myopic at 9 years of age, compared to 4.8% (85/1781) for the children whose AL did not increase by more than 10 percentiles.

Conclusion

This study provides normative values for AL that can be used to monitor eye growth in European children. These results can help clinicians detect excessive eye growth at an early age, thereby facilitating decision‐making with respect to interventions for preventing and/or controlling myopia.     

Normative data for macular and retinal nerve fibre layer thickness in healthy German children and adolescents using optical coherence tomography

Purpose

To establish normative data for macular thickness, macular volume and peripapillary retinal nerve fibre layer (RNFL) thickness using Spectralis® spectral-domain optical coherence tomography (SD-OCT) in healthy German children and adolescents and investigate influencing factors.

Methods

The cross-sectional study included the right eye of 695 children with at least one complete retinal OCT scan. As part of the LIFE Child study, the children underwent an ophthalmological examination including axial length (AL), spherical equivalent (SE) and OCT measurements. Various questionnaires were answered by the children or their parents to identify media use or outdoor time. Multiple linear regression models were used to investigate the potential influencing factors.

Results

A total of 342 boys and 353 girls with an average age (SD) of 12.91 (3.29) years participated. The mean AL (SD) was 23.20 (0.86) mm. The mean macular thickness (SD) was 320.53 (12.29) μm and the mean RNFL thickness (SD) was 102.88 (8.79) μm. Statistical analysis revealed a significant correlation between average macular thickness and age (p < 0.001, β = 0.77) as well as AL (p < 0.001, β = −4.06). In addition, boys had thicker maculae (p < 0.001, β = 5.36). The RNFL thickness showed no significant correlation with children's age (p > 0.05), but with AL (p = 0.002, β = −2.15), birth weight (p = 0.02, β = 0.003) and a gender-specific effect of the body mass index standard deviation score for male participants (p = 0.02, β = 1.93).

Conclusion

This study provides normative data and correlations between macular and RNFL thickness in healthy German children. Especially age, gender and AL must be taken into account when evaluating quantitative OCT measurements to classify them as normal.     

Optical coherence tomography angiography in patients with retinitis pigmentosa who have normal visual acuity

Purpose

To investigate flow area changes measured using optical coherence tomography angiography (OCTA; RTVue XR Avanti^®) in patients with retinitis pigmentosa (RP) with preserved visual acuity (VA).

Methods

This was an age‐ and refraction‐matched case–control study. Consecutive patients with a best‐corrected visual acuity (BCVA) of ≥20/20 and normal subjects were recruited. Fifty eyes (32 patients) and 22 eyes (12 controls) were included. The flow area and foveal avascular zone (FAZ) were measured in both superficial and deep layers within a 3 × 3 mm central area of the fovea. Association between OCTA parameters and the length of the inner segment ellipsoid (ISe) and external limiting membrane (ELM), the area without abnormal fluorescence in fundus autofluorescence (normal FAF area ratio) and the area of I‐2e of the Goldmann perimeter were analysed using mixed‐effects regression analysis.

Results

Foveal avascular zones were significantly smaller in patients with RP than in controls in superficial (p = 0.004) but not in deep layers (p = 0.25). The flow area in superficial (p = 0.007) and deep layers (p = 0.004) was significantly smaller in patients with RP than in controls. In patients with RP, flow areas in the superficial layers, but not in the deep layers, were significantly associated with the lengths of ISe (p = 0.001) and ELM (p = 0.002) and the I‐2e area (p = 0.036), but not with the normal FAF area ratio (p = 0.399).

Conclusion

Optical coherence tomography angiography (OCTA)‐measured flow area in superficial layers gradually reduced with RP progression and may be a useful parameter of RP pathogenesis.     

Conjunctivocystorhinostomy with Jones tube—is it the surgery for children?

Background  

To present experience with conjunctivocystorhinostomies (CDCR) at pediatric age.     

Bevacizumab treatment for choroidal neovascularization due to age-related macular degeneration in Japanese patients

Purpose  

To assess intravitreal bevacizumab (IVB) for choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) in Japanese patients.     

Two Japanese cases of pigmentary glaucoma followed for 15 and 16?years following laser peripheral iridotomy

Purpose  

To report two Japanese cases of pigmentary glaucoma (PG) treated with laser peripheral iridotomy (LPI) that were followed for 15 and 16 years, respectively.     

Aggravation of conjunctival early-phase reaction by <Emphasis Type="Italic">Staphylococcus</Emphasis> enterotoxin B via augmentation of IgE production

Purpose  

To investigate whether Staphylococcus enterotoxin B (SEB) affects the early-phase reaction (EPR) in experimental conjunctivitis.     

Twenty-four-hour ocular hypotensive effects of 0.0015% tafluprost and 0.005% latanoprost in healthy subjects

Purpose  

To compare the intraocular pressure (IOP) reduction over 24 h achieved with tafluprost (0.0015%) with that achieved with latanoprost (0.005%).     

Suppression of interleukin-17-producing T-helper 17 cells by retinal pigment epithelial cells

Purpose  

To determine whether retinal pigment epithelial (RPE) cells can inhibit cytokine production by activated T helper (Th) cells.     

Meta-analysis and review on the effect of bevacizumab in diabetic macular edema

Background  

Systematic review and meta-analysis to evaluate the effect of bevacizumab (Avastin) in diabetic macular edema (DME)     

Oscillatory potentials with repeated-flash electroretinography

Purpose  

To study the influence of retinal adaptation on oscillatory potential (OP) using repeated-flash electroretinography.     

Early trabeculectomy bleb walls on anterior-segment optical coherence tomography

Background  

To correlate the cross-sectional features of filtering blebs on anterior-segment optical coherence tomography (AS-OCT) 2 weeks after trabeculectomy with bleb function at 6 months.     

Anatomic response of occult choroidal neovascularization to intravitreal ranibizumab: a study by indocyanine green angiography

Background  

To investigate changes in indocyanine green angiography (ICGA) features of occult choroidal neovascularization (CNV) after intravitreal ranibizumab injections.     

Anti-aquaporin-4 antibody-positive familial neuromyelitis optica in mother and daughter

Background  

Cases of anti-aquaporin (AQP)-4 antibody-positive familial neuromyelitis optica (NMO) in mothers and daughters are described.     

Target intraocular pressure for stability of visual field loss progression in normal-tension glaucoma

Purpose  

To determine the target intraocular pressure (IOP) level in normal-tension glaucoma (NTG) for visual field (VF) stability following trabeculectomy.     

Melanoma-associated retinopathy associated with intranasal melanoma

Purpose  

To present a case of melanoma-associated retinopathy (MAR) associated with an intranasal melanoma.     

Efficacy and safety of tafluprost in normal-tension glaucoma with intraocular pressure of 16 mmHg or less

Purpose  

To evaluate the intraocular pressure (IOP)-reducing effects and safety of 0.0015% tafluprost ophthalmic solution (tafluprost) in normal-tension glaucoma (NTG) patients with an IOP of 16 mmHg or less.     

Ten-year follow-up of photorefractive keratectomy for myopia

Background  

The aim of this study is to evaluate the long-term (10-year) outcome of excimer laser photorefractive keratectomy (PRK) on myopic eyes.     

Multicenter randomized clinical trial of retinal photocoagulation for preproliferative diabetic retinopathy

Purpose  

To evaluate the effectiveness of selective photocoagulation (S-PC) for nonperfusion areas (NPA) in preproliferative diabetic retinopathy (PPDR).