THE LATEST PUBLISHED RESEARCH

Combining PDT and Bevacizumab Against AMD
The results of a retrospective evaluation suggest that treating choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) with a combination of verteporfin (Visudyne) photodynamic therapy (PDT) and intravitreal bevacizumab (Avastin) may reduce retreatment rates and improve visual acuity.

Twenty-four patients, previously untreated for juxtafoveal or subfoveal CNV, received PDT and 1.25 mg of bevacizumab within a 14-day interval. At the seven-month follow-up, visual acuity stabilized in 20 of the 24 (83 percent) eyes and improved in 16 of 24 (67 percent) eyes. Mean visual acuity improvement was 2.04 Snellen lines. Fifteen eyes (63 percent) required only a single combined treatment for CNV resolution. No endophthalmitis, uveitis or ocular hypertension occurred.

Source: Dhalla MS, Shah GK, Blinder KJ, et al. Combined photodynamic therapy with verteporfin and intravitreal bevacizumab for choroidal neovascularization in age-related macular degeneration. Retina 2006;26(9):988-993.

PDT vs. Macular Translocation for CNV in Pathological Myopia
In 66 consecutive patients with subfoveal CNV due to pathological myopia, limited macular translocation surgery produced better results than PDT at two years, according to a retrospective analysis of a nonrandomized interventional study. Thirty-four of the eyes received PDT, and 32 underwent translocation surgery. In the translocation patients, the nasal inferior margin of the CNV membrane was less than a half disc diameter from the foveal center and duration of symptoms was less than four months.

At two years, mean visual acuity was +2.8 lines in the translocation group and -1.8 lines in the PDT group (p=0.001). The proportion of eyes gaining three or more lines was 55 percent in the translocation group and 10 percent in the PDT group. In the translocation group, CNV recurred at a mean of 40 months for patients younger than 40 and at a mean of 20 months for older patients. Also in the translocation group, three retinal detachments and one macular fold occurred.

Sources: Glacet-Bernard A, Benyelles N, Dumas S, et al. Photodynamic therapy vs. limited macular translocation in the management of subfoveal choroidal neovascularization in pathologic myopia: a two-year study. Am J Ophthalmol 2007;143:68-76.

Bevacizumab Reduces New-Vessel Leakage in DR
In a prospective, nonrandomized, open-label study involving patients with diabetic retinopathy, a single intravitreal injection of bevacizumab reduced fluorescein leakage from active new vessels (NV) without loss of vision. The 15 consecutive patients had best-corrected visual acuity (BCVA) of 20/40 or worse, and the NV leakage had persisted despite laser treatment. Patients were evaluated at one, six and 12 weeks after the injection of bevacizumab.

Early- and mid-phase fluorescein angiography for this study patient with diabetic retinopathy demonstrated persistent, actively leaking new vessels (top). Six weeks after a single intravitreal injection of 1.5 mg of bevacizumab, the early- and mid-phase angiography showed an absence of leakage (bottom). (Images courtesy of Rogerio A. Costa, MD, PhD, and Rodrigo Jorge, MD, PhD)

Mean NV leakage area was 27.79 mm² at baseline. It decreased to 5.43 mm² at one week and to 5.50 mm² at 12 weeks. No leakage was observed at six weeks. Mean logMAR BCVA was 0.90 (20/160) at baseline, 0.76 (20/125+2) at one week, 0.77 (20/125+2) at six weeks, and 0.77 (20/125+2) at 12 weeks. No major adverse events occurred.

Source: Jorge R, Costa RA, Calucci D, et al. Intravitreal bevacizumab (Avastin) for persistent new vessels in diabetic retinopathy (IBEPE Study). Retina 2006;26:1006-1013.

Pilot Study Tests Prednisolone for DME
Results of a retrospective, noncontrolled case series indicate that intravitreal injection of prednisolone sodium succinate may be a safe and effective treatment option for persistent diabetic macular edema. In the study, 19 eyes received prednisolone injections.

Mean visual acuity improvement was statistically significant up to six months after treatment (p=0.015 at six weeks; p=0.004 at three months; p=0.031 at six months). Intraocular pressure did not exceed 22 mmHg in any eye. No endophthalmitis or retinal detachment occurred.

Source: La Heij EC, Lundqvist IJ, Berendschot TJM, et al. Intravitreal prednisolone sodium succinate reduces diabetic macular edema without intraocular pressure rise. Am J Ophthalmol 2007;143:176-178.

Interaction of Genes and Smoking in the Risk for Wet AMD
A group of researchers evaluated whether the genes encoding complement factor H (CFH), apolipoprotein E (APOE), and elongation of very-long-chain fatty acids--like 4 (ELOVL4) affect the risk of developing neovascular AMD independently or interactively when controlling for smoking. They obtained smoking histories and genotyped 103 unrelated individuals with neovascular AMD who each had at least one sibling with normal maculae. They used conditional logistic regression analysis to build multifactor model.

They found that only the CFH CC genotype carried a statistically significant elevation of disease risk (p<0.001). They found no significant association between neovascular AMD and APOE or ELOVL4, no significant interaction between smoking and having the CFH or APOE genotype, and no significant interactions between the CFH, ELOVL4, and APOE genotypes. They concluded that smoking for 10 pack-years or more and having the CFH CC genotype increases the risk of neovascular AMD 144-fold compared with smoking for less than 10 pack-years and having the CT or TT genotype.

Source: DeAngelis MM, Ji F, Kim IK, et al. Cigarette smoking, CFH, APOE, ELOVL4, and risk of neovascular age-related macular degeneration. Arch Ophthalmol 2007;125:49-54.

COMS Report No. 28
The Collaborative Ocular Melanoma Study Group reported that its most recent analysis confirmed its earlier report of no differences in the survival rates of patients who were treated with 125 iodine brachytherapy and those who were treated with enucleation. Eligible patients were free of metastasis and other cancers at enrollment. They were followed for metastasis or another cancer or until death.

Within 12 years after enrollment, 471 of 1,317 patients died. Of 515 patients eligible for 12 years of follow-up, 231 (45 percent) were alive and clinically cancer-free 12 years after treatment. By 12 years, the cumulative all-cause mortality rate was 43 percent in the brachytherapy group 41 percent in the enucleation group.

In the brachytherapy group, the rates of death with confirmed melanoma metastasis were 10 percent at five years, 18 percent at 10 years, and 21 percent at 12 years. In the enucleation arm, the rates of death with confirmed melanoma metastasis were 11 percent at five years, 17 percent at 10 years, and 17 percent at 12 years. The primary predictors of time to death from all causes and death with melanoma metastasis were older age and larger maximum basal tumor diameter.

Source: Collaborative Ocular Melanoma Study (COMS) Group. The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma: COMS Report No. 28. Arch Ophthalmol. 2006;124(12):1684-1693.

Effect of Delayed Scleral Buckling Surgery after Macula-Off Retinal Detachment
Researchers conducted a retrospective observational case series study to determine the effect of duration of macular detachment (DMD) on visual acuity in patients with macula-off rhegmatogenous retinal detachment (RD). The study included 202 consecutive patients (202 eyes) with primary uncomplicated macula-off RD, preoperative visual acuity of 10/100 or worse, a precise history of when macular function was lost, successful reattachment surgery and a minimum follow-up of three months. All RDs were repaired with a primary scleral buckling procedure performed by three surgeons.

The results suggested that the scleral buckling procedure was most effective when performed within seven days of macular detachment. Considering all eyes, the cumulative mean of the best-corrected postoperative visual acuity as a function of DMD showed a rapid worsening when DMD exceeded six days. Eyes were divided into three groups corresponding to DMD: immediate (within 10 days), delayed (11 days to six weeks) and late (longer than six weeks). Mean postoperative acuities were 0.35 +/-0.31 (20/40-20/50 Snellen equivalent) in eyes with DMD up to 10 days; 0.48 +/-0.26 (20/60 Snellen equivalent) in the delayed group; and 0.86
+/-0.30 (8/60 Snellen equivalent) in eyes with DMD longer than six weeks.

Source: Diederen RM, La Heij EC, Kessels AG, et al. Scleral buckling surgery after macula-off retinal detachment: worse visual outcome after more than 6 days. Ophthalmol 2006; Dec 26 [Epub ahead of print].

Report Describes New 27-Ga. Chandelier Endoilluminator
Authors of a recently published report concluded that a newly developed 27-ga. self-retaining transconjunctival chandelier endoilluminator improves the efficacy and efficiency of vitreous surgery. The optical fiber is covered by a malleable sleeve and can be retained in the eyeball without a suture.

The design stabilizes the 27-ga. tip in the eye and provides up to 25 lumens of measured illumination. The adequate lighting potential and self-retaining design allow wide-angle visualization and bimanual manipulation in challenging cases. Easy insertion and removal without suture placement make changing the position of the device during surgery convenient and shorten surgical time.

Source: Oshima Y, Awh CC, Tano Y. Self-retaining 27-gauge transconjunctival chandelier endoillumination for panoramic viewing during vitreous surgery. Am J Ophthalmol 2007;143:166-167.