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Volume 13, Number 6
Monday, February 11, 2013
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FEBRUARY IS AMD/LOW VISION AWARENESS MONTH




In this issue: (click heading to view article)
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######### Plasma Levels of VEGF Before and After Intravitreal Injection of Bevacizumab, Ranibizumab and Pegaptanib in AMD and DME Patients

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######### Treatment of Post Cataract Surgery Inflammation With Loteprednol Etabonate 0.5% vs. Prednisolone Acetate 1.0%
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######### Plasma Endothelin-1 and Severity of Different Types of Glaucoma
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######### Differential Associations of Myopia With Major Age-related Eye Diseases
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Plasma Levels of VEGF Before and After Intravitreal Injection of Bevacizumab, Ranibizumab and Pegaptanib in AMD and DME Patients

In Austria, investigators sought to determine the level of vascular endothelial growth factor (VEGF) in the plasma of patients with diabetic macular edema (DME) and of patients with exudative age-related macular degeneration (AMD) before and after intravitreal injection of bevacizumab, ranibizumab or pegaptanib.

They included 30 patients with DME and 30 patients with AMD in this randomized, controlled study and randomized them to treatment with ranibizumab (0.5 mg), bevacizumab (1.25 mg) or pegaptanib (0.3 mg). A total of 10 patients with DME received bevacizumab, 10 ranibizumab and 10 pegaptanib. The same randomized treatment allocation applied to the 30 patients with AMD. The investigators measured the concentrations of VEGF by ELISA just before the injection, seven days after and one month after.

They reported that plasma VEGF in patients with exudative AMD before the injection of bevacizumab was 89.7 pg/ml and that it was significantly reduced to 25.1 pg/ml after seven days (p=0.01), and to 22.8 pg/ml after one month (p=0.008). In patients with DME, they observed the same systemic reduction by bevacizumab with a significant decrease of baseline VEGF level from 72.2 pg/ml to 13.7 pg/ml after seven days (p=0.008) and 17.1 pg/ml at four weeks with (p=0.012). They found no significant reductions of plasma VEGF in patients receiving ranibizumab or pegaptanib during follow-up.

In conclusion, bevacizumab significantly reduces the level of VEGF in the blood plasma for up to one month in patients with DME as well as in those with ARMD. No significant systemic effects of intravitreal ranibizumab or pegaptanib on plasma VEGF could be observed.

SOURCE: Zehetner C, Kirchmair R, Hubar S, et al. Plasma levels of vascular endothelial growth factor before and after intravitreal injection of bevacizumab, ranibizumab and pegaptanib in patients with age-related macular degeneration, and in patients with diabetic macular edema. Br J Ophthalmol. 2013; Feb 5. [Epub ahead of print].

http://www.revophth.com/Update2013







Treatment of Post Cataract Surgery Inflammation With Loteprednol Etabonate 0.5% vs. Prednisolone Acetate 1.0%

The authors of this comparative case series evaluated the efficacy of loteprednol etabonate 0.5% versus prednisolone acetate 1.0% for the control of postoperative inflammation in patients having routine cataract surgery.

According to the authors, patients were at least 18 years of age and scheduled for routine cataract surgery. They were excluded from the study if they had pre-existing medical conditions (i.e., elevated IOP, retinopathy, maculopathy, uveitis) or required mediations the investigator believed would put the patient at risk or confound the study. They then randomized patients to receive loteprednol etabonate or prednisolone acetate four times daily in addition to bromfenac 0.09% and besifloxacin 0.6% after surgery. The study authors assessed visual acuity, IOP and anterior chamber cell and flare intensity over three weeks following cataract surgery. The primary endpoint was the level of anterior chamber cell and flare intensity in patients treated with loteprednol etabonate or prednisolone acetate.

The study enrolled 88 patients (46 loteprednol etabonate and 42 prednisolone acetate); equivalency was achieved between the two treatment groups with no significant differences throughout the three-week follow-up. The authors noted that there was less fluctuation in IOP assessments in patients treated with loteprednol etabonate than in patients treated with prednisolone acetate, in particular one day and three days postoperatively.

The results indicate that equivalent control of inflammation can be obtained through treatment with loteprednol etabonate or prednisolone acetate after cataract surgery. In addition, treatment with loteprednol etabonate may result in less IOP fluctuation.

SOURCE: Lane SS, Holland EJ. Loteprednol etabonate 0.5% versus prednisolone acetate 1.0% for the treatment of inflammation after cataract surgery. J Cataract Refract Surg. 2013;39(2):168–173.



Plasma Endothelin-1 and Severity of Different Types of Glaucoma

Endothelin-1 (ET-1) has been suggested to play an important role in the pathogenesis of glaucoma. Researchers studied whether increased levels of plasma ET-1 are associated with changes in the visual field and changes in optical coherence tomography (OCT)-measured retinal nerve fiber layer (RNFL) thickness in patients with different types of glaucoma.

They determined plasma concentrations of ET-1 in 31 patients with primary open-angle glaucoma (POAG), 18 patients with normal-tension glaucoma (NTG), 16 patients with primary angle-closure glaucoma (PACG) and in 37 normal controls. In all participants, the researchers performed visual field testing and used OCT to measure RNFL thickness. They then evaluated the correlation between mean ET-1 level and changes in the visual field (mean deviation, dB) and changes in OCT-measured RNFL thickness in one randomly selected eye from each patient in each group.

The ET-1 level was 3.27 ± 1.25 pg/mL in the primary open-angle glaucoma group (–14.09 ± 8.76 dB), 3.12 ± 1.46 pg/mL in the NTG group (–8.87 ± 6.15 dB), 2.58 ± .22 pg/mL in the POAG group (–14.55 ± 10.2 dB) and 1.53 ± 1.49 pg/mL in the control group. Although mean ET-1 levels were significantly higher in all three of the glaucoma groups than in the control group, the researchers found no significant difference in ET-1 level among the three glaucoma groups. Furthermore, no significant correlation was found between levels of plasma ET-1 and structural or functional changes in patients with different types of glaucoma.

To conclude, there was no correlation between plasma levels of ET-1 and severity of glaucoma. The role of ET-1 plays in the pathogenesis of glaucoma remains to be determined.

SOURCE: Chen HY, Chang YC, Chen WC, Lane HY. Association between plasma endothelin-1 and severity of different types of glaucoma. J Glaucoma. 2013;22(2):117–122.






Differential Associations of Myopia With Major Age-related Eye Diseases

The following population-based, cross-sectional study was conducted in Singapore to determine the associations of myopia and axial length (AL) with major age-related eye diseases, including age-related macular degeneration (AMD), diabetic retinopathy (DR), age-related cataract and primary open-angle glaucoma (POAG).

Included were 3,400 Indians (75.6% response rate) aged 40 to 84 years. Refractive error was determined by subjective refraction, and AL was determined by noncontact partial coherence laser interferometry. AMD and DR were defined from retinal photographs according to the Wisconsin Age-Related Maculopathy Grading System and Airlie House classification system, respectively, and age-related cataract was diagnosed clinically using the Lens Opacity Classification System (LOCS) III system. Glaucoma was defined according to International Society for Geographical and Epidemiological Ophthalmology criteria. Main outcome measures were AMD, DR, age-related cataract and POAG.

It was observed that myopic eyes (spherical equivalent [SE] ≤0.5D were less likely to have AMD (early plus late AMD) (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.25–0.79) or DR (OR, 0.68; 95% CI, 0.46–0.98) compared with emmetropic eyes; each millimeter increase in AL was associated with a lower prevalence of AMD (OR, 0.76; 95% CI, 0.65–0.89) and DR (OR, 0.73; 95% CI, 0.63–0.86). It was also noted that myopic eyes were more likely to have nuclear (OR, 1.57; 95% CI, 1.13–2.20) and posterior subcapsular (OR, 1.73; 95% CI, 1.10–2.72) cataract, but not cortical cataract (p=0.64); each millimeter increase in AL was associated with a higher prevalence of posterior subcapsular cataract (PSC) (OR, 1.29; 95% CI, 1.07–1.55), but not nuclear (p=0.77) or cortical (p=0.39) cataract. Moreover, eyes with high myopia (SE ≤6.0D) were more likely to have POAG (OR, 5.90; 95% CI, 2.68–12.97); each millimeter increase in AL was associated with a higher prevalence of POAG (OR, 1.43; 95% CI, 1.13–1.80).

It was concluded that myopic eyes are less likely to have AMD and DR, but more likely to have nuclear cataract, PSC and POAG. For the most part, longer AL explains the associations of myopia with AMD, DR and POAG; however, the association between myopia and nuclear cataract is explained by lens refraction, rather than AL.

SOURCE: Pan CW, Cheung CY, Aung T, et al. Differential associations of myopia with major age-related eye diseases: The Singapore Indian Eye Study. Ophthalmology. 2013;120(2):284–291.




  • GLAUKOS CORPORATION RAISES MILLIONS IN SERIES F FINANCING. Glaukos Corporation announced that it has closed $30 million in financing to fund the U.S. commercial launch of the iStent trabecular micro-bypass device and the U.S. IDE pivotal registration studies of iStent inject, a second-generation trabecular bypass implant, as well as iStent supra, a new suprachoroidal implant. The financing was led by Meritech Capital Partners and joined by an existing group of premier investors including Versant Ventures, Domain Associates, Montreux Equity Partners, InterWest Partners, Frazier Healthcare, OrbiMed Advisors and Gund Investment Corporation.
  • UPGRADES AVAILABLE FOR THE INFINITI VISION SYSTEM. Alcon has launched its latest hardware and software upgrades for its INFINITI Vision System to provide surgeons greater control during cataract surgery. As part of the upgrades, the company is introducing the innovative INTREPID AutoSert IOL Injector, which enables automated delivery of the IOL. Moreover, the INTREPID AutoSert IOL Injector hardware and software upgrades allow customizable parameters for enhanced IOL insertion control, foot pedal control to allow better globe stabilization, single-hand auto insertion for smoother insertions, support for all standard incision sizes, especially Micro-Incision Cataract Surgery, and better wound integrity, with less stretching and minimized disruption and trauma. The INFINITI Vision System hardware and software upgrade kit will become available globally during the first half of 2013. Current customers will be able to seamlessly incorporate the software upgrade to their current INFINITI Vision System. Click here to read more.
  • MCDONALD JOINS ORCA SURGICAL AS CHAIRMAN OF THE SCIENTIFIC ADVISORY BOARD. Marguerite McDonald, MD, FACS, has joined the Scientific Advisory Board of Orca Surgical as the chairman. In this role, she will lead the clinical team investigating Orca Surgical's new surface ablation procedure, Epi Bowman Keratectomy (EBK). The EBK procedure enables controlled removal of the epithelium in a minimum number of passes without damaging Bowman's layer. The foundation of the procedure is the patented Epi-Clear device, which is a multi-blade polymer that allows epithelial removal while simultaneously collecting the sheets into the bowl-shaped tip. The Epi-Clear has CE mark approval but is not yet available in the United States.


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