That’s a wrap for 2019 – an exciting year of research and innovation in medical and surgical retina. As the associate editor for the journal Ophthalmic Surgery, Lasers and Imaging-Retina, I will count down the most-read articles of 2019 discussing their clinical significance and implications into practice. Wishing you all a wonderful holiday season and a happy new year. More information coming to you in 2020!
5 – Preventing Progression in Nonexudative Age-Related Macular Degeneration With Subthreshold Laser Therapy: A Systematic Review
Subthreshold laser was a hot topic for the prevention of progression of age-related macular degeneration. The Laser Intervention in Early Stages of Age-Related Macular Degeneration (LEAD) study results was released in 2019 and investigated the safety and efficacy of subthreshold nanosecond laser treatment to slow the progression of intermediate age-related macular degeneration (AMD). The trial missed its primary endpoint for the progression to late stage AMD for all participants. A secondary analysis demonstrated in those with reticular pseudo-drusen, the laser increased progression to late-stage AMD but in those without the laser prevented late-stage AMD progression. A variety of additional studies are being planned but what has the literature shown on the use of subthreshold laser in the past.
This article by Eng and colleagues was a metanalysis of studies performed previously of subthreshold laser. They identified twelve studies involving 2,481 eyes treated with subthreshold retinal laser that were included in this review. The authors found that treatment led to increased drusen reduction, and studies with significant VA improvement were associated with significant drusen reduction. There was no significant change in the risk of developing CNV or GA unlike what was seen within the LEAD study and additional analyses evaluating particular those with reticular pseudo-drusen were not possible.
In summary, there might be a role for subthreshold laser in drusen reduction and improvement in VA and deterring progression to later stages of AMD are exciting potential benefits of this study.
Chelsey J. Krambeer; Kendall W. Wannamaker, MD; Wayne Tie, MD; Sepehr Bahadorani, MD,
Ph.D.; Julia Singer; Stan Conston; Michael A. Singer, MD
The dexamethasone implant (Ozurdex) has gained popularity for the treatment of diabetic macular edema and posterior uveitis. However, best practices around the injection technique are still lacking in particular around how to reduce the velocity of the pellet injection as there have been a few reports on high-velocity injuries to the retina after injection.
In this article by Krambeer and colleagues, the velocity of the injection was studied with a different injection technique. They found that by depressing the Ozurdex implant injector during a 3 second time interval rolling from front to back over the button, the impact force of the implanted pellet is reduced by about 95%.
Xuejing Chen, MD, MS; Kendra A. Klein, MD; Chirag P. Shah, MD, MPH; Jeffery S. Heier, MD
Deciding on when to intervene in epiretinal membranes has been long discussed. In this retrospective series, Chen at al evaluated patients with good vision (20/40 or better) and their progression to ERM surgery over 7 years. The authors found that those with an intact foveal contour progressed the least (5.5%) while those with complete or partial loss of the contour progressed the fastest at (16% and 17%, respectively). The study is confounded in the fact that ultimately the primary surgeon decided on who needed surgery based upon signs and symptoms and not in a more objective way. Nonetheless, the progression rates are really low in patients with a good foveal and thus patients with this configuration can be reassured that surgery is not likely in their future.
2 – Risk Factors for Retinal Redetachment After Silicone Oil Removal: A Systematic Review and Meta-Analysis
Yueqing He, MD; Shaoxue Zeng, MD; Yunni Zhang, MD; Junjun Zhang, MD
Retina re-detachment after silicone oil removal has been reported previously in the literature between 10%-43% depending on the study evaluated. And given the disparity of features looked at, He and colleagues identified 16 studies with a total of 3,598 patients with 3,620 eyes in this systematic review and meta-analysis due better identified the characteristics of those most at risk for retinal re-detachment.
The analysis found that aphakia, high myopia, previous failed retinal surgery, ocular trauma, shorter duration of SO, inadequate vitreous base shaving, preoperative rubeosis, and abnormal preoperative IOP might be significant risk factors related to the occurrence of re-RD after SOR, whereas placing an encircling band, 360° prophylactic laser before removal of SO, and emulsified oil might be potential protective factors. Interestingly, preoperative PVR had no impact on retinal re-detachment following silicone oil removal.
1 – Evaluation of Abicipar Pegol (an Anti-VEGF DARPin Therapeutic) in Patients With Neovascular Age-Related Macular Degeneration: Studies in Japan and the United States
Derek Kunimoto, MD, JD; Masahito Ohji, MD; Raj K. Maturi, MD; Tetsuju Sekiryu, MD; Ying Wang, MD, Ph.D.; Grace Pan, MS; Xiao-Yan Li, MD; Susan Schneider, MD; For the BAMBOO and CYPRESS Study Groups
One of the ongoing issues with current anti-VEGF therapy is the lack of sustained periods of dosing. Abicipar is a pegylated 34 kDa recombinant ankyrin repeat protein that binds all isoforms of VEGF-A with high affinity and specificity. Multiple studies have validated that Abicipar appears to have a longer duration of effect compared with ranibizumab and that the required frequency of intravitreal injections may be markedly reduced. The most recent data from the MAPLE study demonstrated that Abicipar delivered every 12 weeks was equivalent to ranibizumab delivered every 4 weeks.
BAMBOO and CYPRESS were two phase 2 clinical studies (BAMBOO; CYPRESS) assessing the safety and efficacy of abicipar 1 mg and 2 mg in Japan and the United States, respectively, with Ranibizumab 0.5 mg as an active control. Anatomic and visual results between Abicipar and Ranibizumab were equivalent with uveitis or vitritis was reported in three abicipar-treated patients. Thus, Abicipar appears to be safe and effective in this population of patients with polypoidal choriodovasculopathy as well as age related macular degeneration.