Archive for November 2016

Extent of Internal Limiting Membrane Peeling and its Impact on Macular Hole Surgery Outcomes: A Randomized Trial

Since Kelly and Wendel introduced the victrectomy technique to reattach the macular hole (MH),1 considerable advances in surgical treatment have been achieved. As a consequence, MH has now become a surgically treatable disease with standardized techniques incorporating vitrectomy, induction of posterior vitreous detachment, internal limiting membrane (ILM) peeling, and gas tamponade.2 Although there was a debate on ILM peeling in the past, ILM peeling has been established to improve surgical success rates.3–6 In addition, retinal ILM peeling has been facilitated by staining dye such as indocyanine green.7,8

The rationale for ILM peeling is that MH can occur and enlarge owing to contraction of perifoveal vitreous and cellular constituents with myofibroblastic differentiation on the surface of the ILM.2,9 Although ILM has no inherent contractile properties, it does act as a scaffold for contractile tissue to exert tangential traction on fovea. Several studies using optical coherence tomography (OCT) have reported the dynamic sealing process after MH surgery.10–13 Foveal tissue elongation and macular migration have been noted following ILM peeling after surgery for MH and diabetic macular edema.14–17 In addition, there is a significant correlation between these morphologic changes and visual function such as metamorphopsia.14

Although ILM peeling has become a widely accepted surgical technique since the introduction of MH surgery, the optimal extent of ILM peeling is not known and the anatomic and functional outcomes according to peeling extent have not been investigated. The purpose of this study was to investigate the influence of the extent of ILM peeling on anatomic and functional outcomes of MH surgery.

Full Paper: Extent of Internal Limiting Membrane Peeling and its Impact on Macular Hole Surgery Outcomes: A Randomized Trial
(1.3M PDF)

Page

Cost-effectiveness of Aflibercept, Bevacizumab, and Ranibizumab for Diabetic Macular Edema Treatment

Arecent Diabetic Retinopathy Clinical Research Network (DRCR.net) comparative effectiveness trial found that for patients with diabetic macular edema (DME) and approximate Snellen equivalent baseline visual acuity (VA) of 20/50 or worse aflibercept produced greater mean VA gains at 1 year than bevacizumab or ranibizumab. In contrast, no difference in mean VA improvement was identified for patients with baseline VAs of 20/32 to 20/40.1

These agents also vary substantially in cost. O nthe basis of 2015 wholesale acquisition costs, aflibercept (2.0 mg) costs $1850,2 ranibizumab (0.3mg) costs $1170,2 and bevacizumab repackaged at compounding pharmacies into syringes for ophthalmologic use containing 1.25mg of bevacizumab costs approximately $6 0per dose.3 Considering that these medicines may be given 9 to 11 times in the first year of treatment1 and, on average, 17 times during 5 years,4 total costs can be substantial. In 2010, when these intravitreous agents were being used predominantly for age-related macular degeneration, ophthalmologic use of anti–vascular endothelial growth factor (VEGF)therapy cost approximately $2 billion or one-sixth of the entire Medicare Part B drug budget.3 In 2013, Medicare Part B expenditures for aflibercept and ranibizumab alone totaled $2.5 billion.5 Given these costs, the DRCR.net investigators believed it was important to analyze the relative cost-effectiveness of treating DME using each agent.

Full Paper: Cost-effectiveness of Aflibercept, Bevacizumab, and Ranibizumab for Diabetic Macular Edema Treatment
(385K PDF)

Page