Archive for 2018

Predictive Factors of Visual Outcome for Vitreomacular Traction Syndrome After Vitrectomy

Most patients of VMT gained significant functional and anatomical improvements after vitrectomy. Group 1 optical coherence tomography pattern, shorter symptom duration, and younger age are significant predictive factors of better visual outcome.

“Predictive Factors of Visual Outcome for Vitreomacular Traction Syndrome After Vitrectomy”

Retina 38:1533-1540, 2018
Chang-Sue Yang, MD, MHA; Ming-Hung Hsieh, MD; Yu-Fan Chang, MD; Chiao-Yu Wang, MD; Shih-Jen Chen, MD, PhD

Full Paper: Predictive Factors of Visual Outcome for Vitreomacular Traction Syndrome After Vitrectomy

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Outcomes of Cataract Surgery in Patients With Exudative Age-related Macular Degeneration and Macular Fluid

In a real-world setting, patients with cataracts and wet age-related macular degeneration underwent treatment for age-related macular degeneration fluid and surgery for cataracts. These patients did well postoperatively with no worsening of their neovascular process.

“Outcomes of Cataract Surgery in Patients With Exudative Age-related Macular Degeneration and Macular Fluid”

Am. J. Ophthalmol 192:91-97, August 2018
Matthew R. Starr; Michael A. Mahr; Andrew J. Barkmeier; Raymond Iezzi; Wendy M. Smith; Sophie J. Bakri

Full Paper: Outcomes of Cataract Surgery in Patients With Exudative Age-related Macular Degeneration and Macular Fluid

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Methodological Insights for Randomized Clinical Trials of Retinitis Pigmentosa

There are no approved drug treatments for autosomal-dominant retinitis pigmentosa.
 
A study of oral Valproic acid (VPA) does not support the use of VPA in the treatment of autosomal-dominant retinitis pigmentosa.
 
The lessons learned from a trial of Valproic acid are:

  • Rigorous evaluation of drug treatment for retinitis pigmentosa is necessary.
  • FDA-approved drugs for other uses can have major adverse effects.
  • Patients vary greatly in their rates of progression of retinitis pigmentosa with identical gene mutations.

“Methodological Insights for Randomized Clinical Trials of Retinitis Pigmentosa”
Lessons Learned from a Trial of Valproic Acid

JAMA Ophthalmol 136:857-858, August 2018
Brian P. Brooks, MD, PhD; Brett Jeffrey, PhD

Full Paper: Methodological Insights for Randomized Clinical Trials of Retinitis Pigmentosa_08-13-18

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Genetic Polymorphisms of CFH and ARMS2 Do Not Predict Response to Antioxidants and Zinc in Patients with Age-Related Macular Degeneration

Purpose

Considerable controversy has erupted in recent years regarding whether genotyping should be part of standard care for patients with age-related macular degeneration (AMD) who are being considered for treatment with antioxidants and zinc. We aimed to determine whether genotype predicts response to supplements in AMD.

Design

Three separate statistical teams reanalyzed data derived from the Age-Related Eye Disease Study (AREDS), receiving data prepared by the AREDS investigators and, separately, data from investigators reporting findings that support the use of genotyping.

Participants

The population of interest was AREDS participants with AMD worse than category 1 and genotyping data available. Data from the 2 groups overlap imperfectly with respect to measurements made: the largest common set involved 879 participants for whom the same CFH and ARMS2 single nucleotide polymorphisms were measured by both groups.

Methods

Each team took a separate but complementary approach. One team focused on data concordance between conflicting studies. A second team focused on replicating the key claim of an interaction between genotype and treatment. The third team took a blank slate approach in attempting to find baseline predictors of treatment response.

Main Outcome Measures

Progression to advanced AMD.

Results

We found errors in the data used to support the initial claim of genotypeetreatment interaction. Although we found evidence that high-risk patients had more to gain from treatment, we were unable to replicate any genotypeetreatment interactions after adjusting for multiple testing. We tested 1 genotype claim on an independent set of data, with negative results. Even if we assumed that interactions in fact did exist, we did not find evidence to support the claim that supplementation leads to a large increase in the risk of advanced AMD in some genotype subgroups.

Conclusions

Patients who meet criteria for supplements to prevent AMD progression should be offered zinc and antioxidants without consideration of genotype. Ophthalmology 2018;125:391-397 ª 2017 by the American Academy of Ophthalmology

Full Paper: Genetic Polymorphisms of CFH and ARMS2 Do Not Predict Response to Antioxidants and Zinc in Patients with Age-Related Macular Degeneration
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Evaluation of Full-Field Electroretinogram Reductions After Ocriplasmin Treatment

Results of the OASIS Trial ERG Substudy

Purpose

To explore a possible association between full-field electroretinograms with vitreomacular adhesion resolution and best-corrected visual acuity as part of the prospective, randomized, double-masked, sham-controlled Ocriplasmin for Treatment for Symptomatic Vitreomacular Adhesion Including Macular Hole (OASIS) trial studying ocriplasmin.

Methods

The ERG substudy enrolled 62 of 220 OASIS subjects (randomized 2:1) and analyzed full-field electroretinograms and their association with both vitreomacular adhesion resolution and best-corrected visual acuity from baseline through Month 24. Electroretinogram reductions were defined as acute full-field electroretinogram reductions in amplitude of $40% from baseline occurring at postinjection Day 7 or Day 28.

Results

In the ocriplasmin group, 16/40 (40%) subjects developed ERG reductions, compared to 1/21 (4.8%) in the sham group; 13/16 (81.3%) and 1/1 (100%) resolved by study end, respectively. A total of 11/16 (68.8%) ocriplasmin-treated subjects with ERG reductions achieved vitreomacular adhesion resolution, compared to those without (9/24, 37.5%). The ocriplasmin-treated subjects with ERG reductions also gained more letters on average (11.3 vs. 9.3 letters) from baseline and had a difference of 6.7 letters in mean bestcorrected visual acuity by study end compared to those without ERG reductions.

Conclusion

Ocriplasmin-treated subjects with ERG reductions had a higher rate of vitreomacular adhesion resolution and showed better visual improvement than their counterparts without ERG reductions or sham subjects by study end.

RETINA 38:364–378, 2018

Full Paper: Evaluation of Full-Field Electroretinogram Reductions After Ocriplasmin Treatment
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