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By Brooke Strickland

In this retrospective study, researchers wanted to look at the benefits and complications for patients with ocular inflammatory disorders that had received periocular depot corticosteroid injections. Researchers looked at the medical records of 914 patients (1192 eyes) that had received ≥1 periocular corticosteroid injection at five tertiary uveitis clinics across the United States. They looked at the control of inflammation, improvement of visual acuity (VA) to ≥20/40, improvement of VA loss credited to macular edema (ME), incident cataract affecting VA, cataract surgery, ocular hypertension, and glaucoma surgery.

The results showed that out of the 914 patients (1192 eyes), 286 (31.3%) were classified as having anterior uveitis, 303 (33.3%) as intermediate uveitis, and 324 (35.4%) as posterior or panuveitis. Cumulatively by ≤6 months, 72.7% of the eyes achieved complete control of inflammation and 49.7% showed an improvement in VA from <20/40 to ≥20/40. Among the subset with VA <20/40 attributed to ME, 33.1% improved to ≥20/40. By 12 months, the collective incidence of ≥1 visits with an intraocular pressure of ≥24 mmHg and ≥30 mmHg was 34.0% respectively; glaucoma surgery was performed in 2.4% of eyes. Within 12 months, among phakic eyes initially ≥20/40, the incidence of a reduction in VA to <20/40 attributed to cataract was 20.2%; cataract surgery was performed within 12 months in 13.8% of the initially phakic eyes. (1)

What to take away from the study: Periocular injections were beneficial in treating people that had active intraocular inflammation. They also helped improve reduced visual acuity attributed to macular edema in a large portion of the patients. There was a similar pattern shown across anatomic locations of uveitis and over half of the patients reported improved visual acuity results within 6 months. However, cataract and ocular hypertension occurred in a substantial minority.

1. Sen, H., Nida, MD, MHS, Vitale, Susan, PhD, MHS, Gangaputra, Sapna, S., MD, MPH, Nussenblatt, Robert, B., MD, MPH, Liesegang, Teresa, L., COT, CRC, Levy-Clarke, Grace, A., MD, Rosenbaum, James, T., MD, Suhler, Eric, B., MD, MPH, Thorne, Jennifer, E., MD, PhD, Foster, C. Stephen, MD, Jabs, Douglas, A., MD, MBA, Kempen, John, H., MD, PhD. “Periocular Corticosteroid Injections in Uveitis.” Published online July 11, 2014. Accessed July 14, 2014. http://www.aaojournal.org/article/S0161-6420%2814%2900485-0/abstract

 

 

By Brooke Strickland

In this retrospective study, researchers gathered 150 patients (158 eyes) at 5 tertiary centers across the United States. The goal was to examine what the long-term results were of Boston type 1 keratoprosthesis (KPro) surgery in these patients. There were 133 patients (139 eyes) included in the study and these patients underwent KPro implantation between January 2003 and December 2006. Researchers looked at their medical records and all patients that had at least 1 postoperative visit were included the evaluation. For the patients that had repeat KPro procedures, only the initial surgery result was looked at. Information they looked at included visual acuity (VA) outcomes, complications after surgery, and device retention.

Results showed that the average follow up time was 46.7±26 months with all but four eyes that had at least 6 months of follow-up. Before surgery, only 10.8% of the eyes had VA of ≥20/200. After surgery, the VA in 70% of eyes improved to ≥20/200. The probability of maintaining VA of ≥20/200 at 7 years was 50%. The device retention rate was estimated at 67% at 7 years. The 7-year cumulative incidence of complications was 49.7% for retroprosthetic membrane formation, 21.6% for glaucoma surgery, 18.6% for retinal detachment, and 15.5% for endophthalmitis. (1)

What to take away from the study: There were increased risk of developing complications for those that had a longer follow up time. However, there were overall positive outcomes with better reported vision for people that had the KPro procedure completed in a 7-year time period.

1. Srikumaran, Divya, MD, Munoz, Beatriz, MA, Aldave, Anthony, J., MD, Aguavella, James, V., MD, Hannush, Sadeer, B., MD, Schultze, Robert, MD, Belin, Michael, MD, Akpek, Esen Karamursel, MD. “Long-term Outcomes of Boston Type 1 Keratoprosthesis Implantation.” Manuscript no. 2014-14. Published online July 11, 2014. Accessed July 14, 2014. http://www.aaojournal.org/article/S0161-6420%2814%2900494-1/abstract

 

 

By Brooke Strickland

In this study, researchers wanted to look at the overall safety and effectiveness of intravitreal ranibizumab injections for patients living with subfoveal neovascular age-related macular degeneration (wet AMD). Patients were 50 years old or less and were given the injections once a month or as needed for 24 months (pro re nata [PRN]). Patients were randomly put into two groups to receive injections of 0.5 mg or 2.0 mg monthly or PRN after 3 month loading doses.

The efficiency end point was the average change in best corrected visual acuity (BCVA) from baseline at month 12. Secondary end points were the average change in BCVA from baseline at month 24, the amount of patients that gained 15 letters or less in BCVA, mean number of ranibizumab injections, and the average change of central foveal thickness from baseline.

Results showed that at month 24, the average change from baseline in BCVA was +9.1 letters (.05 mg monthly), +7.9 letters (0.5 PRN), +8.0 (2.0 mg monthly), and +7.6 (2.0 mg PRN). The change in mean BCVA from month 12 to 24 was (letters) −1.0, −0.3, −1.2, and −1.0. The proportion of patients who gained ≥15 letters from baseline in BCVA at month 24 was 34.5%, 33.1%, 37.6%, and 34.8%. The average number of ranibizumab injections through month 24 was 21.4, 13.3, 21.6, and 11.2, respectively; 5.6 and 4.3 mean injections were required in year 2 in the 0.5 mg and 2.0 mg PRN groups, respectively. The time between treatments in the 0.5 mg PRN group was 9.9 weeks after 3 monthly loading doses, and 93% of these patients did not require monthly dosing. Ocular and systemic safety profiles over 2 years were similar among all 4 treatment groups and were consistent with previous ranibizumab trials in AMD. (1)

What to take away from the study: The improvements in BCVA at the end of month 25 were important and were in line with other 4 ranibizumab treatment groups. The 0.5 mg PRN group had an average gain of 7.9 letters at month 24 with an average of 13.3 injections.

1. Ho, Allen, C., MD, Busbee, G., Brandon, MD, Regillo, Carl, D., MD, Wieland, Mark, R., MD, Van Everen, A., Sherri, PharmD, Li, Zhengrong, PhD, PhD, Rubio, Roman, G., MD, Lai, Phillip, MD, for the HARBOR Study Group. Published online July 9, 2014. Accessed July 9, 2014. http://www.aaojournal.org/article/S0161-6420%2814%2900429-1/abstract

 

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