1
|
Eichenbaum DA, Freeman WR, Chang MA, Brooks L, Chaudhry N, Dadgostar H, McCannel CA, Michels M, Mittra RA, Wolfe JD, Beindl VC, Jaycock P, Bobbala A, Gune S, Spicer G, Callaway N. Endophthalmitis in Eyes Treated With the Port Delivery System With Ranibizumab: Summary of Cases During Clinical Trial Development. Ophthalmol Retina 2024:S2468-6530(24)00368-3. [PMID: 39154860 DOI: 10.1016/j.oret.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 08/09/2024] [Accepted: 08/09/2024] [Indexed: 08/20/2024]
Abstract
PURPOSE The Port Delivery System with ranibizumab (PDS) is approved in the United States for neovascular age-related macular degeneration. The US Prescribing Information has a Boxed Warning for endophthalmitis and reports the incidence rate in patients developing endophthalmitis after receiving the PDS compared to monthly intravitreal ranibizumab. Endophthalmitis cases noted in the Boxed Warning, treatment outcomes, potential contributing factors, and potential mitigations are summarized. DESIGN Retrospective review of endophthalmitis cases in PDS-treated patients in the phase 2 Ladder (NCT02510794) and phase 3 Archway (NCT03677934) and Portal (NCT03683251) trials. PARTICIPANTS Endophthalmitis cases in the pooled all-PDS safety population (N = 555) including PDS patients in Ladder, Archway, or Portal. METHODS Ladder patients received PDS (10, 40, or 100 mg/mL) with pro re nata refill-exchanges. Archway patients received PDS 100 mg/mL with fixed refill-exchanges every 24 weeks (PDS Q24W). Portal patients received PDS Q24W from day 1. MAIN OUTCOME MEASURES Clinical features, management, and visual outcomes were summarized. Cases were summarized by date of PDS implant and/or refill, other prior invasive procedures/refills, and preceding/concurrent conjunctival complications. RESULTS Twelve endophthalmitis events were reported in 11 patients (11/555 [2.0%]) through March 12, 2021. All were cultured (3 were culture positive) and treated with intravitreal antibiotics. Two cases (2/555 [0.4%]) occurred in the immediate postoperative period (days 5 and 6). Nine cases occurred later (day range: 57-853), including 4 before the first refill-exchange (day range: 57-161). Five patients received between 1-11 refill-exchanges before the event (onset: 6-168 days after last refill-exchange). Seven cases (7/11 [63.6%]) had preceding/concurrent conjunctival complications. At last follow-up, 7 patients recovered vision to study baseline levels or ≥ 20/40; 4 patients experienced vision loss of ≥ 15 ETDRS letters. CONCLUSIONS Endophthalmitis is a serious complication that can endanger vision after any ocular procedure, including PDS implantation. This limited series of endophthalmitis cases notes most, but not all, cases were late onset, associated with conjunctival breach, and recovered vision with treatment. Meticulous attention to PDS surgical techniques with vigilant monitoring of conjunctiva during follow-up may minimize risk of endophthalmitis. Prompt treatment is critical for optimizing patient outcomes.
Collapse
Affiliation(s)
- David A Eichenbaum
- Retina Vitreous Associates of Florida, St Petersburg, Florida; Morsani College of Medicine, University of South Florida, Tampa, Florida.
| | - William R Freeman
- Department of Ophthalmology, Jacobs Retina Center at Shiley Eye Institute, University of California San Diego, La Jolla, California
| | | | - Logan Brooks
- Southern Vitreoretinal Associates, Tallahassee, Florida
| | - Nauman Chaudhry
- Retina Group of New England, Yale University School of Medicine, New Haven, Connecticut
| | | | - Colin A McCannel
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, California
| | - Mark Michels
- Retina Care Specialists, PLLC, Palm Beach Gardens, Florida
| | | | - Jeremy D Wolfe
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | | | | | | | - Shamika Gune
- Genentech, Inc., South San Francisco, California
| | - Galin Spicer
- Genentech, Inc., South San Francisco, California
| | - Natalia Callaway
- Genentech, Inc., South San Francisco, California; Stanford University Byers Eye Institute, Palo Alto, California
| |
Collapse
|
2
|
Bhatkoti B, Kumar P, Verma G, Mathur V, Waikar S. Trabeculectomy with Ologen implant versus trabeculectomy with P 50 Ex-PRESS shunt in primary open-angle glaucoma. Med J Armed Forces India 2023; 79:26-33. [PMID: 36605351 PMCID: PMC9807680 DOI: 10.1016/j.mjafi.2020.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/21/2020] [Indexed: 01/07/2023] Open
Abstract
Background This is the first randomized controlled trial of trabeculectomy with Ex-Press Shunt versus Ologen implant in primary open-angle glaucoma (POAG) in Indian eyes. Methods A prospective randomized controlled trial of patients of POAG treated with two different methods of augmented trabeculectomy. Group A with Ex-PRESS shunt (P50 model) and Group B with Ologen implant. Surgical success was defined as intraocular pressure of 21 mm Hg or lower at 6 months postoperative. Results N = 40 eyes of 33 patients. Baseline IOP in Group A was 23.70 ± 4.6 mm Hg (Range 22-36 mm Hg), and Group B was 26.00 ± 4.0 mm Hg (Range 23-36 mm Hg). Surgical success was achieved in 85% of patients in both Groups. Change in IOP from baseline was statistically significant in both groups at 1, 4, 8, 12 weeks, and 6 months postoperative. No statistically significant difference in the change in IOP between the two groups. Postoperative complications were lesser in Group A compared to Group B, in both early (35% vs 50%) and late stage (20% vs 30%). The drop in visual acuity became statistically insignificant at 4 weeks in Group A and 8 weeks in Group B. Conclusions There is no difference between the surgical success rates of trabeculectomy with Ex-PRESS Shunt versus Ologen. However, the Ex-PRESS shunt fares better with lower complication rates and faster visual recovery than the Ologen group.
Collapse
Affiliation(s)
- Bhupesh Bhatkoti
- Classified Specialist (Ophthalmology), Command Hospital (CC), Lucknow, India
| | - Pradeep Kumar
- Classified Specialist (Ophthalmology), Army Hospital (Research & Referral), New Delhi, India
| | - Gaurav Verma
- Graded Specialist (Ophthalmology), 155 Base Hospital, India
| | - Vijay Mathur
- Consultant (Ophthalmology), Command Hospital (NC), Udhampur, India
| | - Shrikant Waikar
- Senior Advisor & HoD (Ophthalmology), INHS Asvini, Mumbai, India
| |
Collapse
|
3
|
Glaucoma Treatment Outcomes in Open Angle Glaucoma Patients of African Descent. J Glaucoma 2022; 31:479-487. [PMID: 35353787 PMCID: PMC9246921 DOI: 10.1097/ijg.0000000000002027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/19/2022] [Indexed: 01/31/2023]
Abstract
Open angle glaucoma (OAG), characterized by structural changes to the optic nerve head and retinal nerve fiber layer, is a progressive multifactorial optic neuropathy and a leading cause of irreversible blindness globally. Currently, intraocular pressure is the only modifiable risk factor; however, others have been identified, including genetics and race. Importantly, OAG is much more prevalent in persons of African descent (AD) compared with those of European descent (ED). OAG patients of AD are also known to have a more severe course of the disease, a finding potentially explained by structural and/or vascular differences within eye tissues. In addition, disparities in treatment outcomes have been identified in OAG patients of AD. Specifically, prostaglandin analogues have been suggested to be more effective in patients of AD than in those ED, while beta-adrenergic receptors have been suggested to be less effective, although the evidence is inconsistent. AD has also been identified as a risk factor for trabeculectomy failure while laser trabeculoplasty has been conversely found to be very effective in lowering intraocular pressure in patients of AD. Alternative surgical options, including Ex-Press shunt implantation, viscocanalostomy, and canaloplasty are promising in equivalence but require further research to evaluate disparity in outcome properly. In addition to treatment outcomes, social disparities affecting clinical care also exist for AD persons in the form of reduced adherence, access, and choice. Overall, data suggest the need for properly designed prospective trials with AD populations as a primary focus to identify the potential mechanisms driving disparities in treatment and address overall potential bias in glaucoma management.
Collapse
|
4
|
Nguyen AH, Fatehi N, Romero P, Miraftabi A, Kim E, Morales E, Giaconi J, Coleman AL, Law SK, Caprioli J, Nouri-Mahdavi K. Observational Outcomes of Initial Trabeculectomy With Mitomycin C in Patients of African Descent vs Patients of European Descent: Five-Year Results. JAMA Ophthalmol 2019; 136:1106-1113. [PMID: 30027217 DOI: 10.1001/jamaophthalmol.2018.2897] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance There is evidence that patients of African descent (AD) experience higher surgical failure rate after trabeculectomy without antimetabolites. Objective To compare outcomes of initial trabeculectomy with mitomycin C in AD patients with those of patients of European descent (ED) and to identify prognostic factors for failure. Design, Setting, and Participants In this retrospective matched cohort study, 135 eyes of 105 AD patients were matched with 135 eyes of 117 ED patients by age (within 5 years), surgeon, lens status, and follow-up time (within 1 year) from a single tertiary academic center. Interventions Initial trabeculectomy with mitomycin C. Main Outcomes and Measures Criteria A, B, and C defined qualified success rates as final intraocular pressure of 18 mm Hg or less, 15 mm Hg or less, and 12 mm Hg or less, respectively, in addition to 20% or more, 25% or more, and 30% or more reduction of intraocular pressure or reduction of 2 or more medications. Kaplan-Meier survival curves were compared with log-rank test in AD and ED patients, and Cox proportional hazard models were used to estimate the influence of race/ethnicity on surgical success accounting for confounding variables. Results Of the 105 AD patients, 56 (53.3%) were female, and the mean (SD) age was 67.5 (10.4) years; of the 117 ED patients, 64 (54.7%) were female, and the mean (SD) age was 68.2 (10.0) years. For AD patients compared with ED patients, the qualified success rates at 5 years for criteria A were 61% and 67%, respectively (difference, 7.3%; 95% CI, 4.4-10.4); for criteria B, 43% and 60% (difference, 17.6%; 95% CI, 15.2-20.0); and for criteria C, 25% and 40% (difference, 15.8%; 95% CI, 11.1-20.5). On multivariable Cox regression analyses, AD was associated with higher failure rate with criteria B and C for qualified success and with all criteria for complete success (ie, no need for medications). Incidence of bleb leaks was higher in the AD group (29 vs 11 eyes; P = .002). Additionally, AD patients required additional glaucoma surgeries more often than ED patients (47 vs 26 eyes; P = .004). Conclusions and Relevance African descent was associated with higher failure rates and higher incidence of bleb leaks after initial trabeculectomy with mitomycin C compared with European descent. If this is subsequently shown to be a cause and effect, the findings need to be considered when surgical treatment of glaucoma is contemplated in AD patients.
Collapse
Affiliation(s)
- Andrew H Nguyen
- Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Nima Fatehi
- Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Pablo Romero
- Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles.,Department of Ophthalmology, University of Chile, Santiago, Chile
| | - Arezoo Miraftabi
- Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles.,Eye Research Center, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - EunAh Kim
- Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Esteban Morales
- Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - JoAnn Giaconi
- Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Anne L Coleman
- Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Simon K Law
- Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Joseph Caprioli
- Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Kouros Nouri-Mahdavi
- Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| |
Collapse
|
5
|
Tojo N, Hayashi A, Otsuka M. Factors influencing the filtration-bleb volume after Ex-PRESS ® surgery. Clin Ophthalmol 2018; 12:1675-1683. [PMID: 30233131 PMCID: PMC6134405 DOI: 10.2147/opth.s172400] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose The aim of this study was to investigate the factors influencing the volume of the filtration bleb after Ex-PRESS® surgery. Methods This was a retrospective non-randomized study. After excluding patients who had undergone an additional glaucoma surgery, 99 glaucoma patients who underwent Ex-PRESS® surgeries and were followed up for >2 years were analyzed. We used anterior segment optical coherence tomography to measure the bleb volume, and compared the volume at 1 year with that at 2 years after surgery. We also examined potential influencing factors, including age, number of medications, central corneal thickness, type of glaucoma, preoperative intraocular pressure (IOP), postoperative IOP, reduction ratio of IOP, history of trabeculotomy, and operation method (Ex-PRESS® surgery only or simultaneous cataract surgery). Results Ex-PRESS® surgeries significantly decreased the IOP from 26.3±9.7 mmHg to 11.6±3.7 mmHg after 24 months (P<0.001). The success rate at 2 years was 81.2% (IOP ≥21 mmHg or ≥20% reduction from the baseline IOP). The results showed that age, postoperative IOP, glaucoma type, and simultaneous cataract surgeries influenced the filtration-bleb volume. Conclusion Advanced age, higher postoperative IOP, pseudo-exfoliation glaucoma, and simultaneous cataract surgeries were all found to decrease the volume of the filtration bleb.
Collapse
Affiliation(s)
- Naoki Tojo
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan,
| | - Atsushi Hayashi
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan,
| | - Mitsuya Otsuka
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan,
| |
Collapse
|
6
|
Lan J, Sun DP, Wu J, Wang YN, Xie LX. Ex-PRESS implantation with phacoemulsification in POAG versus CPACG. Int J Ophthalmol 2017; 10:51-55. [PMID: 28149776 DOI: 10.18240/ijo.2017.01.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 04/25/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the long-term outcomes of the Ex-PRESS miniature glaucoma device implanted under a scleral flap in combination of phacoemulsification with intraocular lens implantation in primary open angle glaucoma (POAG) and chronic primary angle-closure glaucoma (CPACG). METHODS Retrospective, comparative study. A total of 60 eyes (60 patients) receiving the Ex-PRESS miniature glaucoma device implantation combined with phacoemulsification were reviewed. Thirty eyes (30 patients) had the combined procedures for POAG, and the other 30 eyes (30 patients) for CPACG. RESULTS The follow-up was 39.37±7.09mo (range 3 to 49mo) in patients with POAG and 37.10±9.26mo (range 9 to 49mo) in patients with CPACG (P=0.29). The mean change in best corrected visual acuity was 0.41 logMAR for POAG and 0.38 logMAR for CPACG at the last follow-up (P=0.22). The postoperative intraocular pressure (IOP) of the POAG group was significantly lower than the CPACG group at 1, 3, 12, and 18mo after surgery (P=0.02, 0.00, 0.04, 0.01) with similar glaucoma medications after surgery (P>0.16). At 3y after surgery, the cumulative complete and qualified success rates were 63.3% (POAG) and 53.3% (CPACG), 83.3% (POAG) and 73.3% (CPACG) (P=0.41, 0.49), respectively. The POAG group had more hypotony than the CPACG group (P=0.04). CONCLUSION The long-term outcomes show the Ex-PRESS implantation combined with phacoemulcification can effectively lower the IOP in both the POAG and CPACG groups. The POAG group seems to have lower postoperative IOP and a higher risk of hypotony.
Collapse
Affiliation(s)
- Jie Lan
- Qingdao University Medical College, Qingdao 266071, Shandong Province, China; Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Da-Peng Sun
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Jie Wu
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Ya-Ni Wang
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Li-Xin Xie
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| |
Collapse
|
7
|
Taubenslag KJ, Kammer JA. Outcomes Disparities between Black and White Populations in the Surgical Management of Glaucoma. Semin Ophthalmol 2016; 31:385-93. [DOI: 10.3109/08820538.2016.1154163] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|