Changes in lesion size after submacular surgery for subfoveal choroidal neovascularization in the submacular surgery trials pilot study

Intraocular properties of a repository urokinase receptor antagonist a36 Peptide in rabbits

PURPOSE

To evaluate the intraocular properties of A36, a peptide that directly antagonizes the cell surface urokinase receptor and so prevents pericellular urokinase plasminogen activator activity.

METHODS

A total of 41 rabbits were used. The toxicity study tested three doses of A36: 1 mg/ eye, 0.3 mg/eye, and 0.1 mg/eye. At 2 and 12 weeks, eyes were evaluated by ERG and histology. Pharmacokinetics were studied in rabbit eyes with the dose of 1 mg/eye in two different formulations: a micronized preparation and a non-micronized formulation. Eyes were enucleated at months 1, 2, 3, 4, and 5. Vitreous, retina, and choroid were collected separately for active A36 analysis.

RESULTS

We did not find ocular toxicity with low and medium doses. At the highest dose, there was a transient toxicity at 2 weeks but was not notable at 3 months. The target choroid concentration of A36 was chosen as > or =100 nM. The micronized formulation at months 1, 2, and 3 combined, showed variable levels in the choroid giving 5/10 (50%) of the therapeutic level; the non-micronized formulation at months 4 and 5 combined, gave 6/7 (86%) of the therapeutic level, although this difference was not statistically significant.

CONCLUSION

A36 appears to be long lasting; the non-micronized formulation of A36 gave concentrations above therapeutic level in the choroid at months 4 and 5. Optimization of the formulation of A36, particularly the particle size, may result in a promising new compound for exudative age-related macular degeneration treatment.

Measurement of greatest linear diameter for choroidal neovascular membrane using optical coherence tomography

PURPOSE

Correlation of greatest linear diameter (GLD) of choroidal neovascularization (CNV) measured by fundus fluorescein angiography (FA) with optical coherence tomography (OCT).

DESIGN

Retrospective noninterventional observational case series.

METHODS

Patients who underwent verteporfin therapy for subfoveal classic CNV were assessed. GLD of CNV was calculated manually from mean of 6 line scans. GLD measured on OCT and FA was correlated by assessing the agreement of the two techniques by interclass correlation and Bland and Altman technique.

RESULTS

Twenty-seven eyes of 27 patients with subfoveal classic CNV were included. The mean age was 49.3 +/- 18.6 years. The mean GLD calculated on FA was 1973.3 microm and OCT was 2024.2 microm. Substantial agreement was observed between GLD measured on FA and OCT (Inter-Class Correlation [ICC] = 0.77%; 95% confidence interval, 0.56 to 0.89).

CONCLUSIONS

GLD measured on OCT correlates to FA measurement. This method could be beneficial where FA is contraindicated while contemplating photodynamic therapy (PDT).

Surgery for subfoveal choroidal neovascularization in age-related macular degeneration: ophthalmic findings: SST report no. 11

PURPOSE

To present visual acuity (VA) and related findings from patients enrolled in one of the Submacular Surgery Trials (SST) evaluating surgical removal versus observation of subfoveal choroidal neovascularization secondary to age-related macular degeneration (SST Group N Trial).

DESIGN

Randomized clinical trial.

PARTICIPANTS

Eligible patients had age-related macular degeneration with subfoveal choroidal neovascularization, some with a classic pattern on fluorescein angiography, and best-corrected VA (BCVA) of 20/100 to 20/800 in one eye (study eye) that had received no treatment in the macula. Any contiguous blood had to account for <50% of the total area occupied by the subfoveal lesion (maximum size, 9.0 disc areas [22.9 mm2]).

METHODS

Randomization was stratified by VA and by clinical center. All patients were scheduled for study examinations at 3, 6, 12, and 24 months after enrollment for assessment of study outcomes.

MAIN OUTCOME MEASURE

A successful outcome was defined a priori to be either improvement of BCVA or VA no more than 1 line (7 letters) worse than baseline at the 24-month examination.

RESULTS

Of 454 patients enrolled, 228 study eyes were assigned to observation and 226 to surgery. The percentages of eyes that had successful outcomes were similar in the 2 arms: 44% assigned to observation and 41% assigned to surgery. Median VA losses from baseline to the 24-month examination were 2.1 lines (10.5 letters) in the observation arm and 2.0 lines (10 letters) in the surgery arm. Median VA declined from 20/100 at baseline to 20/400 at 24 months in both arms. No subgroup of patients was identified in which submacular surgery led to better VA outcomes. In the surgery arm, 55 (39%) of 142 initially phakic eyes had cataract surgery by the 24-month examination, compared with 6 (5%) of 133 eyes in the observation arm. Rhegmatogenous retinal detachment occurred in 12 surgery eyes (5%) and 1 observation eye.

CONCLUSIONS

Submacular surgery, as performed in this clinical trial, did not improve or preserve VA for 24 months in more eyes than observation and is not recommended for patients with similar lesions. This article contains additional online-only material available at http://www.ophsource.com/periodicals/ophtha.