Nepafenac in cataract surgery

The role of topical non-steroidal anti-inflammatory drugs (NSAIDs) in routine cataract surgery has been established since decades. Topical NSAIDs have been shown to reduce postoperative ocular inflammation and pain, preserve intraoperative mydriasis, and reduce the risk of postoperative cystoid macular oedema, whilst carrying a very low side-effect profile. Nepafenac is one of the currently available topical NSAIDs. The studies have shown that is has a high ocular penetration, allowing for potentially better results than other NSAIDs. This review gathers the current literature on the role of nepafenac in cataract surgery aiming to help surgeons maximise the benefits of its use to achieve improved surgical outcomes.

Choroidal thickness in geographic atrophy secondary to age-related macular degeneration

PURPOSE

To analyze choroidal thickness (CT) in eyes with geographic atrophy (GA) secondary to age-related macular degeneration (AMD).

METHODS

A total of 72 eyes of 72 patients (mean age, 75.97 ± 7.09 years) with GA and 37 eyes of 37 healthy controls (73.89 ± 6.19 years) were examined by confocal scanning laser ophthalmoscopy and enhanced depth imaging (EDI) spectral-domain optical coherence tomography. Choroidal thickness was measured at 25 defined points in horizontal and vertical scans. Geographic atrophy size was determined in fundus autofluorescence (FAF) images and GA subtypes were classified based on abnormal FAF in the perilesional zone.

RESULTS

In GA, subfoveal CT (fCT) was significantly thinner compared to controls (173.03 ± 90.22 vs. 253.95 ± 69.19 μm, P < 0.001). Analysis of averaged measurements of all 25 points obtained per patient (mCT) revealed similar results (162.07 ± 76.26 vs. 228.00 ± 66.24 μm, P < 0.001). Spatial differences in CT between both groups were largest superior to the fovea. Addressing "diffuse-trickling" (n = 15) and "non-diffuse-trickling" (n = 57) GA independently, fCT was 114.67 ± 43.32 and 188.39 ± 93.26 μm, respectively (P = 0.002), with both groups being significantly thinner than controls (P < 0.001 for "diffuse-trickling" and P < 0.001 for "?non-diffuse-trickling"). Similar results were obtained for mCT, which was 110.21 ± 29.66 μm in "diffuse-trickling," 175.72 ± 79.02 μm in "?non-diffuse-trickling" and 228.00 ± 66.24 μm in controls. Differences were significant with P = 0.002 between both GA groups and P ≤ 0.001 toward controls for each GA group.

CONCLUSIONS

The results indicate that the choroid in eyes with GA is thinner compared to normal eyes of similar age. Hereby, the extent of thinning is most pronounced in a specific subtype of GA identified by FAF imaging ("diffuse trickling"). Such GA subtype-related differences in choroidal thickness may reflect heterogeneity in the pathogenesis of disease. (ClinicalTrials.gov number, NCT02051998.).

The "diffuse-trickling" fundus autofluorescence phenotype in geographic atrophy

PURPOSE

To further characterize a subgroup of patients exhibiting the fundus autofluorescence (FAF) "diffuse-trickling" phenotype associated with geographic atrophy (GA).

METHODS

In the context of the Fundus Autofluorescence in Age-Related Macular Degeneration (FAM) Study, patients with diffuse-trickling GA were examined and characterized by FAF and spectral-domain optical coherence tomography imaging. Age, sex distribution, and medical history were compared with FAM study patients (n = 288, 60.1% female) with other GA phenotypes (non-diffuse-trickling). In a subset of patients, subfoveal choroidal thickness (SCT) was analyzed.

RESULTS

Patients with diffuse-trickling (n = 61), compared with patients with non-diffuse-trickling GA, had a significantly younger age at first presentation (68.2 ± 11.6 vs. 75.4 ± 8.1 years, P < 0.001), a shift in the proportion of men from 55% in the age group younger than 65 to 19% in the age group older than or equal to 65, and a significantly higher rate of myocardial infarction (MI) in the age group younger than 65 (24% vs. 0%, P = 0.011); all but one patient with MI were male. Further evaluation revealed that in the age group younger than 65, 54% of patients with diffuse-trickling had been hospitalized due to cardiovascular diseases including hypertensive crisis, angina, and MI. Analysis of choroidal thickness revealed a significantly thinner SCT in diffuse-trickling compared with non-diffuse-trickling GA (135.2 ± 56.4 vs. 191.4 ± 77.8 μm, P < 0.001).

CONCLUSIONS

The results indicate an association of diffuse-trickling GA with systemic cardiovascular disorders in the younger study population. Together with the ocular morphologic characteristics including a lobular appearance and a thin choroid, a vascular insufficiency at the level of the choroid may play a pathogenetic role in this distinct GA phenotype. (ClinicalTrials.gov number, NCT00393692.).

Functional and anatomical results after a single intravitreal Ozurdex injection in retinal vein occlusion: a 6-month follow-up -- the SOLO study

PURPOSE

To evaluate the efficacy of intravitreal dexamethasone implants in eyes with cystoid macular oedema (CME) secondary to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) in the clinical everyday practice, examine the effects of early retreatment and compare the results with the GENEVA study.

METHODS

The charts of 102 patients (102 eyes) with CME secondary to BRVO (n = 54) or CRVO (n = 48) treated with Ozurdex at 8 centres were retrospectively reviewed. The patients were examined monthly over a 24-week period. Slit-lamp biomicroscopy, measurement of best-corrected visual acuity (BCVA) and measurement of the central retinal thickness (CRT) with spectral-domain optical coherence tomography (SD-OCT) were performed at baseline and at every follow-up examination. With progression of the disease (loss of one line or increased central retinal thickness (CRT) of 150 μm), a reinjection of Ozurdex or anti-VEGF was offered. Additional supplementing sectorial or panretinal laser photocoagulation was considered based on the individual status of the retina.

RESULTS

In the BRVO group, the median BCVA was 0.6 logMAR (Snellen equivalent of 0.25) at baseline and improved to 0.4 logMAR (Snellen equivalent of 0.40) after 4 weeks, 0.3 logMAR (Snellen equivalent of 0.50) after 8 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 12 weeks, 0.5 logMAR (Snellen equivalent of 0.32) after 16 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 20 weeks and 0.45 logMAR (Snellen equivalent of 0.35) after 24 weeks. The mean CRT was 559 ± (SD) 209 μm at baseline and it decreased to 335 ± 148 μm after 4 weeks, 316 ± 137 μm after 8 weeks, 369 ± 126 μm after 12 weeks, 407 ± 161 μm after 16 weeks, 399 ± 191 μm after 20 weeks and 419 ± 196 μm after 24 weeks. In the CRVO group, the median BCVA was 0.7 logMAR (Snellen equivalent of 0.20) at baseline and improved to 0.4 logMAR (Snellen equivalent of 0.40) after 4 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 8 weeks, 0.6 logMAR (Snellen equivalent of 0.25) after 12 weeks, 0.6 logMAR (Snellen equivalent of 0.25) after 16 weeks, 0.5 logMAR (Snellen equivalent of 0.32) after 20 weeks and 0.52 logMAR (Snellen equivalent of 0.30) after 24 weeks. The mean CRT at baseline was 740 ± 351 μm and it decreased to 419 ± 315 μm after 4 weeks, 352 ± 261 μm after 8 weeks, 455 ± 251 μm after 12 weeks, 497 ± 280 μm after 16 weeks, 468 ± 301 μm after 20 weeks and 395 ± 234 μm after 24 weeks. The BCVA improvement was statistically significantly better (p < 0.05) compared with baseline in both groups at every follow-up visit. The mean CRT maintained significantly better when compared with baseline in both groups at all follow-up visits. Early reinjection was indicated in BRVO in 40.7% after 17.5 ± 4.2 weeks and in CRVO in 50% after 17.68 ± 4.2. Six eyes (11%) with BRVO received a sectorial laser photocoagulation at a mean interval of 22 ± 5.0 weeks. Seven eyes (15%) with CRVO received a panretinal laser photocoagulation after a mean interval of 18 ± 7.0 weeks. The BCVA improvement and the mean CRT reduction were statistically significant (p < 0.05) compared with baseline in both groups at every follow-up visit.

CONCLUSIONS

Dexamethasone intravitreal implant resulted in a significant improvement of the BCVA and reduction of CME in patients with BRVO or CRVO. Early retreatment after 16 weeks instead of 24 weeks, like in the GENEVA study, was indicated in 50% to stabilize the improved functional and anatomical results.