Treatment of chronic diabetic macular oedema with intravitreal fluocinolone acetonide implant; real-life analysis of outcomes during overall treatment period

PURPOSE

To assess the clinical efficacy of the fluocinolone acetonide (FA) intravitreal implant (Iluvien, Alimera Sciences) over a 12-month period in a population resistant to treatment with first-line anti-VEGF agents.

METHODS

This study is a retrospective cohort study assessing functional and anatomical outcomes in 13 eyes of 12 patients treated for diabetic macular oedema (DMO) with a single fluocinolone implant (FA) (Iluvien) under real-world conditions. The follow-up period includes the time of first intravitreal treatment (incl anti-VEGF or short-lasting steroids) given until 12 months post FA implant insertion. Primary outcomes were best corrected visual acuity (BCVA), measured using the modified Early Treatment Diabetic Retinopathy Study (ETDRS) grading scale, and central foveal thickness (CFT), measured using Topcon 3DOCT-2000 (Topcon Inc) SD-OCT imaging. Mean BCVA and CFT were measured before anti-VEGF treatment, after anti-VEGF treatment, at the time of Iluvien implant insertion, and 6 and 12 months after Iluvien implant insertion. The t-paired sample test was used to ascertain statistical significance of changes in comparison of two samples while the ANOVA analysis was used in comparison of three or more samples.

RESULTS

The baseline BCVA (SD) of the cohort prior to initiation of anti-VEGF treatment was 47.45 (12.27) ETDRS letters whilst the mean CFT (SD) was 579 (203) microns. Following completion of anti-VEGF therapy, the mean improvement in vision was 8.9 ETDRS letters (p = 0.1) whilst the mean reduction in CFT was 197 microns (p = 0.028). Mean BCVA (SD) at the time of insertion of the FA implant was 55.15 (11.16) ETDRS letters and mean (SD) CFT at time of insertion of the FA was 454.62 μm (109.51). Following the 12-month treatment period with the FA implant, BCVA (SD) was 62.15 (10.25) ETDRS letters (p = 0.0331) and the mean (SD) CFT was 404.36 μm (142.92), a change of -50.26 μm from baseline (p = 0.0369).

CONCLUSIONS

This study has shown that statistically significant improvements in BCVA and CFT can be achieved over a 12-month period with the Iluvien implant. The implant has been shown to be a safe option in the treatment of DMO and may have a role to play in achieving good functional and anatomical outcomes in DMO while also reducing the frequency of follow-up appointments required to maintain stable vision in the working-age population.

Characterization of Ebola Virus-Associated Eye Disease

IMPORTANCE

Survivors of Ebola virus disease (EVD) may experience ocular sequelae. Comparison with antibody-negative individuals from the local population is required to characterize the disease.

OBJECTIVE

To assess features of ophthalmic disease specific to EVD.

DESIGN, SETTING, AND PARTICIPANTS

This baseline cross-sectional analysis of survivors of EVD and their close contacts was conducted within PREVAIL III, a 5-year, longitudinal cohort study. Participants who enrolled at John F. Kennedy Medical Center in Liberia, West Africa from June 2015 to March 2016 were included in this analysis. Close contacts were defined as household members or sex partners of survivors of EVD. Data were analyzed from July 2016 to July 2020.

EXPOSURES

All participants, both survivors and close contacts, underwent testing of IgG antibody levels against Ebola virus surface glycoprotein.

MAIN OUTCOMES AND MEASURES

Ocular symptoms, anterior and posterior ophthalmologic examination findings, and optical coherence tomography images were compared between antibody-positive survivors and antibody-negative close contacts.

RESULTS

A total of 564 antibody-positive survivors (320 [56.7%] female; mean [SD] age, 30.3 [14.0] years) and 635 antibody-negative close contacts (347 [54.6%] female; mean [SD] age, 25.8 [15.5] years) were enrolled in this study. Survivors were more likely to demonstrate color vision deficit (28.9% vs 19.0%, odds ratio [OR], 1.6; 95% CI, 1.2-2.1) and lower intraocular pressure (12.4 vs 13.5 mm Hg; mean difference, -1.2 mm Hg; 95% CI, -1.6 to -0.8 mm Hg) compared with close contacts. Dilated fundus examination revealed a higher percentage of vitreous cells (7.8% vs 0.5%; OR, 16.6; 95% CI, 5.0-55.2) and macular scars (4.6% vs 1.6%; OR, 2.8; 95% CI, 1.4-5.5) in survivors than in close contacts. Uveitis was present in 26.4% of survivors and 12.1% of close contacts (OR, 2.4; 95% CI, 1.8-3.2). Among all participants with uveitis, survivors were more likely than close contacts to have intermediate uveitis (34.2% vs 6.5% of all cases; OR, 7.8; 95% CI, 3.1-19.7) and had thicker mean central subfield thickness on optical coherence tomography (222 vs 212 μm; mean difference, 14.4 μm; 95% CI, 1.9-26.9 μm).

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, survivors of EVD had a distinct spectrum of ocular and neuro-ophthalmologic findings compared with close contacts that potentially require medical and surgical treatment.

Poster - Thur Eve - 26: Interfraction reproducibility of heart position during breast irradiation using Active Breathing Control

The moderate deep-inspiration breath hold (mDIBH) technique using the Active Breathing Coordinator (ABC) from Elekta is used in our clinic to lower the heart dose during left breast irradiations. The purpose of this work was to investigate the interfraction reproducibility of the heart to chest distance during these treatments and to evaluate the dosimetric effect of any changes in the heart position. Daily CBCT images were available for 5 patients who had been treated with ABC tangents and a cavity boost. On these images, one-dimensional measurements of the distance between the heart and the chest wall were taken at two anatomical locations corresponding roughly with the location where the radiation field most likely intercepts the heart. The average change in this distance was interpreted as a shift of the heart position. To assess the effect of this shift on the delivered heart dose, the heart contours in the clinical plans of the corresponding patients were shifted towards the treatment field using standard Pinnacle tools. Although the ABC device allows good reproducibility of the volume of air held, this does not warrant reproducibility of heart position for all patients during treatment. The largest average heart shift extracted from CBCT images in this study was 6.2mm. The heart dose reconstructed using this shift for the corresponding patient also showed the largest effect. However, even in the presence of a systematic heart shift of this magnitude, the ABC plan still showed superior heart dose reduction compared to the free-breathing plan.

Aspheric Ablation With the Nidek EC-5000 CX II With OPD-Scan Objective Analysis

PURPOSE

To analyze the efficacy, predictability, stability, and safety of laser in situ keratomileusis (LASIK) to correct myopia and myopic astigmatism using the Nidek EC-5000 CX II laser and the Customized Aspheric Transition Zone (CATz) profile.

METHODS

We conducted a retrospective analysis of 100 eyes (50 patients) with myopic astigmatism. A CATz profile was used in all eyes (profile 4) with an ablation zone of 5 mm and a transition zone of 9 mm, using Nidek FinalFit software.

RESULTS

Average patient age was 39 years (range 21 to 69 yr). Preoperative mean spherical equivalent refraction was -4.70 +/- 2.53 D (range -11.88 to -0.50 D), mean preoperative sphere was -4.31 +/- 2.53 D (range -11.25 to -0.25 D), and mean preoperative cylinder was -0.78 +/- 0.69 D (range -3.25 to 0). Postoperative mean spherical equivalent refraction at 6 months was 0.12 +/- 0.53 D (range -1.63 to +0.88 D), mean postoperative sphere was 0.02 +/- 0.56 D (range -1.50 to +2.00 D), and mean postoperative cylinder was -0.29 +/- 0.50 D (range 0 to -1.75 D). Uncorrected visual acuity was 6/6 or better in 58% (58 eyes) and better than 6/12 in 93% (93 eyes).

CONCLUSION

LASIK with the Nidek EC-5000 CX II laser and the CATz profile was effective, reasonably predictable, stable, and safe for correction of myopic astigmatism with a spherical component between -0.25 and -11.25 D, and a cylindrical component up to 3.25 D, using the techniques in this study. Astigmatism was undercorrected with the current algorithm.

Radiation-induced craniofacial bone growth inhibition: development of an animal model

Craniofacial deformities caused by therapeutic radiation-induced bone growth inhibition can occur in up to 100% of survivors of childhood head and neck cancers. The mechanism of radiation-induced craniofacial bone growth inhibition is poorly understood. The objective of this study is to establish a model of radiation-induced craniofacial bone growth inhibition to study the pathophysiology of radiation on growing membranous bone. Seven-week-old male New Zealand white rabbits were randomized into 4 groups (n = 10/group) and received a single dose of orthovoltage radiation (0, 15, 25, or 35 Gy) to the right orbital-zygomatic complex. Serial radiographs and computed tomography scans were performed for cephalometric analysis, bone volume, and bone density measurements until skeletal maturity at 21 weeks. Statistically significant ( P < 0.05) reductions in orbital-zygomatic complex linear bone growth, bone volume, and bone density were found after radiation with 25 or 35 Gy compared with nonirradiated control animals. A significant ( P < 0.05) decrease in orbital-zygomatic complex volume was noted after 15-Gy radiation but there were no significant effects on linear bone growth as assessed by cephalometric analysis at this dose. This study establishes the rabbit orbital-zygomatic complex as a suitable model for the study of radiation-induced craniofacial bone growth inhibition and will permit investigation into the underlying cellular and molecular basis of this injury.

A practical approach to inverse planning for high-precision dose escalated conformal prostate radiotherapy

The problem of choosing the best gantry angles and beam weights for dose-escalated conformal prostate treatment planning is formulated using a mixed-integer linear programming approach, to account for tumour dose homogeneity and dose-volume constraints. The formulation allows the number of beams to be restricted and for some of the beams to be compulsory. The present planning algorithm interfaces with and utilizes the three-dimensional planning capabilities of a commercial treatment planning system. A case study is illustrated, which represents a particularly challenging planning problem due to a large planning target volume and an unusually small bladder. Treatment plans with different numbers of beams are generated to compare with each other and with the standard six-field plan. Significant improvement is shown in the reduction of hot regions within the femoral heads and rectal wall, while not unduly compromising homogeneity constraints for the tumour.

An automated approach to seed assignment for eye plaque brachytherapy

Episcleral plaques are commonly used for the treatment of ocular tumours such as choroidal melanoma. Treatment planning involves the assignment of seeds to slots on the plaque to achieve a desired dose rate distribution. Seed assignment is rather straightforward if seeds are ordered on demand. However, the assignment task becomes tedious and laborious if the seeds have to be chosen from an existing stock of seeds with different activities. To date, this task has usually been performed by a human planner through trial and error. An algorithm has been developed to automate the task of seed assignment using a mixed-integer programming method. We also explore ways to simplify the problem such that the method becomes practical in most facilities. We have tested the method on three randomly chosen clinical cases from our past records, to show that the algorithm could yield solutions within a shorter time frame and with less deviation from the desired dose rate distributions, as compared with the solutions from a human counterpart.

Attitudes towards organ donation in Hong Kong

In this paper, a survey is conducted to study the attitudes of Hong Kong residents towards organ donation after death. It is found that 60.3% of the respondents are willing to donate organs, which is comparable to those cited in the literature. The results also indicate that the willingness to donate is related to age, occupation and attitude. A factor analysis of attitudes yielded four factors, including form of burial, altruism, lack of understanding on organ donation and lack of confidence in professional conduct of medical doctors. Further analysis of the factor scores provides information that is useful to the design of effective public education programs in organ donation.