JOURNAL CLUB

RECENT NOTEWORTHY STUDIES TO STIMULATE DISCUSSION AND DEBATE

■ Lucentis in pseudophakes. Reports have been published on phacoemulsification triggering progression of wet AMD. Therefore, a South Korean team of ophthalmologists has reported their findings on whether any difference exists in the outcomes of Lucentis injections in phakic vs pseudophakic eyes.

In this retrospective chart review, 75 phakic eyes and 45 pseudophakic eyes were compared with regard to BCVA and central macular thickness on OCT. There were no statistically significant differences in either outcomes measurements, nor were the number of injections administered to the groups different.

Within the limitations of a retrospective study, the authors suggested there are no differences in outcomes relative to the presence of a natural lens.

Sun Baek J, Cho HJ, Cho SW, Kim CG, Kim JW. Intravitreal ranibizumab injection for neovascular age-related macular degeneration in phakic versus pseudophakic eyes. Retina. 2013;33:467-473.

■ Cone-rod disorder identified. Scientists in Saudi Arabia have identified the phenotype associated with a specific mutation in the gene that encodes the CABP4 protein. The gene, which is associated with congenital stationary night blindness, had been identified in three individuals from two families in Switzerland.

However, the 11 patients in the Saudi study, who came from four related families, had nystagmus, low vision, and photophobia but no night blindness. Electroretinography from the 11 patients indicated a cone-rod synaptic disorder.

The authors thus recommended that this CABP4 mutation be identified in the future with this photoreceptor disorder, rather than with night blindness.

Khan AO, Alrashed M, Alkuraya FS. Clinical characterisation of the CABP4-related retinal phenotype. Br J Ophthalmol. 2013;97:262-265.

■ DME study results. Sixteen-week results have been published from a study of MP0012, a designed ankyrin repeated protein (DARPin) that binds to VEGF, in patients with DME.

One injection of the drug was administered to three dosage cohorts of six patients each, who were then assessed for safety and pharmacokinetics, as well as changes in BCVA and foveal thickness. BCVA improved on a dose-related basis by four to 10 letters.

However, ocular inflammation was detected in 11 of the patients, with one severe case. Having identified and eliminated the inflammation-causing agent from the preparation, the authors of the study are confident that future studies will not have similar problems.

Campochiaro PA, Channa R, Berger BB, et al. Treatment of diabetic macular edema with a designed ankyrin repeat protein that binds vascular endothelial growth factor: a phase I/II study. Am J Ophthalmol. 2013;155:697-704.

■ New ETROP data. A study based on data from the ETROP study indicates posterior-pole appearance correlates well with VA in these children.

Six hundred six eyes for which VA and retinal structural assessments were available, were included. Of these eyes, 76.2% showed concordant outcomes. Among discordant outcomes, the majority had unfavorable VA outcomes, although the structural outcomes were positive. The authors suggested if retinal structure appears normal but VA is poor in children with ROP, other diagnoses, such as optic atrophy, could account for the difference in outcomes.

Wallace DK, Bremer DL, Good WV, et al. Correlation of recognition visual acuity with posterior retinal structure in advanced retinopathy of prematurity. Arch Ophthalmol. 2012;130:1512-1516.

■ MERSI uveitic edema study. The Massachusetts Eye Research and Surgery Institute undertook a case series to compare Avastin, triamcinolone, and bromfenac for macular edema resulting from uveitis. Sixty-seven eyes of 55 patients received bromfenac eyedrop monotherapy, Avastin plus bromfenac, or triamcinolone plus bromfenac.

Figure. Cystoid macular edema as seen on fundus autofluorescence (top) and OCT (bottom).

IMAGE ADAPTED FROM UDAONDO P, GARCIA-POUS M, GARCIA-DELPECH A, SALOM D, DIAZ-LLOPIS M. PROPHYLAXIS OF MACULAR EDEMA WITH INTRAVITREAL RANIBIZUMAB IN PATIENTS WITH DIABETIC RETINOPATHY AFTER CATARACT SURGERY: A PILOT STUDY. J OPHTHALMOL. 2011;159436, COURTESY OF HINDAWI PUBLISHING CORP.

After three months of follow-up, no significant effects in VA or central macular thickness were seen in the monotherapy group; half required retreatment before the three-month endpoint. Both combination groups showed improvements in both outcomes; however, with greater resolution of edema seen in the Avastin group.

The authors concluded bromfenac is ineffective in uveitic macular edema, although it could exert a synergistic effect when used with other agents. RP

Radwan AE, Arcinue CA, Yang P, et al. Bromfenac alone or with single intravitreal injection of bevacizumab or triamcinolone acetonide for treatment of uveitic macular edema. Graefes Arch Clin Exp Ophthalmol. 2013 Mar 22. [Epub ahead of print]