JOURNAL CLUB

RECENT NOTEWORTHY STUDIES TO STIMULATE DISCUSSION AND DEBATE

■ Four-year Lucentis data. Four-year treatment results with Lucentis (ranuibizumab, Genentech) are becoming more common, and the January 2013 American Journal of Ophthalmology has such data, this time from Denmark.

Retinal physicians conducted a retrospective study of 855 patients with a minimum of 15 months of follow-up data. Of these patients, 456 were still receiving treatment, while the remainder discontinued.

Surprisingly, the overall treatment results indicated a decrease in ETDRS letters (from 53.2 to 50.5 letters). The authors suggested their study offers more evidence that visual acuity does seem to decrease with longer-term Lucentis treatment.

Nevertheless, they could distinguish good and bad responders from regular, nonextraordinary responders, and they believe that such responders, both good and bad, can generally be identified within the first two years of treatment. The remainder of regular responders, who constituted almost two-thirds of their study group, require continuous monitoring and ongoing treatment.

■ GA after anti-VEGF. With reports of geographic atrophy in patients treated for CNV with anti-VEGF drugs, increasing research has focused on this topic. The December 2012 British Journal of Ophthalmology features a study addressing this issue.

Twenty-one eyes were enrolled in this retrospective case series, most of which (95.2%) had type 2 CNV. All developed GA at least two years after treatment with Lucentis.

After a mean of 5.0 ±0.87 injections, logMAR BCVA worsened from 0.73 ±0.05 to 0.88 ±0.08, even as intraretinal cystic lesions, subretinal fluid, and pigment epithelial detachments all decreased.

The authors believe that Lucentis provides no improvement in BCVA at 24 months in GA-associated CNV, despite anatomic improvement. They note that Lucentis is effective in reversing CNV but that vision loss due to GA remains irreversible.

■ Methotrexate for CSC. Central serous chorioretinopathy remains a challenge in retina, with several drugs under investigation to treat it. One team, which investigated lowdosemethotrexate, has published their findings in the November-December 2012 Retina.

Figure. Advanced age-related macular degeneration, showing extensive fibrovascular scarring that covers the macula.

IMAGE FROM TAYLOR HR, TIKELLIS G, ROBMAN LD, MCCARTY, CA, MCNEIL JJ. VITAMIN E SUPPLEMENTATION AND MACULAR DEGENERATION: RANDOMISED CONTROLLED TRIAL. BMJ. 2002;325:11 REPRINTED WITH PERMISSION OF BMJ JOURNALS

In their retrospective review of nine eyes of nine patients treated for CSC with oral methotrexate, the authors assessed VA, central macular thickness, and total volume. At eight weeks, VA improved from 20/67 to 20/35, while macular thickness decreased from 309 μm to 213 μm, and total macular volume decreased from 8.14 to 7.21. Subretinal fluid resolved in 83%; no methotrexate toxicity–related events were seen.

The authors noted prospective studies are needed to substantiate their findings, but they suggested methotrexate might be useful in the treatment of CSC.

■ ROP study. To provide additional insight into the correlation between VA and retinal structure in patients with retinopathy of prematurity, ophthalmologists conducted a study of 6-year-old children with ROP. They report their findings in the December 2012 Archives of Ophthalmology.

Six hundred six eyes were enrolled of patients submitted to ETDRS VA testing. Agreement between VA and retinal structural outcomes was seen in 76.2% of cases. Of these 462 eyes, 402 had favorable outcomes.

The authors concluded posterior pole appearance correlated well with CV in 6-year-olds with ROP. If the retinal structure is normal but poor VA persists, they recommended considering other diagnoses, including optic atrophy.

■ Retinal vascular study. Graefe’s Archive of Clinical and Experimental Ophthalmology published in December 2012 results of one the largest studies of retinal microvascular signs in the Chinese population. The Handan Eye Study, which followed 6,830 rural adults, looked for correlations between metabolic syndrome, its components and signs of disease.

After adjusting for demographic factors, 5,519 participants with metabolic syndrome or one of its components (large waist circumference, high blood pressure, etc.) had a greater likelihood of developing retinopathy, arteriovenous nicking, focal arteriolar narrowing, enhanced arteriolar wall reflex, and generalized retinal arteriolar narrowing.

The study further clarified the relationship between metabolic syndrome and changes in the diameters of the retinal vasculature. RP