JOURNAL CLUB

RECENT NOTEWORTHY STUDIES TO STIMULATE DISCUSSION AND DEBATE

■ More IRay results. On the heels of April’s announcement that the IRay system (Oraya Therapeutics, Newark, CA) met its endpoints in recent clinical trials, a team of retinal physicians, collaborating among several centers in the United States and Mexico have published their own findings with IRay in combination with ranibizumab (Lucentis, Genentech, South San Francisco, CA).

The team enrolled 47 eyes of 47 patients with wet AMD, and the subjects received 16 Gy or 24 Gy of X-ray irradiation, after received two loading doses of ranibizumab.

The subjects experienced a mean approval in visual acuity of 8.4 ±11.9 and 7.8 ±12 ETDRS letters in the 16- and 24-Gy groups, and three quarters of the patients in both groups gained at least one letter.

The team saw no side effects of radiation retinopathy, optic neuropathy, or cataracts. IRay appears to reduce the treatment burden in combination with ranibizumab.

Morales-Canton V, Quiroz-Mercado H, Velez-Montoya R, et al. 16 and 24 Gy low-voltage X-ray irradiation with ranibizumab therapy for neovascular age-related macular degeneration: 12-month outcomes. Am J Ophthalmol. 2013;155:1000-1008.

■ New injection technique. Doctors in the United Kingdom conducted a prospective review of 200 intravitreal injections: 100 administered using the conventional technique, and 100 using a new conjunctival mold called InVitria (FCI Ophthalmics, Marshfield Hills, MA).

Comparing pain scores using a visual analog scale, as well as patient and doctor preferences and cost, the authors found injections using the new mold were significant less painful.

Only one case included an injection with the mold reported as difficult. Each injection with the mold saved £7.70 (~$11.50). Given the increasing rate of intravitreal injections, the authors recommended InVitria.

Ratnajaran G, Nath R, Appaswamy S, Watson S-L. Intravitreal injections using a novel conjunctival mould: a comparison with a conventional technique. Br J Ophthalmol. 2013;97:395-397.

■ Vitrectomy in eyes with NLP. To determine if vitrectomy with silicone oil tamponade would be effective in traumatized eyes with no light perception, surgeons in China undertook a retrospective case series of 19 patients over a three-year period.

After a mean follow-up of 12 months, slightly less than two-thirds of the eyes had better than NLP visual acuity, with 10.5% having VA ≤20/400. The patients with better recoveries had all suffered blunt trauma and had intact eyewalls.

The authors concluded that early vitrectomy combined with silicone oil tamponade and reattachment of the remaining retina could avoid permanent vision.

Figure. Fundus photo (top) of a right eye with early dry AMD. Note the numerous yellow subretinal drusen. In advanced dry AMD (bottom), the funds photo shows where RPE cells have died from apoptosis (arrowheads).

Yang S-S, Jiang T. Vitrectomy combined with silicone oil tamponade in the treatment of severely traumatized eyes with the visual acuity of no light perception. Int J Ophthalmol. 2013;6:198-203.

■ LUTEGA results. After one year of supplementation with lutein, zeaxanthin, omega 3 long-chain polyunsaturated fatty acids, and antioxidants, patients with dry AMD (Figure) in the European LUTEGA study experienced a considerable increase in macular pigment optical density (MPOD).

In addition, BCVA improved in both dosage arms of the trial. Despite two different dosages being administered, the study found no difference in MPOD between treatment arms, indicating that lutein and zeaxanthin reach saturation levels in the retina. RP

Dawczynski J, Jentsch S, Schweitzer D, Hammer M, Lang GE, Strobel J. Long term effects of lutein, zeaxanthin and omega-3-LCPUFAs supplementation on optical density of macular pigment in AMD patients: the LUTEGA study. Graefes Arch Clin Exp Ophthalmol. 2013 May 22. [Epub ahead of print]