Ophthalmology

Peeling of the internal limiting membrane has increasingly become a dogma of surgical retina, while maintenance of the face-down positioning may become anachronistic in many cases.

Researchers have identified a new biomarker they believe can be used as a predictor of vision change in patients with diabetic macular edema, either during the natural history of the disease or after undergoing anti-VEGF therapy. The biomarker is disorganization of the retinal inner layers, or DRIL.

The Centers for Disease Control and Prevention (CDC) estimates that 29.1 million people, or 9.3% of the U.S. population, have diabetes. Over 8 million (27.8%) have the disease and are not diagnosed. The number of diagnosed cases are projected to increase 165% from the year 2000 to 2050, according to the American Diabetes Association. By 2050, there will be 29 million diagnosed cases of diabetes in the United States.

Retinal vascular changes do not show non-pathological age-related cognitive decline, researchers say. The study does not rule out the use of retinal information in diseases such as Alzheimer’s.

Cystoid macular edema (CME) might become less problematic in patients with non-ischemic central retinal vein occlusions (CRVOs).

A new class of ophthalmic drug continues to show promise for treating patients with diabetic macular edema (DME).

Patients treated with ranibizumab (Lucentis, Genentech) for diabetic macular oedema (DMO) in the National Health Service of the United Kingdom can fare about as well as patients in clinical trials, a review of patient records suggests.

Patients may respond differently to anti-vascular endothelial growth factor (VEGF) treatments for neovascular age-related macular degeneration (nAMD) depending on their genotypes, researchers say.

When it comes to finding new treatments for diabetic macular edema (DME), there is no shortage of promising targets, said Peter A. Campochiaro, MD. He presented an overview of future compounds with various mechanisms of action that may change how clinicians treat DME.

Looking back at 2016, incremental improvements in devices are changing how retina surgeons approach and treat surgeries, said a group of experts. For Charles Wykoff, MD, PhD, two novel improvements may not radically alter surgical approaches today, but will have a long-lasting impact down the road.

This has been the year of optical coherence tomography (OCT) angiography, numerous retina specialists said. Commercially available systems are available from Carl Zeiss Meditec, Heidelberg Engineering, and Optovue provide a noninvasive way to image retinal vasculature and confirm clinicians’ diagnoses of abnormalities.

The advent of three-dimensional optical coherence tomography to live surgery may bring greater clarity to how ophthalmologists visualize structures and how they operate.

Pharmacologic activity in the retina realm continues to hold much excitement for new therapies to treat retinal disorders.

In this Q&A with members of the Ophthalmology Times Europe Editorial Advisory Board, participants take a look at some of the top challenges and opportunities facing ophthalmologists in Europe today.

Aflibercept, an anti-VEGF agent, can enable treatment interval extensions and provide rapid and sustained vision gain in retinal vascular diseases as well as significantly reducing the severity of diabetic retinopathy.

Retina specialists who are Diabetic Retinopathy Clinical Research Network investigators offer views on whether laser panretinal photocoagulation or anti-VEGF therapy deserves consideration as first-line treatment for proliferative diabetic retinopathy.

Aflibercept (Eylea, Regeneron Pharmaceuticals) intravitreal injection, administered according to an as-needed regimen, improved the anatomic outcomes in many eyes refractory to monthly bevacizumab or ranibizumab injections that had persistent or recurrent fluid. However, half of the patients might require aflibercept injections every 4 weeks in order to achieve a completely dry retina.

A novel vascular endothelial growth factor receptor 2 (VEGF-R2) topical eye drop, PAN-90806 (PanOptica, Inc.), may revolutionize the treatment of neovascular age-related macular degeneration by making intravitreal injections of anti-VEGF drugs a thing of the past for certain patients and eliminating the risk associated with the intravitreal injections.

Adalimumab (Humira, AbbVie), an immunosuppressive biologic therapy, improves the symptoms of noninfectious active uveitis, but causes some adverse events and does not cure the disease, researchers say.

The inverted internal limiting membrane (ILM) flap technique is not only a safe and effective procedure for treating macular holes, but compared with conventional ILM peeling, it is significantly more effective for achieving macular hole closure in certain situations, said Stanislao Rizzo, MD, at Retina Subspecialty Day 2016.

A permanent keratoprosthesis (KPro) can help restore the vision of patients with severe corneal disease, but clinicians must watch out for complications, according to Donald J. D’Amico, MD. Dr. D’Amico of the Weill Cornell Medical College, New York, described some of those complications in his Pyron Award Lecture during the American Society of Retina Specialists 2016 Annual Meeting.

Use of voretigene neparvovec in gene therapy demonstrates positive outcomes to treat a gene mutation in patients with retinal dystrophy.

Earlier treatment of patients with DME who have had visual acuity loss results in the need for fewer intravitreal injections of ranibizumab over the long term.

The increasing prevalence of diabetes, which implies a rise in the number of cases of diabetic retinopathy, suggests that ophthalmologists need to ensure their knowledge of this disease is up-to-date. Hazy memories of a long-ago medical school lecture from an endocrinologist or the guidelines in an outdated textbook are inadequate given changes in the understanding of the pathogenesis, diagnosis, and especially the treatment of diabetes.

A digitally assisted vitreoretinal surgery system offers enhanced visualization for surgeons and observers, better ergonomics for greater surgeon comfort, and may improve patient safety by allowing use of lower endoillumination levels.

A real-world safety study of fluocinolone acetonide implant (Iluvien, Alimera Sciences) in patients with chronic DME (328 eyes from 292 patients) showed that 81.6% of patients did not require initiation of IOP-lowering therapy during the study and 60% of patients included in this registry study gained vision after injection of Iluvien that was sustained over the study period.

The Argus II Retinal Prosthesis System (Second Sight Medical Products) is providing a safe option for restoration of some visual function in patients with severe vision loss associated with retinitis pigmentosa.

By shrinking the core technology of optical coherence tomography to the size of a coin-and reducing its cost-a team of European scientists hopes to improve early diagnosis and screening of retinal diseases.

Complications of silicone oil occur when it is inadvertently placed in anatomic areas other than the vitreous cavity, migrates, or emulsifies. Methods for avoiding these issues and their management are discussed in this article.

An oral anti-VEGF/PDGF inhibitor had no dose-limiting toxicity and improved visual acuity and OCT findings in patients with exudative age-related macular degeneration in a phase I study.