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JOURNAL REVIEW
Year : 2019  |  Volume : 57  |  Issue : 4  |  Page : 340-343

Journal Scan


R K Eye Care Centre, Rasipuram, Namakkal, Tamil Nadu, India

Date of Submission19-Nov-2019
Date of Acceptance19-Nov-2019
Date of Web Publication26-Dec-2019

Correspondence Address:
Dr. R Vasumathi
R K Eye Care Centre, Rasipuram, Namakkal, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_113_19

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How to cite this article:
Vasumathi R. Journal Scan. TNOA J Ophthalmic Sci Res 2019;57:340-3

How to cite this URL:
Vasumathi R. Journal Scan. TNOA J Ophthalmic Sci Res [serial online] 2019 [cited 2020 Jul 14];57:340-3. Available from: http://www.tnoajosr.com/text.asp?2019/57/4/340/273996




  Efficacy and Safety of 0.1% Cyclosporine-A Cationic Emulsion in the Treatment of Severe Dry Eye Disease: a Multicenter Randomized Trial Top


Leonardi A, Van Setten G, Amrane M, Ismail D, Garrigue JS, Figueiredo FC, et al. Efficacy and safety of 0.1% cyclosporine A cationic emulsion in the treatment of severe dry eye disease: A multicenter randomized trial. Eur J Ophthalmol 2016;26:287-96.

Purpose: This study was conducted to assess the treatment effect of 0.1% cyclosporine A cationic emulsion (CsA CE) eye drops on signs and symptoms of patients with severe dry eye disease (DED). Methods: This was a multicenter, randomized, double-masked, 2-parallel-arm, 6-month Phase III study with a 6-month open-label treatment safety follow-up. Patients with severe DED with corneal fluorescein staining (CFS) grade 4 on the modified Oxford scale were randomized to receive once-daily CsA CE (Ikervis®) or its vehicle. Results: A total of 246 patients were randomized. The proportion of patients achieving ≥2 grades improvement in CFS and a 30% improvement in symptoms (Ocular Surface Disease Index [OSDI]) by month 6 was 28.6% with CsA CE versus 23.1% with vehicle (P = 0.326) (primary endpoint). Assessment of corneal damage showed greater improvement with CsA CE over vehicle in mean adjusted CFS change from baseline to month 6 (−1.764 vs. −1.418, P = 0.037). There was a reduction in ocular surface inflammation assessed by human leukocyte antigen DR expression in favor of CsA CE at month 6 (P = 0.021). The mean OSDI change from baseline was − 13.6 with CsA CE and − 14.1 with vehicle at month 6 (P = 0.858). The main adverse event was instillation site pain (29.2% vs. 8.9% in the CsA CE and vehicle groups, respectively), and it was mostly mild.

Take-home message

This study confirmed the positive benefit-risk ratio of this new formulation of CsA for the treatment of severe keratitis in DED. 0.1% CsA CE is well-tolerated and effective in improving corneal damage and ocular surface inflammation.


  Detailed Analysis of Retinal Morphology in Patients With Diabetic Macular Edema (Dme) Randomized to Ranibizumab or Triamcinolone Treatment Top


Karst SG, Lammer J, Mitsch C, Schober M, Mehta J, Scholda C, et al. Detailed analysis of retinal morphology in patients with diabetic macular edema (DME) randomized to ranibizumab or triamcinolone treatment. Graefes Arch Clin Exp Ophthalmol 2018;256:49-58.

Purpose: The purpose of the study was to compare the impact in diabetic macula edema (DME) of two intravitreal drugs (0.5 mg ranibizumab vs. 8 mg triamcinolone) on changes in retinal morphology in spectral-domain optical coherence tomography (OCT) images, color fundus photography (CF) and fluorescein angiography (FA) images during a 1-year follow-up. Methods: Post hoc analysis was conducted of morphologic characteristics in OCT, FA and CF images of eyes with a center involving DME that were included in a prospective double-masked randomized trial. Eligible patients were divided at random into two groups receiving either Pro re nata treatment with 0.5 mg ranibizumab or 8 mg triamcinolone after a fixed loading dose. OCT and CF images were acquired at monthly visits and FA images every 3 months. Results: Twenty-five eyes of 25 patients (ranibizumab: n = 10; triamcinolone: n = 15) were included in this study. Patients treated with ranibizumab showed better visual acuity results after 12 months than patients receiving triamcinolone (P = 0.015) although edema reduction was similar (P = 0.426) in both groups. The initial effect on macular edema shedding after a single ranibizumab injection could be amplified with the following two injections of the loading dose. After a single injection of triamcinolone the beneficial initial effect on the macula edema faded within 3 months. Subretinal fluid and inner nuclear layer (INL) cystoid spaces diminished early in the course of treatment while fluid accumulation in the outer nuclear layer (ONL) seemed to be more persistent in both treatment arms. In FA, the area of leakage diminished significantly in both treatment arms. After repeated injections the morphologic OCT and FA characteristics of the treatment arms converged.

Take-home message

Despite the higher dosage of triamcinolone, both therapies were safe and effective for treating diabetic macular edema. Fluid accumulation in the INL and subretinal space was more responsive to therapy than fluid accumulation in the ONL.


  Potential of Small Molecule-Mediated Reprogramming of Rod Photoreceptors to Treat Retinitis Pigmentosa Top


Nakamura PA, Tang S, Shimchuk AA, Ding S, Reh TA. Potential of small molecule-mediated reprogramming of rod photoreceptors to treat retinitis pigmentosa. Invest Ophthalmol Vis Sci 2016;57:6407-15.

Purpose:Mutations in rod photoreceptor genes can cause retinitis pigmentosa (RP). Rod gene expression is regulated by the nuclear hormone receptor, Nr2e3. Genetic deletion of Nr2e3 reprograms rods into cells that resemble cone photoreceptors, and might therefore prevent their death from some forms of RP. There are no identified ligands for Nr2e3; however, reverse agonists might mimic the genetic rescue effect and may be therapeutically useful for the treatment of RP. Methods: Small molecule modulators of Nr2e3 were screened using primary retinal cell cultures and characterized the most potent, which was named photoregulin1 (PR1),in vitro and in vivo. The ability of PR1 to slow the progression of photoreceptor degeneration was tested in two common mouse models of autosomal dominant RP, the RhoP23H and the Pde6brd1 mutations. Results: In developing retina, PR1 caused a decrease in rod gene expression and an increase in S opsin + cones. Photoregulin1 continued to inhibit rod gene expression in adult mice. When applied to two mouse models of RP, PR1 slowed the degeneration of photoreceptors.

Take-home message

Chemical compounds identified as modulators of Nr2e3 activity may be useful for the treatment of RP through their effects on expression of disease-causing mutant genes.


  Levels of Aqueous Humor Trace Elements in Patients With Open-Angle Glaucoma Top


Hohberger B, Chaudhri MA, Michalke B, Lucio M, Nowomiejska K, Schlötzer-Schrehardt U, et al. Levels of aqueous humor trace elements in patients with open-angle glaucoma. J Trace Elem Med Biol 2018;45:150-5.

Purpose: Trace elements might play a role in the complex multifactorial pathogenesis of open-angle glaucoma. The aim of this study was to analyze concentrations of trace elements in aqueous humor samples of patients with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG). Patients and Methods: Thirty-three aqueous humor samples were obtained from patients undergoing cataract surgery: 12 patients with POAG (age 65.3 ± 10.50, female 8, male 4), 10 patients with PEXG (age 65.9 ± 11.27, female 6, male 4) and 11 patients without glaucoma (age 69.5 ± 13.70, female 7, male 4) serving as controls. Aqueous humor levels of cadmium, iron, manganese, cobalt, copper and zinc were measured by flow-injection-inductively-coupled-plasma-mass-spectrometry. Results: From the statistical evaluation, it was observed that patients with POAG had significantly higher aqueous humor levels of zinc (P = 0.006) compared to controls. Increased aqueous humor levels of zinc were also observed in patients with PEXG in relation to control (P = 0.0006). For iron a significant reduction was observed in PEXG compared to control (P = 0.002) and a significant difference between POAG and PEXG (P = 0.0091). No significant differences were observed in aqueous humor levels of manganese, cobalt, copper, cadmium between glaucoma and control patients. No differences were seen for iron (POAG vs. controls).

Take-home message

Significant differences in aqueous humor levels of zinc and iron between glaucoma and control patients support the hypothesis that these trace elements are involved in the pathogenesis of open-angle glaucoma.


  Differential Molecular Expression of Extracellular Matrix and Inflammatory Genes at the Corneal Cone Apex Drives Focal Weakening in Keratoconus Top


Pahuja N, Kumar NR, Shroff R, Shetty R, Nuijts RM, Ghosh A, et al. Differential molecular expression of extracellular matrix and inflammatory genes at the corneal cone apex drives focal weakening in keratoconus. Invest Ophthalmol Vis Sci 2016;57:5372-82.

Purpose: In this study, the differential expression of a set of local molecular factors in ectatic cone area of the cornea were elucidated to uncover a functional cause for focal corneal weakening characteristic of the keratoconus (KC) disease. Methods: All human corneal samples were collected after approval of Institutional Ethics Committee and informed consent. KC patients were classified based on clinical parameters, topographical features, and structural deformity. Epithelial cells were collected from KC patients (n = 66) undergoing corneal cross-linking procedures from cone apex and periphery. Nonectatic refractive surgery patients (n = 23) served as controls. The ratio of epithelial gene expression in cone and periphery of each eye was estimated by quantitative PCR and correlated with clinical data. Similar cone versus periphery analysis was done from the KC stroma and from KC patients with Bowman's layer (BL) breach observed by anterior segment optical coherence tomography. Results: Epithelium from the cone apex of KC patients had elevated levels of inflammatory factors tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6), and matrix metalloproteinase 9 (MMP-9) but reduced Lysyl oxidase and Collagen IVA1, which also demonstrated correlation with corneal curvature and deformity parameters. Stromal gene expression from KC patients showed trends similar to epithelium. Epithelium collected from the cone apex of BL breached KC patients showed significantly elevated MMP-9, TNF-α, and IL-6 levels but reduced IL-10, tissue inhibitor of metalloproteinases 1, and Collagen IVA1 expression.

Take-home message

This study provides the first evidence that altered corneal epithelial and stromal expression of specific genes at the corneal cone apex drives focal structural weakness in KC.


  Current Protocols of Corneal Collagen Cross-Linking: Visual, Refractive, and Tomographic Outcomes Top


Shetty R, Pahuja NK, Nuijts RM, Ajani A, Jayadev C, Sharma C, et al. Current protocols of corneal collagen cross-linking: Visual, refractive, and tomographic outcomes. Am J Ophthalmol 2015;160:243-9.

Purpose: To study the effect of different protocols of collagen cross-linking on visual, refractive, and tomographic parameters in patients with progressive keratoconus. Design: Prospective randomized interventional study. Methods: In this study, 138 eyes of 138 patients with progressive keratoconus underwent corneal collagen cross-linking (CXL). Following detailed preoperative examination, Group I underwent conventional cross-linking (36 patients, 3 mW/cm2 for 30 min); Group II (36 patients, 9 mW/cm2 for 10 min), Group III (33 patients, 18 mW/cm2 for 5 min), and Group IV (33 patients, 30 mW/cm2 for 3 min) underwent accelerated cross-linking. Changes in corrected distance visual acuity (CDVA), spherical equivalent (SE), flat keratometry, steep keratometry, thinnest pachymetry, specular microscopy, and demarcation line were studied at 6 and 12 months. Results: Improvement in the mean CDVA and SE were statistically significant in all groups except Group IV (P = 0.15 at 6 months, P = 0.17 at 12 months), with Group III (P = 0.01 at 6 and 12 months) showing the best results. Flattening of steep and flat keratometry was significant in Groups I (P = 0.01) and II (P = 0.01) as compared to the other groups. There was no significant difference in the pachymetry or specular microscopy in any of the groups. Groups I and II demonstrated a good demarcation line when compared to other groups.

Take-home message

Conventional CXL (Group I) and accelerated CXL with irradiations of 9 mW/cm2 (Group II) and 18 mW/cm2 (Group III) showed better visual, refractive, and tomographic improvements at the end of 12 months.


  Diagnostic Ability of Peripapillary Vessel Density Measurements of Optical Coherence Tomography Angiography in Primary Open-Angle and Angle-Closure Glaucoma Top


Rao HL, Kadambi SV, Weinreb RN, Puttaiah NK, Pradhan ZS, Rao DA, et al. Diagnostic ability of peripapillary vessel density measurements of optical coherence tomography angiography in primary open-angle and angle-closure glaucoma. Br J Ophthalmol 2017;101:1066-70.

Aims: To evaluate the diagnostic ability of peripapillary vessel density measurements on optical coherence tomography angiography (OCTA) in primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG), and to compare these with peripapillary retinal nerve fibre layer (RNFL) thickness measurements. Methods: In a cross-sectional study, 48 eyes of 33 healthy control subjects, 63 eyes of 39 patients with POAG and 49 eyes of 32 patients with PACG underwent OCTA (RTVue-XR, Optovue, Fremont, California, USA) and RNFL imaging with spectral domain OCT. Diagnostic abilities of vessel density and RNFL parameters were evaluated using area under receiver operating characteristic curves (AUC) and sensitivities at fixed specificities. Results: AUCs of peripapillary vessel density ranged between 0.48 for the temporal sector and 0.88 for the inferotemporal sector in POAG. The same in PACG ranged between 0.57 and 0.86. Sensitivities at 95% specificity ranged from 13% to 70% in POAG, and from 10% to 67% in PACG. AUCs of peripapillary RNFL thickness ranged between 0.51 for the temporal sector and 0.91 for the inferonasal sector in POAG. The same in PACG ranged between 0.61 and 0.87. Sensitivities at 95% specificity ranged from 8% to 68% in POAG, and from 2% to 67% in PACG. AUCs of all peripapillary vessel density measurements were comparable (P > 0.05) to the corresponding RNFL thickness measurements in both POAG and PACG.

Take-home message

Diagnostic ability of peripapillary vessel density parameters of OCTA, especially the inferotemporal sector measurement, was good in POAG and PACG. Diagnostic abilities of vessel density measurements were comparable to RNFL measurements in both POAG and PACG.


 Stevens-Johnson syndrome More Details in Children: Long-Term Impact of Appropriate Therapy on Natural History of Disease">  Chronic Ocular Sequelae of Stevens-Johnson Syndrome in Children: Long-Term Impact of Appropriate Therapy on Natural History of Disease Top


Basu S, Shanbhag SS, Gokani A, Kedar R, Bahuguna C, Sangwan VS. Chronic ocular sequelae of Stevens-Johnson syndrome in children: Long-term impact of appropriate therapy on natural history of disease. Am J Ophthalmol 2018;189:17-28.

Purpose: To describe the long-term ocular and visual morbidity in children with chronic sequelae of Stevens-Johnson syndrome (SJS) and visual outcomes of various management strategies. Design: Retrospective comparative case series. Methods: This study included 568 eyes of 284 children with SJS who presented between 1990 and 2015. Affected eyes received either conservative therapy (n = 440) or definitive management (n = 128), including lid margin mucous membrane grafting (MMG), prosthetic replacement of the ocular surface ecosystem (PROSE) contact lenses, allogeneic limbal transplantation, or keratoprosthesis using an algorithmic approach based on the severity of dryness and cause and extent of corneal damage. The primary outcome measure was best-corrected visual acuity (BCVA). Results: Two thirds of patients presented more than a year after acute SJS, 99% without prior amniotic membrane grafting, with low vision or blindness in 60% of eyes. Children 8 years or younger in age had significantly worse ocular and visual morbidity (P ≤ 0.037). At 5 years of follow-up, definitive therapy significantly altered the natural history of the disease by improving BCVA and preventing the development or progression of keratopathy, as compared to conservative therapy (P ≤ 0.002). In eyes with lid-related keratopathy, MMG was significantly more effective than PROSE, although both were significantly better than conservative therapy and the combination of MMG followed by PROSE provided the best results (P < 0.0001).

Take-home message

Children receiving suboptimal care during acute SJS presented later with severe ocular and visual morbidity. Timely therapy, particularly with PROSE and MMG in eyes with lid-related keratopathy, changed the natural course and helped in preserving and improving vision.


  Oxidative Stress Parameters and Serum Magnesium Levels in Patients With Seasonal Allergic Conjunctivitis Top


Dadaci Z, Oncel M, Oncel Acir N, Sahin E, Borazan M. Oxidative stress parameters and serum magnesium levels in patients with seasonal allergic conjunctivitis. Cutan Ocul Toxicol 2016;35:270-4.

Purpose: To evaluate oxidative stress parameters and serum magnesium (Mg) levels in patients with seasonal allergic conjunctivitis (SAC) during the pollen season. Methods: This observational cross-sectional study involved 35 patients with SAC without any other ocular and systemic diseases, and 38 consecutive, age-and sex-matched healthy subjects. Serum malondialdehyde (MDA), adjusted ischemia modified albumin (IMA), and Mg levels were quantified, and the results were compared between the groups. Results: No significant differences were found between the groups with respect to age (P = 0.416) and sex (P = 0.362). Serum MDA and adjusted IMA levels of the subjects with SAC (69.54 ± 7.71 μM and 0.74 ± 0.39 ABSU) were significantly higher than the control group (64.61 ± 5.89 μM and 0.57 ± 0.19 ABSU) (P = 0.002 and P = 0.025, respectively). There was no significant difference for serum Mg levels between the groups (P = 0.177).

Take-home message

Higher levels of oxidative stress parameters were demonstrated in patients with SAC compared to the control group, which imply a possible role of oxidative stress in the pathogenesis of SAC.


  Effect of Uncorrection Versus Full Correction on Myopia Progression in 12-Year-Old Children Top


Sun YY, Li SM, Li SY, Kang MT, Liu LR, Meng B, et al. Effect of uncorrection versus full correction on myopia progression in 12-year-old children. Graefes Arch Clin Exp Ophthalmol 2017;255:189-95.

Purpose: To investigate the effects of no correction versus full correction on myopia progression in Chinese children over a period of 2 years. Methods: Myopia was defined as cycloplegic spherical equivalent (SE) of ≤ −0.50 D. Uncorrection was defined as no spectacles worn, and full correction was defined as when the value of SE subtracted from the dioptric power of the child's current spectacles was <0.5 D. Ocular examinations included visual acuity, cycloplegic autorefraction, axial length and vertometer measurements. Questionnaires were completed by parents on behalf of the children. Results: A total of 121 myopic children, with a median age of 12.7 years, were screened from the Anyang Childhood Eye Study, with 65 in the uncorrected group and 56 in the full correction group. At 2-year follow-up, children with no correction had slower myopia progression (−0.75 ± 0.49 D vs. −1.04 ± 0.49 D, P < 0.01) and less axial elongation (0.45 ± 0.18 mm vs. 0.53 ± 0.17 mm, P = 0.02) than children with full correction. In multivariate modeling, adjusting for baseline SE or axial length, age, gender, height, number of myopic parents, age at myopia onset, and time spent in near work and outdoors, children with no correction still had slower myopia progression (−0.76 ± 0.07 vs. −1.03 ± 0.08 D, P < 0.01) and less axial elongation (0.47 ± 0.03 mm vs. 0.51 ± 0.03 mm, P < 0.01). Myopia progression decreased significantly with an increasing amount of undercorrection in all children (r = 0.22, b = 0.16, P = 0.01).

Take-home message

The findings of this study suggest that myopic defocus slows the progression of myopia in already myopic children, supporting previous findings from animal studies.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.






 

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