COMPARISON OF VISUAL AND ANATOMICAL OUTCOMES OF EYES UNDERGOING TYPE I BOSTON KERATOPROSTHESIS WITH COMBINATION PARS PLANA VITRECTOMY WITH EYES WITHOUT COMBINATION VITRECTOMY.

PURPOSE: To determine whether 1-year visual and anatomical results after surgery combining pars plana vitrectomy, Boston keratoprosthesis, and a glaucoma drainage device as needed are similar, better, or worse than Boston keratoprosthesis initial implantation alone. METHODS: We performed a retrospective review of adult patients undergoing Boston keratoprosthesis at our institution. Visual acuity outcomes, anatomical results, and complication rates of patients undergoing combination surgery (including pars plana vitrectomy and a posterior glaucoma drainage device) were compared with those undergoing keratoprosthesis placement alone. RESULTS: There were 70 eyes in the keratoprosthesis alone group and 55 eyes in the keratoprosthesis with pars plana vitrectomy group. Mean follow-up durations were 54.67 months in the keratoprosthesis alone group and 48.41 months in the combination group. Baseline mean Snellen equivalent visual acuities were worse for the combination group compared with the keratoprosthesis alone group (P = 0.027). Visual acuities improved postoperatively by 1 month after keratoprosthesis implantation for both groups and improved three or more lines of Snellen acuity in the majority of eyes for both groups (≥72% by 12 months). Eyes undergoing pars plana vitrectomy had lower rates of de novo (P = 0.015) and significantly lower rates of secondary procedures (P = 0.002) at 1 year. One year complications rates for retroprosthetic membrane formation, retinal detachment, hypotony, cystoid macular edema, epiretinal membrane formation, endophthalmitis, and corneal melting were similar for both groups. CONCLUSION: Compared with keratoprosthesis alone, combining keratoprosthesis with pars plana vitrectomy and a glaucoma drainage device as needed, resulted in lower rates of de novo glaucoma, lower rates of additional surgical procedures, similar visual acuity outcomes at 1 year, and did not result in higher complication rates.

Longitudinal Assessment of Retinal Thinning in Adults With and Without Sickle Cell Retinopathy Using Spectral-Domain Optical Coherence Tomography.

Importance: Determination of retinal thinning rates may help to identify patients who are at risk of progression of sickle cell retinopathy. Objective: To assess the rates of macular thinning in adults with and without sickle cell retinopathy using spectral-domain optical coherence tomography (OCT) and to identify ocular and systemic risk factors associated with retinal thinning. Design, Setting, and Participants: This longitudinal prospective case-control study enrolled adult participants from a university-based retina subspecialty clinic between February 11, 2009, and July 3, 2019. The study was designed in autumn 2008 and conducted from February 2, 2009, to July 3, 2020. Participants with sickle cell retinopathy (sickle cell group) were matched by age and race with participants without sickle cell retinopathy (control group). Participants received annual spectral-domain OCT and clinical examinations. Those with at least 1 year of follow-up by July 3, 2020, were included in the analysis. Data were analyzed from February 2, 2009, to July 3, 2020. Main Outcomes and Measures: The primary outcome was comparison of spectral-domain OCT measurements from early-treatment diabetic retinopathy study subfield rates of retinal thinning between eyes with and without sickle cell retinopathy and between different sickle cell hemoglobin subtypes. The secondary outcome was identification of ocular and systemic risk factors associated with rates of retinal thinning. Results: Among 370 adults (711 eyes) enrolled in the study, 310 participants (606 eyes) had sickle cell retinopathy, and 60 participants (105 eyes) did not. Of those, 175 of 310 participants (56.5%; 344 of 606 eyes [56.8%]; mean [SD] age, 37.8 [12.8] years; 126 women [72.0%]) in the sickle cell group and 31 of 60 participants (51.7%; 46 of 105 eyes [43.8%]; mean [SD] age, 59 [15.4] years; 22 women [71.0%]) in the control group had at least 1 year of clinical and spectral-domain OCT follow-up data from baseline. The mean (SD) follow-up was 53.7 (32.6) months for the sickle cell group and 54.6 (34.9) months for the control group. Rates of macular thinning in the sickle cell group were significantly higher than those in the control group for the inner nasal (difference, -1.18 µm per year; 95% CI, -1.71 to -0.65 µm per year), inner superior (difference, -1.03 µm per year; 95% CI, -1.78 to -0.29 µm per year), inner temporal (difference, -0.61 µm per year; 95% CI, -1.16 to -0.07 µm per year), and outer nasal (difference, -0.41 µm per year; 95% CI, -0.80 to -0.03 µm per year) quadrants. Patients with sickle cell hemoglobin SC and sickle cell hemoglobin ß-thalassemia subtypes had higher rates of retinal thinning than those with the sickle cell hemoglobin SS subtype. Risk factors associated with greater rates of retinal thinning included participant age, stage of retinopathy, previous stroke, and presence of hypertension, acute chest syndrome, or diabetes. Hydroxyurea therapy was associated with decreased rates of retinal thinning and may be a protective factor. Conclusions and Relevance: In this study, rates of retinal thinning were higher among participants with sickle cell retinopathy compared with those without sickle cell retinopathy, and thinning rates increased with participant age and stage of retinopathy. These findings suggest that identifying anatomic worsening of sickle cell maculopathy through spectral-domain OCT may be a useful parameter to evaluate the progression of sickle cell retinopathy.

One year results of a phase 1 study of the safety and tolerability of combination therapy using sustained release intravitreal triamcinolone acetonide and ranibizumab for subfoveal neovascular AMD.

PURPOSE: To investigate safety and evidence of efficacy of IBI-20089, an intravitreal, liquid, sustained drug delivery system formulated with triamcinolone acetonide (TA) in combination with ranibizumab (Lucentis) for neovascular age related macular degeneration. METHODS: Patients received a single intravitreal injection of IBI-20089 containing either 6.9 mg (25 µL) TA or 13.8 mg (50 µL) TA followed a week later by intravitreal injection of 0.5 mg ranibizumab. Patients were followed monthly and underwent best corrected visual acuity testing, slit lamp biomicroscopy, dilated ophthalmoscopy, fundus photos and optical coherence tomography. Patients received pro re nata dosing of ranibizumab. RESULTS: Patients ranged in age from 59 years to 81 years (mean 73.4 years) and all completed 1 year follow-up. No serious related adverse events occurred. Ocular adverse events included mild, transient, elevated intraocular pressure in eight patients and cataract progression in three of the five phakic patients. At 1 year, 30 of a total 120 (25%) possible pro re nata re-Rx's had been given. Combination therapy resulted in a median number of 3.5 re-treatments at and including month 12. CONCLUSIONS: Combination therapy IBI-20089 and ranibizumab was well-tolerated and resulted in fewer ranibizumab retreatments. Transient intraocular pressure elevation and cataract progression occurred. TRIAL REGISTRATION NUMBER: NCT01175395.

Inner and outer retinal thickness mapping of nonproliferative diabetic retinopathy by spectral-domain optical coherence tomography.

BACKGROUND AND OBJECTIVE: To report inner retinal thickness (IRT), outer retinal thickness (ORT), and total retinal thickness (TRT) mapping of nonproliferative diabetic retinopathy (DR). PATIENTS AND METHODS: Spectral-domain optical coherence tomography (SD-OCT) images were obtained in 31 study participants with nonproliferative DR. Semi-automated software generated IRT, ORT, and TRT maps. IRT, ORT, and TRT in each macular subfield were compared between groups with and without increased central subfield thickness. RESULTS: There were statistically significant differences in IRT, ORT, and TRT between groups (P < .007). In participants with nonproliferative DR with increased central subfield thickness, TRT was significantly increased in parafoveal and perifoveal inferior subfields (P < .001). In these subfields, both IRT and ORT were significantly increased (P < .007) compared to those in participants without increased central subfield thickness. CONCLUSION: Mapping of inner and outer retinal thickness shows promise for monitoring depth-specific thickness alterations by macular subfields due to DR.