Optical Coherence Tomography Angiography Biomarkers in Thai Patients With Diabetic Nephropathy: A Diabetic Eye and Kidney Diseases (DEK-D) Study.

Purpose: To identify optical coherence tomography angiography (OCTA) biomarkers to predict the diabetic nephropathy (DN) and their associations with 24-hour urine albumin levels in diabetic patients. Methods: This cross-sectional, observational study examined 186 eyes from 93 individuals subdivided into three groups according to 24-hour urine albumin levels: no DN, early DN, and late DN. Vessel density (VD), fractal dimension, foveal avascular zone area, intercapillary area, central retinal thickness, and subfoveal choroidal thickness were measured from OCTA images to determine their association with the DN stages. Results: VD values of the superficial capillary plexus, deep capillary plexus, and whole retina were significantly lower in the early DN group compared to the no DN group (adjusted P = 0.042, 0.016, and 0.008, respectively). VD values for the deep capillary plexus and whole retina were significantly decreased in the late DN group compared to the no DN group (adjusted P = 0.025 and 0.021, respectively). Mean fractal dimension, intercapillary area, foveal avascular zone area, central retinal thickness, and subfoveal choroidal thickness were not statistically different among the three groups. Conclusions: VD may be a useful parameter for the early non-invasive screening of DN. Further studies in larger populations are needed to establish a cutoff value for detection. Translational Relevance: This study investigated the association of each retinal vasculature measurement by OCTA and diabetic nephropathy status which could serve as an alternative way to screen for albuminuria.

The sterility, stability and efficacy of repackaged ziv-aflibercept for intravitreal administration.

To evaluate the sterility, stability, and efficacy of repackaged ziv-aflibercept in 1-mL plastic tuberculin syringes for intravitreal injection after storage for up to 90 days at controlled (4 °C) and ambient (25.8 °C) temperature. A total of 168 tuberculin-type 1-mL syringes were prepared containing ziv-aflibercept (100 mg/4 mL). Samples were stored at 4 °C and 25.8 °C for 0, 3, 7, 14, 21, 28, 60, and 90 days. At each time point, four samples were evaluated for the stability and binding affinity of anti-VEGF to VEGF (efficacy) using enzyme-linked immunosorbent assays (ELISAs). All samples were analyzed for microbial growth. No microbial growth was obtained from any of the ziv-aflibercept samples during each time point, indicating that the repackaged ziv-aflibercept stored at 4 °C and 25.8 °C remained sterile. ELISA analysis revealed no significant decrease in concentration, and binding affinity was observed, indicating that the stability and efficacy were preserved. However, the concentration of ziv-aflibercept decreased less than the minimum expected concentration of 8 ng/mL after 60 days at 4 °C and after 30 days at 25.8 °C. The repackaged anti-VEGF drug ziv-aflibercept does not lose stability or efficacy and remains uncontaminated if prepared under sterile conditions and stored at 4 °C for up to 60 days or stored at 25.8 °C for up to 30 days.

Outcomes of Pre-Early Treatment for Retinopathy of Prematurity (Pre-ETROP).

INTRODUCTION: The earlier treat stage 3 ROP is more likely to achieve better outcomes. PRIMARY PURPOSE: To study the unfavorable outcomes and regression after pre-early treatment for ROP. SECONDARY PURPOSE: To evaluate the progression and recurrence of ROP requiring retreatment after pre-early treatment for ROP. PATIENTS AND METHODS: The data were retrieved retrospectively from the medical records of all infants who were screened and treated for ROP from January 2009 to January 2014 at a tertiary care facility. The outcomes measured the following: 1. unfavorable outcomes; 2. regression of ROP; 3. progression of ROP and 4. recurrence of ROP requiring retreatment. We treated all stage 3 ROP in any zone, with or without plus. The study also compared the outcomes between the pre-ETROP and the ETROP subgroups. RESULTS: There were 91 eyes with stage 3 ROP. Of the total of 91 eyes, there were 63 eyes with the pre-ETROP group and 28 eyes of the ETROP group. The unfavorable outcomes after treatment occur 6 eyes from 28 eyes (21.43%) in the ETROP group but no unfavorable outcomes in the pre-ETROP group (P=0.001). The pre-ETROP group who were treated with laser LIO alone had 100% regression, while the ETROP group who were treated with LIO (26 eyes) had 88.46% regression. There were 2 eyes of this group who were treated with a combination of LIO and IVT Bevacizumab. Both of them did not have regression. The recurrence of ROP requiring retreatment occurred in 2 eyes (7.14%) of the ETROP group, but no recurrence in the pre-ETROP group (P=0.092). The progression after treatment occurred in 3 eyes (10.71%) in the ETROP group, but no progression in the pre-ETROP group (P=0.027). CONCLUSION: The pre-ETROP treatment is useful for reducing unfavorable outcomes and increasing the regression of ROP. Further, the treatment can reduce the recurrence of neovascularization and progression after treatment.

Intrapersonal comparison of initial axial length, keratometric readings, and intraocular lens power over a 6-month interval using an IOLMaster device.

PURPOSE: In order to improve current biometry practice, we investigated changes in axial length (AL), keratometry (K), and intraocular lens (IOL) power measured by the IOLMaster in adults within a 6-month period at the outpatient eye clinic, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. PATIENTS AND METHODS: This was a nonrandomized prospective cohort study. The AL, steepest K, flattest K, and IOL power of nondilated eyes were measured at the initial examination and later at 6 months by the IOLMaster. Changes in AL, K, and IOL power using the SRK (Sanders, Retzlaff, and Kraff)-T formula within 6 months were compared using the paired-sample t-test. RESULTS: The study comprised 90 eyes from 90 patients. The mean age of the patients was 62.99±13.95 years (range 28-87 years). Mean values and standard deviation for AL, steepest K, flattest K, and IOL power at initial visit and 6 months later were 23.56±1.51 mm and 23.56±1.52 mm (P=1.0; 95% confidence interval [CI] -0.01 to 0), 44.94±1.37 D and 44.98±1.43 D (P=0.96; 95% CI -0.13 to 0.04), 43.85±1.43 D and 43.89±1.36 D (P=0.93; 95% CI -0.02 to 0.07), and 20.27±4.12 D and 20.15±4.51 D (P=0.99; 95% CI -0.05 to 0.29), respectively. CONCLUSION: There was no statistically significant difference in AL (P=1.0), both K (P=0.96, P=0.93), or IOL power (P=0.99) within the 6-month period using the IOLMaster. Remeasurement at 6 months may be required in some cases, but should not be routine.