Dexamethasone intravitreal implant in previously treated patients with diabetic macular edema : Subgroup analysis of the MEAD study

Background: Dexamethasone intravitreal implant 0.7 mg (DEX 0.7) was approved for treatment of diabetic macular edema (DME) after demonstration of its efficacy and safety in the MEAD registration trials. We performed subgroup analysis of MEAD study results to evaluate the efficacy and safety of DEX 0.7 treatment in patients with previously treated DME. Methods: Three-year, randomized, sham-controlled phase 3 study in patients with DME, best-corrected visual acuity (BCVA) of 34.68 Early Treatment Diabetic Retinopathy Study letters (20/200.20/50 Snellen equivalent), and central retinal thickness (CRT) 65300 \u3bcm measured by time-domain optical coherence tomography. Patients were randomized to 1 of 2 doses of DEX (0.7 mg or 0.35 mg), or to sham procedure, with retreatment no more than every 6 months. The primary endpoint was 6515-letter gain in BCVA at study end. Average change in BCVA and CRT from baseline during the study (area-under-the-curve approach) and adverse events were also evaluated. The present subgroup analysis evaluated outcomes in patients randomized to DEX 0.7 (marketed dose) or sham based on prior treatment for DME at study entry. Results: Baseline characteristics of previously treated DEX 0.7 (n = 247) and sham (n=261) patients were similar. In the previously treated subgroup, mean number of treatments over 3 years was 4.1 for DEX 0.7 and 3.2 for sham, 21.5 % of DEX 0.7 patients versus 11.1 % of sham had 6515-letter BCVA gain from baseline at study end (P = 0.002), mean average BCVA change from baseline was +3.2 letters with DEX 0.7 versus +1.5 letters with sham (P = 0.024), and mean average CRT change from baseline was -126.1 \u3bcm with DEX 0.7 versus -39.0 \u3bcm with sham(P < 0.001). Cataract-related adverse events were reported in 70.3 % of baseline phakic patients in the previously treated DEX 0.7 subgroup; vision gains were restored following cataract surgery. Conclusions: DEX 0.7 significantly improved visual and anatomic outcomes in patients with DME previously treated with laser, intravitreal anti-vascular endothelial growth factor, intravitreal triamcinolone acetonide, or a combination of these therapies. The safety profile of DEX 0.7 in previously treated patients was similar to its safety profile in the total study population

Prevalence of Age-Related Macular Degeneration in Europe: The Past and the Future

Purpose Age-related macular degeneration (AMD) is a frequent, complex disorder in elderly of European ancestry. Risk profiles and treatment options have changed considerably over the years, which may have affected disease prevalence and outcome. We determined the prevalence of early and late AMD in Europe from 1990 to 2013 using the European Eye Epidemiology (E3) consortium, and made projections for the future. Design Meta-analysis of prevalence data. Participants A total of 42 080 individuals 40 years of age and older participating in 14 population-based cohorts from 10 countries in Europe. Methods AMD was diagnosed based on fundus photographs using the Rotterdam Classification. Prevalence of early and late AMD was calculated using random-effects meta-analysis stratified for age, birth cohort, gender, geographic region, and time period of the study. Best-corrected visual acuity (BCVA) was compared between late AMD subtypes; geographic atrophy (GA) and choroidal neovascularization (CNV). Main Outcome Measures Prevalence of early and late AMD, BCVA, and number of AMD cases. Results Prevalence of early AMD increased from 3.5% (95% confidence interval [CI] 2.1%–5.0%) in those aged 55–59 years to 17.6% (95%

Seroprävalenz und SARS-CoV-2-Testung in Gesundheitsberufen.

SARS-CoV‑2 verursacht ein Krankheitsspektrum, das auch asymptomatische und wenig symptomatische Infektionen mit subklinischen Manifestationen einschließt, die aber dennoch potenziell ansteckend sein können. Hinweise von SARS-CoV-2-infizierten Makaken und aus Studien mit saisonalen Coronaviren deuten darauf hin, dass die Infektion wahrscheinlich eine Immunität erzeugt, die für eine gewisse Zeit protektiv ist. Verfügbare Testmethoden ermöglichen ein hohes Maß an Zuverlässigkeit, falls qualitativ hochwertige serologische Methoden kombiniert werden. Obwohl individuelle Testergebnisse vorsichtig interpretiert werden, kann Sero-Surveillance in einer Klinik der Maximalversorgung und einem Forschungsinstitut Ängste abbauen und Klarheit in Bezug auf die tatsächliche Durchseuchung mit SARS-CoV‑2 schaffen

Diagnostik und Therapie der choroidalen Lymphome

Photograph of a Native American wall mural

Testing for SARS-CoV-2 seroprevalence: Experiences of a tertiary eye centre.

Introduction The actual prevalence of a SARS-CoV-2 infection and the individual assessment of being or having been infected may differ. Facing the great uncertainty - especially at the beginning of the pandemic - and the possibility of asymptomatic or mildly symptomatic, subclinical infections, we evaluate the experience of SARS-CoV-2 antibody screening at a tertiary clinical setting. Methods and analysis All employees of a tertiary eye centre and a research institute of ophthalmology were offered antibody testing in May 2020, using a sequential combination of different validated assays/antigens and point-of-care (POC) testing for a subset (NCT04446338). Before taking blood, a systematic inquiry into past symptoms, known contacts and a subjective self-assessment was documented. The correlations between serostatus, patient contacts and demographic characteristics were analysed. Different tests were compared by Kappa statistics. Results Among 318 participants, SARS-CoV-2 antibodies were detected in 9 employees. Chemiluminescence assays (chemiluminescence immunoassay and electrochemiluminescence) showed superior specificity and high reproducibility, compared with ELISA and POC results. In contrast to the low seropositivity (2.8%) of healthcare workers, higher than that of the other departments of the hospital, a large proportion mistakenly assumed that they might have already been infected. Antiviral antibody titres increased and remained on a plateau for at least 3 months. Conclusions The great demand and acceptance confirmed the benefit of highly sensitive testing methods in the early phase of the pandemic. The coincidence of low seroprevalence and anxious employees may have contributed to internalising the need of hygiene measures

Macular pigment and fixation after macular translocation surgery.

BACKGROUND: After full macular translocation (MT) surgery with 360 degrees retinotomy, the fovea is rarely identifiable. Our aim was to verify the position of the fovea, to determine how patients fixate after MT and to examine distribution and optical density of macular pigment (MP). METHODS: 9 patients after MT were investigated. The Utrecht Macular Pigment Reflectometer was used to quantify the MP optical density. A Scanning Laser Ophthalmoscope (SLO) was used to identify the fovea as the centre of MP distribution and determine the retinal locus of fixation. RESULTS: In all patients, we identified the fovea as the centre of MP distribution. The retinal areas used for fixation were displayed by SLO fixation analysis. Comparing their spatial relationship with the fovea, five patients fixated centrally and four eccentrically up to 7.5 degrees. In those patients, microperimetry showed that the atrophy caused by choroidal neovascularization (CNV) extraction prevented central fixation. CONCLUSION: The combination of MP distribution and fixation analysis permits quantifying fixation behaviour even if the fovea morphologically cannot be localized. Our results suggest that the scotoma caused by spreading chorioretinal atrophy is the main cause for reduced visual acuity after MT and therefore the MT rotation angle is crucially important