questionnaires administered to surgeons across different levels of training (two consultants and five fellows). The study was conducted in standard surgical settings in two teaching hospitals and compared standard PPV 23-, 25- and 27-G with digital channels. Cameras used in the study were the Leica M844 and M822 at 175-200 mm focal lengths and an aperture of approximately 35%. Intra-ocular illumination was tangential and direct, with brightness, hue and gain adjusted with color channels (i.e. vitreous
removal, diabetic, and macula filters). Study participants were asked if the procedure was easier, same, worse, much worse or better with the surgical filters. The study team included 398 patients over the 3.5year follow-up period, and these patients were homogenously distributed among the fellows and consultants. A majority of the surgeons (60%) found the procedure better or much better than standard settings (without filters). Furthermore, with the diabetic
Aflibercept Treatment PERMEATEs Better in DME and RVO
(UWFA) and optical coherence tomography angiography (OCTA). Dr. Ehlers presented the 6-month interim data analysis for the 26 patients who had completed their month 6 visits. The mean age of subjects was 67 years, and majority (62%) were men. There was an even patient distribution between diabetic macular edema and retinal vein occlusion. The baseline mean visual acuity was 20/80 and baseline mean central subfield thickness was 505 µm. Dr. Ehlers highlighted that excellent outcomes of visual acuity were seen at 6 months, with mean score of 20/40, and 38% of eyes gaining 3 lines. From an anatomic standpoint, he noted significant improvements at month 6, with mean CST of 265 µm, 54% of eyes achieving dryness via OCT, and 100% of eyes with no sub-retinal fluid. When they assessed qualitative data, they found significant reductions in leakage, micro-aneurysms, macular and peripheral ischemia at month 6, when compared to baseline. Quantitative leakage assessment revealed an overall 47% reduction at month 6 compared to baseline, especially marked at the posterior pole (83%) and mid-peripheral area (87%). The leakage index at month 6 was 1%. Furthermore, analysis of the evolution of micro aneurysms revealed an overall 10% reduction
A
t the recent ASRS 2017 meeting in Boston, Dr. Justin Ehlers, M.D. from Cleveland, Ohio, USA, presented data from the PERMEATE (Peripheral and Macular Retinal Vascular Perfusion and Leakage in DME and RVO) study, which was designed to characterize longitudinal retinal vascular dynamics with an angiographic quantitative assessment tool for both diabetic retinopathy and retinal vein occlusion. The study included male and female patients ≥ 18 years of age, with foveal-involving retinal edema secondary to DME or RVO, and E-ETDRS bestcorrected visual acuity of 20/25 or worse in the study eye. Patients with any prior or concomitant therapy to treat DME or RVO in the study eye, prior laser treatment for retinal disease, prior vitrectomy, trabeculectomy, other filtration surgery or history of retinal detachment in study eye were excluded. Patients with significant vitreous hemorrhage obscuring view of macula or retinal periphery and patients unable to undergo fluorescein angiography were also excluded. All patients received initial monthly treatment of aflibercept (Eylea, Bayer, Leverkusen, Germany), quarterly ultra-wide field fluorescein angiography
filters, 70% of surgeons found the procedure either better or much better. When asked about the depth of field filters compared to standard optical microscopes, 100% preferred the depth of field filters. Based on their findings, Dr. Mura and colleagues concluded that, “the 3D DAVS enhances surgical maneuvers and makes them easier to perform through increased depth of field. The possible use of these color channels offers superior ergonomics and a better teaching environment.”
Quantitative “segmentation of ultra wide field angiography may provide unique opportunities for understanding of important underlying changes in retinal vascular dynamics, such as leakage, micro-aneurysms and ischemia.
”
- Dr. Justin Ehlers when compared to baseline, which was notable at the posterior pole (54%). The ischemia index, assessed at month 6, showed an overall 53% reduction when compared to baseline. Based on their findings from this treatment naive cohort study, Dr. Ehlers and colleagues concluded that aflibercept therapy resulted in significant improvements in visual acuity and reduction in macular edema. Furthermore, he proposed that “quantitative segmentation of ultra wide field angiography may provide unique opportunities for understanding of important underlying changes in retinal vascular dynamics, such as leakage, micro-aneurysms and ischemia.”
11