This Issue at a Glance

Abstract

Liao et al (p. 186) conducted a prospective, multicenter, randomized, sham-controlled phase 2 study to evaluate the safety and efficacy of intravitreally administered pegcetacoplan, a complement C3 inhibitor peptide, for treatment of geographic atrophy (GA). A total of 246 patients with GA were randomized 2:2:1:1 to receive 15 mg pegcetacoplan or sham intravitreal injections monthly or every other month (EOM) for 12 months. Geographic atrophy lesion growth rate was reduced by 29% and 20% compared with sham treatment in patients receiving pegcetacoplan monthly or EOM, respectively, over 12 months. The effect was particularly evident in the second 6 months of treatment, with observed reductions of 45% and 33% for pegcetacoplan monthly and EOM, respectively. The researchers observed a higher incidence of exudative age-related macular degeneration in eyes treated with pegcetacoplan compared with the sham treatment, suggesting that pegcetacoplan might alter disease course. The researchers conclude that C3 inhibition with pegcetacoplan can slow the progression of GA and demonstrated acceptable safety to proceed to phase 3 studies. In a retrospective cohort study, Pershing et al (p. 151) determined the recent incidence and visual outcomes for acute-onset endophthalmitis after cataract surgery performed in the United States. A review of the Intelligent Research in Sight Registry identified 8 542 838 eyes among 5 401 686 patients undergoing cataract surgery between 2013 and 2017. A total of 3629 (0.04%) eyes demonstrated acute-onset postoperative endophthalmitis; incidence was highest among patients aged 0 to 17 years, followed by patients aged 18 to 44 years. Endophthalmitis occurred 4 times more often among patients undergoing cataract surgery combined with other ocular procedures than after standalone cataract surgeries, with the highest incidence (0.35%) among patients who underwent cataract surgery with anterior vitrectomy. Despite lower average postoperative visual outcomes, 4% of endophthalmitis patients still achieved visual acuity of 20/20 or better at 3 months, and 44% achieved visual acuity of 20/40 or better. The authors find that acute-onset endophthalmitis occurred in 0.04% of 8 542 838 cataract surgeries between 2013 and 2017 in the US, and risk factors may include younger age, cataract surgery combined with other ophthalmic surgeries, and anterior vitrectomy. Prajna et al (p. 159) conducted a randomized controlled clinical trial to evaluate adjuvant corneal cross-linking (CXL) and to compare natamycin versus amphotericin B for filamentous fungal keratitis. A total of 111 patients were randomized to 1 of 4 groups: topical natamycin 5% alone, topical natamycin 5% plus CXL, topical amphotericin 0.15% alone, and topical amphotericin 0.15% plus CXL. Patients randomized to CXL regardless of medication had 1.32-fold greater odds of 24-hour culture positivity, but this was not statistically significant. There was also no difference in 24-hour culture positivity between those randomized to amphotericin and those randomized to natamycin. The best spectacle-corrected visual acuity was approximately 0.22 logMAR worse on average at 3 weeks and 0.32 logMAR worse at 3 months among those receiving CXL. There was no difference in ulcer infiltrate or scar size and percentage of adverse events when comparing CXL with no CXL or the 2 medications. The authors suggest that there was no benefit of adjuvant CXL for treating filamentous fungal ulcers, and adjuvant CXL may have a negative effect on visual acuity. Chauhan et al (p. 177) conducted a cross-sectional, multicenter study to determine the differential effects of aging in the inner 6 layers of the macula compared to the minimum neuroretinal rim width (MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness. The researchers analyzed data from 246 subjects and found a statistically significant decline with age of the ganglion cell layer (GCL), inner plexiform layer (IPL), and inner nuclear layer (INL) thickness, with rates of –0.11 μm/year, –0.07 μm/year, and –0.03 μm/year corresponding to 2.82%, 2.10%, and 0.78% loss per decade, respectively. The rate of loss of MRW and peripapillary RNFL thickness was –1.22 μm/year and –0.20 μm/year, corresponding to 3.75% and 2.03% loss per decade respectively. The association between GCL thickness change and age was approximately twice that of MRW and RNFL thickness. The authors conclude that there was a stronger association between aging and GCL thickness compared with the rim or peripapillary RNFL and suggest that age-related structural changes may be best measured through macular OCT imaging.