Prof. Dr. Matthias Becker¤sentationen... · 2020. 2. 26. · SAoO 2020, Matthias Becker, Swiss Ophthal 2019, 26.2.2020, Seite 3. Liste der peer-reviewed Journals • American Journal

Top of 2019 Praxisrelevante Highlights aus der Fachliteratur

Prof. Dr. Matthias Becker

www.triemli.ch/augenklinik

[email protected]

Augenzentrum

http://www.triemli.ch/augenklinik

SAoO 2020, Matthias Becker, Swiss Ophthal 2019, 26.2.2020, Seite 2

Swiss Ophthal

• Alterung medizinischen Wissens Halbwertszeit 5 Jahre (Cochrane Library)

• Stand der aktuellsten Literatur für die PraktikerIn, quartalsweise

• Persönliche Auswahl durch Editor• Innovative Trends• Seriöse klinische Forschung• Artikel von Schweizer Arbeitsgruppen• Keine Grundlagenforschung• Keine Case-Reports• Relevanz für Niedergelassene

• Ca. 240 Abstracts pro Jahr• Englisch-sprachige Literatur• Abstracts in 3 Landessprachen übersetzt• Vorlage, Inspiration für Journal Club• Finanziert durch Industrie-Sponsoring


Liste der peer-reviewed Journals

• American Journal of Ophthalmology• British Journal of Ophthalmology• Cornea• Graefe’s Archive of Ophthalmology• International Journal of Retina and Vitreous• Investigative Ophthalmology & Visual Science• JAMA Ophthalmology• Journal of Cataract and Refractive Surgery• Journal of Glaucoma• Journal of Ophthalmic inflammation and

Infection

• Journal of Refractive Surgery• Lancet• New England Journal of Medicine• Ocular Immunology and Inflammation• Ophthalmologica• Ophthalmology• Progress in Retinal and Eye Research• Retina• Survey of Ophthalmology


Top-of-the-top: 5 Papers der Ophthalmologie der letzten 12 Monate

• FEMCAT vs. Phakoemulsifikation• Zulassungsstudie Brolucizumab• Silikonölbläschen nach intravitrealen

Injektionen• Trabekulektomie vs. Nicht-penetrierende

Verfahren• YAG-Vitreolyse• Leitlinie Therapie Uveitis


• Does Femtosecond laser-assisted cataract surgery (FLACS) improve outcomescompared with phacoemulsification cataract surgery (PCS) despite havinghigher costs?

• Five French University Hospitals • Funded by the French Ministry of Health• 907 patients (1476 eyes) randomly assigned between 2013, and 2015• 704 eyes in FLACS group vs. 685 eyes in the PCS group• No significant difference in the success rate of surgery between the FLACS and

PCS groups• Not cost-effective for the French health-care system

Schweitzer C, et al. Lancet 2020;395:212


FEMCAT trialICER = incremental cost-effectiveness ratio



Transfer to your practice

• First cost-effectiveness analysis of FLACS compared with PCS within a clinical trial

• Despite its advanced technology, FLACS was not superior to PCS

• FLACS was more expensive and lesseffective than PCS

• FLACS did not provide an additional benefit over PCS for patients orhealth-care systems with higher costs



• Brolucizumab (Br) = single-chain antibody fragment that inhibits VEGF-A• Compared to aflibercept (Af) for AMD• Similarly designed, phase 3, double-masked, multicenter, active-controlled, randomized trials• 1’817 patients• After loading with 3 monthly injections, Br-treated eyes received an injection every 12 weeks

(q12w) and were interval adjusted to every 8 weeks (q8w) if disease activity was present; Af-treated eyes received q8w dosing

• Br was non-inferior to Af in visual function at week 48• >50% of Br 6 mg treated eyes were maintained on q12w dosing interval through Week 48• Anatomic outcomes favored brolucizumab over aflibercept

Dugel PU, et al. Ophthalmology 2020;127:72



• Market of drugs for intravitreal therapyis continously expanding

• Brolucizumab first single-chainAntibody fragment (scFv) on themarket

• Opens a new product class formacular therapy

• Less injections necessary for AMD patients



Melo GB, et al. Br J Ophthalmol 2020;104:291

• Retina specialists worldwide are concerned about inflammation after intravitreal injections of antiangiogenics without a clear etiology

• Silicone oil (SO) droplets in the vitreous of 68% and 75% of 37 consecutiveeyes treated with intravitreal injections when assessed by slit-lamp and ultrasound

• To assess SO release by different brands of syringes used for intravitreal injection under different handling condition

• Eight types of syringes, 586 syringes were analysed


Silicone droplets after intravitreal injection

• SO released by various syringes usedfor intravitreal injections

• Highlights impact of agitation byflicking on SO release

• Priming the plunger, different temperatures and the presence of airbubbles (without agitation) had littleimpact on the release of SO



• Syringes commonly used for intravitreal injectionsfrequently release SO droplets

• Especially when agitated by flicking• Syringes should not be agitated before intravitreal

injection• Desirable that syringes be manufactured

specifically for ophthalmic use


• Meta-analysis on efficacy + safety of trabeculectomy (TE) and non-penetratingglaucoma surgery (NPGS) techniques in different types of open-angle glaucoma

• 21 studies included• NPGS: deep sclerectomy (DS), viscocanalostomy (VC), canaloplasty (CP) • NPGSs are more complex and difficult to perform• IOP reduction at 6 and 12 months, and to DS at 24 months

Gabai A, et al. J Glaucoma 2019;28:823



• First meta-analysis studying theefficacy in terms of IOP reduction at 24 months

• First including >1 study in eachsubgroup of comparison (TE vs. DS, TE vs. VC, and TE vs. CP).



• TE is more effective in reducing IOP• TE presents a higher risk of

complications as compared withNPGS, except for hyphema

• DS with intraoperative MMC seems tobe the best compromise between IOP reduction and safety

• Inclusion of nonrandomized controlledstudies is a considerable strength of the present work because RCTs provide an ideal setting that does not reflect the real-world clinical practice



Nguyen JH, et al. Ophthalmology 2019;126:1517

• Studies of structural and functional effects with objective outcomemeasures for YAG-laser treatment performed on vitreous floaters arelacking

• Evaluate eyes previously treated with Nd:YAG laser vitreolysis usingobjective quantitative measures of vitreous structure and visual function

• Provides a real-world perspective• Retrospective, monocentric comparative study• One eye was enrolled for each of 132 participants


• Of these, 25 were dissatisfied and sought vitrectomy (65%)

• 13 were satisfied with observation(35%)



• Many patients who have undergoneNd:YAG laser treatment to vitreousopacities remain symptomatic and arestill sufficiently bothered by floaters toseek further medical attention

• Prospective randomized study of Nd:YAG laser treatment of vitreous iswarranted, using uniform lasertreatment parameters and objectivequantitative outcome measures


• International, expert-led consensus initiative • Develop systematic, evidence-based recommendations based on published

literature for the treatment of noninfectious uveitis in the era of biologics• International expert steering committee identified clinical questions and conducted

systematic review of the literature• Areas of clinical focus

1. Optimal timing for treatment escalation2. Transitioning treatment to a noncorticosteroid immunomodulator or immunomodulatory agent, including

biologic agents3. Multidisciplinary team collaboration

Dick AD, et al. Ophthalmology 2018;125:757


Ten questions resulting in 21 evidence-based guidancestatements

• When to start noncorticosteroidimmunomodulatory therapy, includingboth biologic and nonbiologic agents

• What data to collect before treatment• When to modify or withdraw treatment• How to select agents based on

individual efficacy and safety profiles• Evidence in specific uveitic conditions

• Pharmacoeconomic considerationsnot addressed




• Understand relevant questionsconcerning immunosuppressivetherapy of non-infectious uveitis

• Be on same level when discussingwith rheumatologist or GP

• Knowledge about commonly usedimmunosuppressives

• Mostly US- and european experts• Regional differences remain



Journal Club


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Top of 2019 �Praxisrelevante Highlights aus der FachliteraturSwiss OphthalListe der peer-reviewed Journals�Top-of-the-top: 5 Papers der Ophthalmologie der letzten 12 MonateFoliennummer 5FEMCAT trial Transfer to your practiceFoliennummer 8Foliennummer 9Transfer to your practiceFoliennummer 11Silicone droplets after intravitreal injectionTransfer to your practiceFoliennummer 14Foliennummer 15Transfer to your practiceFoliennummer 17Foliennummer 18Transfer to your practiceFoliennummer 20Ten questions resulting in 21 evidence-based guidance statements Transfer to your practiceJournal ClubFoliennummer 24slido.com-Votingsystem �

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Prof. Dr. Matthias Becker¤sentationen... · 2020. 2. 26. · SAoO 2020, Matthias Becker, Swiss Ophthal 2019, 26.2.2020, Seite 3. Liste der peer-reviewed Journals • American Journal