Mount Sinai Health System Top Presentations and Abstracts From AAO

Source: Mount Sinai Health System

Mount Sinai Health System in New York City made several presentations and poster sessions at the American Academy of Ophthalmology meeting in Chicago.

Below is a summary of the abstracts and presentations:

“Long-term Efficacy of Fractionated Conformal Radiotherapy for the Management of Primary Optic Nerve Sheath Meningiomas”
– Mark Kupersmith, MD,
Professor of Ophthalmology, Neurology, and Neurosurgery at the Icahn School of Medicine at Mount Sinai


Purpose- To determine the long-term efficacy / safety of fractionated conformal radiotherapy (FCRT) for optic nerve sheath meningiomas (ONSM). 

Methods- The charts of OSNM patients across four tertiary centers were reviewed; 16 patients with 10+ years of follow-up since FCRT were included. 

Results-  FCRT was performed at a mean of 2.3 years after symptom onset, with mean follow-up of 14.6 years after treatment. Visual acuity (VA) improved / stabilized in 88%, and 69% retained > 20/40 VA. Mean deviation on automated perimetry was stable (−14.5 dB versus −12.2 dB; P = .68). Eleven percent had persistent pain, proptosis, or diplopia, compared with 44% pretreatment (P = .11). Radiation retinopathy developed in 13% and progressive optic neuropathy in 6%. There were no cases of tumor involvement or radiation damage in the fellow eye. 

Conclusion- This study provides the longest follow-up data treatment of ONSM with FCRT. Further study is needed to identify those at higher risk for radiation-induced morbidity. 

“Pain Control Following Intravitreal Injection Using Topical Nepefanac 0.3% or Pressure Patching: A Prospective, Randomized, Placebo Controlled Trial”
Ronald C. Gentile, MD, Professor of Ophthalmology at the Icahn School of Medicine at Mount Sinai; Director of the Ocular Trauma Service at New York Eye and Ear Infirmary of Mount Sinai


Purpose- To evaluate a topical nonsteroidal anti-inflammatory drug (NSAID) and patching for the reduction of post-intravitreal injection (IVI) pain. 
Methods- Fifty-six eyes of 56 patients receiving IVI were randomized to receive either a single drop of nepafenac 0.3% (n = 19), a pressure patch for two hours (n = 18), or a single drop of preservative-free tears (control group, n = 19) following IVI. A single-blinded, placebo-controlled design was used for the topical treatments. Pain was assessed using the Numeric Pain Rating Scale. 
Results- After controlling for age, gender, number of prior injections, and administering physician, patients in the NSAID group had significantly lower pain scores than those in the control group at six hours (−1.3 ± 0.6 less, P = .047) and at 24 hours (−0.7 ± 0.3 less, P = .047). The patch group had lower pain scores than the control group, but the difference did not reach statistical significance.
Topical NSAID appears to be effective in reducing pain after six and 24 hours compared to placebo. 

“MiLOOP as a Non-phaco Technique” – Ophthalmic Premier League: A Team Symposium on Managing Cataract Complications
– Sean Ianchulev, MD, MPH,
Professor of Ophthalmology at the Icahn School of Medicine at Mount Sinai; Director of the Ophthalmic Innovation and Technology Program at New York Eye and Ear Infirmary of Mount Sinai 


Aim- To assess the safety and efficacy of microinterventional endocapsular nuclear fragmentation in moderate to severe cataracts.

Methods- This was a prospective single-masked multisurgeon interventional randomised controlled trial (ClinicalTrials.gov NCT02843594) where 101 eyes of 101 subjects with grade 3‒4+ nuclear cataracts were randomized to torsional phacoemulsification alone (controls) or torsional phacoemulsification with adjunctive endocapsular nuclear fragmentation using a manual microinterventional nitinol filament loop device (miLOOP group). Outcome measures were phacoemulsification efficiency as measured by ultrasound energy (cumulative dispersed energy (CDE) units) and fluidics requirements (total irrigation fluid used) as well as incidence of intraoperative and postoperative complications.

Results- Only high-grade advanced cataracts were enrolled with more than 85% of eyes with baseline best corrected visual acuity (BCVA) of 20/200 or worse in either group. Mean CDE was 53% higher in controls (32.8±24.9 vs 21.4±13.1 with miLOOP assistance) (P=0.004). Endothelial cell loss after surgery was low and similar between groups (7‒8%, P=0.561) One month BCVA averaged 20/27 Snellen in miLOOP eyes and 20/24 in controls. No direct complications were caused by the miLOOP. In two cases, capsular tears occurred during IOL implantation and in all remaining cases during phacoemulsification, with none occurring during the miLOOP nucleus disassembly part of the procedure.

Conclusions- Microinterventional endocapsular fragmentation with the manual, disposable miLOOP device achieved consistent, ultrasound-free, full-thickness nucleus disassembly and significantly improved overall phaco efficiency in advanced cataracts.

Trial registration number NCT02843594

“A Compounded, Fixed Combination of Latanoprost 0.005%, Dorzolamide Hydrochloride 2%, Timolol Maleate 0.5%, Brimonidine Tartrate 0.2%, Compared to Standard Therapy for Glaucoma”

Nathan Radcliffe, MD, Clinical Assistant Professor of Ophthalmology at the Icahn School of Medicine at Mount Sinai

Purpose- To compare a four-agent fixed combination drop (IP; latanoprost 0.005%, dorzolamide 2%, timolol 0.5%, brimonidine 0.2%) q.h.s. and a three-agent combination drop (dorzolamide 2%, timolol 0.5%, brimonidine 0.2%) q.a.m. to multiple (3-4) drop therapy for glaucoma (control) in a multicenter prospective randomized clinical trial. 

Methods- Subjects who signed the informed consent and met all inclusion / exclusion criteria were randomized (1:1) to IP versus control and were evaluated on Days 7 ± 2, 30 ± 7, 60 ± 7, and 90 ± 7. The primary outcome measurement was IOP change, and the secondary outcome was tolerability and safety. 

Results- Twenty-nine patients were randomized to IP and 23 to control. IP was noninferior to control at all time points, and IOP was statistically lower with IP versus control at Days 30, 60, and 90. Corneal fluorescein staining score decreased more in the IP than in control at Days 7, 60, and 90. 

Conclusion- The potential benefits of compounded combination medications warrant further investigation. 

“Baseline Age and Mean Deviation Affect Rates of Glaucomatous Vision Loss”
Louis R. Pasquale, MD, Professor of Ophthalmology at the Icahn School of Medicine at Mount Sinai; Site Chair of the Department of Ophthalmology at The Mount Sinai Hospital and Mount Sinai Queens, and Vice Chair of Translational Ophthalmology Research for the Mount Sinai Health System.
– Robert Ritch, MD, Clinical Professor of Ophthalmology at the Icahn School of Medicine at Mount Sinai; Shelley and Steven Einhorn Distinguished Chair of Ophthalmology, Surgeon Director Emeritus, and Chief of Glaucoma Services at New York Eye and Ear Infirmary of Mount Sinai


Purpose- To assess the relationship between baseline age and visual field (VF) mean deviation (MD) on the rate of glaucoma VF progression. 
Methods- 75,409 VF tests from 7783 eyes with ≥ 6 VFs and baseline MD ≥ −10 dB were selected from the Glaucoma Research Network. The rate of MD change (dB/year) was calculated for each eye. We tested the relationship between baseline age and MD and the rate of MD change. 
Results- Univariate models yielded the following coefficients β (P-values): age: β = −0.007/year (P < .001); MD: β = 0.008/dB (P = .002). In multivariable regression with baseline age and MD, both were significant (P < .001 and .013, respectively). The interaction term for the two was also significant: β = 0.0005 (P = 0.014). 
Conclusion- The rate of glaucoma progression is faster with older age and worse baseline MD. The effect of age on MD rates of change is influenced by baseline MD severity, supporting the importance of early detection and more aggressive therapy in older patients with worse VF damage. 

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