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December 11, 2015
Volume 20, Number 47

Dextenza NDA accepted 
A New Drug Application for Dextenza, a sustained release dexamethasone intracanalicular depot for the treatment of ocular pain following ophthalmic surgery, has been accepted by the Food and Drug Administration, said developer Ocular Therapeutix (Bedford, Mass.). The data included in the NDA are from a phase 2 clinical trial and two phase 3 clinical trials, the company said. Dextenza is placed through the punctum into the canaliculus and is designed to deliver dexamethasone to the ocular surface for 4 weeks; after treatment the depot resorbs and exits through the nasolacrimal system without need for removal.
The FDA has set a target action date under the Prescription Drug User Fee Act (PDUFA) of July 24, 2016.
Ocular Therapeutix is also evaluating Dextenza for allergic conjunctivitis.
Glaucoma treatment CF101 completes phase 2 patient enrollment
A phase 2 study on CF101, an oral compound for the treatment of glaucoma, has completed patient enrollment, OphthaliX (Carson City, Nev.) said in a press release. The study has enrolled 88 patients in Europe and Israel; top line results are expected in mid-2016.
The study is being conducted with 2 cohorts. In the first cohort, patients were treated with 1 mg CF101 and placebo. Masked results from this cohort showed that the drug had a favorable safety profile and was well tolerated, OphthaliX said. In the second cohort, dosage was increased, with patients receiving 2 mg of CF101 and matching placebo, given orally every 12 hours for 16 weeks.
CF101 is an A3 adenosine receptor (A3AR) agonist shown to have neuroprotective effects in the eye. 
Peachtree study enrolls first patient
A 6-month, randomized, masked, sham-controlled phase 3 study (dubbed "Peachtree") of the safety and efficacy of CLS-TA (triamcinolone acetonide) administered via microinjection to the suprachoroidal space in patients with macular edema associated with non-infectious uveitis has enrolled its first patient, developer Clearside Biomedical (Alpharetta, Ga.) said in a news release.
The primary endpoint of the study is the proportion of patients with a change from baseline of at least 15 letters in BCVA at 24 weeks. Patients will be randomized to receive 2 unilateral injections of 4 mg of CLS-TA or sham injections about 12 weeks apart.
Clearside expects to enroll approximately 150 patients across 50 clinical sites. Assuming the trial is successful, Clearside hopes to file for regulatory approval some time in 2017.
U Illinois: OcuCheck can quickly determine extent of eye injury
Researchers at the University of Illinois have developed a portable sensor that can quickly and inexpensively determine whether an eye injury is mild or severe, the university said in a news release.
OcuCheck works by measuring levels of vitamin C in the fluids that coat or leak from the eye. The sensor could speed efforts to determine the extent of eye injuries at accident sites, in rural areas lacking ophthalmology specialists, or on the battlefield, the researchers said.
"The sensor takes advantage of the fact that the ocular tear film contains low levels of ascorbic acid, while the interior of the eye contains much higher levels," said University of Illinois bioengineering professor Dipanjan Pan, who is creating the device in collaboration with ophthalmologist Leanne Labriola, MD. "The concept is if there is severe damage to the eye that penetrates deeply, the ascorbic acid will leak out in high concentration."
In tests with clinical samples from 16 patients undergoing eye surgery, the team found that their sensor could, with high sensitivity, accuracy, and specificity, detect a range of ascorbic acid concentrations. The device has not been tested yet on tear samples from trauma patients.
Alcon opens ocular health center
Alcon (Fort Worth, Texas) opened the Alcon Experience Center to provide hands-on training for physicians in a "realistic practice environment," the company said. The center will also host high school and university students throughout the north Texas region as part of its efforts to promote education in science, technology, engineering and math (STEM), Alcon said.
RESEARCH BRIEFS
  • Femtosecond laser pretreatment for brunescent cataracts allowed for a significant reduction in effective phacoemulsification time (EPT) compared with manual standard phacoemulsification techniques, according to Kathryn M. Hatch, MD, and colleagues. They evaluated 240 eyes, with 60 eyes in each of 4 groups: Groups 1 and 2 contained eyes with LOCS III grade nuclear opalescence (NO) 3 cataracts treated with standard cataract surgery and femtosecond laser-assisted cataract surgery, respectively. Groups 3 and 4 contained brunescent cataracts, LOCS III grade NO 5, treated with standard cataract surgery and femtosecond laser-assisted cataract surgery, respectively. The EPT in Group 1 ranged from 0.46 to 3.10; the EPT in all eyes in Group 2 was 0 (P<.001). The EPT in Groups 3 and 4 was 2.12 to 19.29 and 0 to 6.75, respectively (P<.001). A comparison between EPT in Groups 1 and 4 showed that EPT in Group 4 was also lower than in Group 1 (P=.013). Groups 4 and 1 were the most statistically similar of all groups compared, suggesting that EPT for a femtosecond laser-treated grade 5 cataract was most similar to that of a standard-treated grade 3 cataract. The study is published in the Journal of Cataract & Refractive Surgery.
  • Fixation of an existing unstable angle-supported anterior chamber IOL to the iris is an effective and simple alternative to intraocular lens exchange and posterior chamber fixation, according to A. Belkin and colleagues. They discussed a case series of 8 patients who underwent iris fixation of an unstable open-looped ACIOL associated with progressive corneal damage. The loops of the intraocular lens were firmly fixated to the iris using 9-0 or 10-0 polypropylene sutures. In 6 of the cases, iris fixation was performed with a closed-system technique; the remaining 2 cases were associated with penetrating keratoplasty. All procedures were uneventful, with no intraoperative or postoperative complications. Suture fixation effectively prevented anterior-posterior or propelling movement. The ACIOLs in all cases were stable and well centered at the end of follow-up. The study is published in Cornea.
  • In cases of uncomplicated Ahmed glaucoma valve implantation, the cumulative risk of corneal decompensation was 3.3%, 5 years after the operation, according to a study published in the British Journal of Ophthalmology. K.N. Kim and colleagues retrospectively evaluated changes in the corneal endothelial cell density (ECD) and corneal decompensation following Ahmed glaucoma valve implantation in 127 patients who were followed for at least 5 years (mean follow up of 43.1 months). There were no cases of postoperative tube-corneal touch. The cumulative risk of corneal decompensation was 3.3%, 5 years after AGV implantation. There was a more rapid loss of ECD in the 72 subject eyes compared with the 31 controls (-7.0% and -0.1%/year, respectively; p<0.001). However, the rate of loss decreased over time, and statistical significance compared with control eyes disappeared after 2 years postoperatively.
 
NEW PRODUCT BRIEF
  • Geuder (Heidelberg, Germany) introduced sterile Single-Use Trephines, Single-Use Vacuum-Trephines, sterile Single-Use Trephine-Punches and Single-Use Vacuum Trephine-Punches from Surgistar. The width portfolio of different diameters, starting with 2.5 mm up to 18 mm in steps of 0.25 mm, and different versions of long and short trephines, radial and vacuum trephines as well as trephine punches and vacuum trephine punches complete the product range, the company said.




Important Safety Information about PROLENSA®
  •  PROLENSA®contains sodium sulfite, a sulfite that may cause allergic type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. The overall prevalence of sulfite sensitivity in the general population is unknown and probably low. Sulfite sensitivity is seen more frequently in asthmatic than in non asthmatic people.
  • All topical nonsteroidal anti-inflammatory drugs (NSAIDs), including bromfenac, may slow or delay healing. Concomitant use of topical NSAIDs and topical steroids may increase the potential for healing problems.
  • There is the potential for cross-sensitivity to acetylsalicylic acid, phenylacetic acid derivatives, and other NSAIDs, including bromfenac. Use with caution in patients who have previously exhibited sensitivities to these drugs.
  • There have been reports that ocularly applied NSAIDs may cause increased bleeding of ocular tissues (including hyphemas) in conjunction with ocular surgery. Use with caution in patients with known bleeding tendencies or who are receiving other medications which may prolong bleeding time.
  • Use of topical NSAIDs may result in keratitis. Patients with evidence of corneal epithelial breakdown should immediately discontinue use of topical NSAIDs, including bromfenac, and should be closely monitored for corneal health. Patients with complicated ocular surgeries, corneal denervation, corneal epithelial defects, diabetes mellitus, ocular surface diseases (e.g., dry eye syndrome), rheumatoid arthritis, or repeat ocular surgeries within a short period of time may be at increased risk for corneal adverse events which may become sight threatening. Topical NSAIDs should be used with caution in these patients. Post-marketing experience with topical NSAIDs suggests that use more than 24 hours prior to surgery or use beyond 14 days post-surgery may increase patient risk for the occurrence and severity of corneal adverse events.
  • PROLENSA®should not be instilled while wearing contact lenses. The preservative in PROLENSA®, benzalkonium chloride, may be absorbed by soft contact lenses. Lenses may be reinserted after 10 minutes following administration of PROLENSA®.
  • The most commonly reported adverse reactions in 3%-8% of patients were anteriorchamber inflammation, foreign body sensation, eye pain, photophobia, and blurred vision. 
Click here for Prescribing Information about PROLENSA®.

EyeWorld Weekly Update is edited by Stacy Jablonski and Michelle Dalton.

 

EyeWorld Weekly Update (ISSN 1089-0319), a digital publication of the American Society of Cataract and Refractive Surgery and the American Society of Ophthalmic Administrators, is published every Friday, distributed by email, and posted live on Friday.

 

 

Medical Editors: Eric D. Donnenfeld, MD, chief medical editor; Rosa Braga-Mele, MD, cataract editor; Clara C. Chan, MD, cornea editor; Reay H. Brown, MD, glaucoma editor; Steven C. Schallhorn, MD, refractive editor; and John A. Vukich, MD, international editor

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