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STUDY / TRIAL OBJECTIVE
To evaluate the role of corticosteroids in the treatment
of unilateral optic neuritis
1 Optic Neuritis Treatment Trial ONTT
To evaluate whether cryotherapy for
ROP in preterm infants with birth weights <1251 g
Prevents unfavorable outcomes (posterior retinal fold ,
Stage 4b or 5 retinal detachment, or visual acuity of
200/20or worse(
2 Cryotherapy for ROP Study Cryo-ROP
2015
CONCLUSION
In general, about 30% develop MS within 4 years and
38% develop MS by 10 years (risk is higher in women
than men)
Consider treating optic neuritis with IV steroids; do not
initiate treatment with oral steroids
Regardless of MRI status, there is a higher risk of
developing MS if the patient has previous neurologic
symptoms or a history of optic neuritis in the fellow eye
Cryotherapy preserves visual acuity in eyes with
threshold disease :
Initial examination: 4–6 weeks after birth or
at 3 0weeks’ gestational age (whichever
is later), then every 2 weeks until vessels reach
zone 3
Prethreshold disease: examine every week
until regression or threshold disease develops
Threshold disease :perform cryotherapy within
72hours of diagnosis
Laser photocoagulation or cryotherapy to avascular
retina, 9 0% regression rate
After 1 week, plus disease is usually less if
treatment will work, fibrovascular proliferation
often takes 2 weeks to begin regressing; consider
retreatment if ROP is worse after 1 week; retreat
untreated areas
Stage 4 disease: 60% reattachment rate with scleral
buckle; 5% obtain useful vision
Stage 5 disease: vitrectomy (very poor success rate
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STUDY / TRIAL
3 Herpetic Eye Disease Study HEDS
OBJECTIVE
Five trials to evaluate the role of steroids
and antiviralal medication in the treatment and prevention
of ocular HSV disease:
Efficacy of oral acyclovir in treating stromal keratitis
(non-necrotizing [disciform] and necrotizing):
10-week course of ACV 400 mg 5×/day or placebo,
in addition to topical steroids and trifluridine
Efficacy of topical corticosteroids in treating stromal
keratitis: 10week tapering course of prednisolone phosphate
or placebo in addition to topical trifluridine (prednisolone
acetate 8×/day and trifluridine [Viroptic] qid × 1 week,
then gradual taper over 10 weeks)
Efficacy of oral acyclovir (ACV) in treating
iridocyclitis: 10-week course of ACV 400 mg 5 ×/day
or placebo, in addition to topical steroids and
trifluridine.
Efficacy of oral acyclovir in preventing stromal
keratitis or iritis in patients with epithelial keratitis:
3-week course of ACV 400mg 5 ×/day or placebo, in
addition to topical trifluridine.
Efficacy of oral acyclovir in preventing recurrent
ocular HSV disease: 12-month course of ACV
400 mg bid or placebo and 6-month observation
period for patients with a history of ocular HSV
within the preceding year
Determinants of recurrent HSV keratitis: analyzed
the placebo group from the acyclovir prevention trial
2015
CONCLUSION
Oral ACV is not useful for the treatment of stromal
keratitis
Topical corticosteroids are beneficial for the
treatment of stromal keratitis
Results were not statistically significant but suggest a
possible benefit of oral acyclovir for the treatment of
iridocyclitis
In patients with epithelial keratitis, a 3-week course
of oral acyclovir has no apparent benefit in
preventing stromal disease or iritis
Oral acyclovir prophylaxis significantly reduces the
risk of recurrent ocular and orofacial HSV disease ,
especially in patients with previous stromal keratitis
In patients with ocular HSV disease in the previous
year, a history of epithelial keratitis is not a risk
factor for recurrent epithelial keratitis, but a history
of stromal keratitis increases the risk of subsequent
stromal keratitis, and this risk is strongly associated
with the number of previous episodes
2
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STUDY / TRIAL
Collaborative Corneal Transplantation
4 ocular surface disorders
Studies CCTS
5 Endophthalmitis Vitrectomy Study EVS
OBJECTIVE
To determine whether histocompatibility matching of
corneal transplant donors and recipients can reduce the
incidence of graft rejection in high-risk patients.
To evaluate the treatment of acute (<6 weeks)
postoperative (cataract or secondary IOL surgery)
endophthalmitis with immediate vitrectomy vs ‘tap and
inject,’ and whether intravenous antibiotics (ceftazidime
and amikacin) are necessary
2015
CONCLUSION
ABO blood type incompatibility is a possible risk factor
for rejection
HLA matching is not cost-effective or advantageous
High-risk status: vascularization of cornea in 2
quadrants, history of previous graft rejection ,
glaucoma, extensive PAS, traumatic or hereditary
Preop endothelial counts have nothing to do with graft
rejection but may be a cause of primary graft failure.
The most important conclusion drawn from CCTS is
that high dose postop steroids, good patient compliance
and close follow ups are keys to a successful transplant.
For endopthalmitis after cataract or secondary IOL
surgery perform emergent treatment with AC tap and
injection of intravitreal antibiotics when vision is better
than LP
Vitrectomy should be reserved for patients presenting
with light perception vision or worse
IV antibiotics do not improve the outcome
3
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STUDY / TRIAL OBJECTIVE
To evaluate argon laser trabeculoplasty (ALT)
Vs trabeculectomy as the initial surgery in
patients with dvanced open-angle glaucoma
not controlled by medical treatment main
outcome variable was visual function (field
and Acuity)
Advanced Glaucoma Intervention Study
6
AGIS
To evaluate the effect of topical medication
in delaying or preventing POAG in patients
with ocular hypertension (IOP between 24 and
32 mmHg in one eye and between 21 and
32 mmHg in the fellow eye; normal visual
Ocular Hypertension Treatment Study fields and optic nerve)
7 The goal in the treatment group was to
OHTS
reduce the IOP by at least 20% from
baseline and obtain a target pressure of ≤24
mmHg.
The primary outcome variable was visual
field loss or optic nerve damage
2015
CONCLUSION
In patients with advanced POAG, ALT
should be considered as the first surgical
treatment in African American patients;
trabeculectomy should be considered first in
Caucasians
Risk factors for ALT failure are younger
age and higher IOP
Risk factors for trabeculectomy failure are
younger agehigher IOP, diabetes, and
postoperative complications (particularly elevated
IOP and marked inflammation.(
Risk factors for bleb encapsulation include
male sex and previous ALT (but this was
not statistically significant)
Low IOP reduces VF deterioration
Trabeculectomy is associated with an
increased risk of cataract formation
Topical ocular hypotensive medication is
effective in delaying or preventing POAG in
eyes with ocular hypertension
Predictive factors for developing POAG
include baseline IOP, age, cup-to-disc ratio,
and central corneal thickness (CCT ≤555µm)
4
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STUDY / TRIAL
8 Early Manifest Glaucoma Trial EMGT
9 Glaucoma Laser Trial GLT
Collaborative Normal Tension Glaucoma
10
Study CNTGS
OBJECTIVE
To evaluate the effectiveness of reducing IOP
(vs no treatment) on the progression of
newly diagnosed
open-angle glaucoma
The treatment group received argon laser
Trabeculoplasty plus topical betaxolol.
The primary outcome measures were
progression of visual field loss and optic
disc changes
A secondary aim was to assess risk
factors for progression
To evaluate the efficacy and safety of
starting treatment for POAG with ALT vs
topical medication
(Timoptic 0.5% bid(
To evaluate whether IOP is a causative
factor in NTG
The goal in the treatment group was to
reduce the IOP by 30% with medication,
laser, and/or surgery
2015
CONCLUSION
Treatment of early glaucoma halves the
risk of progression
Risk factors for progression included higher
baselineIOP, exfoliation, bilateral disease, older
age, and frequent disc hemorrhages
Initial treatment of POAG with ALT is at
least as efficacious as initial treatment with
Timoptic
IOP is a factor in the pathogenesis of
NTG and lowering the IOP by 30% is
beneficial
5
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MAJOR AGE-RELATED MACULAR DEGENERATION CLINICAL STUDIES
STUDY / TRIAL
11 Macular Photocoagulation Study MPS
Treatment of Age-Related Macular
12 Degeneration with Photodynamic Therapy
Trial (TAP)
Verteporfin in Photodynamic Therapy (VIP)
Trial Verteporfin in Photodynamic
13
Therapy–Pathologic Myopia (VIP-PM)
Trial
14 Age-Related Eye Disease Study (AREDS)
OBJECTIVE
To evaluate efficacy of laser photocoagulation in
preventing visual loss from CNV
To evaluate verteporfin (Visudyne) ocular
photodynamic therapy (OPT) in the management of
subfoveal CNV with some classic characteristics
To evaluate Visudyne ocular photodynamic therapy
(OPT) in the management of subfoveal CNV not
included in the original TAP investigation
To evaluate the effect of high-dose supplements on the
progression of AMD, and on the development and
progression of cataracts
2015
CONCLUSION
Treat extrafoveal CNV in patients with AMD, POHS,
and idiopathic lesions
Patients with juxtafoveal CNV (AMD, POHS, and
idiopathic) benefit from krypton laser photocoagulation,
except for hypertensive AMD patients
AMD patients with subfoveal CNV (new or recurrent)
benefit equally from argon green or krypton red laser
treatment.
For unilateral CNV, large drusen and focal
hyperpigmentation are risk factors for development of
CNV in fellow eye
Treatment of AMD patients with juxtafoveal CNV is
beneficial when the lesion is classic, even though CNV
recurs; treatment of classic CNV alone in lesions with
both classic and occult CNV was not beneficial
Visudyne ocular photodynamic therapy is
recommended for subfoveal, predominantly classic,
CNV
Visudyne ocular photodynamic therapy (OPT) is
recommended in the management of subfoveal occult
but not classic CNV when there is evidence of recent
disease progression, especially if the baseline lesion
size is smaller than 4 MPS DA, or the baseline vision is
worse than 20/50
High-dose supplements are beneficial in reducing the
risk of vision loss in patients with high-risk AMD
(categories 3 and 4). Caution should be exercised in
smokers or recent smokers in the use of high-dose beta-
carotene because of the possible increased risk of lung
cancer
Treatment is of no benefit in patients with no AMD or
early AMD (several small or intermediate drusen)
Treatment does not affect development or progression
of cataract
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MAJOR AGE-RELATED MACULAR DEGENERATION CLINICAL STUDIES
STUDY / TRIAL
15 Age-Related Eye Disease Study (AREDS2)
VEGF Inhibition Study in Ocular
16
Neovascularization trial (VISION)
Anti-vascular endothelial growth factor
(VEGF) Antibody for the Treatment of
17 Predominantly Classic Choroidal
Neovascularization (CNV) in Age-related
Macular Degeneration (ANCHOR) Trial
Minimally Classic / Occult Trial of the Anti-
VEGF Antibody Ranibizumab in the
18
Treatment of Neovascular AMD (MARINA)
Trial
OBJECTIVE
To evaluate the effect of high-dose supplements,
macular carotenoids, and omega-3-fatty acid on the
progression of AMD
To evaluate intravitreal pegaptanib for subfoveal CNV
due to neovascular AMD
Compared ranibizumab with the active control
verteporfin PDT in subfoveal predominantly classic
CNV due to wet AMD
Compared monthly intravitreal injections of
ranibizumab 0.3 or 0.5 mg or sham injections (n = 716)
in patients with subfoveal occult only or minimally
classic CNV due to wet AMD
2015
CONCLUSION
Patients randomized to receive various combinations of
vitamin C (500 mg), vitamin E (400 IU),
Beta-carotene (vitamin A, 15 mg), zinc (80 mg plus 2
mg copper), lutein (10 mg), zeaxanthin (2 mg), omega-
3 long-chain polyunsaturated fatty acids (LCPUFA) in
the form of docosahexaenoic acid (DHA) (350 mg)
and eicosapentaenoic acid (EPA) (650 mg)
Pegaptanib was better than sham and PDT for
neovascular AMD
Ranibizumab was superior to verteporfin for treatment
of predominantly classic CNV due to neovascular
AMD
Ranibizumab was better than sham for occult with no
classic and minimally classic CNV due to neovascular
AMD
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MAJOR DIABETIC RETINOPATHY CLINICAL STUDIES (VIP)

STUDY / TRIAL OBJECTIVE CONCLUSION
To evaluate whether photocoagulation prevents severe 1. Perform PRP for patients with high-risk proliferative
visual loss in eyes with diabetic retinopathy retinopathy (HR-PDR) regardless of vision
N.B: Severe NPDR defined as having at least 3 of the 2. NVD (new vessels on or within 1 disc diameter of
following: the disc) ≥ 1/4 – 1/3 of disc area
 Cotton wool spots 3. Any NVD with vitreous or preretinal hemorrhage
 Venous beading NVE (new vessels elsewhere) ≥ 1/2 of disc area with
 Intraretinal microvascular abnormalities (IRMA) in vitreous or preretinal hemorrhage.
19 Diabetic Retinopathy Study (DRS) ≥2 of 4 contiguous overlapping photographic fields 4. PRP is also indicated for NVI
 Moderate to severe retinal hemorrhages and / or 5. DRS did not report a clear benefit for immediate
microaneurysms in ≥1 standard photographic field. PRP in patients with severe nonproliferative diabetic
retinopathy and proliferative diabetic retinopathy
without high-risk characteristics. However, older-
onset diabetic patients should be considered for
earlier PRP
To evaluate : 1. Treat all patients with CSME regardless of vision
 Whether photocoagulation is effective for diabetic 2. Immediate PRP should be reserved for patients with
macular edema high-risk PDR and possibly those with severe NPDR
 Effect of aspirin on the course of diabetic in both eyes
retinopathy 3. No benefit from aspirin (650 mg/day)
 When to initiate PRP treatment for diabetic
retinopathy
N.B:
Patients were excluded if they had high-risk
proliferative diabetic retinopathy.
Mild NPDR defined as: At least 1 microaneurysm, but
Early Treatment Diabetic Retinopathy
20 not enough to qualify as moderate NPDR.
Study (ETDRS) Moderate NPDR defined as: Extensive intraretinal
hemorrhages and / or microaneurysms, cotton wool
spots, IRMA, venous beading, but not enough to
qualify as severe NPDR.
Severe NPDR defined with ‘4-2-1 rule’ as any one of
the following:
Intraretinal hemorrhages and / or microaneurysms in
all 4 quadrants
Venous beading in at least 2 quadrants
IRMA in at least 1 quadrant.

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CSME defined as one of the following:
-Retinal thickening at or within 500 µm of the
foveal avascular zone (FAZ)
-Hard exudates at or within 500 µm of the foveal
avascular zone (FAZ) with associated thickening of
the adjacent retina.
-Retinal thickening ≥1 disc area in size ≤1 disc
diameter from the center of the fovea
To observe patients with severe DR in type 1 and type 2
diabetes over 2 years to determine visual outcomes
Diabetic Retinopathy Vitrectomy Study
21
DRVS
To evaluate effect of tight vs conventional control of
Diabetes Control and Complications Trial blood sugar on diabetic complications in type 1 diabetic
22 patients
DCCT
Epidemiology of Diabetes Interventions and To gain further follow-up of patients from the DCCT
23
Complications (EDIC) Trial
To compare the effects on the risk of microvascular and
United Kingdom Prospective Diabetes Study macrovascular complications of intensive blood glucose control, as do type 1 diabetic patients
24 control with oral hypoglycemics and / or insulin and
UKPD
conventional treatment with diet therapy
The United Kingdom Prospective Diabetes To compare the effects of intensive blood pressure
25 Study – Hypertension in Diabetes Study control on the risk of microvascular and macrovascular
)(UKPDS-HDS complications
to compare efficacy of Ranibizumab versus sham with
26 RIDE & RISE laser rescue in patients with diabetic macular edema
2015
Early vitrectomy for eyes with severe visual loss due
to nonclearing vitreous hemorrhage (at least 1 month)
is helpful in type 1 diabetic patients and monocular
patients despite the type of diabetes.
Early vitrectomy is also recommended for eyes with
useful vision and advanced active pdr, especially when
extensive neovascularization is present.
NLP was seen in 20% of eyes regardless of
intervention once a severe vitreous hemorrhage had
occurred.
Eyes with traction retinal detachment not involving the
fovea can be observed until the fovea becomes
detached, provided that the fibrovascular proliferation
is not severe
Tight control is beneficial; however, rapid
normalization and tight control of blood sugar after a
period of prolonged hyperglycemia can lead to an initial
worsening of retinopathy
Tight control is still beneficial
type 2 diabetic patients benefit from intensive glycemic
tight blood pressure control reduced the risk of
complications from diabetic retinopathy
Ranibizumab injections are effective in diabetic
macular edema
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FOLLOW- UP: MAJOR DIABETIC RETINOPATHY CLINICAL STUDIES (VIP)
STUDY / TRIAL OBJECTIVE
To compare efficacy of ranibizumab with or without
27 RESTORE / RESOLVE laser versus laser alone in patients with diabetic
macular edema
PROTCOL B: To compare intravitreal triamcinolone
acetonide injections at doses of 1 mg or 4 mg and
macular laser photocoagulation in the treatment of
diabetic macular edema
PROTCOL I: To evaluate the safety and efficacy of
Diabetic Retinopathy Clinical Research (1) intravitreal ranibizumab in combination with focal
laser photocoagulation,
28 Network (DRCR.net): Major Protocols (2) intravitreal ranibizumab treatment alone, and
Only (3) intravitreal triamcinolone acetonide in combination
with focal laser photocoagulation in eyes with center-
involved DME
2015
CONCLUSION
Ranibizumab therapy with or without laser resulted in
significant visual gain over laser treatment alone.
Triamcinolone acetonide injections were not superior to
focal / grid photocoagulation, and resulted in more
adverse events
Intravitreal ranibizumab with prompt or deferred (≥
24 weeks) focal / grid laser had superior VA and OCT
outcomes compared with focal / grid laser treatment
alone. Although intravitreal triamcinolone combined
with focal / grid laser did not result in superior VA
outcomes compared with laser alone, an analysis
limited to pseudophakic eyes showed that the
triamcinolone group’s outcome for VA appeared to be
of similar magnitude to that of the 2 ranibizumab
groups.
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MAJOR RETINAL VEIN OCCLUSION CLINICAL STUDIES
STUDY / TRIAL OBJECTIVE
To evaluate photocoagulation in patients with branch
vein occlusion (BVO) for:
1. Prevention of neovascularization
29 Branch Vein Occlusion Study (BVOS) 2. Prevention of vitreous hemorrhage
3. Improvement of vision in eyes with macular edema,
reducing vision to 20/40 or worse
to compare intravitreal triamcinolone to observation in
retinal vein occlusion
The Standard Care vs Corticosteroid for
30
Retinal Vein Occlusion (SCORE) Study
To assess the safety and efficacy profile of ranibizumab
31 BRAVO Study (Lucentis, Genentech) in macular edema secondary to
branch retinal vein occlusion.
To evaluate patients with central retinal vein occlusion
(CVO) for:
1. Natural history of eyes with perfused (<10 disc areas
of nonperfusion) CVO
2. Improvement of vision in eyes with perfused
macular edema
3. Eyes with nonperfused CVO; does early PRP
prevent NVI?
4. Eyes with nonperfused CVO; is early PRP more
32 Central Vein Occlusion Study CVOS effective than delayed PRP in preventing NVG?
N.B:
Risk factors for progression to nonperfused:
CVO of less than 1 month duration, visual acuity less
than 20/200, presence of greater than 5 disc areas of
nonperfusion
Risk factors for developing nvi:
amount of nonperfused retina, extent of retinal
hemorrhages, male sex, CVO of less than 1-month
duration.
2015
CONCLUSION
1. Grid pattern laser photocoagulation recommended
for eyes with a BVO of 3–18 months duration if
visual acuity is 20/40 or worse and if fluorescein
angiography documents macular edema without
foveal hemorrhage as the cause of visual loss
2. Perform PRP if retinal neovascularization develops,
especially if ≥5 DD of nonperfusion exists
Triamcinolone acetonide was superior to observation in
CVO (5 times greater chance of gaining 3 lines), but
not to laser in BVO. The complications were higher in
the 4 mg TA group than the 1 mg TA group, so 1 mg is
preferred.
Ranibizumab injections are safe and effective in branch
retinal vein occlusion
1. No benefit from early PRP in nonperfused CVO;
therefore, wait until first sign of NVI before initiating
PRP.
2. PRP for nonperfused CVO when 2 clock hours of
NVI or any angle NV present
3. Monthly follow-up with gonioscopy during first 6
months after CVO
4. No benefit from focal laser for treatment of macular
edema after CVO
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FOLLOW- UP: MAJOR RETINAL VEIN OCCLUSION CLINICAL STUDIES

STUDY / TRIAL OBJECTIVE CONCLUSION
To assess the safety and efficacy profile of ranibizumab Ranibizumab injections are safe and effective in central
33 CRUISE Study (Lucentis, Genentech) in macular edema secondary to retinal vein occlusion
central-RVO.

STUDY / TRIAL OBJECTIVE CONCLUSION

To Evaluate Treatment Options For Choroidal Small tumor study: otherwise healthy patients with
Malignant Melanomas small choroidal melanomas have a low risk of death
within 5 years
Medium tumor trial: there is a high risk of substantial
visual loss from I-125 brachytherapy (up to 49%); I-125
Collaborative Ocular Melanoma Study
34 brachytherapy does not change the survival rate (for up
)COMS) to 12 years) in patients with medium choroidal
melanomas
Large tumor trial: pre-enucleation radiation does not
change the survival rate in patients with large choroidal
melanomas with or without metastases

12