Ophthalmology最新文献

Purpose: To investigate the natural course of vitreous hemorrhage (VH) due to posterior vitreous detachment (PVD).

Design: Retrospective chart review.

Participants: Consecutive patients with VH due to presumed PVD between January 1, 2017, and December 31, 2021. Patients were followed conservatively.

Methods: Patients with a first episode of VH at a large eye hospital were included retrospectively through review of medical charts. Patients with a history of proliferative diabetic retinopathy, retinal venous occlusion, or wet age-related macular degeneration were excluded.

Main outcome measures: Patients were followed for a minimum of 2 years until one of the following outcomes occurred: spontaneous VH clearing, rhegmatogenous retinal detachment (RRD), vitrectomy for persistent VH, or referral to a medical retinal service.

Results: We included 366 patients (366 eyes); mean age was 65.2 years (standard deviation, 10.8), and 42.9% were women. Vitreous hemorrhage obscured the fundus in 295 eyes (80.6%). Vitreous hemorrhage cleared spontaneously in 227 eyes (62%), whereas RRD occurred in 61 eyes (17%). Rhegmatogenous retinal detachment plateaued at 20 days, indicating a time-dependent pattern. The risk of retinal detachment was significantly higher in men (hazard ratio [HR], 2.90 [1.64-5.12], P < 0.001) compared with women. Older patients exhibited a lower risk of RRD (HR, 0.27; 95% confidence interval [CI], 0.13-0.59, P < 0.001 in the 65- to 73-year age group and HR, 0.25; 95% CI, 0.10-0.63, P = 0.003 in the 73- to 94-year age group). Spontaneous clearing was associated with the density of VH. After 60 days, only 48% of the eyes cleared spontaneously. Thirty-six eyes did not clear, requiring vitrectomy after a median duration of 98 days (62.75-140.75).

Conclusions: This study demonstrates that VH presumed secondary to PVD showed great variability but generally took several months to clear, with 62% resolving spontaneously. However, 17% developed RRD, the majority during the first 3 weeks. Male gender and young age increased RRD risk. These findings highlight the importance of vigilant monitoring during the early phase and indicate that individual patient characteristics may guide management strategy. Further prospective studies are warranted to refine risk stratification and optimize management protocols in this patient population.

Financial disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Purpose: Avacincaptad pegol (ACP) is a pegylated RNA aptamer that inhibits complement C5. The efficacy and safety of ACP 2 mg was investigated in GATHER2, with positive year 1 results published. Herein, 2-year results are reported.

Design: Phase 3, randomized, sham-controlled study (ClincalTrials.gov identifier, NCT04435366).

Participants: Patients with non-center point-involving geographic atrophy (GA).

Methods: Eligible patients were randomized 1:1 to receive monthly ACP 2 mg (n = 225) or sham (n = 222) for 1 year. At month 12, patients who received ACP 2 mg were randomized again 1:1 to dosing every month (EM; n = 96) or every other month (EOM; n = 93) with ACP 2 mg. Patients who had received monthly sham continued with sham (n = 203).

Main outcome measures: The safety and efficacy of ACP versus sham administration over 2 years and the effect of ACP EM or EOM dosing in year 2.

Results: Overall, 175 and 184 patients in the ACP and sham group completed the study at year 2, respectively. At 2 years, treatment with ACP demonstrated a continued reduction in GA growth (slope) with both ACP EM and EOM versus sham. From baseline to year 2, the mean rate of GA area growth was 4.46 mm² (standard error [SE], 0.25 mm²) with ACP EM and 5.18 mm² (SE, 0.17 mm²) with sham, a difference in growth of 0.724 mm² (95% confidence interval [CI], 0.133-1.315 mm²; P = 0.0165), representing a 14% difference. From baseline to year 2, the mean rate of GA area growth was 4.20 mm² (SE, 0.25 mm²) with ACP EOM, a difference in growth of 0.976 mm² (95% CI, 0.377-1.575 mm²; nominal P = 0.0015) versus sham, representing a 19% difference. The incidence of choroidal neovascularization (study eye) was 11.6% with ACP (all treated) versus 9.0% with sham over 2 years. No events of retinal vasculitis, ischemic optic neuropathy, or serious intraocular inflammation occurred over 2 years.

Conclusions: Dosing of ACP 2 mg, either EM or EOM, continued to reduce GA growth versus sham therapy over 2 years with no new safety signals compared with year 1.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.