Ophthalmologica最新文献

Introduction: The aim of this study was to report 2-year follow-up data on patients with diabetic macular edema (DME) treated with simultaneous intravitreal dexamethasone (DEX) and aflibercept.

Methods: Multicenter, retrospective analysis of eyes with DME treated with simultaneous DEX implant and aflibercept injection. Main outcome measures were changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) from baseline to 24 months. The secondary endpoint was the interval of retreatment.

Results: Two-year data were available for 52 of the 76 initially included eyes. Compared to baseline, significant improvements in mean BCVA and CRT were observed at 6, 12, 18, and 24 months. An average of 3.26 ± 1.70 intravitreal treatments was required, with a mean retreatment interval of 10.21 ± 6.35 months throughout the study period.

Conclusion: Simultaneous intravitreal DEX and aflibercept treatment resulted in sustained improvements in both visual and anatomical outcomes over a 24-month period. This combination therapy represents a valid treatment strategy and demonstrates synergistic efficacy in the management of DME.

Introduction: Silicone oil removal-related vision loss (SORVL) is a rare, sight-threatening condition occurring in patients who previously underwent silicone oil removal (ROSO) surgery. Today, few cases have been reported in the literature, predominantly described as unrecoverable, and the disease spectrum and its pathophysiology are mostly unknown.

Methods: We retrospectively report 6 different cases of SORVL, analyzing the different clinical outcomes. Patients clinical characteristics at presentation and throughout follow-ups are reported, including cases of significant improvement and a rare case of complete recovery.

Results: Among enrolled patients, 83% were males who underwent ROSO for a previous rhegmatogenous retinal detachment surgery with pars plana vitrectomy. Two (33.3%) cases presented significant improvement over time, with one of them (16.6%) experiencing complete recovery. Clinical presentation, diagnosis and course of the disease outline both similarities and differences that may help in the hypothesis-generating process on possible underlying mechanisms.

Conclusion: Although sharing connections in the onset of symptoms and clinical spectrum, this case series evidences differences in outcome in SORVL cases and highlights the heterogeneity of SORVL. Future studies should be aimed at investigating the pathophysiology of SORVL and factors influencing the course of this condition.

Introduction: This study directly compared the real-world effectiveness of bevacizumab, aflibercept 2 mg, and ranibizumab as first-line treatments for neovascular age-related macular degeneration (nvAMD).

Methods: A multicenter retrospective cohort of treatment-naïve nvAMD eyes managed with a treat-and-extend regimen in Israel and Canada. Primary outcomes were changes in visual acuity (VA) and central retinal thickness (CRT). Secondary outcomes included treatment burden (total injections and final maintained interval), non-response (persistent/worsening exudation or functional decline despite adequate treatment), non-extension (final interval of 4 weeks), and absence of active exudation.

Results: A total of 322 eyes received bevacizumab (n = 174), aflibercept (n = 110), or ranibizumab (n = 38) over a mean follow-up of 16.75 ± 12.66 months. Mean VA improved from 0.77 ± 0.47-0.60 ± 0.45 logarithm of the minimum angle of resolution following an average of 10.5 ± 6.3 injections. Aflibercept produced greater CRT reduction (-51.94 μm; p < 0.001), fewer injections (-2.35; p = 0.001), longer final intervals (+2.14 weeks; p < 0.001), and lower odds of non-response (adjusted odds ratio [aOR] 0.016; p < 0.001) and non-extension (aOR 0.128, p < 0.001) versus bevacizumab. It showed the largest mean VA gain, just short of significance on multivariable analysis (p = 0.059). Ranibizumab showed greater CRT reduction (-44.53 μm; p = 0.012) and lower non-extension odds (aOR 0.079; p = 0.001) than bevacizumab but did not significantly reduce treatment burden or improve VA.

Conclusion: In this first real-world, head-to-head comparison, aflibercept and ranibizumab outperformed bevacizumab in key anatomic and treatment-efficiency outcomes, with aflibercept showing the most consistent advantages. These findings highlight clinically relevant differences among anti-vascular endothelial growth factor agents and underscore the importance of real-world data to guide nvAMD management.

Introduction: The detection of chorioretinal atrophy (CRA) following voretigene neparvovec (VN) therapy for RPE65-IRD highlights the need for long-term monitoring to better understand the safety and efficacy of this gene augmentation treatment. This study aimed to longitudinally assess the development of VN-associated CRA, its presentation in multimodal retinal imaging, and potential implications on visual function in patients with RPE65-IRD.

Methods: This single-center, prospective cohort study was conducted at the University of Bonn. A total of 21 patients with confirmed RPE65-IRD underwent subretinal VN therapy. Multimodal imaging, including blue-light fundus autofluorescence (BAF), near-infrared imaging (IR), near-infrared fundus autofluorescence (IRAF), and color fundus photography (CFP), assessed atrophy development. The primary outcome measure was the incidence and size of CRA, while secondary outcomes included the relationship between CRA and changes in visual function.

Results: The study reported a 50% (16/32 eyes) incidence of CRA, with lesions primarily located in the macula (86.7%), bleb area (86.67%), injection site (80%), and periphery (80%). Lesion detection and size varied between BAF, IR, IRAF, and CFP, with the largest CRA detected in BAF imaging. Initially, the median enlargement rate of CRA was 60.50 mm2/year (131.20). Notably, eyes with CRA development had significantly better baseline low luminance visual acuity.

Discussion: This study highlights the crucial role of multimodal imaging in monitoring VN-associated CRA. Differences in lesion detection and size assessment across imaging modalities were observed, with the largest CRA extent detected in BAF imaging. Median visual function remained stable. These findings emphasize the complexity of VN therapy outcomes and the need for close surveillance using combined multimodal imaging to better understand the long-term clinical implications.

Introduction: The bullous variant of central serous chorioretinopathy (bvCSC) represents a rare and severe manifestation of CSC. This study aims to evaluate the clinical features, underlying systemic factors, and outcomes of bvCSC through a multicentric study.

Methods: A retrospective analysis was conducted on patients diagnosed with bvCSC across five tertiary eye centers. Demographic data, visual acuity (VA), treatment modalities, and follow-up outcomes were analyzed. A literature review was performed to contextualize the findings.

Results: The study included 35 eyes from 25 patients (80% male), with a mean age of 47.7 ± 12.2 years. Systemic comorbidities were identified in 60% of patients. Baseline VA was 1.18 ± 0.89 logMAR. Serous retinal detachment resolved in 63% of eyes, but persistent subretinal fibrosis contributed to limited visual recovery. Treatment varied, with observation (37%) being the most common approach, followed by systemic eplerenone (17%) and focal laser (13%). Available data did not show a clear advantage of any treatment modality.

Conclusion: The bvCSC is frequently associated with systemic conditions and has a guarded visual prognosis despite anatomical resolution in most cases. The study underscores the importance of early diagnosis and a tailored treatment to optimize outcomes in this severe CSC variant.

Introduction: Long-term, global data evaluating intravitreal aflibercept (IVT-AFL) 2 mg for treatment of neovascular age-related macular degeneration (nAMD) in real-world practice are needed. This study investigated the long-term, real-world effectiveness and safety of IVT-AFL 2 mg in patients with nAMD.

Methods: XTEND was a multicenter, observational, prospective study. Enrollment was conducted between May 2019 and May 2020; the patient follow-up period was 36 months. Treatment-naïve patients were treated with IVT-AFL 2 mg (fixed dosing or treat-and-extend [T&E]) according to the local label; for the T&E regimen, treatment intervals could be extended according to the national label (either European Medicines Agency [EMA]-aligned or non-EMA-aligned).

Results: Overall, 1,483 patients across 17 countries were treated with IVT-AFL 2 mg; mean ± standard deviation (SD) age was 78.8 ± 8.5 years; 60.4% were female. Overall, 62.6% of patients completed the 36-month follow-up visit. The mean (95% confidence interval [CI]) changes in best-corrected visual acuity from baseline were +4.6 (3.7, 5.4), +2.3 (1.3, 3.3), and +0.9 (-0.2, 1.9) at months 12, 24, and 36, respectively. The mean (95% CI) changes in central subfield thickness from baseline were -106 (-114, -99) μm, -109 (-117, -102) μm, and -110 (-118, -103) μm at months 12, 24, and 36, respectively. The mean ± SD numbers of injections from baseline to months 12, 24, and 36 were 7.7 ± 2.7, 11.3 ± 5.3, and 13.7 ± 7.5, respectively. No new safety concerns were identified.

Conclusion: This study demonstrates that improvements with IVT-AFL 2 mg were maintained through month 36, suggesting that long-term durability of vision is achievable in patients with treatment-naïve nAMD in real-world practice.

Introduction: Loss to follow-up (LTFU) among patients receiving anti-vascular endothelial growth factor therapy for neovascular age-related macular degeneration (nAMD) remains a critical challenge for maintaining visual outcomes. This systematic review and meta-analysis evaluated the prevalence, risk factors, and impact on visual prognosis of LTFU across real-world studies.

Methods: A comprehensive literature search of PubMed, Embase, Cochrane, Scopus, and Google Scholar identified studies published between 2015 and 2025. Eligible studies included observational cohorts and registry-based analyses that reported the LTFU rates, risk factors, and visual outcomes following treatment discontinuation. Random-effects meta-analysis (DerSimonian-Laird) estimated pooled odds ratios (ORs) and 95% confidence intervals (CIs); heterogeneity was assessed via I2 and Cochran's Q. Continuous predictors were analysed using regression-based ORs or standardized mean differences (SMDs), where appropriate.

Results: We included 52 studies. Short-term LTFU was defined as 6-12 months without treatment; long-term LTFU as ≥12 months. LTFU rates ranged from <5% to >75% over up to 10 years. Older age was moderately associated with LTFU (SMD = 0.47, 95% CI: 0.37-0.57; ≈6-7 years older). Greater travel distance increased LTFU risk (OR = 1.35 per 10-km increase, 95% CI: 1.14-1.60). Male sex (OR = 1.20, 95% CI: 1.05-1.37) and caregiver/transport dependence (OR = 2.00, 95% CI: 1.45-2.75) were also associated with a higher likelihood of LTFU. Treat-and-extend (T&E) regimens showed lower LTFU than pro re nata. Patients who were LTFU had worse visual outcomes even after resuming care.

Conclusion: LTFU in nAMD treatment is common and driven by demographic (age, sex, and race), socioeconomic (income and insurance), and access (distance and caregiver need) factors. Continuous treatment, early response, and structured regimens (e.g., T&E) mitigate dropout risk. Interventions to improve access and personalize support are essential to reduce LTFU and preserve visual outcomes.

Introduction: The aim of the study was to compare clinical findings, OCT characteristics, and postoperative outcomes in eyes with epiretinal membrane (ERM) with and without associated epiretinal proliferation (EP).

Methods: Eyes with ERM with or without associated EP were analyzed for clinical findings and OCT characteristics. The primary outcomes measured were changes in best-corrected visual acuity (BCVA) and OCT features from baseline to the final follow-up visit. Patients with ERM were categorized into two groups based on the presence or absence of EP. Surgical outcomes were also evaluated.

Results: Significant changes were reached in each group, particularly for BCVA (p < 0.001 for the ERM group, p = 0.010 for the EP-ERM group). Compared with ERM eyes, EP-ERM had a lower BCVA recovery at 6 months after surgery (p = 0.009). EP-ERM patients demonstrated more frequent microcystic macular edema (MME) (73.3% vs. 37.1%, p = 0.008) and increased central retinal thickness (CRT) (p < 0.001) at 6 months after surgery. No statistically significant differences in terms of external limiting membrane and ellipsoid zone defects were registered at 6 months (p = 0.234, p = 0.446, respectively).

Conclusion: EP-ERM showed poorer post-surgical BCVA compared with ERM alone. EP-ERM had a greater chance of MME at 6 months after surgery, with higher CRT. These findings highlight the need for deeper assessment of ERM characteristics to accurately predict surgical outcomes.

Introduction: Sustainability is becoming increasingly important in ophthalmology due to growing environmental, economic, and social responsibilities. Integrating sustainability into clinical practice requires not only advocacy by clinicians but also patients' collaboration and awareness. This study aimed to understand patients' perspectives on sustainability and the role attributed to ophthalmologists.

Methods: In this multi-item survey, ophthalmologic patients were assessed regarding their views on sustainability in general and in ophthalmology in particular. Levels of agreement were measured using a Likert scale.

Results: In total, 105 patients were included. There was high agreement on statements that anthropogenic climate change is an urgent issue, requires action, and is impacting population health (all, ≥85%). Patients supported advocacy of ophthalmologists for more sustainability, and there was broad agreement (74%) that ophthalmology practices should become more environmentally sustainable. No clear trend was observed whether the healthcare sector is taking sufficient measures to become more sustainable and whether the carbon footprint of ophthalmology is smaller compared to other specialties (44% and 33% disagreed; 41% and 63% [strongly] agreed, respectively). Patients aged ≥70 years agreed significantly more than younger patients that healthcare plays an important role in fighting climate change. A similar trend was observed for female compared to male patients. Female and older patients also tended to express greater expectations for ophthalmologists to advocate for sustainability, along with a call for increased advocacy from legislators and ophthalmology societies.

Conclusion: Patients showed strong awareness of anthropogenic climate change and the need for ophthalmology to become more sustainable. Especially female and older patients tended to expect more advocacy from ophthalmologists, ophthalmological societies, and the legislators.