Ophthalmology and Therapy最新文献

Introduction: This study reports the 1-year efficacy of aflibercept 8 mg (afl8) in a real-world cohort of treatment-naïve patients with neovascular age-related macular degeneration (nAMD).

Methods: An observational, retrospective case series from nine centers of the Swiss Retina Research Network including treatment-naïve eyes with nAMD started on intravitreal afl8. Changes in visual acuity (VA), macular thickness, pigment epithelial detachment (PED) height, and retinal fluids were evaluated over 12 months and compared with baseline. Treatment intervals and safety data were recorded along with subgroup analyses based on macular neovascularization type, loading-phase completion, and treatment regimen.

Results: A total of 91 eyes met the inclusion criteria. After 1 year of treatment, VA changed by + 1.0 ± 13.2 letters (p = 0.018), mean CST changed by -110.0 ± 130.9 µm (p < 0.001), and mean PED height changed by -71.2 ± 104.8 µm (p < 0.001). After 12 months, 66.2% of eyes demonstrated a complete absence of macular fluids. Mean treatment interval was 13.9 ± 7.9 weeks, with 56.1% of eyes being extended to ≥ 12 weeks with an anatomy-driven approach. No functional or anatomical differences were observed between eyes receiving a clean loading phase and in terms of different macular neovascularization (MNV) subtypes. Two adverse events were observed.

Conclusions: The first 1-year real-world experience with afl8 in patients with nAMD revealed a robust anatomical response but only a variable and limited visual gain over 12 months due to a ceiling effect. Our findings confirm the fast and sustained macular drying reported from clinical trials, allowing for extended treatment intervals without compromising safety and efficacy.

Introduction: Recent advances in the development of antivascular endothelial growth factor (VEGF) therapy for neovascular age-related macular degeneration (nAMD) include the approval of aflibercept 8 mg, which delivers four times the previously commercially available dose. A longer durability of aflibercept 8 mg compared with 2 mg was reported in the clinical trial results. However, there are limited data in patients switching to aflibercept 8 mg from other agents in clinical practice. This study reports the initial real-world experience of consecutive patients switched to aflibercept 8 mg.

Methods: Consecutive eyes with previously treated nAMD receiving aflibercept 8 mg switched from other agents were retrospectively reviewed. Patients were switched either owing to suboptimal control of disease activity (efficacy group) or to potentially extend treatment intervals (durability group). The main outcome measures included change in optical coherence tomography (OCT)-based anatomical parameters, including central subfield thickness (CST) and presence of subretinal fluid (SRF), intraretinal fluid (IRF), and pigment epithelial detachment (PED) before and after switching. In addition, quantification of OCT biomarkers was performed using the RetinAI Discovery algorithm.

Results: A total of 30 eyes from 29 patients were identified. Among the 25 eyes in the efficacy group, 20 eyes remained on aflibercept 8 mg through to the last follow-up visit. Median CST showed a significant reduction from 291 (275-301) µm to 279 (269-289) µm (p = 0.02). Volumetric analysis showed a significant reduction in SRF volume, a small nonsignificant increase in IRF volume, and a trend toward reduction in PED volume. The five eyes in the durability group had no SRF, IRF, or hemorrhage at the time of switching and remained stable during the follow-up period.

Conclusions: These results provide early experience of aflibercept 8 mg in a clinical cohort in hard-to-treat patients. The current analysis demonstrated favorable anatomical outcomes after switching in most patients, with no safety signals.

Light is a major environmental signal that shapes circadian rhythms, mood regulation, and ocular growth through a network of non-visual photoreceptive pathways. Increasing evidence suggests that photic information, particularly as decoded by intrinsically photosensitive retinal ganglion cells (ipRGCs), converges on central circuits governing both affective states and refractive development. To integrate these cross-system interactions, we propose the conceptual framework of a "light-eye-brain axis," which outlines how environmental light cues are encoded by the retina and subsequently modulate neuroendocrine, autonomic, and inflammatory processes. Within this framework, mood disturbances may contribute to myopic progression through altered light-exposure behaviors, neurotransmitter imbalance, hypothalamic-pituitary-adrenal axis instability, and impaired neuroplasticity, whereas high myopia may increase vulnerability to anxiety or depressive symptoms through shared neural and immune pathways. Taken together, this integrative perspective highlights how light-dependent signaling shapes both emotional and refractive outcomes, and provides a conceptual foundation for future mechanistic studies as well as evidence-informed approaches to optimizing light exposure in the context of mood and visual health.

Despite topical ocular hypotensive treatment and selective laser trabeculoplasty being the preferred first-line treatment modalities for lowering intraocular pressure, many patients require surgery for further controlling glaucoma progression. The XEN stent is a surgical device designed for the management of glaucoma where previous medical treatments have failed, offering greater predictability and fewer vision-threatening complications compared to trabeculectomy or tube shunts. This comprehensive and narrative review aims to assess different aspects related to XEN implant, including its efficacy, patient profile, surgical technique, and the identification of potential predictors of clinical outcomes. Additionally, this paper describes the most frequently reported adverse events associated with the XEN implant, with the objective of reducing their incidence through a comprehensive understanding of their underlying pathophysiology. Moreover, the authors draw on both existing literature and their clinical experience to provide recommendations for the optimization of the use of this implant.

Introduction: Patients with retinitis pigmentosa (RP) frequently exhibit zonular weakness, which poses challenges for intraocular lens (IOL) stability and refractive prediction. This study aimed to evaluate the impact of capsular tension ring (CTR) implantation on the predictive accuracy of 12 IOL power calculation formulas in patients with RP receiving cataract surgery.

Methods: We conducted a retrospective cohort study where the predictive accuracy of 12 IOL formulas was assessed using refractive prediction error (PE), mean absolute error (MAE), root-mean-square absolute error (RMSAE), and the percentage of eyes achieving target refraction within ± 0.25 D to ± 1.00 D. These metrics were compared between eyes with (n = 23) and without (n = 30) CTR implantation. The influence of lens thickness (LT) on formula accuracy was also evaluated.

Results: In the overall cohort of 53 eyes from 38 patients with RP, the Barrett Universal II (BUII) formula yielded the lowest numerical MAE (0.45 D) and RMSAE (0.56 D), though none of the formulas were statistically superior in RMSAE. In the CTR group, significantly lower MAE was observed for Cooke K6 (P = 0.024), Kane (P = 0.016), Emmetropia Verifying Optical (EVO) 2.0 (P = 0.040), and PEARL-DGS (P = 0.021) compared to the non-CTR group. The CTR group also exhibited a significantly higher percentage of eyes within ± 0.50 D (P = 0.016), ± 0.75 D (P < 0.001), and ± 1.00 D (P < 0.001) of target refraction. Increasing LT correlated with a hyperopic shift for all formulas; however, BUII demonstrated relatively stable MAE across LT quartiles.

Conclusions: Implantation of a CTR was associated with significantly improved predictive accuracy for several modern IOL formulas in patients with RP. The BUII formula showed the highest overall predictive accuracy.

Introduction: A retrospective analysis was performed to determine if a glueless, sutureless surgical technique utilizing a triple-layer dehydrated, decellularized amniotic basement membrane tissue, combined with short exposure to mitomycin‑C (MMC), can reduce recurrence and complications after pterygium surgery. Surgical excision remains the mainstay of treatment when symptoms such as vision impairment, foreign body sensation, or cosmetic concerns arise. Wide variation in recurrence rates reflects differences in patient populations, follow-up duration, surgical technique nuances, and definition of recurrence. A dehydrated triple-layer decellularized amniotic basement membrane tissue has unique attributes compared to other amniotic membrane tissue (AMT). Decellularization removes the pro-inflammatory chorion and residual donor cellular debris, thereby reducing immunogenicity while preserving extracellular matrix proteins such as collagen, fibronectin, and laminin, which produce anti-inflammatory cytokines and growth factors, promoting epithelial adhesion and migration. In pterygium excision, decellularized basement membrane may contribute to faster, more comfortable recovery, improved cosmesis, and a reduced risk of recurrence.

Methods: A total of 34 eyes from 33 patients underwent pterygium excision using dehydrated, three-layer decellularized basement membrane.

Results: All patients reported minimal postoperative discomfort, and the operative eyes were relatively quiet with minimal subconjunctival injection. Recurrence was 0% (0/34 eyes) at a mean follow-up of 394 days (range, 174-668). In addition, no pyogenic granuloma, infections, dellen, or melts occurred.

Conclusions: Compared with traditional AMT and conjunctival autograft (CAG) methods using glue or sutures, this approach not only reduces operative time, postoperative discomfort, postoperative visits, and topical steroids but also saves costs without compromising outcomes.

Introduction: This study aimed to establish an in vivo neurovascular staging framework for non-arteritic anterior ischemic optic neuropathy (NAION) by integrating wide-field swept-source optical coherence tomography angiography (SS-OCTA) and adaptive optics scanning laser ophthalmoscopy (AOSLO), enabling precise mapping of visual field (VF) defects.

Methods: This prospective study enrolled 22 acute NAION eyes (≤ 3 weeks), 27 chronic NAION eyes (≥ 3 months), and 20 age-/sex-matched healthy controls. SS-OCTA (12 × 12 mm) quantified peripapillary and pan-retinal nerve fiber layer (RNFL) thickness and vessel density (VD) corresponding to VF defect location. AOSLO assessed axonal grading and photoreceptor integrity. Multivariable linear regression was performed to identify independent predictors of visual function.

Results: Within VF defect regions, acute cases showing widespread RNFL swelling, vascular dilation, and VD increase in the temporal sector and intermediate capillary plexus (ICP), chronic cases exhibiting axonal thinning and a nasal-to-temporal capillary attenuation (adj-P < 0.05). Deep capillary plexus (DCP) VD was an independent predictor of acute visual function, whereas chronic visual function was primarily determined by macular ganglion cell thickness and optic disc perfusion. AOSLO confirmed acute axonal edema with hyperreflective dot-like foci (HDF) and chronic atrophy with vessel narrowing (adj-P < 0.05), while photoreceptors remained preserved (P > 0.05).

Conclusions: Wide-field SS-OCTA and AOSLO delineate the stage-specific neurovascular cascade of NAION. Acute NAION is characterized by DCP VD serving as an independent biomarker of visual functional impairment, alongside axonal swelling and early imaging features (e.g., HDF). In the chronic stage, visual outcome is primarily determined by macular neuro-axonal loss and progressive capillary attenuation.

Dry eye disease (DED) is a multifactorial and prevalent condition of the ocular surface that is associated with a wide range of risk factors. In the modern world, environmental conditions and pollution have become increasingly relevant contributors. Recent findings from the Tear Film & Ocular Surface Society Dry Eye Workshop III (TFOS DEWS III) highlight the contribution of oxidative stress, inflammatory cytokines, and neurosensory alterations to environmentally associated DED. This narrative, non-systematic review aims to synthesize current evidence on the impact of climate change and exposure to pollutants on the epidemiology, pathophysiology, and management of DED, with a particular emphasis on clinical practice. A targeted search of peer-reviewed literature was conducted in PubMed and Scopus, focusing on previous reviews and original human studies evaluating environmental exposures and DED, and findings were synthesized qualitatively due to heterogeneity in study design and diagnostic criteria. Environmental influences on the ocular surface encompass a wide range of factors, including climate conditions such as temperature, humidity, wind speed, altitude, dew point, ultraviolet radiation, and allergens, as well as exposure to air pollution from gases, particulate matter, volatile organic compounds, and other airborne contaminants. Individuals living in densely populated cities, industrial zones, and dry climates are at increased risk, and emerging challenges such as wildfires and desertification warrant increasing attention due to their rising global impact. Exposure to these agents may induce or exacerbate tear film instability, epithelial damage, immune dysregulation, and ocular surface inflammation. Although most available studies are cross-sectional or observational, and therefore limited in establishing causality, environmental exposures remain a key contributor to DED and can impair occupational performance, exacerbate pre-existing health conditions, and diminish overall quality of life. Comprehensive screening, environmental risk assessment, patient counseling, and personalized management strategies are essential to the prevention and management of DED in the face of accelerating environmental change.

Introduction: To evaluate the early outcomes of aflibercept 8 mg (afl8) treatment in patients with neovascular age-related macular degeneration (nAMD) previously treated with aflibercept 2 mg (afl2).

Methods: A retrospective, observational, monocentric Swiss study. Patients with nAMD who had received ≥ 3 consecutive afl2 injections and switched to afl8 because of persistent or recurrent fluids, or to extend treatment intervals, were included in the study. All patients started a loading phase of 3-monthly afl8 injections, followed by a treat-and-extend regimen. Outcome measures included changes in best-corrected visual acuity (BCVA), maximal pigment epithelial detachment (PED) height, central subfield thickness (CST), optical coherence tomography (OCT) biomarkers quantified using artificial intelligence, and treatment intervals until month 6.

Results: Fifty-two eyes of 44 patients who concluded the loading phase were included in this analysis. Mean age was 80.2 ± 8.5 years; 73% of patients were females. At month 6, BCVA was unchanged, PED and CST height experienced a significant decrease by - 18.5 ± 12.9 μm (p = 0.0005) and - 14.0 ± 3.5 μm (p = 0.0042), respectively. Volumes of intraretinal fluid (IRF), subretinal fluid (SRF), and PED decreased (IRF: 4.4 ± 15.6-3.8 nl; SRF: 15.7 ± 35.7-10.3 ± 34.0 nl; PED: 268.2 ± 423.2-252.2 ± 484.1 nl). Mean treatment intervals increased by 1.7 ± 0.5 weeks from the last assigned interval and by 0.6 ± 0.2 weeks from previous maximal fluid-free intervals after switching (p = 0.0005 and p = 0.18, respectively). One mild vitritis was observed and resolved with vitrectomy and topical drops without decreased visual acuity.

Conclusion: Our real-world study supports the potential short-term benefits of afl8 in improving anatomical and durability outcomes in patients with recurrent nAMD. These findings also highlight the added value of data-driven evaluations. Long-term studies are needed to confirm the effectiveness and durability of afl8 in this population.

Introduction: Dry eye disease (DED) is a common comorbidity in patients undergoing cataract surgery. Perfluorohexyloctane ophthalmic solution (PFHO) forms a protective layer on the tear film surface to reduce evaporation and is approved for treatment of signs and symptoms of DED. Because PFHO has a long ocular surface residence time, it was of interest to assess whether PFHO interfered with preoperative biometry and keratometry measurements to affect postoperative refractive accuracy in patients undergoing cataract surgery. This study evaluated the perioperative use of PFHO in patients undergoing cataract surgery.

Methods: This phase 4, multicenter, open-label, single-arm study enrolled patients with DED who were candidates for phacoemulsification with posterior chamber intraocular lens (IOL) implantation. Patients instilled PFHO bilaterally four times daily for 30 days preoperatively and received a second 30-day PFHO treatment approximately 1 month after surgery. The primary endpoint was the mean difference in absolute deviations between the manifest refraction spherical equivalent and predicted refractive error.

Results: Ninety-seven patients were enrolled (mean age: 68.6 years; female: 75.3%). The mean difference in absolute deviations between manifest refraction and predicted refractive error was -0.027 ± 0.167 D (p = 0.1385). The difference in predicted refractive error at baseline versus post-PFHO treatment was within ± 0.3 D for 94.2% of study eyes. More patients had a calculated IOL power within ± 0.50 D of the correct IOL power post-PFHO treatment than pre-PFHO (83.7% vs. 72.1%). Treatment with PFHO significantly improved DED signs and symptoms, including total and central corneal fluorescein staining, eye dryness, and Ocular Surface Disease Index scores, before and after cataract surgery (p < 0.0001 for all). The percentage of patients with best-corrected visual acuity of 20/20 or better was 86.0% at first postsurgical assessment and 91.8% after 30 days of subsequent PFHO treatment. Two adverse events were considered related to treatment (mild eye pruritus and mild noninfectious conjunctivitis).

Conclusions: In patients with DED undergoing cataract surgery, PFHO did not affect the accuracy of preoperative biometry and keratometry measurements or the predicted refractive error. Patients experienced significant reductions in signs and symptoms of DED.

Trial registration: ClinicalTrials.gov identifier, NCT06346340.