Clinical and Experimental Ophthalmology最新文献

Background: To provide insights into the effectiveness and safety of faricimab for treatment-naïve eyes with neovascular age-related macular degeneration (nAMD).

Methods: A retrospective cohort study using a prospectively-designed registry. Treatment-naïve eyes with nAMD in Australia starting treatment with faricimab between Jan 2023-Sep 2024 were included. Controls were treatment-naïve eyes starting with aflibercept 2 mg before 2022. Visual acuity (VA), macular neovascularisation activity, time to first inactivity, number of injections, injection intervals and number of visits at 12 months were investigated. Eyes treated with faricimab versus aflibercept 2 mg were compared using overlap weighting. The main outcome measure was the 12-month VA change.

Results: Twenty-three practitioners treated 160 eyes with a 4-letter gain in VA (mean, 61.5-65.5 letters) and 48% attaining a dosing interval of ≥ 12 weeks, although 22% were still treated at < 8 weekly intervals. The small proportion (6.9%) of eyes switching to another agent had improved vision but were mostly active when switching off faricimab. Eyes received 7.2 injections (mean) at 7.4 visits (mean), receiving treatment at 98% of visits indicating a strongly proactive treatment regimen. Most (71%) lesions became inactive by 12 months with a mean time to inactivation of 10.3 weeks. Eyes starting faricimab had a significantly higher inactivation rate with more eyes reaching the last injection interval of ≥ 12 weeks than those starting aflibercept 2 mg.

Conclusions: These findings indicate that faricimab is safe and effective for treatment-naive eyes with nAMD. Faricimab had a stronger effect on nAMD lesion activity than aflibercept 2 mg.

Uveal melanoma is a rare malignancy arising from uveal tract melanocytes. Definitive treatment options for primary disease include plaque brachytherapy, proton beam radiotherapy and enucleation, which provide high rates of local control, but are associated with vision impairment, reduced quality of life and unsatisfactorily high rates of metastatic relapse. In the metastatic setting, average life expectancy remains less than 2 years, despite the availability of immune checkpoint inhibitors and the more recent arrival of the T cell-engaging agent, tebentafusp. Here, we provide an update regarding the current treatment of uveal melanoma, and discuss the potential roles of novel targeted therapies, immunotherapy and neoadjuvant therapy in shaping future management.

This review provides an updated overview of the contemporary management of malignant eyelid tumours, focusing on evidence-based advances in both surgical and immunotherapeutic approaches. Eyelid malignancies represent a significant health burden, particularly in Australia and New Zealand where skin cancer rates are the highest globally. The article details the epidemiology, clinical presentation, diagnosis, and risk stratification for the five most common eyelid cancers: basal cell carcinoma, squamous cell carcinoma, sebaceous gland carcinoma, melanoma, and Merkel cell carcinoma. Current best practises emphasise microscopically controlled surgical excision as the mainstay of curative therapy, with excision margins tailored according to tumour and histology type. Mohs micrographic surgery and peripheral and deep margin assessment techniques are highlighted for improved local control and eyelid preservation. The review discusses the expanding role of immuno- and targeted therapies such as checkpoint inhibitors including program cell death (PD-1) and programmed cell death ligand (PD-L1) inhibitors, as well as targeted hedgehog inhibitors for unresectable and metastatic disease in melanoma, Merkel cell carcinoma, and advanced squamous cell carcinoma, demonstrating enhanced progression-free survival and durable responses. Management algorithms are increasingly multidisciplinary, integrating ophthalmology, dermatology, oncology, pathology, and reconstructive surgery. Ongoing challenges include timely detection, management of adverse effects, and the risk of recurrence and metastasis, necessitating long-term surveillance and individualised care.

Systemic anti-cancer treatment has evolved rapidly with the introduction of immunotherapy and targeted therapies, substantially improving survival across a broad spectrum of malignancies. However, as their use expands, ophthalmic toxicities are increasingly recognised as clinically significant adverse effects. This review outlines the pathophysiology, clinical spectrum and management strategies for ophthalmic adverse events linked to immune checkpoint inhibitors, MEK, BRAF, FGFR, ERK, EGFR, HER2, BTK, FLT-3, Bcr-Abl, ALK inhibitors and antibody-drug conjugates.