Clinical and Experimental Ophthalmology最新文献

Background: We analysed 12-month real-world outcomes of treatment of eyes with neovascular age-related macular degeneration switched to brolucizumab from a first-generation VEGF inhibitor to determine whether switching chronically active eyes that required frequent treatment improved control of the disease safely with fewer injections.

Methods: Retrospective analysis of Australian and Italian data from the prospectively designed observational Fight Retinal Blindness! registry. We studied eyes that switched to brolucizumab and received at least two injections with 12 months of follow-up.

Results: Of the 81 eligible eyes, the proportion of inactive lesions increased from 5% at baseline to 37% 12 months after switching to brolucizumab (p < 0.001). Mean (95% CI) visual acuity (VA) was stable (0.6 [-1.5, 2.8] letters, p = 0.55), while median treatment intervals increased from 44 to 63 days (p < 0.001). Nearly a third (30%) of eyes switched back to another VEGF inhibitor within 12 months. Eyes that stayed on brolucizumab had a significantly longer mean treatment interval at 12 months than eyes that switched off it (66.1 [Q1, Q3: 56, 91] vs. 49 [28, 63.2] days, p ≤ 0.001) while VA change and inactivation rates were similar. Intraocular inflammation (IOI) was recorded in 7 (9%) eyes receiving at least one injection of brolucizumab.

Conclusions: Eyes that switched from a first generation VEGF inhibitor to brolucizumab in routine clinical practice achieved a clinically significant extension of their treatment interval, with more than a third becoming inactive but with a relatively high rate of IOI.

Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy has revolutionised the treatment of neovascular age-related macular degeneration (nAMD), significantly improving visual outcomes and enhancing the quality of life for affected patients. However, the decision to discontinue anti-VEGF therapy in nAMD management remains complex and lacks consensus, with various criteria being applied. This narrative review examines the available evidence on the cessation of anti-VEGF treatment in nAMD in detail.

Background: While the association between obstructive sleep apnoea (OSA) and glaucoma has been well studied, the long-term effects of continuous positive airway pressure (CPAP) therapy on intraocular pressure (IOP) and glaucoma progression are less known. This study aims to systematically synthesise evidence to clarify the association between CPAP therapy and IOP.

Methods: PubMed, Embase, The Cochrane Library, CINAHL, Scopus and Web of Science were searched through 26 March 2025 for interventional studies evaluating the effect of CPAP therapy on IOP among OSA adult patients. Two independent authors selected relevant articles, extracted data and evaluated the quality of evidence using the Newcastle-Ottawa scale (NOS), Cochrane Risk-of-Bias Tool for Randomised Trials (RoB 2) and Grading of Recommendations Assessment, Development and Evaluation (GRADE). Inverse variance meta-analyses were conducted using random effects. I² values were used to evaluate heterogeneity.

Results: This study included 16 studies, pooling a cohort of 602 patients. The risk of bias of studies ranged from low to moderate, and the quality of evidence was moderate on GRADE. CPAP therapy significantly increased IOP levels overnight (MD: -4.14; 95% CI: -7.76, -0.52; I² = 76%; p = 0.04), and within 1 month (MD: -0.78; 95% CI: -1.21, -0.35; I² = 0%; p = 0.60). IOP levels remained unchanged with CPAP therapy of more than 1 month from baseline.

Conclusions: While short-term CPAP therapy of 1 month or less in OSA patients was associated with elevated IOP, minimal long-term effects were observed. Nonetheless, these findings underscore the importance of exercising caution when administering CPAP therapy on IOP especially in glaucomatous patients.

RANZCO Fellows can claim CPD points by reading the following two articles which appear in this issue, and answering the five questions. Half an hour is awarded for each set of five questions answered. Please remember to claim your points.

Answers to questions published in previous issue.

A: c. No increased incidence was identified. Despite long-term intravitreal injections, no significant rise in serious ocular adverse events (e.g., endophthalmitis, retinal detachment) was noted. However, the potential link between anti-VEGF therapy and geographic atrophy remains unresolved and warrants further investigation.

Artificial intelligence (AI) has comparable accuracy to ophthalmologists for diabetic retinopathy (DR) screening, yet its cost-effectiveness is crucial for implementation. Our review of 18 health economic analyses of AI versus manual grading for DR found significant methodological variation, with cost-utility analysis and Markov modelling being the commonest evaluation and modelling approaches, respectively. We identified three key considerations when appraising health economic analyses of AI-enabled DR screening: the importance of contextualised parameters including subgroup analysis, real-world data on adherence to ophthalmology follow-up, and the trade-off between diagnostic accuracy and cost-effectiveness. 39% of studies followed standardised reporting guidelines, and most did not consider improved follow-up after AI screening, potentially underestimating its economic value. Future evaluations should incorporate contextualised parameters, including adherence and regional data, and recognise that the most accurate diagnostic screening may not reflect the most cost-effective. Studies should follow updated reporting guidelines such as CHEERS-AI or PICOTS-ComTeC to improve methodological transparency.

Background: The PAUL glaucoma implant (PGI) is a novel valveless glaucoma drainage device featuring a large endplate surface area to enhance aqueous absorption, as well as a smaller internal and external tube diameter to minimise postoperative hypotony and corneal endothelial damage, particularly in eyes with refractory glaucoma. This is the first meta-analysis on the clinical efficacy and safety of the PGI.

Methods: Medline, Embase and CENTRAL databases were searched for articles on the use of the PGI. A meta-analysis of single means and binary outcomes was conducted to assess clinical endpoints.

Results: A total of 15 studies with 640 eyes were analysed. At the 12 months postoperatively, the mean reduction in IOP and IOP-lowering medications from baseline were 16.11 mmHg (k = 13, n = 550, 95% CI: 12.91-19.31 mmHg, I² = 96.10%, p < 0.001) and 2.34 (k = 12, n = 482, 95% CI: 1.99-2.69, I² = 91.90%, p < 0.001), respectively. The mean complete and qualified success rates at 12 months postoperatively were 50.22% (k = 8, n = 209, 95% CI: 38.73%-61.70%, I² = 80.30%) and 92.40% (k = 11, n = 490, 95% CI: 88.83%-95.40%, I² = 41.40%), respectively. Postoperative complications such as hypotony (k = 13, n = 39, 6.05%, 95% CI: 2.81%-10.16%, I² = 57.70%) and hyphema (k = 13, n = 33, 5.63%, 95% CI: 2.52%-9.61%, I² = 56.60%) were uncommon, and sight-threatening complications such as corneal decompensation and endophthalmitis were rare. There was no statistically significant difference in mean visual acuity compared to baseline (k = 7, n = 312, MD: -0.03 logMAR, 95% CI: -0.09-0.04 logMAR, I² = 0.00%, p = 0.43).

Conclusions: This meta-analysis provides quantitative evidence supporting the clinical efficacy and safety of the PGI in patients with refractory glaucoma.