Long-Term Outcomes of Intravitreal Injections for AMD
In the largest patient series to date, Gillies et al. analyzed the long-term outcomes of patients with neovascular age-related macular degeneration (AMD) who had received intravitreal injections of anti-VEGF agents. They found good long-term outcomes from baseline up to 6 years, with a drop in visual acuity (VA) after that point in eyes that were still being treated.
For this observational study, the researchers analyzed data on 1,212 eyes. Patients’ initial visits took place between 2007 and 2010 in Australia, New Zealand, and Switzerland. Mean follow-up time was 53.5 months, with 549 patients (45%) continuing to be treated after 60 months.
Mean VA improved from 55.1 letters to 61.4 letters after 6 months and remained above mean presenting VA for 6 years. However, after 7 years, mean VA had dropped 2.6 letters below baseline for the 131 eyes that were still being followed. The researchers noted that patients tended to discontinue treatment once they had lost the initial gain in VA.
The patients in this study received a slightly higher number of injections compared with those in other studies, the researchers noted. A median of 6 injections and 9 visits was recorded during the first year; this dropped to 5 treatments and 7 to 9 visits per year thereafter. The rate of serious adverse events was low.
Prompt Intervention Improves Outcomes of Repeat DMEK
Price et al. evaluated the outcomes of secondary Descemet membrane endothelial keratoplasty (DMEK) after failed primary DMEK procedures. They found that early regrafting produced outcomes comparable to those of successful primary DMEK.
For this retrospective case series, the researchers assessed 55 DMEK recipients. Most had Fuchs endothelial dystrophy, and their median age was 69 years (range, 42-89 years). Secondary DMEK was performed in all 55 eyes; reasons for the 55 regrafts included unsuitable donor tissue, surgical complications, early failure to clear for no identifiable reason, late endothelial failure, and refractive failure. Median follow-up was 18 months (range, 3-61 months). All 55 regrafts cleared successfully, and none experienced immunologic rejection.
A paired analysis was performed in a subset of 29 patients who underwent secondary DMEK in 1 eye and successful primary DMEK in the other. In this group, the median duration of endothelial decompensation before the regraft was 21 days (range, 2-133 days). At 1, 3, 6, and 12 months following surgery, corrected distance visual acuity did not differ between the primary and secondary grafts.
The results of this study suggest that prompt intervention after graft failure can minimize the duration of central corneal decompensation and associated stromal changes, the researchers said. For optimal visual results, the authors recommend regrafting as soon as possible if bullae or microcystic edema is present over the pupil area.
Utility of Cap Color and Bottle Characteristics for Glaucoma Eyedrops
How do glaucoma patients identify their medications and distinguish between different bottles? Bottle cap color remains the method of choice, Marando et al. found.
For this study, the researchers evaluated 126 patients with glaucoma seen at a single university eye center. Patients ranged in age from 35 to 92 years. Most (90%) had been on glaucoma therapy for more than 1 year, and 50.7% were on monotherapy.
When queried about medication recall, 64.8% of patients referred to bottle cap color, and 48% cited bottle size and shape. Other recall methods mentioned by patients included storage site and bottle color. However, despite its popularity as a recall method, cap color was not a foolproof strategy. Among those who said that they relied on cap color for identifying their drops, 20% did not correctly identify all of the cap colors associated with their prescribed drops.
When asked about potential improvements to glaucoma eyedrop bottles, patients requested that bottles be redesigned to come in larger sizes, be less rigid and easier to manipulate, and be more consistent in dispensing 1 drop at a time.
Photodynamic Therapy for Retinal Tumors
Hussain et al. investigated photodynamic therapy (PDT) with verteporfin in treating retinal vasoproliferative tumors. In the largest series to date with long-term follow-up, they reported that PDT successfully treated a majority of tumors with minimal side effects.
For this prospective study, 24 patients (25 eyes) were treated with PDT between 2006 and 2014. Patients received a second treatment 1 to 3 months after the initial dose, if deemed necessary by the investigator. All told, 18 patients needed only 1 session of PDT, 5 needed 2 sessions, and 1 patient needed 3 sessions.
Mean follow-up was 26 months (range, 12-70 months). During this time, 17 eyes (68%) achieved complete tumor regression. In contrast, 4 (16%) experienced no response or progression of their tumors; these lesions all had extensive subretinal fluid.
Visual gain or stabilization occurred in 23 of the 25 eyes (92%), with 15 of the 24 patients improving by 1 to 2 lines. No adverse reactions or complications related to PDT occurred during the follow-up period.
Ophthalmology summaries are written by Jean Shaw and edited by Susan M. MacDonald, MD.
More from this month’s Journal Highlights
American Journal of Ophthalmology
Roundup of Other Journals