Aflibercept Treatment for Neovascular Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy Refractory to Anti-vascular Endothelial Growth Factor

PURPOSE: To report the results of switching treatment to vascular endothelial growth factor (VEGF) Trap-Eye (aflibercept) in neovascular age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) refractory to anti-VEGF (ranibizumab and bevacizumab). METHODS: This is a retrospective study involving 32 eyes from 29 patients; 18 were cases of neovascular AMD and 14 were cases of PCV. The best-corrected visual acuity (BCVA) and central macular thickness (CMT) of spectral-domain optical coherence tomography were evaluated. RESULTS: BCVA and CMT improved from 0.58 to 0.55 (p = 0.005) and from 404 to 321 microm (p < 0.001), respectively, after switching to aflibercept. The 14 eyes that received 6 or more aflibercept injections remained stable at 0.81 to 0.81 and 321 to 327 microm (p = 1.0, 0.29), respectively, after 3 aflibercept injections. The 10 eyes that received 3 or more bevacizumab injections after 3 or more aflibercept injections worsened, from 0.44 to 0.47 and from 332 to 346 microm (p = 0.06, 0.05), respectively. The results showed similar improvement of BCVA and CMT in neovascular AMD and PCV. CONCLUSIONS: Aflibercept seems to be effective for improvement and maintenance of BCVA and CMT for neovascular AMD and PCV refractory to anti-VEGF. Switching from aflibercept back to bevacizumab treatment may not be a proper strategy.

Analysis of Clinical Effectiveness of Tafluprost by Ocular Pulse Amplitude

PURPOSE: To analyze the clinical effectiveness of tafluprost used in the treatment of glaucoma, using ocular pulse amplitude (OPA) measurements with dynamic contour tonometry (DCT). METHODS: Sixty patients (119 eyes) with normal tension glaucoma (NTG) or primary open angle glaucoma (POAG) treated with tafluprost or other eyedrops were investigated in the present study. Intraocular pressure (IOP) was measured with Goldmann applanation tonometry (GAT), and OPA was measured with DCT, before and after treatment, retrospectively. RESULTS: In 20 patients treated with tafluprost, IOP decreased from 17.1 mm Hg before treatment to 13.0 mm Hg 3 months after treatment (24.0% descent rate), and OPA decreased from 2.35 to 1.57 (33.2% descent rate). For 20 patients who switched from another monotherapy to tafluprost, IOP decreased from 15.7 mm Hg to 13.2 mm Hg from 15.7 mm Hg (15.3%) and OPA from 2.38 to 1.69 (27.7%). CONCLUSIONS: Tafluprost used to treat glaucoma has a large OPA and IOP lowering effect and, therefore can be applied to patients who have a large OPA with glaucoma progression in spite of well controlled IOP.

Vitrectomy and Ahmed Valve Implantation in Neovascular Glaucoma Patients with Vitreous Hemorrhage

PURPOSE: To compare the surgical outcomes between sequential -and simultaneous combined vitrectomy and Ahmed valve implantation (AVI) in neovascular glaucoma (NVG) patients with vitreous hemorrhage. METHODS: The medical records of 22 eyes of 22 patients, who had NVG with vitreous hemorrhage treated with vitrectomy and AVI, were retrospectively reviewed. Surgical success was defined as 6 mm Hg < or = IOP < or = 21 mm Hg, with or without the use of antiglaucoma medications and failure was defined as cases that had no light perception during the study period and which required additional surgery. The authors of the present study evaluated the surgical success rates and factors affecting surgical success between sequential and simultaneous combined vitrectomy and AVI. RESULTS: The cumulative surgical success rate by the Kaplan-Meier survival analysis was 45% in sequential combined vitrectomy and AVI (group1), and 18% in combined vitrectomy and AVI (group 2), at 1 year, a significant difference. Preoperative panretinal photocoagulation was related to surgical success rate by Cox's regression model analysis. CONCLUSIONS: Simultaneous combined vitrectomy and AVI is considered as a primary procedure in a patient who has NVG with vitreous hemorrhage. Panretinal photocoagulation in the preoperative periods, is thought to increase the surgical success rate.