Clinical experience of switching anti-VEGF therapy from ranibizumab to aflibercept in age-related choroidal neovascularization.

PURPOSE: To report the response of participants switching from ranibizumab to aflibercept treatment for neovascular age-related macular degeneration (nAMD) requiring further anti-vascular endothelial growth factor treatment. METHODS: In this retrospective case review of 68 participants treated in a single hospital, all participants, prior to switching, received ranibizumab injections only. Best-corrected visual acuity (BCVA), clinical examination, and optical coherence tomography (OCT) were performed at each visit. Active nAMD was defined as persistent intraretinal or subretinal fluid on OCT. Participants had their first aflibercept injection at baseline and 2 more injections at 2 monthly intervals. Afterwards, they were followed up every 6-8 weeks and given injections as needed. The main outcome measures were visual acuity and the OCT central retinal thickness (CRT), average thickness (AT), and total macular volume (TMV). RESULTS: The BCVA at baseline visit was 0.57 ± 0.33 log MAR and the final BCVA was 0.54 ± 0.37 log MAR (p = 0.215). The CRT mean change was -75.6 ± 85.6 (p = 0.001), the AT mean change was -24.2 ± 27.2 (p = 0.001), and TMV mean change was -0.69 ± 0.78 (p = 0.001). There were no significant ophthalmic complications related to treatments. CONCLUSIONS: Intravitreal aflibercept improved anatomic outcomes (as measured by OCT) in eyes with nAMD that were previously treated with intravitreal ranibizumab and were still active. There was no statistically significant difference in logMAR visual acuity in participants who switched to aflibercept with a follow-up of at least 6 months.

Peripapillary retinal nerve fibre layer thickness measurement with SD-OCT in normal and glaucomatous eyes: distribution and correlation with age.

AIM: To determine peripapillary retinal fiber layer thickness (RNFL) measured with spectral domain optical coherence tomography (SD-OCT) in normal and glaucomatous eyes in a large sample of exclusively white population and compare results with other similarly constructed studies. METHODS: Average, maximum, minimum and per quadrant RNFL thickness were measured in normal and glaucomatous Greek patients with a scanning laser ophthalmoscope (SLO)/SD-OCT device. The effect of age in normal RNFL thickness was also determined. RESULTS: A total of 278 normal (278 patients) and 67 glaucomatous (67 patients) eyes were included in the study. Average RNFL thickness was 114.8±13.3µm in normal and 92.1±18.5µm in glaucomatous eyes (P<0.001). In normal discs, superior quadrant was the thickest, followed by the inferior, nasal and temporal. Decline of normal RNFL thickness with age was statistically significant for average RNFL thickness (1.92µm per decade of life) and for the superior and inferior quadrants of the disc. CONCLUSION: SD-OCT peripapillary RNFL measurements can be used to distinguish between normal and glaucomatous eyes and establish normative databases, since normal disc measurements differ between different ethnic groups and between different SD-OCT devices.

Combining phacoemulsification with endoscopic cyclophotocoagulation to manage cataract and glaucoma.

BACKGROUND: To examine the outcome and complications of combined phacoemulsification and endoscopic cyclophotocoagulation as surgical management of cataract and glaucoma. DESIGN: Retrospective uncontrolled case series from the glaucoma unit, Western Eye Hospital, London, UK. PARTICIPANTS: Sixty-three eyes from 59 patients with coexisting cataract and glaucoma. METHODS: Patients underwent routine phacoemulsification followed by 270-360 degree endoscopic cyclophotocoagulation as a single procedure. MAIN OUTCOME MEASURES: Intraocular pressure, number of intraocular pressure-lowering medications, logMAR visual acuity, recorded complications. RESULTS: Baseline characteristics included mean age (77.3 ± 11.1 years), mean logMAR visual acuity (1.01 ± 0.98), mean intraocular pressure (21.13 ± 6.21 mmHg) and mean number of intraocular pressure-lowering medications, (2.71 ± 1.06). Twelve months after phacoemulsification and endoscopic cyclophotocoagulation, mean intraocular pressure had reduced to 16.09 ± 5.27 mmHg (P < 0.01), number of intraocular pressure-lowering medications reduced to 1.47 ± 1.30 (P < 0.01) and mean logMAR acuity improved to 0.33 ± 0.22 (P < 0.01). Success, defined as an intraocular pressure reduction > 20% with intraocular pressure 6-21 mmHg, was achieved in 55.5% of eyes at 12 months. Complications included fibrinous uveitis, elevated intraocular pressure, posterior vitreous detachment and induced astigmatism. CONCLUSION: Phacoemulsification and endoscopic cyclophotocoagulation is both safe and effective as surgical management for cataract and glaucoma. Larger intraocular pressure reductions can be achieved in older patients and those with higher baseline intraocular pressure.

Intraocular Pressure rise after Anti-VEGF Treatment: Prevalence, Possible Mechanisms and Correlations.

Intraocular pressure (IOP) rise after anti-vascular endothelial growth factor (VEGF) treatment for neovascular age-related macular degeneration (AMD) can be either short-term or long-term and may require medical intervention. Short-term IOP spikes are a fairly common and well recognized complication of anti-VEGF injections. Long-term IOP rise is less well-understood and disputed as a complication by some authors. We try to review current literature on the subject and especially studies focused on the prevalence of this complication, speculate on possible mechanisms of IOP rise and discuss correlations of long-term IOP rise with the nature of the injected agent, average number of injections, previous glaucoma history and other factors. How to cite this article: Kampougeris G, Spyropoulos D, Mitropoulou A. Intraocular Pressure rise after Anti-VEGF Treatment: Prevalence, Possible Mechanisms and Correlations. J Current Glau Prac 2013;7(1):19-24.