Real-World Weekly Efficacy Analysis of Faricimab in Patients with Age-Related Macular Degeneration.

Objectives: This study entailed a weekly analysis of real-world data (RWD) on the safety and efficacy of intravitreal (IVT) faricimab in neovascular age-related macular degeneration (nAMD). Methods: A retrospective, single-centre clinical trial was conducted at the Department of Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland, approved by the Cantonal Ethics Committee of Zurich, Switzerland. Patients with nAMD were included. Data from patient charts and imaging were analysed. The safety and efficacy of the first faricimab injection were evaluated weekly until 4 weeks after injection. Results: Sixty-three eyes with a complete 4-week follow-up were enrolled. Six eyes were treatment-naïve; fifty-seven eyes were switched to faricimab from another treatment. Neither group showed signs of retinal vasculitis during the 4 weeks after injection. Central subfield thickness (CST) and volume (CSV) showed a statistically significant decrease compared to the baseline in the switched group (CST: p = 0.00383; CSV: p = 0.00702) after 4 weeks. The corrected visual acuity returned to the baseline level in both groups. The macular neovascularization area decreased in both groups, but this was not statistically significant. A complete resolution of sub- and intraretinal fluid after 4 weeks was found in 40% (switched) and 75% (naïve) of the treated patients. Conclusions: The weekly follow-ups reflect the structure-function relationship beginning with a fast functional improvement within two weeks after injection followed by a return to near-baseline levels after week 3. The first faricimab injection in our cohort showed a high safety profile and a statistically significant reduction in macular oedema in switched nAMD patients.

Vitamin A deficiency retinopathy related to medical interventions in a Swiss cohort: a case series.

AIMS OF THE STUDY: Vitamin A deficiency retinopathy is a potentially blinding disease. In developed countries, vitamin A deficiency due to malnutrition is rare. However, vitamin A deficiency can be caused by malabsorption resulting from bowel resection or medication. In this retrospective study, we present five cases of vitamin A deficiency retinopathy related to malabsorption secondary to medical interventions. METHODS: Electronic charts over a ten-year period (2012-2022) were screened for vitamin A deficiency retinopathy. Only patients with vitamin A deficiency confirmed by laboratory tests were included. Symptoms, medical history, visual acuity, optical coherence tomography, fundus autofluorescence, electrophysiological examination, and vitamin A levels were reviewed. RESULTS: Five eligible cases were identified. Median age was 44.7 years (range 22.2-88.9), median duration of ocular symptoms prior to diagnosis was 14 months, and median visual acuity was 1.0 (range 0.5-1.0, Snellen, decimal). Three patients had a history of bariatric surgery, one patient had a small bowel resection and was on octreotide treatment, and one patient suffered from cystic fibrosis and had a history of small bowel resection and severe hepatopathy. Optical coherence tomography showed various abnormalities, including a reduced interdigitation zone, subretinal drusenoid deposits, and a thinned outer nuclear layer. Electroretinogram findings ranged from abnormal oscillatory potentials to non-recordable rod responses. CONCLUSIONS: Vitamin A deficiency retinopathy can occur following medical interventions associated with malabsorption. In cases of night blindness, vitamin A levels should be measured.

Age-dependent retinal neuroaxonal degeneration in children and adolescents with Leber hereditary optic neuropathy under idebenone therapy.

BACKGROUND: The aim of this study was to investigate the neuroretinal structure of young patients with Leber hereditary optic neuropathy (LHON). METHODS: For this retrospective cross-sectional analysis, the peripapillary retinal nerve fiber layer (pRNFL) thickness and the macular retinal layer volumes were measured by optical coherence tomography. Patients aged 12 years or younger at disease onset were assigned to the childhood-onset (ChO) group and those aged 13-16 years to the early teenage-onset (eTO) group. All patients received treatment with idebenone. The same measurements were repeated in age-matched control groups with healthy subjects. RESULTS: The ChO group included 11 patients (21 eyes) and the eTO group 14 patients (27 eyes). Mean age at onset was 8.6 ± 2.7 years in the ChO group and 14.8 ± 1.0 years in the eTO group. Mean best-corrected visual acuity was 0.65 ± 0.52 logMAR in the ChO group and 1.60 ± 0. 51 logMAR in the eTO group (p < 0.001). Reduced pRNFL was evident in the eTO group compared to the ChO group (46.0 ± 12.7 µm vs. 56.0 ± 14.5 µm, p = 0.015). Additionally, a significantly lower combined ganglion cell and inner plexiform layer volume was found in the eTO compared to the ChO group (0.266 ± 0.0027 mm3 vs. 0.294 ± 0.033 mm3 , p = 0.003). No difference in these parameters was evident between the age-matched control groups. CONCLUSION: Less neuroaxonal tissue degeneration was observed in ChO LHON than in eTO LHON, a finding that may explain the better functional outcome of ChO LHON.

A prospective randomized pilot study evaluating the scar outcome after gluteal dermis fat graft with and without kinesiotaping.

PURPOSE: To compare gluteal wound healing after dermis fat graft (DFG) implantation in patients with and without local application of kinesiotapes. METHODS: In this prospective, single-center analysis, 16 patients who underwent DFG implantation were randomized in two groups. Wound healing was compared 4-6 weeks after therapy and 3 months later (after application of 2 cycles of kinesiotaping for 2-3 weeks in the case and no specific therapy in the control group). Demographic data, patient content and wound healing were assessed. Scarring was graded (0-3) by evaluation of photodocumentation by 2 blinded, independent observers. RESULTS: Mean scar grading by both observers decreased from 2.31 ± 0.48 to 1.13 ± 0.72 in the case and from 2.38 ± 0.52 to 1.44 ± 0.50 in the control group with interobserver agreement on scar grading being substantial to almost perfect in both groups. Scar length decreased significantly in both groups (p = 0.008). Scar prominence decreased in 2/3 of cases in the case and 1/3 in the control group. Scar coloring significantly improved in the case group alone (p = 0.031). CONCLUSION: No functionally impairing or painful scar developed. No adverse effects occurred after kinesiotaping. Gluteal scars shortened significantly over time and were significantly paler in the case group. Kinesiotaping may improve scar elevation over no specific scar therapy.

What would an 'ideal' glaucoma examination be like? - A conjoint analysis of patients' and physicians' preferences.

PURPOSE: To structurally determine patients' and physicians' preferences for glaucoma diagnostic methods in order to improve glaucoma patient care and improve patient compliance with follow-up visits. METHODS: Forty-one patients with glaucoma and 32 ophthalmologists were included in this cross-sectional study. Profiles representing glaucoma examinations were created using conjoint analysis (CA). The following factors of a glaucoma examination method were evaluated: (1) examination comfort, (2) examination frequency, (3) follow-up examination necessary in case of suspicious result, (4) cost for the patient, (5) travel time to examination site, (6) sensitivity and (7) specificity of the examination method. RESULTS: Preferences were highest in both groups for examination sensitivity, followed by cost and specificity for the patient group. For the physician group, specificity was second most important, followed by cost. Least important was travel time for the patients and follow-up examinations for the physicians. CONCLUSIONS: Participants would rather pay more and travel longer to get a highly sensitive examination. This form of care is present in university eye hospitals. Consequently, it would be advisable to enhance capacities of these centers. Outpatient practices that offer glaucoma service should be fully equipped and should employ a glaucoma specialist.

Refractive outcomes of 8 biometric formulas in combined phacovitrectomy with internal limiting membrane peeling for epiretinal membrane.

PURPOSE: To investigate the accuracy of 8 different biometric formulas in combined phacovitrectomy and the effect of constant optimization on refractive outcome. SETTING: Ludwig-Maximilians-University, Munich, Germany. DESIGN: Retrospective observational case series. METHODS: In this single-center study, patients with cataract and epiretinal membrane who underwent combined phacovitrectomy with internal limiting membrane peeling (Group B) and axial length-matched patients who underwent phacoemulsification (Group A) were included. In Group C, optimized constants from Group A were applied in patients of Group B. One eye of each patient was included. Main outcome measures after constant optimization for each biometric formula were refractive prediction error (PE), mean absolute error (MAE), and percentages of eyes with a PE within ±0.25 diopters (D), ±0.5 D, and ±1.0 D. RESULTS: The study comprised 128 patients. For all formulas in Group A and Group B, refractive PE was 0.000 (P = .964 and P = .967, respectively). For formulas Barrett, Haigis, Hill, Hoffer Q, Holladay 1, Holladay 2, Kane, and SRK-T, refractive PE was -0.147, -0.204, -0.180, -0.212, -0.180, -0.178, -0.153, and -0.159, respectively, in Group C (P = .569); MAE was 0.346, 0.375, 0.382, 0.379, 0.355, 0.377, 0.318, and 0.364, respectively, in Group A (P = .286); 0.402, 0.422, 0.417, 0.427, 0.417, 0.402, 0.370, and 0.401, respectively, in Group B (P = .364); and 0.401, 0.424, 0.419, 0.444, 0.424, 0.404, 0.391, and 0.422, respectively, in Group C (P = .767). Effect of constant optimization in phacovitrectomy was statistically significant for all formulas (P < .001 for each formula). CONCLUSIONS: No statistically significant difference was observed between the biometric formulas with regard to PE and MAE. However, in terms of phacovitrectomy, constant optimization should be considered for individual intraocular lens power calculations attributable to myopic shift.

Accuracy of SS-OCT biometry compared with partial coherence interferometry biometry for combined phacovitrectomy with internal limiting membrane peeling.

PURPOSE: To evaluate the accuracy of a swept-source optical coherence tomography (SS-OCT) biometer compared with a standard partial coherence interferometry (PCI) biometer in terms of phacovitrectomy for vitreomacular pathology and cataract. SETTING: Department of Ophthalmology, Ludwig-Maximilians-University Munich, Germany. DESIGN: Prospective, nonrandomized, single center consecutive case series. METHODS: Patients with age-related cataract, regular corneal astigmatism less than 1.25 diopters (D) and a clinically significant vitreomacular pathology (epiretinal membrane [ERM], macular hole, or vitreomacular traction [VMT] syndrome) who had combined phacovitrectomy with internal limiting membrane peeling were enrolled. Objective and manifest refraction, corrected distance visual acuity, SS-OCT biometry, and PCI biometry were obtained preoperatively and 3 months postoperatively. The refractive prediction error and mean absolute error (MAE) were calculated for each biometric device with the Haigis formula. The percentage of eyes with a prediction error within ±0.50 D or less were calculated. RESULTS: The study comprised 79 eyes of 79 patients. The mean refractive prediction error of all eyes was -0.27 D ± 0.76 (SD) for the PCI biometer and -0.28 ± 0.57 D for the SS-OCT biometer (P = .802), and the MAE was 0.61 ± 0.53 D and 0.46 ± 0.43 D, respectively (P = .012). A prediction error within ±0.50 D or less was observed in 55 eyes (70%) with the SS-OCT biometer compared with 42 eyes (53%) with the PCI biometer (P = .0001). The MAE with the SS-OCT biometer was statistically significantly lower in eyes with ERMs or macular holes compared with the PCI biometer (P = .043 and P = .028, respectively), whereas no statistically significant difference was observed in eyes with VMT syndrome (P = .286). CONCLUSIONS: The SS-OCT biometer showed a statistically significant lower MAE compared with the PCI biometer, and it is recommended for precise intraocular lens power calculations in combined phacovitrectomy for cataract and vitreomacular diseases.

Structure-Function Relationship Between Bruch's Membrane Opening-Based Optic Nerve Head Parameters and Visual Field Defects in Glaucoma.

PURPOSE: This study was performed to evaluate the structure-function relationship between Bruch's membrane opening (BMO) parameters of the optic nerve head (ONH) and visual field (VF) sensitivity. METHODS: Forty-six right eyes of 46 patients with open-angle glaucoma (OAG) in the patient group and 12 right eyes in the control group were included. Standard automated perimetry (SAP) and spectral-domain optical coherence tomography (SD-OCT) were assessed. Three BMO-based distances and two areas of the neuroretinal rim were used for correlation: the minimum rim width (MRW), the perpendicular rim width (PRW), the horizontal rim width (HRW), the minimum rim area (MRA) within the neuroretinal tissue defined by the MRW, and the perpendicular rim area (PRA) within the neuroretinal tissue defined by the PRW. These parameters were correlated with global and sectoral VF sensitivities. Spearman's correlation coefficients between BMO parameters and global and sectoral VF sensitivities were obtained. RESULTS: Within the patient group, significant correlations could be observed between global and sectoral VF sensitivities and BMO parameters, with PRW and PRA showing the highest values. In the sectoral analysis the highest correlations were found for the temporal-inferior VF sector (MD-TI): PRW-TI (ρ = 0.72394; P < 0.00001) and PRA-TI (ρ = 0.77205; P < 0.00001). Minimum rim width and MRA performed more weakly than PRW and PRA. CONCLUSIONS: The BMO-based parameters PRW and PRA presented with a very good structure-function relationship in glaucoma patients, statistically at least equal to MRW and MRA. Using new BMO-based parameters might allow early objective assessments of functional glaucomatous impairments.