Real-World Results of Switching Treatment from Ranibizumab to Aflibercept in Macular Oedema Secondary to Branch Retinal Vein Occlusion.

INTRODUCTION: To investigate treatment outcomes after switching from ranibizumab to aflibercept intravitreal injections in patients with macular oedema (MO) secondary to branch retinal vein occlusion (BRVO). METHODS: Eligible patients with refractory MO secondary to BRVO, post treatment with a minimum of three intravitreal injections of ranibizumab at 4-weekly intervals were recruited. Suboptimal or non-responders were defined as patients who had persistent intraretinal fluid (< 75% decrease from baseline) despite a minimum of three consecutive injections. These patients were switched to aflibercept injections on an as-needed basis. The primary study outcomes assessed trends in best-corrected distance visual acuity (BCVA) and central retinal thickness (CRT). To compare means of BCVA and CRT, a paired t test two-tailed with a level of significance set at 0.05 was used. Pearson correlation coefficient was also applied to demonstrate correlation. Participants were followed up for a period of 24 weeks after switching. RESULTS: Thirty-eight eyes of 38 patients were included in the study. Patients had an average of 8.37 ranibizumab intravitreal injections over a mean period of 12 months presenting suboptimal or no response. A significant decrease of mean CRT from 388.63 ± 93.4 µm to 290.29 ± 93.5 µm (p < 0.001) and an improvement in mean BCVA from logMAR 0.66 ± 0.38 to logMAR 0.57 ± 0.27 (p = 0.025) was achieved after an average of 2.27 aflibercept injections. CONCLUSIONS: Given the spectrum of therapies available to date for the management of MO secondary to BRVO, aflibercept appears to be an effective treatment option in cases refractory to ranibizumab. This study based on a small cohort of patients indicates that satisfactory results on retinal anatomy and visual outcomes can be accomplished with a smaller number of injections. Larger-scale studies are needed to extrapolate these promising results.

Polypoidal lesions associated to choroidal naevus: spectrum of pachychoroid disease?

A 78-year-old woman was referred by an optician for an incidental finding of peripapillary naevus in the absence of visual symptoms. On examination, the right eye showed a choroidal naevus of around 1.5 disc diameter, adjacent to the optic disc. Optical coherence tomography detected the presence of pigment epithelium detachment and subretinal fluid within the context of the naevus. Fundus fluorescein angiography and indocyanine green showed multiple polypoidal lesions (Polypoidal Choroidal Vasculopathy, PCV) in the choroid within the spectrum of a pachychoroid, without any sign of malignancy related to neovascularisation. The patient underwent a follow-up of 6 months, showing stability of the lesions over this timeframe. No treatment has been required since the polypoidal lesions were outside the fovea and visual acuity remained stable. The association between choroidal naevi and polypoidal lesions is rare1; however, this seems to confirm that these findings are part of the spectrum of pachychoroid disease.

Development of the Preverbal Visual Assessment (PreViAs) questionnaire.

BACKGROUND: Visual cognitive functions of preverbal infants are evaluated by means of a behavioral assessment. Parents or primary caregivers may be appropriate to certify the acquisition of certain abilities. AIMS: To develop the PreViAs (Preverbal Visual Assessment) questionnaire to assess visual behavior of infants under 24 months of age and to assess the normative outcomes for each item at each age. STUDY DESIGN: The process was divided into three phases: scale development (items and domains generation), pilot testing, and exploratory analysis. RESULTS: The final version of the PreViAs questionnaire consisted of 30 items, each related to one or more of four domains (visual attention, visual communication, visual-motor coordination, and visual processing). For the exploratory analysis, 298 children (159 boys and 139 girls) were recruited. Their ages ranged from 0.1 to 24 months (mean, 11.2 months). Internal consistency of the questionnaire was high for all domains (Cronbach's α coefficients of 0.85-0.94). CONCLUSIONS: The PreViAs questionnaire is a useful scale for assessing visual cognitive abilities of infants under 24 months of age. It is easy and feasible to complete by primary caregivers.