Effects of three intravitreal injections of aflibercept on the ocular circulation in eyes with age-related maculopathy

Aims: To investigate changes in ocular perfusion following three consecutive intravitreal injections with aflibercept for treatment of neovascular age-related macular degeneration (nAMD). Methods The study included 20 eyes from 20 Caucasian patients with unilateral nAMD and 20 fellow eyes. All nAMD eyes were treated with standard intravitreal injection of aflibercept (IVA;2 mg). Measurements of ocular perfusion at the optic nerve head (ONH) and the choroid were performed with laser speckle flowgraphy (LSFG). Measurements were conducted at baseline, 1 week after the first injection, at the time point of the second and third injection as well as 1 month after the third injection. Results In treated eyes, mean blur rate (the main output parameter of LSFG) in the ONH microvasculature and in the choroid was significantly reduced 1 week after the first IVA treatment. The effect persisted throughout the entire follow-up period (p<0.001). No change in ocular perfusion was observed in fellow eyes. Conclusions: IVA for treatment of nAMD leads to a reduction in perfusion of the ONH and the choroid in the treated eye with no apparent effect on the fellow eye

Subthreshold laser therapy with a standardized macular treatment pattern in chronic central serous chorioretinopathy

PURPOSE There is an ongoing controversial debate about the effectiveness of laser treatments in chronic central serous chorioretinopathy (cCSC). We performed a prospective non-randomized interventional study to learn about the effects of a subthreshold laser treatment (Topcon Endpoint Management™, Topcon Healthcare Inc., Tokyo, Japan) in patients with cCSC. METHODS Patients with cCSC and a minimum symptom duration of 4~months were included and treated with a standardized laser pattern covering the macular area. Retreatment was performed every 3~months if persistent subretinal fluid was observed. The primary endpoint was resolution of subretinal fluid at 6~months. Further outcome parameters included best corrected visual acuity, microperimetry, central macular and subfoveal choroidal thickness. RESULTS A total of 42 eyes of 39 patients were included. Mean patient age was 48 ± 10.6~years (range 25-67). Mean symptomatic time before inclusion into the study was 134 ± 133.4~weeks (16-518). Before inclusion, 78.6% of the patients had failed to resolve subretinal fluid under mineralocorticoid receptor antagonists and 14.3% had a recurrence after half-dose photodynamic therapy. Complete resolution of subretinal fluid was observed in 42.9% at 6~months and in 53.8% at 12~months after baseline. Central retinal thickness decreased from 398 ± 135~µm to 291 ± 68~µm (p < 0.001), subfoveal choroidal thickness changed slightly (430 ± 116~µm to 419 ± 113~µm, p = 0.026), microperimetry-derived macular function improved by 19.1 ± 4.7~dB to 21.3 ± 4.8~dB (p = 0.008) and mean BCVA improved by 4.9 ± 8.6 ETDRS letters (p < 0.001). CONCLUSION The results show that the investigated laser treatment is effective in reducing subretinal fluid and leads to an improvement of functional parameters

3D Heads-Up Display vs. Standard Operating Microscope Vitrectomy for Rhegmatogenous Retinal Detachment

Purpose: To assess the efficacy and outcomes of 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment using a three-dimensional heads-up display (3D HUD) surgical platform as compared to a standard operating microscope (SOM) setting. Design: Retrospective cohort study. Participants: One hundred and forty consecutive eyes of 140 patients with primary retinal detachment. Methods: All eyes underwent 23-gauge pars plana vitrectomy for primary retinal detachment using either a 3D HUD (NGENUITY;Alcon Inc., Fort Worth, Texas, USA;n = 70 eyes) or a SOM setting (n = 70 eyes);in cases of significant cataract, additional phacoemulsification with intraocular lens (IOL) implantation was performed. Minimum follow-up was 2 months. Main Outcome Measures: Primary retinal reattachment rate, rate of proliferative vitreoretinopathy (PVR), best-corrected visual acuity (BCVA), and duration of surgery. Results: There were 70 eyes each in the 3D HUD and the SOM group. Both groups did not differ concerning age (p = 0.70), extent of retinal detachment (p = 0.07), number of retinal tears (p = 0.40), macular involvement (p = 0.99), and preoperative BCVA (p = 0.99). Postoperatively, 3D HUD and SOM were comparable concerning the primary retinal reattachment rate (88.6 vs. 94.3%;p = 0.37), the development of postoperative PVR (12.9% vs. 7.1%;p = 0.40) and final BCVA (0.26 +/- 0.40 vs. 0.21 +/- 0.38 logMAR;p = 0.99). Duration of surgery was significantly longer in the 3D HUD group (66.2 +/- 16.5 vs. 61.2 +/- 17.1 min;p = 0.04), an effect which however vanished after a "learning curve" of the first 35 eyes (p = 0.49). Conclusions: On par results to a conventional operating microscope can be achieved with a 3D HUD setting when performing 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment, including the primary retinal reattachment rate, the incidence of postoperative PVR and final BCVA. However, duration of surgery might initially be slightly longer with 3D HUD, suggesting the effect of a learning curve

Ranibizumab non-response in pachychoroid neovasculopathy: Effects of switching to aflibercept

Non-response to intravitreal ranibizumab represents a frequent problem in pachychoroid neovasculopathy (PNV). To investigate the effectivity of switching to aflibercept, the database of the Ludwig Maximilians University, Munich, was screened for patients fulfilling the following inclusion criteria: (i) diagnosis of PNV;(ii) inadequate response to >= 3 ranibizumab injections, in spite of monthly dosing, defined as persistence of subretinal-fluid four weeks after the last ranibizumab injection;(iii) resulting switch to aflibercept administered as three monthly injections. Primary outcome measure was percentage of eyes with a dry macula four weeks after the third aflibercept injection. Secondary outcome measures included changes in maximum subretinal fluid (SRF), central subfield thickness (CST) and subfoveal choroidal thickness (SFCT). In total, 14 eyes of 14 patients were included. Mean age was 64.1 +/- 7.5 (range: 51-78) years. Switching to aflibercept was performed after mean 8.4 +/- 4.1 (3-15) ranibizumab injections. While no eye (0%) achieved a dry macula status during ranibizumab treatment, switching to aflibercept achieved a dry macula status in eight eyes (57.1%) after three injections. While both ranibizumab and aflibercept showed an effect on CST (p=0.027, p=0.003), only aflibercept showed a significant effect on SRF (p=0.0009) and SFCT (p=0.044). In cases of PNV not responding to intravitreal ranibizumab, switching treatment to aflibercept induces a favorable short-term response resolving persistent fluid and achieving a dry macula. Further studies with longer follow-up are warranted

Intraocular Lens Power Calculation after Small Incision Lenticule Extraction

With more than 1.5 million Small Incision Lenticule Extraction (SMILE) procedures having already been performed worldwide in an ageing population, intraocular lens (IOL) power calculation in post-SMILE eyes will inevitably become a common challenge for ophthalmologists. Since no refractive outcomes of cataract surgery following SMILE have been published, there is a lack of empirical data for optimizing IOL power calculation. Using the ray tracing as the standard of reference - a purely physical method that obviates the need for any empirical optimization - we analyzed the agreement of various IOL power calculation formulas derived from the American Society of Cataract and Refractive Surgeons (ASCRS) post-keratorefractive surgery online calculator. In our study of 88 post-SMILE eyes, the Masket formula showed the smallest mean prediction error [-0.36 +/- 0.32 diopters (D)] and median absolute error (0.33D) and yielded the largest percentage of eyes within +/- 0.50D (70%) in reference to ray tracing. Non-inferior refractive prediction errors and +/- 0.50D accuracies were achieved by the Barrett True K, Barrett True K No History and the Potvin-Hill formula. Use of these formulas in conjunction with ray tracing is recommended until sufficient data for empirical optimization of IOL power calculation after SMILE is available

Semiautomated SD-OCT Measurements of Corneal Sublayer Thickness in Normal and Post-SMILE Eyes

Purpose:To test the reliability of a novel algorithm for measuring corneal epithelial thickness (ET) and stromal thickness of normal eyes and post-small incision lenticule extraction (SMILE) corneas with spectral-domain optical coherence tomography.Methods:In this prospective observational study, a customized semiautomated software algorithm was developed and applied to measure corneal ET and stromal thickness along the horizontal corneal meridian. Measurements were performed by 2 examiners in a randomized fashion on a sample of 40 eyes with previous SMILE for treatment of myopia and a control group composed of 40 normal eyes. The intrauser repeatability and interuser reproducibility were analyzed by calculating typical indices including the coefficient of variation and intraclass correlation coefficient. Corneal sublayer thickness profiles were compared between normal and post-SMILE eyes.Results:In both groups, coefficients of variation were 3.2% or lower and intraclass correlation coefficients were 0.929 or higher indicating excellent reliability of the measurement method. Central ET was on an average 6 m greater in post-SMILE corneas (58.8 5.4 m) compared with normal eyes (52.8 +/- 4.0 m), with P < 0.01. Also, there was greater interindividual variability in ET in post-SMILE corneas and their horizontal epithelial profile seemed to show a lenticular appearance.Conclusions:Highly favorable indices of measurement reliability were achieved for this novel method of measuring corneal sublayer pachymetry not only in normal eyes but also in eyes with previous SMILE. The corneal ET profile was significantly altered in post-SMILE eyes compared with normal corneas