PURPOSE:To evaluate visual outcomes observed across visit gaps in patients with neovascular age-related macular degeneration (nAMD) treated with anti-VEGF therapy in routine clinical practice. DESIGN:Retrospective data analysis from a prospectively designed observational outcomes registry: the Fight Retinal Blindness!. PARTICIPANTS:Treatment-naïve nAMD eyes receiving intravitreal anti-VEGF therapy (≥1 injection), monitored at least quarterly during the first treatment year, and experiencing a visit gap of ≥6 to 12 months, with subsequent follow-up over the next 9 months (≥3 visits). METHODS:Visual outcomes were assessed using a segmented linear mixed-effect model. Cumulative incidence and risk factors for visit gaps were evaluated using Aalen-Johansen estimators and Cox regression models. MAIN OUTCOME MEASURES:The main outcome was the mean estimated change in visual acuity (VA) immediately after the visit gap. Secondary outcomes included the cumulative incidence and associated risk factors of visit gaps. RESULTS:From 3694 eligible eyes for the survival analysis, we tracked 262 (7.1%) eligible eyes experiencing a visit gap for the visual outcome analysis. Neovascular age-related macular degeneration-treated eyes experiencing a 6- to 12-month visit gap had a significant drop in vision immediately after the visit gap, with a mean (95% confidence interval) estimated change in VA of -4.9 letters (-6.0 to -3.7; P < 0.001). Eyes with active choroidal neovascularization (CNV) lesions (difference -3.9 [-7.1 to -0.3] letters vs. inactive CNV) and without subfoveal macular atrophy (MA) (difference 3.4 [-0.3 to 7.0] letters vs. subfoveal MA) at the last visit before the gap experienced a greater decline in VA after the visit gap. A quarter of the eyes experienced a 6- to 12-month visit gap at 6.5 years. Neovascular age-related macular degeneration eyes with a longer time interval since last injection were more likely to experience a visit gap, whereas eyes with better VA and that had active CNV with subretinal fluid only at follow-up visits were less likely. CONCLUSIONS:Visit gaps were common and associated with a significant visual decline across the visit gap in nAMD eyes treated with anti-VEGF therapy in routine clinical practice. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Purpose:To correlate automated artificial intelligence-based retinal fluid quantification with ellipsoid zone (EZ) thickness and loss, macular neovascularization (MNV) type, and visual function. Design:This is a post hoc analysis of a prospective, real-world, multicenter clinical trial. Subjects:Patients with active neovascular age-related macular degeneration (nAMD) were included. Methods:Best-corrected visual acuity (BCVA), measured using the ETDRS chart, OCT, OCT angiography, and microperimetry, were collected by the same certified examiners. Subretinal fluid (SRF), intraretinal fluid (IRF), and pigment epithelial detachment (PED) volumes for the central 1- and 6- mm areas were calculated at baseline using the Fluid Monitor (Retinsight) on Spectralis OCT (Heidelberg Engineering). An automated algorithm segmented EZ thickness and loss detectable after fluid resolution at month 1. Main Outcome Measures:Fluid volumes were associated with MNV type, EZ thickness and loss, retinal sensitivity, and BCVA using univariate and multivariate regression models and Wilcoxon rank-sum tests with bootstrapped confidence intervals. Spearman correlation was used to analyze retinal sensitivity and EZ loss. Results:Two hundred ninety eyes from 290 consecutive patients with active MNV were included in the study at baseline. Macular neovascularization type 1 was the most prevalent in this cohort. Comparing MNV types, lower amounts of IRF were found in type 1 (all P < 0.001) and lower amounts of SRF for type 3 (all P < 0.05), in the central 1- and 6-mm areas. A decreased BCVA at month 1 was associated with IRF in the central 1 mm at baseline (-6.8 letters/100 nL; P < 0.001). Intraretinal fluid and PED volumes at baseline were correlated with EZ loss at month 1 in the central 6 mm. High fluid volumes of IRF, SRF, and PED in the central 1- and 6- mm areas also correlated with decreased mean retinal sensitivity (all P < 0.01). Ellipsoid zone loss in the central 1- and 6-mm area correlated with decreased retinal sensitivity (all P < 0.01). Conclusion:Retinal fluid volumes in nAMD are triggered by MNV types and correlate with photoreceptor integrity and visual function, with the impact depending on the fluid compartment. Although fluid is central to disease monitoring, a more comprehensive approach to structural-functional assessment in nAMD is of interest. Financial Disclosures:Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Purpose: The aim of this study was to compare fundus blue autofluorescence (BAF) images, indicating photoreceptor alteration, and indocyanine green angiography (ICGA), indicating retinal pigment epithelium (RPE) alteration, in multiple evanescent white dot syndrome (MEWDS) to investigate the initial damage location within the RPEDesign: Multicentric retrospective cohort study carried out across tertiary centers for retinal and inflammatory diseases in France. Participants: A total of 31 eyes affected by primary MEWDS were included. Methods: Only primary MEWDS, with sufficiently high-quality images, were included, and their data were analyzed cross-sectionally at baseline and at the recovery phase, between 4 and 8 weeks. A standardized protocol was set up for measuring the areas affected by MEWDS on the late-phase ICGA and on BAF; this was always carried out by the same investigator. On 55 degrees macular-centered images, both the BAF and ICGA areas were delimited and calculated in the FIJI/ ImageJ Software and then compared with each other. The same process was used to compare macular areas bounded by a 6-mm diameter Early Treatment Diabetic Retinopathy Study circle centered on the fovea. Main Outcome Measures: Areas in mm2 affected by MEWDS on BAF and ICGA. Results: The median hypofluorescent area on ICGA (93.03 mm2, interquartile range [IQR: 54.08-134.00]) was significantly larger than that affected on BAF (76.22 mm2 [IQR: 43.65-122.20], P < 0.0001). The median damaged surface was 37.21% (IQR: 21.63%-53.61%) on ICGA vs. 30.49% (IQR: 17.15%-46.60%) on BAF (P < 0.0001). Regarding only the macular area, damage was also significantly larger on ICGA than in BAF (15.16 [9.55-24.08] mm2 vs. 13.48 Conclusions: Our study showed that MEWDS lesions are more extensive in ICGA than in BAF, indicating a predominant RPE dysfunction. We therefore support the hypothesis that MEWDS is a primary retinal pigment epitheliopathy, causing reversible and nondestructive dysfunction of the RPE and photoreceptors. Our results support recent analysis of modern multimodal imaging. Further studies using en face OCT are needed to analyze the outer retinal layers and corroborate the hypothesis. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology Science 2025;5:100731 (c) 2025 by the American Academy of Ophthalmology. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

PURPOSE:To investigate the association between best-corrected visual acuity (BCVA) and quantitative macular fluid volumes, compared to central subfield thickness (CST) in treatment-naïve and previously treated patients with active neovascular age-related macular degeneration (nAMD). METHODS AND ANALYSIS:Baseline data were collected from 290 eyes of 290 participants consecutively enrolled in a prospective, randomized phase III clinical trial. Intraretinal fluid (IRF), subretinal fluid (SRF) and pigment epithelial detachment (PED) volumes were quantified and localized using an MDR-certified AI algorithm (Fluid Monitor, RetInSight). Fluid volumes and CST were included in linear regression models for comparison. RESULTS:Significantly greater IRF volumes within each macular region were observed in treatment-naïve patients, whereas larger PED volumes contributed to higher CST values in pretreated patients. In both subgroups, the largest proportion of BCVA variance could be explained by measuring IRF and SRF volumes within the entire 6-mm area (adjusted R2 = 0.140 and 0.225, respectively). In pre-treated eyes, CST explained only half as much BCVA variance as the 6-mm fluid model, and the model's fit was even poorer when compared to the CST model in the treatment-naïve subgroup (adjusted R2 = 0.078 vs. 0.198). CONCLUSION:The examination of IRF and SRF volumes significantly impacts BCVA in nAMD. The weaker association of CST highlights its limitations as a parameter of disease activity. These findings emphasize the necessity of distinct fluid volume quantification as a relevant surrogate for visual function loss or benefit in nAMD, with particular emphasis on treatment duration and fluid in regions beyond the central 1-mm.

PURPOSE:To assess the efficacy and safety of 0.19-mg fluocinolone acetonide (FAc) intravitreal implant (Iluvien) in treating chronic postoperative cystoid macular edema (PCME) after pars plana vitrectomy. DESIGN:Retrospective multicentric case series in clinical settings. SUBJECTS:Patients with chronic PCME who underwent vitrectomy in tertiary care centers in France. METHODS:Review of charts and OCT scans. MAIN OUTCOME MEASURES:The primary end points were the best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Secondary end points were the intraocular pressure (IOP); proportion of patients maintaining a BCVA ≥20/40; need for additional nonstudy treatment; differences between eyes that underwent a single and multiple surgeries; and OCT biomarkers of better BCVA. RESULTS:Forty-nine eyes of 49 patients with a mean follow-up of 24.5 ± 3.87 months were included. The mean BCVA increased from 0.40 ± 0.26 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.32 ± 0.24 logMAR at month 24 (P = 0.0035). The mean CRT decreased from 409 ± 139 μm at baseline to 340 ± 92 μm at month 24 (P = 0.0001). The mean IOP was 14.0 ± 4 mmHg at baseline and remained stable at 14.03 ± 4.1 mmHg at month 24 (P = 0.99). During the follow-up, the IOP exceeded 21 mmHg in 9 eyes, with one eye requiring cyclophotocoagulation. The BCVA was ≥20/40 in 47% of eyes (95% confidence interval [CI], 34%-61%) at baseline and in 58% of eyes at month 24 (95% CI, 41%-73%). At month 18, the likelihood of achieving a BCVA ≥20/40 was higher in eyes with intact external limiting membrane and ellipsoid zone. Additional dexamethasone (DEX) implant was injected in 14 eyes (28.6%). The treatment burden of 2.45 ± 1.35 DEX implant/y was decreased to 0.57 ± 0.60 DEX implant/y after FAc implantation (P = 0.001). CONCLUSIONS:Fluocinolone acetonide implant improved the BCVA, reduced the CRT, and allowed reducing treatment burden in eyes with chronic PCME after vitrectomy. The safety profile was acceptable. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Anti-vascular endothelial growth factor (VEGF) is generally given using pro re nata or “treat-and-extend” (T E) regimens for neovascular age-related macular degeneration (nAMD). Randomized clinical trials have reported that T E is superior to Pro re nata (PRN), but results from clinical trials may not always be replicated in clinical practice. Real-world data comparing T E and PRN regimens for nAMD are limited. The objective of this work was to report 24-month outcomes of PRN versus T E regimens for ranibizumab and aflibercept to treat nAMD in routine clinical practice. We conducted a retrospective analysis of data from a prospectively designed observational outcomes registry, the Fight Retinal Blindness! Project (FRB). Treatment-naïve eyes starting nAMD treatment with at least three injections using a T E or PRN regimen were tracked by using the FRB. The primary outcome was the mean change in visual acuity (VA) measured by the number of letters read on a logarithm of the minimum angle of resolution chart at 2 years versus baseline. The secondary outcome was the number of injections at 2 years. From January 1, 2015 to January 31, 2019, 3313 eyes from 2948 patients with nAMD were included: 1243 eyes from 1065 patients were classified as PRN and 2070 eyes from 1935 patients started a T E regimen. At 24 months, patients on the T E regimen experienced significantly greater mean (95

PURPOSE: To assess the prognostic value of subretinal (SRF) and intraretinal fluid (IRF) localizations in type 1 macular neovascularization (MNV) due to age-related macular degeneration (AMD). SUBJECTS: Eyes were prospectively treated with anti-vascular epithelial growth factor (anti-VEGF) intravitreal injections (IVT) according to a Pro-Re-Nata (PRN) or Treat and Extend (TAE) regimen during 24 months. A total of 211 eyes with treatment-na & iuml;ve type 1 MNV secondary to AMD were consecutively included. Eyes were divided between 2 groups according to the fluid localization: presence of SRF alone (SRF group), or presence of IRF associated or not with SRF (IRF +/- SRF group). RESULTS: At baseline the mean BCVA was 66.2 letters. SRF was present in 94.8% of eyes, IRF in 30.8%, and both in 25.6%. Data were available for 201 eyes at 12 months, and 157 eyes at 24 months. The presence of IRF at baseline was associated with lower baseline BCVA and significantly lower BCVA at 12 months (p < 0.001) and 24 months (p < 0.001). Eyes with SRF alone displayed better visual outcomes (BCVA at month 12, SRF = 74.3 letters, IRF +/- SRF = 56.9 letters). In the presence of baseline IRF, fibrosis (p = 0.03) and atrophy (p < 0.001) were more frequently found at 24 months. In a multivariate model, the presence of baseline IRF was significantly associated with lower BCVA at month 12 but not at month 24. CONCLUSION: In type 1 MNV, the presence of baseline IRF was associated with worse visual outcomes compared to SRF alone, and more frequent atrophy and fibrosis.

To compare baseline characteristics, initial response and 12-month efficacy and safety outcomes in eyes with branch and central retinal vein occlusion (BRVO and CRVO) treated with dexamethasone implants (DEX) or anti-vascular endothelial growth factor (anti-VEGF) we performed a multi-centre, retrospective and observational study using Fight Retinal Blindness! Registry. Of 725 eligible eyes, 10% received DEX initially with very frequent adjunctive anti-VEGF (BRVO-DEX 49%, CRVO-DEX 60%). The primary outcome of mean adjusted change in VA at 12 months with DEX and anti-VEGF initiated groups were not statistically significantly different (BRVO: DEX + 6.7, anti-VEGF + 10.6 letters; CRVO: DEX + 2.8, anti-VEGF + 6.8 letters). DEX initiated eyes had fewer injections and visits than anti-VEGF initiated eyes. The BRVO-DEX eyes had greater initial mean changes in VA and central subfield thickness (CST) and achieved inactivity sooner than BRVO-anti-VEGF eyes. The mean CST after the first three months was above 350 μm in all but the BRVO-anti-VEGF group, suggesting undertreatment. In routine care DEX is uncommonly used when available as initial treatment of BRVO and CRVO requiring supplemental anti-VEGF within the first year. The 12-month outcomes were similar, but DEX initiated eyes had fewer injections and visits but more episodes of raised IOP Vs those starting anti-VEGF.

PURPOSE:To assess subretinal fibrosis (SF) occurrence in neovascular age-related macular degeneration (nAMD), according to macular neovascularisation (MNV) subtypes. METHODS:A Retrospective national multi centre cohort study included eyes with naive nAMD. Main outcome measures were, according to MNV subtypes, cumulative incidence for SF, risk factors, and best corrected visual acuity (BCVA) for 36 months. RESULTS:Four hundred and twenty eyes were included. Cumulative incidence of SF was 34.3% at 1 year, 39.0% at 2 years and 50.6% at 3 years. In multivariable analysis, Type 2 and mixed type 1 and 2 MNV were associated (p < 0.001) with a more frequent and rapid development of SF (respectively 85.5% and 81.0% at 1 year, then 95.8% and 93.1% at 3 years) than Types 1 and 3 (respectively 11.3% and 3.6% at 1 year, then 22.9% and 12.7% at 3 years). In Type 2 and mixed type 1 and 2 MNV combined, at baseline a worse BCVA (p = 0.02) and a higher maximal subretinal hyperreflective material (SHRM) thickness (p = 0.005) were associated with SF development at 3 years. In Type 1 MNV, the presence at baseline of intraretinal fluid (IRF) (p = 0.007) or SHRM (p < 0.001) and a higher percentage of visits with IRF (p < 0.001) or with SHRM (p < 0.001) were associated with SF occurrence. For Type 3 MNV, only a higher percentage of visits with SHRM (p = 0.001) was associated with SF. Including all MNV subtypes, eyes with a worse BCVA at baseline were associated with SF development (p < 0.001). Conversely, presence of SF at 3 years was associated with a worse baseline BCVA (p < 0.001). CONCLUSION:Occurrence of SF differs when considering apart MNV subtypes.

Abstract Aim: To compare baseline characteristics, initial response and 12-month efficacy and safety outcomes in eyes with branch and central retinal vein occlusion (BRVO and CRVO) initially treated with either dexamethasone implants (DEX) or vascular endothelial growth factor (VEGF) inhibitors where both are available as first-line therapy. Methods: Multi-centre study from European Fight Retinal Blindness! centres using the retinal vein occlusion module in routine clinical care. Results: Of 725 eligible eyes, only 10% received DEX initially with very frequent adjunctive VEGF inhibitors (BRVO-DEX 49%, CRVO-DEX 60%). The primary outcome of mean adjusted change in VA at 12 months with DEX and VEGF inhibitors initiated groups were not statistically significantly different (BRVO: DEX +6.7, VEGF +10.6 letters; CRVO: DEX +2.8, VEGF +6.8 letters). DEX initiated eyes had fewer injections and visits than VEGF inhibitors initiated eyes but intraocular pressure required treatment more often in BRVO with DEX than VEGF inhibitors. We found the BRVO-DEX eyes had greater initial mean changes in VA and central subfield thickness (CST) and achieved inactivity sooner than BRVO-VEGF eyes. The mean CST after the first three months was above 350μm in all but the BRVO-VEGF group, suggesting undertreatment in routine care. Conclusion:In routine care DEX is uncommonly used when available as initial treatment of BRVO and CRVO and is often supplemented with VEGF inhibitors within the first year. The 12-month outcomes were similar, but DEX initiated eyes did have fewer injections and visits but more episodes of raised IOP compared with those starting VEGF inhibitors.

Purpose:The aim of this study was to compare primary versus secondary forms of multiple evanescent white dot syndrome (MEWDS) at T0 (baseline) and T1 (1-4 months after the onset of symptoms).Methods:A total of 101 eyes in 100 patients were included in a multicentric retrospective study.Results:Secondary MEWDS was defined as MEWDS associated with underlying chorioretinal inflammatory pathologies, mainly multifocal choroiditis and punctuate inner choroidopathy. Patients with secondary MEWDS were older (P = 0.011). The proportion of women (P = 0.8), spherical equivalent (P = 0.3), and best-corrected visual acuity at T0 (P = 0.2) were not significantly different between the two groups. The area of MEWDS lesions on late-phase indocyanine green angiography was significantly smaller in secondary MEWDS (P = 0.001) and less symmetrical with respect to both horizontal (P = 0.003) and vertical (P = 0.004) axis. At T0, neither the clinical (P = 0.5) nor the multimodal imaging (P = 0.2) inflammation scores were significantly different between the groups. At T1, the multimodal imaging inflammation score was higher in secondary MEWDS (P = 0.021).Conclusion:In secondary MEWDS, outer retinal lesions are less extensive and located close to preexisting chorioretinal lesions. Mild signs of intraocular inflammation on multimodal imaging are more frequent in secondary MEWDS during recovery. These findings suggest that chorioretinal inflammation may trigger secondary MEWDS.

Purpose The aim of this study is to compare the one year outcome of neovascular age-related macular degeneration (nAMD) patients treated by a PRN regimen of Anti-vascular endothelial growth factor (VEGF) intravitreal injections (IVTs), using optical coherence tomography B-scan (OCT-B) or OCT Angiography (OCT-A) imaging modalities during follow-up. Methods Patients older than 50 years with nAMD currently treated by PRN regimen of Anti-VEGF IVTs were recruited from Rothschild Foundation Hospital – Paris and Centre Ophtalmologique Maison Rouge – Strasbourg and followed-up for a year. Patients were randomized in two groups: one group was followed by OCT-B while the other was followed by OCT-A. Results Thirty-three patients were followed by OCT-A and 31 patients were followed by OCT-B. Twenty-nine patients in the OCT-A group and 27 patients in the OCT-B group attended the last visit. No statistically significant difference was found between the two groups at 1 year concerning: improvement or stabilization of the best corrected distance visual acuity (BCVA) (p > 0.9), exudative signs (p > 0.9), number of injections (p = 0.8) and the delay until the first reinjection was performed (p = 0.5). Conclusion The use of OCT-A or OCT-B as imaging modalities in nAMD treated by a PRN regimen of Anti-VEGF IVTs seem to be comparable at one year.

Background: This paper reports the case of a young man who presented with syphilis masquerading as multiple evanescent white dots syndrome (MEWDS), which turned out to be an acute syphilitic posterior placoid chorioretinopathy (ASPPC) during follow-up. Case presentation: A 59-year-old healthy male consulted for a three days' history of visual impairment in both eyes. On multimodal imaging, he was diagnosed as MEWDS. Fundus fluorescein angiography (FFA) showed early peripheral bilateral granular hyperfluorescence that correlated with the yellow-white dots found on fundus exam. Indocyanine green angiography (ICGA) depicted hypofluorescent dots on late phase. Spectral-domain optical coherence tomography (SD-OCT) revealed numerous inner retinal highly reflective deposits in the outer nuclear layer and disruption of the ellipsoid zone. After initial improvement, he presented again for a sudden visual loss at 3 weeks. FFA, ICGA and SD-OCT demonstrated the same but more numerous and outer lesions suggesting an ASPPC. A full inflammatory work-up revealed highly positive titers of rapid plasma regain (RPR) and fluorescent treponemal antibody absorption (FTA-Abs), suggesting a syphilis infection. The ophthalmological manifestations dramatically improved after the patient was admitted for high-dose intravenous penicillin G 24 million per day for 2 weeks. Conclusion: This is the first case that reports an ocular syphilitic infection masquerading as MEWDS at presentation and that turns to be an ASPPC. Syphilis serology should be routinely done in every case of atypical MEWDS especially when unusually presented in a young healthy man, with bilateral involvement and a bad clinical evolution.

Breast cancer patients presenting with symptomatic brain metastases have poor prognosis, and current chemotherapeutic agents are largely ineffective. In this study, we evaluated the hypomethylating agent azacitidine (AZA) for its potential as a novel therapeutic in preclinical models of brain metastasis of breast cancer. We used the parental triple-negative breast cancerMDA-MB-231 (231) cells and their brain colonizing counterpart (231Br) to ascertain phenotypic differences in response to AZA. We observed that 231Br cells have higher metastatic potential compared to 231 cells. With regard to therapeutic value, the AZA IC50 value in 231Br cells is significantly lower than that in parental cells (P <.01). AZA treatment increased apoptosis and inhibited the Wnt signaling transduction pathway, angiogenesis, and cell metastatic capacity to a significantly higher extent in the 231Br line. AZA treatment in mice with experimental brain metastases significantly reduced tumor burden (P =.0112) and increased survival (P =.0026) compared to vehicle. Lastly, we observed a decreased expression of keratin 18 (an epithelial maker) in 231Br cells due to hypermethylation, elucidating a potential mechanism of action of AZA in treating brain metastases from breast cancer.

Purpose: To report long-term changes in intraocular pressure (IOP) in eyes receiving vascular endothelial growth factor (VEGF) inhibitors for various retinal conditions over 12 and 24 months in routine clinical practice. Design: Retrospective analysis of data from a prospectively designed observational outcomes registry, the Fight Retinal Blindness! Project. Participants: Treatment-naive eyes receiving monotherapy with VEGF inhibitors (ranibizumab [0.5 mg], aflibercept [2 mg], or bevacizumab [1 mg]) with at least 3 injections from December 2013 through December 31, 2018, and at least 12 months of follow-up. Methods: Intraocular pressure was measured at each clinical visit for all eyes as part of routine practice. Main Outcome Measures: The primary outcome was the mean change in IOP (in millimeters of mercury) at 12 months. The following secondary IOP outcome measures were investigated at 12 and 24 months: (1) mean change in IOP from baseline and (2) proportion of clinically significant IOP increase defined as an elevation of at least 6 mmHg to an IOP of more than 21 mmHg at any point during the follow-up. Results: We identified 3429 treatment-naive eyes (395 receiving bevacizumab, 1138 receiving aflibercept, and 1896 receiving ranibizumab) with complete IOP data from 3032 patients with 12 months of follow-up data, of which 2125 (62%) had 24 months of follow-up data. The overall mean IOP change was -0.5 mmHg (95% confidence interval CI, -0.6 to -0.3 mmHg) at 12 months and -0.4 mmHg (95% CI, -0.6 to -0.3 mmHg) at 24 months, whereas the proportions of clinically significant IOP increases were 5.6% and 8.8%, respectively. A lower mean IOP change and fewer IOP elevations at 12 and 24 months was observed in eyes receiving aflibercept than in those receiving bevacizumab and ranibizumab (P <= 0.01 for both comparisons at each time point and outcome). Eyes with pre-existing glaucoma demonstrated more IOP increases over 12 and 24 months (odds ratio [OR], 2.2 [95% CI, 1.2-3.8; P = 0.012] and 2.1 [95% CI, 1.1-3.8; P = 0.025], respectively). Conclusions: Mean IOP did not change significantly from baseline to 12 and 24 months in eyes receiving VEGF inhibitors, whereas clinically significant IOP elevations occurred in a small proportion of eyes. Aflibercept was associated with fewer clinically significant IOP elevations, whereas eyes with pre-existing glaucoma were at a higher risk. (C) 2020 by the American Academy of Ophthalmology

Importance Long-term data of intravitreal injections of vascular endothelial growth factor (VEGF) inhibitors are lacking. Background This study aims to assess visual and anatomic outcomes of eyes with neovascular age-related macular degeneration (nAMD) after 10 years of anti-VEGF therapy. Design Retrospective analysis of data from a prospectively designed database. Participants One hundred and sixteen eyes with nAMD (94 participants) that started anti-VEGF therapy at least 10 years earlier. Methods Eyes were tracked by the Fight Retinal Blindness! registry. Main Outcome Measures Mean change in visual acuity at 10 years vs baseline. Visual acuity was assessed by the number of letters read on a logarithm of the minimum angle of resolution chart. Results Eyes received a median of 27.5 injections over 10 years. Mean visual acuity was 57.5 letters (SD 17.5) at baseline. It increased slightly at 1 year, then dropped steadily by 18 letters (95% CI: 13.7; 22.3) at 10 years. Overall, 10% of eyes gained >= 10 letters, 64% lost >= 10 letters and 23% remained stable (+/- 5 letters from baseline). Geographic atrophy and subretinal fibrosis were found in 93% and 71%, respectively, after 10 years, both mostly affecting the centre of the fovea. Pre-treated eyes (47.5%) had significantly worse visual acuity than treatment-naive eyes at baseline and during follow-up and were significantly more likely to have atrophy and fibrosis. Conclusions and Relevance Despite short-term stabilization, long-term visual outcomes of nAMD eyes under anti-VEGF therapy may be poor. Development of atrophy and fibrosis, resulting from the natural progression of the disease, may partly explain this evolution.