OBJECTIVE:To characterize temporal changes in clinical severity, bacterial spectrum, and antimicrobial susceptibility in acute postcataract endophthalmitis over 23 years. DESIGN:Retrospective comparative cohort study. SUBJECTS, PARTICIPANTS, AND/OR CONTROLS:This study included 234 eyes of 234 patients presenting within 6 weeks after cataract surgery at 2 French tertiary referral centers. The historical cohort comprised 126 eyes managed from 2002 through 2007, and the recent cohort comprised 108 eyes managed from 2016 through 2025. METHODS, INTERVENTION, OR TESTING:Microbiological analyses included conventional cultures and 16S polymerase chain reaction on aqueous and/or vitreous samples. Antimicrobial susceptibility testing was performed on bacterial isolates. Baseline clinical severity, pathogen distribution, and resistance profiles were compared between cohorts. MAIN OUTCOME MEASURES:Pathogen distribution, cefuroxime susceptibility, methicillin resistance among staphylococci, and markers of clinical severity at presentation. RESULTS:Bacterial identification was obtained in 85 of 126 eyes (67.5%) in the historical cohort and 63 of 108 eyes (58.3%) in the recent cohort. Coagulase-negative staphylococci decreased from 38% to 25% of isolates, whereas Enterococcus faecalis increased from 2% to 10%; Gram-negative bacteria increased from 3.1% to 7.3%. Cefuroxime resistance increased from 26.0% (13/50) to 66.1% (adjusted OR, 3.75; 95% CI, 1.59-8.82; P = .003) of tested isolates. Among staphylococci, methicillin resistance increased from 30.3% to 75.0% (adjusted OR, 6.75; 95% CI, 1.99-22.83; P = .002), and multidrug-resistant phenotypes increased from 3.0% to 37.5% (P = .003). Eyes in the recent cohort had milder clinical presentation, with visual acuity of 20/400 or better in 29.0% versus 11.2%, visible fundus in 24.1% versus 9.6%, and pars plana vitrectomy performed in 51.9% versus 63.5%. Interpretation is limited by the retrospective design and incomplete susceptibility data. CONCLUSIONS:This retrospective comparative cohort study of 234 cases across two periods spanning 23 years was associated with a marked shift in the bacterial spectrum of acute postcataract endophthalmitis, with fewer coagulase-negative staphylococci and more Enterococcus faecalis isolates, alongside increased cefuroxime and methicillin resistance. Continued microbiological surveillance is warranted to guide empiric therapy and future prophylactic strategies.

Purpose:To analyze and compare functional and refractive postoperative outcomes of a low-addition refractive bifocal intraocular lenses (IOL) and its toric version at 1 month. Settings:Desgenettes Military Hospital, Lyon. Design:Single-center retrospective study. Methods:This study included 316 eyes of patients who underwent bilateral phacoemulsification with implantation of either the standard IOL, the Comfort LS-313 MF15 (n=245, group 1) or its toric version, the Comfort LS-313 MF15T (n=71, group 2). Patients were evaluated at 7 days and 1 month postoperatively to measure uncorrected and corrected distance (UDVA and CDVA), uncorrected intermediate (UIVA), and near (UNVA) visual acuity at 4 meters, 60 cm and 40 cm. Spectacle independence and photic phenomena were assessed using a modified McAlinden questionnaire. Results:At one month, both groups had similar mean UDVA (0.004 vs 0.02 logMAR; p=0.063). UIVA (0.12 vs 0.17 logMAR; p=0.783) and UNVA (0.34 vs 0.3 logMAR; p=0.292) were also comparable. CDVA was excellent (-0.009 vs -0.02 logMAR; p=0.348). The toric IOL significantly reduced residual astigmatism (p<0.01), with a mean of 0.23±0.34 D. Photic phenomena were minimal (score: 2.17), with no severe effects. Twenty-five patients responded to the questionnaire, 56% of them reported total or high spectacle independence. Conclusion:The low-addition refractive bifocal IOL and its toric version provide effective refractive correction, ensuring excellent UDVA and satisfactory UIVA. The toric model yields comparable outcomes to the non-toric version, with the added benefit of improved control of preoperative astigmatism. The refractive performance of the toric model remained consistent regardless of the axis of implantation and the position of the low addition segment. These findings demonstrate satisfactory functional outcomes, though validation in larger prospective studies with objective optical quality assessments is needed.

To evaluate the long-term effectiveness and safety of selective laser trabeculoplasty (SLT) for controlling intraocular pressure (IOP) in patients with steroid-induced ocular hypertension (OHT) treated with fluocinolone acetonide (FAc) intravitreal implants. This was a single-center retrospective case series of patients with steroid-induced OHT. Eligibility required prior to exposure to ≥ 3 sustained-release dexamethasone intravitreal implants per eye. SLT was performed in all eyes either before (group 1, n = 6), after (group 2, n = 6), or both before and after (group 3, n = 3) the FAc implantation. IOP was analysed with linear mixed-effects models (random intercept for eye). The mean IOP and within-eye variability (SD-IOP) were summarized for the pre-SLT and post-SLT periods. Fifteen eyes from thirteen patients treated for macular edema were followed for 32 ± 17.7 months after SLT. The mean IOP decreased by 14.2 mmHg across the cohort (p < 0,001). In group 1, which was treated with SLT before FAc implantation, the mean IOP decreased from 16.5 ± 4.8 mmHg to 13.7 ± 2.1 mmHg (p < 0.001) with significantly reduced IOP variability (-2.1 mmHg, p < 0.001). No eye required filtering surgery. Steroid-induced OHT resolved in all eyes within ≤ 4 months after the last dexamethasone implant and ≤ 36 months after the FAc implant. SLT is a safe, effective, and repeatable intervention for preventing or controlling IOP elevation in OHT responders’ eyes receiving FAc implants. Performing SLT prior to FAc injection may offer better IOP control and reduce variability in such patients.

Introduction Angioid streaks are rare, dark red, radiating fundus lesions surrounding the optic nerve head caused by breaks in Bruch's membrane. They predispose to choroidal neovascularization and recurrent hemorrhages requiring proactive management. Case description We report a 44-year-old pseudoxanthoma elasticum patient with bilateral, atypical macular angioid streaks and a 14-year follow-up.In 2011, fundus examination revealed horizontal angioid streaks traversing the macula bilaterally without evidence of choroidal neovascularization; best-corrected visual acuity was 10/10 Parinaud 2 both eyes. The left eye subsequently developed neovascularization complicated by macular hemorrhages. Within two years, bilateral neovascularization with recurrent macular hemorrhages developed, prompting transition from a PRN to a treat-and-extend regimen. After 11 years of intravitreal ranibizumab therapy, the right eye maintained baseline visual acuity, while the left eye progressively declined to 1/10 (Parinaud 16) due to fibrotic sequelae. Discussion This case illustrates an interesting angioid streak pattern, characterized by giant horizontal streaks crossing the fovea, an anatomical configuration associated with particularly high risk of choroidal neovascularization and submacular hemorrhages. The 14-year follow up demonstrates the limitations of a pro re nata regimen in these high-risk presentations, as delayed transition to treat-and-extend failed to prevent subfoveal fibrosis and severe visual loss in the left eye. Conversely, earlier treatment initiation and earlier transition to treat-and-extend protocol was associated with preserved vision in the right eye. This case could suggest that a proactive approach may optimize visual outcomes as in age related macular degeneration. There is a lack of guidelines and studies on this therapeutic strategy. Conclusion Close monitoring, assessment with optical coherence tomography angiography, and preventive education are essential, particularly regarding the risk of neovascularization and hemorrhage in patients with foveal-spanning angioid streaks. A proactive regimen may represent a more suitable and effective option for these patients when complications appear.

BACKGROUND/OBJECTIVES:To assess the effectiveness and safety of 0.19-mg fluocinolone acetonide implant (FAc-implant) in inflammatory macular oedema (MO). SUBJECTS/METHODS:This observational, retrospective, multicentre cohort included consecutive eyes treated with FAc-implant between June 2020 and January 2024 for recurrent uveitic or postoperative MO requiring at least two prior dexamethasone-implants (DEX-implants) and ≥6 months of follow-up. The primary endpoints were best-corrected visual acuity (BCVA) and central macular thickness (CMT) at 6, 12, 18, and 24 months. The secondary endpoints were anatomical and functional outcomes, additional treatments and safety outcomes (intraocular pressure (IOP), ocular hypertension (OHT)). RESULTS:A total of 73 eyes were included, with a mean follow-up of 16.8 (8.4) months. The median difference in BCVA was +4.0 [0.0;10.0] (p < 0.001), +2.0 [0.0;9.0] (p = 0.006), +5.0 [0.0;10.0] (p = 0.010) and +5.0 [0.0;9.0] (p = 0.043) letters at 6, 12, 18 and 24 months. The median difference in CMT was -71.0 [-181.3;-25.5] (p < 0.001), -71.0 [-195.0;-30.5] (p < 0.001), -75.0 [194.0;-43.0] (p < 0.001) and -154.0 [-253.0;-110.0] (p < 0.001) μm at 6, 12, 18 and 24 months. Over the follow-up, 38 eyes (52.1%) did not require any additional intravitreal treatment. At 12 months after FAc-implant, the probability of not receiving a rescue injection of DEX-implant was 54.0% [43.0%;67.0%]. Eight eyes (11.0%) developed OHT (IOP ≥ 25 mmHg or an increase in IOP ≥ 10 mmHg), mostly resolved by IOP-lowering eye drops; two eyes required surgery. CONCLUSIONS:This real-life study shows the functional and anatomical effectiveness of the FAcimplant in recurrent inflammatory MO, with limited adverse effects and a reduced treatment burden.

INTRODUCTION:The SHIFT-HB study (SwitcH Faricimab Treatment in High Burden patients) aimed to evaluate the anatomical and functional outcomes -and the short-term stability of extended dosing intervals- after switching to faricimab in high treatment burden (HB) neovascular age-related macular degeneration (nAMD) previously treated with first-generation anti-VEGF agents. The primary aim was to assess treatment interval changes after 6 intravitreal injections (IVI) and the persistence of interval gains between the 5th and 6th faricimab IVI. METHODS:Single-center, retrospective real-world study (November 2023-November 2024; tertiary center Edouard Herriot Hospital, Lyon). Eligible eyes had nAMD requiring ≤8-weeks intervals despite ≥6 prior aflibercept or ranibizumab injections. After the switch, all eyes received ≥6 faricimab IVIs under a proactive Treat-and-Extend regimen. Short-term stability was defined, among eyes with any interval gain, as a prescribed interval at V6 identical to or longer than that at realized at V5. RESULTS:190 eyes from 158 patients (mean age 81 ± 7.5 years; 57.9% female) were included. The mean pre-switch interval was 4.9 ± 1.2 weeks and increased to 6.7 weeks after 6 faricimab IVIs (p=5.85x10-20). Interval increased in 61.6% of eyes; among these, 45% gained ≥ 3 weeks (range +3 to +8). Short-term stability between V5 and V6 occurred in 82.3% of responders. The maximum interval was first achieved at V6 in 52.1% of responder eyes. Among eyes with paired baseline and V6 measurements, best corrected visual acuity remained stable (69.2 vs 71.2 ETDRS letters; p=0.67), while central retinal thickness (CRT) decreased (303.1 µm to 287.2 µm; p=9.98x10-4). Intraocular inflammation occurred in 7 eyes (3.7%; 0.61% of injections) and led to drug discontinuation. CONCLUSION:In real world HB nAMD, switching to faricimab enabled a significant extension of injection intervals in nearly two-thirds of eyes while maintaining vision and improving OCT anatomy, supporting faricimab as a strategy to reduce treatment burden in this difficult to treat population.

Purpose To describe a case of carboplatin-induced macular toxicity occurring during systemic treatment for metastatic non–small cell lung cancer (NSCLC). Methods Retrospective case report with a literature review. Results A 48-year-old man developed bilateral vision loss one week after receiving a second cycle of chemoimmunotherapy consisting of carboplatin, pemetrexed, and pembrolizumab administered intravenously every four weeks. Clinical evaluation revealed rapidly progressive bilateral visual decline with a central scotoma. Multimodal imaging demonstrated foveal hyperautofluorescence and disruption of the foveal ellipsoid zone in both eyes. Electrophysiological testing showed foveal peak impairment on multifocal ERG, consistent with a toxic mechanism. Ocular and systemic findings were not suggestive of a paraneoplastic process. Following discontinuation of carboplatin, anatomical and functional abnormalities stabilized. Conclusion Carboplatin-induced toxic maculopathy is rare and may result in visual acuity loss. Multimodal imaging indicates involvement of foveal photoreceptor. The reversibility of structural and functional changes after treatment cessation remains uncertain.

To assess the evolution of retinal atrophy secondary to focal laser photocoagulation (FLP) for telangiectatic capillaries (TelCaps) in patients with diabetic macular oedema (DMO) or macular oedema secondary to retinal vein occlusion (MERVO). A multicentre retrospective study was conducted in DMO or MERVO patients who underwent at least one FLP session for TelCaps followed for 36 months after FLP. The post-FLP horizontal diameter and surface area of atrophic scars were measured by Optical Coherence Tomography (OCT) and on the OCT infrared image, respectively. The degree of atrophy was quantified on the OCT B-scan. Sixty-nine eyes of 61 patients were included, corresponding to 86 laser scars analysed. The mean scar diameter increased from 315 ± 162 µm at month 1 (M1) to 350 ± 167 µm at M36 (mean increase: 35 µm, p < 0.001). The mean scar area increased from 0.10 ± 0.09 mm2 at M1 to 0.13 ± 0.10 mm2 at M36 (mean increase: 0.03 mm2, p < 0.01) At M1, 2 (2.6

The aim of this prospective randomized bicenter study was to compare the effects of continuous versus intermittent use of tear substitutes on the ocular surface and dry eye symptoms in patients receiving repeated and frequent intravitreal injections (IVIs) for neovascular age-related macular degeneration (nAMD). Patients with nAMD treated with anti-vascular endothelial growth factor (anti-VEGF) for more than 1 year at 4–8-week intervals were included. The intermittent treatment group received standard 1.5

PURPOSE:The identification of telangiectatic capillaries (TelCaps) in chronic macular oedema (ME) resistant to conventional intravitreal injections (IVIs) has renewed interest in focal laser treatment. However, the indications and modalities of this laser treatment remain to be clarified. METHODS:A modified Delphi approach was used to establish a consensus among French macular laser specialists regarding recommendations on assessment of TelCaps, indications for laser treatment, treatment procedures and follow-up. RESULTS:Presence of TelCaps should be considered in cases of recurrent vascular oedema that do not respond, or partially respond, to IVIs. A strong consensus has emerged on treating TelCaps with laser when they are located ≥1000 μm from the fovea and associated with thickening of the surrounding retina, usually in combination with IVIs. For TelCaps located <1000 μm from the centre, IVIs alone were preferred. ICG-guided laser treatment was advised to target TelCaps but was not considered mandatory if TelCaps were visible on fundus photography or OCT. Assessment of the effectiveness of laser treatment should be based on reduction in macular thickness on OCT after 3 months, before a second laser session may be considered. Although experts have recommended the use of small, short-duration impacts allowing greying of the lesion, no consensus has been reached on the optimal numerical parameters for the laser procedure. CONCLUSION:This study provides precise guidelines on laser treatment for vascular ME in cases of TelCaps, and emphasizes the need for standardized lesion selection and laser parameters to ensure safe and effective ME management.

INTRODUCTION:Submacular hemorrhage (SMH) is a severe complication of neovascular age-related macular degeneration (nAMD), often causing profound vision loss. The aim of this study was to assess the long-term outcomes of SMH patients managed with anti-VEGF monotherapy (MT) versus surgical displacement (SD) and to identify prognostic factors for visual acuity. METHODS:This multicenter retrospective study included patients with SMH secondary to nAMD treated in three hospitals in Lyon between 2018 and 2023. Patients were treated with MT or underwent pneumatic displacement (PD) or SD. The best-corrected visual acuity (BCVA) and clinical parameters were assessed at baseline (time of SMH onset), months 1, 3, 9, and 12. RESULTS:Sixty-six eyes were included: 33 received MT, 6 underwent PD, and 27 underwent SD. The baseline VA was strongly reduced (mean BCVA: 0.14). The VA improved to 0.21 at M1, 0.29 at M3, and 0.33 at M6 but was stabilized at 0.28 at M12. At M12, VA did not significantly differ between MT and SD groups (0.27 vs. 0.32, p = 0.624). However, multivariate analysis revealed a significantly greater VA gain in the SD group (p = 0.025), despite more severe baseline characteristics. SMH thickness was significantly associated with a poorer VA (p = 0.02). CONCLUSION:SD may offer greater visual improvement in cases of large and thick SMH. Maximum SMH thickness appears to be a key prognostic factor. Treatment decisions should consider initial hemorrhage severity.

To compare the efficacy and safety between a first and a second injection of fluocinolone acetonide implants (FAc-I) in the treatment of diabetic macular oedema (DMO). This retrospective, multicentre cohort study included eyes with chronic DMO that received two consecutive FAc-I injections. We analysed visual and anatomical outcomes, additional DMO treatments, and intraocular pressure (IOP)-related adverse events. We included 61 eyes from 44 patients. Stable or improved BCVA was observed in 100% of eyes after the first injection and in 93% after the second, demonstrating statistical equivalence within a ±15% margin (p = 0.005). Statistical equivalence was also found for the lowest CRT (±10% margin, p < 0.001) and for the proportion of eyes with ≥20% CRT decrease (±20% margin, p = 0.026). The proportion of patients requiring additional treatments during the first year was equivalent between injections (p = 0.036), with a therapeutic burden reduction of 63% and 59%, respectively. Regarding peak IOP, equivalence was observed between the two injections (±5 mmHg margin, p < 0.001). The incidence of OHT was numerically higher after the second injection (19.7% vs 11.5%, p = 0.302), but this difference was not statistically significant. Multiple FAc-I injections are a safe and effective treatment option for chronic DMO in real life. The second injection maintained similar functional and anatomical outcomes to the first, supporting the sustainability and repeatability of the treatment.

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.

PurposeTo compare two swept-source OCT optical biometers, the Anterion® (Heidelberg Engineering GmbH, Heidelberg, Germany) and the IOLMaster 700® (Carl Zeiss Meditec AG, Jena, Germany), in the analysis of biometric data, intraocular lens (IOL) calculation and postoperative spherical equivalent predictability.MethodsThis was a real-life, single-center, retrospective study including 152 eyes of 81 consecutive patients referred for cataract surgery. All patients were examined with the IOLMaster 700® and the Anterion®. Biometric data (axial length [AL], anterior chamber depth [ACD], mean keratometry [Km], K1 [flat keratometry], K2 [steep keratometry] and axis, TK1 [flat total keratometry], TK2 [steep total keratometry], central pachymetry, lens thickness [LT], white-to-white distance [WTW]), IOL calculation with the SRK/T formula, and postoperative refractive outcome at 1 month were compared.ResultsAll biometric measurements were significantly different between the two biometers. Correlations were excellent for AL, pachymetry, ACD, LT and keratometry measurements, and for the IOL calculation (r>0.96, intraclass correlation coefficient=1). The IOL power for emmetropia was similar between both biometers when the SRK/T formula was used (20.84±3.24D versus 20.86±3.29D, P=0.61). The mean postoperative spherical equivalent prediction error calculated using the SRK/T formula was 0.03±0.5D for the IOLMaster 700® versus 0.01±0.47D for the Anterion® (P=0.12).ConclusionsThis study showed excellent correlation and agreement for the biometric measurements and the IOL power calculation with the SRK/T formula between both biometers.

Objectives: To compare central corneal topography (CT) obtained using the IOLMaster 700 (R) biometer to corneal topography obtained using a Swept-Source OCT-based predicated topographer (PT), in candidates for toric intraocular lens (IOL) implantation. Methods: A retrospective comparative study was conducted in consecutive patients undergoing a routine cataract surgery assessment with significant astigmatism on keratometry. Each patient was examined using both the IOLMaster 700 (R) (Carl Zeiss Meditec, Jena, Germany) and the Anterion (R) (Heidelberg Engineering, Heidelberg, Germany) for routine preoperative measurements. The corneal axial anterior power map obtained with each device was then anonymized and analysed independently by two ophthalmologists using a reading grid. The reading grid assessed the usual parameters describing astigmatism and evaluated if a toric IOL was indicated or a second topography examination was needed to confirm the indication. ResultsIn total, 169 eyes of 120 patients were included. The inter-examination agreement for the astigmatism description ranged from 56 to 85% depending on the reader and parameter. The decision to implant a toric IOL based on the axial map was the same in 59-60% of cases depending on the examiner. A second examination was needed in 18-25% and 8-14% of cases after CT and PT, respectively. The IOLMaster 700 (R) central anterior axial map allowed toric IOL implantation in 58-70% of cases with no need for second corneal examination. Conclusion: The agreement between the anterior axial maps obtained using both devices was good. However, in about a quarter of the cases, dedicated topography had to be performed to confirm the surgical indication.

Background Anti-VEGF’s have changed the prognosis of exudative age-related macular degeneration (AMD). Ranibizumab and aflibercept have proven their functional efficacy, but their use has revealed in real life a wide variety of patient profiles with varied responses to treatment. This work focused on patients receiving "intensive" IVT treatment with a sustained injection rhythm, also referred to as having a high treatment burden. Objective The main objective of this work was to determine, in real-life conditions, the proportion of patients receiving "intensive" treatment among those being followed for exudative AMD. Secondary objectives were to analyze the long-term functional outcomes of these patients, their anatomical characteristics, and the evolution of their treatment regimen. Method A retrospective descriptive single-center real-life study was conducted on patients treated for exudative AMD with intensive treatment (intervals of less than 8 weeks during the first year of treatment). A subgroup analysis compared patients who exceeded Q8 during follow-up (Group 1) versus patients remaining in intensive treatment (Group 2). Results A total of 301 records were analyzed, with 24.9% of the eyes (n = 75) considered under intensive treatment. The mean age was 84 years (± 7.5), and 61% were men. Type 1 choroidal neovascularization (CNV) accounted for 64% of our cohort, type 2 CNV represented 29.3%, and type 3 was involved in 6.7%. The mean follow-up was 5.6 years (± 3.6), with an average number of 41 IVT (± 26.7). Visual acuity was maintained at 0.53 (± 0.2) baseline vs. 0.61 (± 0.2) after 5 years of follow-up (p = 0.02). Central retinal thickness (CRT) and subretinal fluid (SRF) were significantly reduced during our follow-up, and PED height remained stable. Almost half of the eyes (44%) had an extension of their interval (> Q8) beyond the first year; however, this objective was achieved on average after 4.5 years of treatment. The visual acuity of Group 2 (< Q8), despite receiving more injections, was superior to that of Group 1 (> Q8) with baseline values of 0.57 (± 0.2) and 0.48 (± 0.2) (p = 0.161) respectively, and at 5 years 0.79 (± 0.2) and 0.54 (± 0.2) (p = 0.026). Similarly, CRT, PED height, and SRF were higher in Group 2. The distribution of neovascular types showed more type 2 in Group 1 (45.5% vs. 16.7%). Conclusion Patients requiring intensive treatment represent about ¼ of our AMD patient population. Despite the high treatment burden, these patients maintain their visual acuity at 5 years. An extension of intervals is observed in nearly half of the patients, occurring late. Intensive treatment during the first year appears to be predictive of a future hight treatment burden.