Improved brilliant blue G staining of the internal limiting membrane with sharp cut filters of a novel viewing filter system

Long-term longitudinal study of patients treated with ranibizumab for neovascular age-related macular degeneration

PURPOSE OF REVIEW

To review the current literature regarding long-term treatment beyond 2 years with anti-vascular endothelial growth factor (VEGF) inhibition for neovascular age-related macular degeneration (nv-AMD).

RECENT FINDINGS

Only few studies of anti-VEGF treatment for nv-AMD exist beyond 2 years, and the number of patients followed for 4 years or longer is small. The results of studies show that the majority of patients with nv-AMD can preserve visual acuity compared with baseline, subgroups reveal large variations in visual benefit. Approximately 20-30% of patients seem to respond poorly to the treatment, and 20% obtain a condition with inactivity and good results. The majority of patients will need continuous active treatment. Long-term decline of visual acuity reflects the natural progression of the disease, however, insufficient treatment cannot be excluded leaving a potential for further improvement. Close follow-up to detect recurrent activity of nv-AMD and activity in fellow eye is important. Definitive evidence of systemic side-effects is lacking, but long-term VEGF inhibition seems to be tolerated well with few ocular and systemic complications.

SUMMARY

The majority of patients with nv-AMD can preserve visual acuity and expect long-term treatment beyond 2 years. Ocular complications and systemic adverse events remain few.

Factors influencing the exudation recurrence after cataract surgery in patients previously treated with anti-vascular endothelial growth factor for exudative age-related macular degeneration

PURPOSE

To investigate factors influencing exudation recurrence following cataract surgery in patients already treated with anti-vascular endothelial growth factor (VEGF) agents for exudative age-related macular degeneration (AMD).

METHODS

A retrospective review of medical records was performed for patients who underwent cataract surgery and had been previously treated with anti-VEGF for exudative AMD. Visual acuity was examined before surgery and 1 and 6 months after surgery. The time between diagnosis and surgery, and the exudation-free period before surgery were examined and compared between patients who had exudation recurrence and those that did not.

RESULTS

Thirty-nine eyes of 39 patients were included in analyses. The logarithm of the minimum angle of resolution visual acuity was 1.02 ± 0.58 and had significantly improved 1 month (0.81 ± 0.62, P < 0.001) and 6 months (0.85 ± 0.64, P = 0.001) following surgery. Both the diagnosis-to-surgery period (P = 0.001) and the preoperative exudation-free period (P < 0.001) were significantly longer in patients without recurrence than in patients with recurrence.

CONCLUSIONS

Cataract surgery was beneficial in patients previously treated with anti-VEGF for exudative AMD. Our data suggests that cataract surgery should be performed after a sufficiently long exudation-free period to minimize exudation recurrence. But larger prospective studies are required to draw definitive clinical guidelines.