INTRAVITREAL DEXAMETHASONE FOR THE TREATMENT OF MACULAR EDEMA SECONDARY TO HYDROXYCHLOROQUINE TOXICITY

PURPOSE

Cystoid macular edema is a vision-threatening complication infrequently associated with hydroxychloroquine retinal toxicity. There are limited data on the best treatment for this pathology.

METHODS

A retrospective case series is presented.

RESULTS

In this series, we present three cases of cystoid macular edema in patients with diagnosed hydroxychloroquine maculopathy successfully treated with intravitreal dexamethasone implantation.

CONCLUSION

Minimal literature has been published regarding the best management of cystoid macular edema related to hydroxychloroquine toxicity. Our case series suggests a possible new agent in the treatment of this rare occurrence.

Effect of High-Dose Intravitreal Aflibercept, 8 mg, in Patients With Neovascular Age-Related Macular Degeneration: The Phase 2 CANDELA Randomized Clinical Trial

Importance

Aflibercept, 8 mg, may have greater therapeutic benefits compared with aflibercept, 2 mg, in patients with neovascular age-related macular degeneration (nAMD), including potentially improved outcomes and decreased treatment burden.

Objective

To assess safety and efficacy of aflibercept, 8 mg, in patients with nAMD.

Design, Setting, and Participants

The CANDELA trial was a phase 2, randomized, single-masked, open-label, 44-week clinical trial conducted in the US. Treatment-naive patients with active subfoveal choroidal neovascularization secondary to nAMD and a best-corrected visual acuity score of 78 to 24 letters (approximately 20/32 to 20/320) in the study eye were enrolled between November 2019 and November 2021.

Interventions

Eligible participants were randomized 1:1 to receive 3 monthly doses of 8 mg (70 μL) or 2 mg (50 μL) of aflibercept followed by doses at weeks 20 and 32.

Main Outcomes and Measures

Coprimary end points were the proportion of eyes without fluid (absence of intraretinal and subretinal fluid) in the central subfield at week 16 and safety.

Results

All 106 eligible eyes were randomized to receive aflibercept, 8 mg (n = 53), or aflibercept, 2 mg (n = 53). Overall, 66 participants (62.3%) were female. The proportion of eyes without fluid in the central subfield with 8-mg vs 2-mg aflibercept was 50.9% (n = 27) vs 34.0% (n = 18) (difference, 17.0 [95% CI, -1.6 to 35.5] percentage points; P = .08) at week 16 and 39.6% (n = 21) vs 28.3% (n = 15) (difference, 11.3 [95% CI, -6.6 to 29.2] percentage points; nominal P = .22) at week 44. At week 44, mean (SE) change in central retinal thickness was -159.4 (16.4) vs -137.2 (22.8) μm with 8 mg vs 2 mg of aflibercept, respectively (least squares mean difference, -9.5 [95% CI, -51.4 to 32.4]; nominal P = .65) and mean (SE) change in best-corrected visual acuity score was +7.9 (1.5) vs +5.1 (1.5) letters (least squares mean difference, +2.8 [95% CI, -1.4 to +7.0]; nominal P = .20). No differences in safety profiles between the groups were observed.

Conclusions and Relevance

Although aflibercept, 8 mg, did not achieve the primary efficacy end point at week 16 at the 2-sided significance level of 5%, the observed trends in anatomic and visual improvements over 44 weeks with aflibercept, 8 mg, indicate potential additional therapeutic benefit over aflibercept, 2 mg. No new safety signals were observed over 44 weeks. These findings support further evaluation of aflibercept, 8 mg, in pivotal trials of exudative retinal diseases including nAMD and diabetic macular edema.

Trial Registration

ClinicalTrials.gov Identifier: NCT04126317.

SPECTRAL DOMAIN-OPTICAL COHERENCE TOMOGRAPHY FINDINGS OF COMMOTIO RETINAE WITH ASSOCIATED SEROUS RETINAL DETACHMENT

PURPOSE

To describe the appearance of a serous retinal detachment associated with commotio retinae on spectral domain optical coherence tomography.

METHODS

Case report.

RESULTS

This case demonstrates the rare presentation of subretinal fluid in commotio retinae. Characteristic outer retinal changes associated with commotio retinae were also seen. Treatment was deferred and the subretinal fluid resolved within 1 week.

CONCLUSION

Commotio retinae is rarely associated with a serous retinal detachment. This presentation is important to identify as it can avoid unnecessary workup and treatment.

Analysis of short-term change in subfoveal choroidal thickness in eyes with age-related macular degeneration using optical coherence tomography

BACKGROUND AND OBJECTIVE

To measure the subfoveal choroidal thickness in patients with age-related macular degeneration (AMD) over 6 months.

PATIENTS AND METHODS

A retrospective, observational study of patients with AMD followed up for 6 months at the New England Eye Center. Baseline and 6-month follow-up subfoveal choroidal thickness was measured using spectral-domain OCT and compared.

RESULTS

For the entire cohort, there was statistically significant thinning of the subfoveal choroidal thickness at 6 months compared to baseline that was driven by the cohort of patients with neovascular AMD (181.2 ± 75 μm to 173.4 ± 63 μm; P = .049).

CONCLUSION

There was a statistically significant decrease in subfoveal choroidal thickness observed in this cohort of patients with AMD over 6 months, but it was driven by the subgroup of patients with neovascular age-related macular degeneration.