Aims: To investigate the putative association between semaglutide and non‐arteritic anterior ischaemic optic neuropathy (NAION). Materials and Methods: Data from national health registries in Denmark (2018–2024) and Norway (2018–2022) were used to compare NAION risk in individuals with type 2 diabetes initiating semaglutide versus sodium‐glucose co‐transporter 2 inhibitors (SGLT‐2is). A supplementary self‐controlled analysis examined NAION risk among all semaglutide users. National estimates were pooled using a fixed‐effects model. Results: We identified 44 517 users of semaglutide for the management of type 2 diabetes in Denmark and 16 860 in Norway, with a total of 32 NAION events observed. The unadjusted incidence rate of NAION was 2.19/10 000 person‐years among Danish semaglutide initiators, compared to 1.18 among SGLT‐2i initiators. In Norway, the corresponding rates were 2.90 and 0.92, respectively. After adjustment, the pooled hazard ratio (HR) was 2.81 (95% confidence interval [CI] 1.67–4.75), and the incidence rate difference (IRD) was +1.41 (95% CI +0.53 to +2.29) per 10 000 person‐years. Estimates were consistent across both countries but higher and less precise in Norway (HR 7.25; 95% CI 2.34–22.4) compared to Denmark (HR 2.17; 95% CI 1.20–3.92). Results remained consistent across sensitivity and supplementary analyses, with a stronger association observed in a post hoc per‐protocol analysis (HR 6.35; 95% CI 2.88–14.0). In the supplementary self‐controlled study, symmetry ratios (SRs) for NAION were 1.14 (95% CI 0.55–2.36) in Denmark and 2.67 (95% CI 0.91–8.99) in Norway. Conclusions: The use of semaglutide for managing type 2 diabetes is associated with an increased risk of NAION compared with the use of SGLT‐2is. However, the absolute risk remains low.

Purpose: To analyse current off-label use of bevacizumab for wet age-related macular degeneration (AMD) in Europe. Methods: The study was conducted as a combined survey and literature review. It included the 22 most populous countries in Europe. In each country, ophthalmologists with particular knowledge about off-label treatment responded to a questionnaire. Results: Answers were obtained from twenty European countries. The off-label use of bevacizumab for wet AMD greatly differed between nations; the bevacizumab proportion varied from non-existent (0%) to very high (97%). There were also large disparities within single countries (e.g. 0–80%), which were attributable to differences in regional decision-making. Both governmental institutions and national ophthalmological societies expressed highly diverging opinions on the use of off-label treatment. Intravitreal administration of bevacizumab had been a matter of legal dispute in several countries. The question about responsibility for off-label therapy mainly remained unanswered. Conclusions: There was a highly varying utilization of bevacizumab between European countries. Despite an intention of a consistent approach to medical regulations, Europe has not yet reached a professional or political consensus on the ophthalmic off-label use of bevacizumab.

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Purpose To describe the first 13 years of anti‐vascular endothelial growth factor (anti‐VEGF) therapy from the perspective of a public ophthalmic department serving a local community of almost one million people. Methods Retrospective registry study. Data from Oslo University Hospital, Norway were collected from 2006 through 2018. Hospital episode statistics were searched for episodes of care encompassing intravitreal anti‐VEGF procedures. Patient‐specific ID numbers, diagnoses, and drug codes were registered. In general, bevacizumab was used as first‐line treatment, with aflibercept reserved for resistant cases from 2013. Results The number of unique patients treated per year increased from 130 in 2006 to 3428 in 2018. In 2018, 2488 (73%) patients had also received treatment the previous year. The number of yearly injections increased from 228 in 2006 to 25 570 in 2018. In 2018 the diagnosis macular degeneration constituted 69% of injections, diabetic retinopathy constituted 15%, retinal vein occlusion constituted 13%, and other diagnoses constituted 3%. In the same year 49% of injections were with bevacizumab, 46% with aflibercept, 4% with ranibizumab, and 1% with dexamethasone implants. The bevacizumab to aflibercept ratio was almost 1:1 for macular degeneration and diabetic retinopathy; for retinal vein occlusion the ratio was 13:7. Conclusion In 13 years there was an approximately 100‐fold increase in the number of yearly intravitreal injections. A majority of patients received long‐term treatment. Macular degeneration was the most common diagnosis. Using bevacizumab as first‐line treatment, with aflibercept reserved for resistant cases from 2013, eventually resulted in a nearly 1:1 ratio in drug usage.

To compare accuracy, precision, and residual volume of commonly used syringes for intravitreal injections (IVI), and to assess the intraocular pressure (IOP) rise by variations in volumes delivered. Experimental lab study. No subjects were involved in this study. We tested 8 syringe models with 2 different needle setups, with 2 different solutions (distilled water or glycerin) and target volumes (50 and 70 μL). To obtain the delivered and residual volumes, we weighed the syringe-needle setups with scale before liquid withdrawal, with liquid, and after liquid release. We also created an experimental eye model to determine the transient rise in IOP following stepwise 10-μL increases in injection volumes. Delivered and residual volumes, IOP rise. We tested a total of 600 syringe-needle setups. BD Ultra-Fine (0.34 ± 0.28 μL), Zero Residual (1.53 ± 1.15 μL) and Zero Residual Silicone Oil-free (1.40 ± 1.16 μL) syringes showed the lowest residual volume (p<0.001) in comparison to the others (range: 24.86 ± 1.78 μL for Injekt-F to 51.97 ± 3.37 μL for Omnifix-F). The most accurate setups were (percentage deviation from target volume): Zero Residual Silicone Oil-free (+0.70%), Zero Residual 0.3 mL (+4.49%), BD Ultra-Fine (+7.83%), Injekt-F (9.42%), Norm-Ject (+15.88%), Omnifix-F (+16.96%), BD Plastipak Brazil (+17.96%), and BD Plastipak Spain syringes (+19.41%). There was a statistically significant difference between the Zero Residual Silicone Oil-free syringe and all other syringes (p<0.0001), except for the Zero Residual 0.3 mL syringe (p=0.029). The coefficient of variation was low for all syringes. The modeled IOP rise ranged from 32.3 (SD 1.4) mmHg for 20-μL injection volume to 76.5 (SD 1.0) mmHg for 80-μL injection volume. For the standard 50-μL injection volume, the peak pressure was 50.7 (SD 0.1) mmHg, and the pressure rise duration was 28 (SD 2) minutes. There were significant differences in accuracy and residual volume between syringes, whereas they showed a high precision. Volume excess results in a considerable increase in IOP rise following injection. These findings may provide a relevant overview to clinicians and to both device and drug manufacturers regarding pharmacoeconomic, safety and efficacy issues.