Intravitreal injections (IVI) have become the most common intraocular procedure worldwide with increasing numbers every year. The article presents the most up-to-date review on IVI epidemiology and techniques. Unfortunately, important issues related to pre-, peri- and postinjection management lack randomized clinical trials for a final conclusion. Also, a great diversity of approaches exists worldwide. Therefore, expert consensus recommendations on IVI techniques are provided.

Aim The current accepted standard treatment for neovascular age-related macular degeneration (AMD) consists of antivascular endothelial growth factor agents including ranibizumab and bevacizumab. The aim of the study was to examine whether bevacizumab is inferior to ranibizumab with respect to maintaining/improving visual acuity. Methods In this prospective randomised parallel group multicentre trial patients aged more than 50 years with treatment naive nAMD were included at 10 Austrian centres. Patients were randomised to treatment either with 0.5 mg ranibizumab or 1.25 mg bevacizumab. Both groups received three initial monthly injections and thereafter monthly evaluation of visual acuity and the activity of the lesion. Re-treatment was scheduled as needed. Outcome measures were early treatment of diabetic retinopathy visual acuity, retinal thickness, lesion size and safety evaluation. Results A total of 321 patients were recruited of which four had to be excluded due to different reasons. Of the 317 remaining patients 154 were randomised into the bevacizumab group and 163 into the ranibizumab group. At month 12, there was a mean increase of early treatment of diabetic retinopathy visual acuity of 4.9 letters in the bevacizumab and 4.1 letters in the ranibizumab group (p=0.78). Furthermore, there were no significant differences in the decrease of retinal thickness, change of lesion size and number of adverse events between the groups. Conclusions Bevacizumab was equivalent to ranibizumab for visual acuity at all time points over 1 year. There was no significant difference of decrease of retinal thickness or number of adverse events.

Purpose. The present experiments were undertaken to evaluate the validity of absolute flow velocity measurements with a dual-beam bidirectional Doppler Fourier-domain optical coherence tomography (FD-OCT) system. Methods. The flow velocities of diluted milk through a glass capillary were measured at 30 different preset velocities in the range of 0.9 to 39.3 mm/s by bidirectional Doppler FD-OCT. The flow through the capillary was controlled by two infusion pumps working in different flow ranges and based on different technical principles. In vivo the validity of the method for measuring blood flow in retinal vessels was tested at bifurcations. The continuity equation was verified at 10 retinal venous bifurcations of 10 young healthy subjects (mean age, 29 ± 3 years) by velocity measurements, using dual-beam bidirectional Doppler FD-OCT, and measurements of retinal diameters, using the Dynamic Vessel Analyzer. Results. Flow velocities as measured with bidirectional Doppler FD-OCT in the glass capillary were in good agreement with the preset velocities (r = 0.994, P < 0.001 each). No significant difference was found between flow in the trunk vessels before the bifurcation (11.3 ± 5.2 μL/min) and the sum of flows in the daughter vessels (10.7 ± 4.8 μL/min). A significant association was found between retinal vessel diameters and both retinal blood velocities (r = 0.72, P < 0.001) and retinal blood flow (r = 0.95, P < 0.0001). Conclusions. Dual-beam bidirectional Doppler FD-OCT delivered accurate retinal blood velocity values and, thus, offers high potential for examination of retinal blood flow in ocular disease.

Purpose. To characterize retinal metabolism during normoxia and hyperoxia in healthy subjects. Methods. Forty-six healthy subjects were included in the present study, and data of 41 subjects could be evaluated. Retinal vessel diameters, as well as oxygen saturation in arteries and veins, were measured using the Dynamic Vessel Analyzer. In addition, retinal venous blood velocity was measured using bidirectional laser Doppler velocimetry, retinal blood flow was calculated, and oxygen and carbon dioxide partial pressures were measured from arterialized capillary blood from the earlobe. Measurements were done during normoxia and during 100% oxygen breathing. Results. Systemic hyperoxia caused a significant decrease in retinal venous diameter (−13.0% ± 4.5%) and arterial diameter (−12.1% ± 4.0%), in retinal blood velocity (−43.4% ± 7.7%), and in retinal blood flow (−57.0% ± 5.7%) (P < 0.001 for all). Oxygen saturation increased in retinal arteries (+4.4% ± 2.3%) and in retinal veins (+19.6% ± 6.2%), but the arteriovenous oxygen content difference significantly decreased (−29.4% ± 19.5%) (P < 0.001 for all). Blood oxygen tension in arterialized blood showed a pronounced increase from 90.2 ± 7.7 to 371.3 ± 92.7 mm Hg (P < 0.001). Calculated oxygen extraction in the eye decreased by as much as 62.5% ± 9.5% (P < 0.001). Conclusions. Our data are compatible with the hypothesis that during 100% oxygen breathing a large amount of oxygen, consumed by the inner retina, comes from the choroid, which is supported by previous animal data. Interpretation of oxygen saturation data in retinal arteries and veins without quantifying blood flow is difficult. (ClinicalTrials.gov number, NCT01692821.)

Animal experiments indicate that the inner retina keeps its oxygen extraction constant despite systemic hypoxia. For the human retina no such data exist. In the present study we hypothesized that systemic hypoxia does not alter inner retinal oxygen extraction. To test this hypothesis we included 30 healthy male and female subjects aged between 18 and 35 years. All subjects were studied at baseline and during breathing 12% O₂ in 88% N₂ as well as breathing 15% O₂ in 85% N₂. Oxygen saturation in a retinal artery (SO_2art) and an adjacent retinal vein (SO_2vein) were measured using spectroscopic fundus reflectometry. Measurements of retinal venous blood velocity using bidirectional laser Doppler velocimetry and retinal venous diameters using a Retinal Vessel Analyzer (RVA) were combined to calculate retinal blood flow. Oxygen and carbon dioxide partial pressure were measured from earlobe arterialized capillary blood. Retinal blood flow was increased by 43.0 ± 23.2% ( P < 0.001) and 30.0 ± 20.9% ( P < 0.001) during 12% and 15% O₂ breathing, respectively. SO_2art as well as SO_2vein decreased during both 12% O₂ breathing (SO_2art: −11.2 ± 4.3%, P < 0.001; SO_2vein: −3.9 ± 8.5%, P = 0.012) and 15% O₂ breathing (SO_2art: −7.9 ± 3.6%, P < 0.001; SO_2vein: −4.0 ± 7.0%, P = 0.010). The arteriovenous oxygen difference decreased during both breathing periods (12% O₂: −28.9 ± 18.7%; 15% O₂: −19.1 ± 16.7%, P < 0.001 each). Calculated oxygen extraction did, however, not change during our experiments (12% O₂: −2.8 ± 18.9%, P = 0.65; 15% O₂: 2.4 ± 15.8%, P = 0.26). Our results indicate that in healthy humans, oxygen extraction of the inner retina remains constant during systemic hypoxia.

Purpose: The purpose of this study is to compare the ability of spectral domain optical coherence tomography angiography (SD-OCTA) and indocyanine green angiography (ICGA) to detect and measure lesion area in patients with type 1 and 2 choroidal neovascularization (CNV). Methods: Types 1 and 2 neovascular AMD (nAMD) were included in this prospective and observational case series. ETDRS best-corrected visual acuity (BCVA), ophthalmic examination with funduscopy, OCTA (AngioVue), fluorescein angiography (FA), ICGA, and OCT (Spectralis) were performed. CNV measurements were done manually by two experienced graders using the systems' innate region selection tools. Results: Forty eyes of 39 consecutive patients with nAMD were included. Mean age was 77 ± 6.4 years, ETDRS BCVA was 67 ± 13 letters, and 11 eyes were treatment naïve. Nineteen CNV lesions were classified as type 1 and 21 as type 2. ICGA was able to identify CNV in all eyes. By contrast, OCTA detected CNV in 95% of type 1 and 86% of type 2 nAMD eyes. Mean overall CNV area (CNV-A) was 2.8 ± 2.7 mm² in ICGA and 2.1 ± 2.7 mm² in OCTA. Both lesion types CNV-A appeared significantly smaller in OCTA compared with ICGA (P < 0.01). Bland-Altman plot revealed a mean difference (bias) between OCTA and ICGA CNV-A of 0.76 ± 1.74 mm². Intraclass correlation coefficient (ICC) for CNV-A was 0.91 and 0.93 for ICGA and OCTA, respectively. ICGA CNV-A in the four OCTA-negative eyes (median 4.7 mm²) was not significantly different from the 36 OCTA-positive eyes (median 1.7 mm²). Conclusions: Type 1 and 2 CNV-A were significantly smaller in OCTA than in ICGA. OCTA was generally less successful in detecting CNV than ICGA in patients who were included into this study based on FA and OCT. However, OCTA detected all type 1 lesions except for one, indicating that the SD-OCTA signal is limited by detection limits of blood flow velocity rather than lesion type. Further efforts are needed pushing the limits of lowest detectable and fastest distinguishable flow until OCTA can deliver realistic qualitative and quantitative imaging of type 1 and 2 CNV for diagnosis and monitoring.