Monitoring for potential inflammatory events following intravitreal anti-vascular endothelial factor (VEGF) injection is crucial with the use of new agents such as aflibercept 8 mg. Despite a safety profile comparable to aflibercept 2 mg in pivotal and phase 3 studies, reporting such cases in clinical practice helps evaluate potential risk of these agents. In this case series, a cluster of 8 patients manifesting acute intraocular inflammation (IOI) after intravitreal aflibercept 8 mg injection at three different centers are described. All patients developed inflammation of the vitreous and anterior chamber within 2–17 days following the injection. All subjects had previously received intravitreal anti-vascular endothelial growth factor (VEGF) therapy (ranibizumab, aflibercept 2 mg or faricimab) without injection-related complications. No signs of vasculitis, papillitis or retinitis were noted. In view of the clinical presentation, vitreous cultures were not performed. Inflammation resolved with topical steroids and non-steroidal anti-inflammatory drugs over a course of 11–24 days with excellent visual recovery. We report a cluster of injection-related ocular inflammation following intravitreal aflibercept 8 mg with at present unknown cause. It underlines the need for clinical awareness to detect such cases despite the low-risk safety profile in pivotal studies.

Purpose: To analyse the efficacy and outcome predictors of ranibizumab using a spectral-domain optical coherence tomography (SD-OCT)-driven treat-and-extend regimen (TER) versus SD-OCT-driven pro re nata regimen (PRN) in patients with cystoid macular oedema (CME) due to branch or central retinal vein occlusion (BRVO, CRVO). Methods: Retrospective, consecutive case series. Evaluation included best corrected visual acuity (BCVA), morphological parameters on SD-OCT, and treatment frequency. Results: From baseline to months 12, 18, and 24, BCVA improved by 16.6 ± 13.1, 15.5 ± 14.4, and 16.6 ± 15.8 letters, respectively, in TER (n = 45), compared to 11.3 ± 17.0, 11.0 ± 15.0, and 10 ± 20.5 letters in PRN (n = 31) (p = 0.152, p = 0.237, p = 0.172). The mean reduction in central retinal thickness was –261 ± 189, –272 ± 188, and –264 ± 158 μm, respectively, in TER, compared to –130 ± 196, –140 ± 210, and –166 ± 207 μm in PRN (p = 0.006, p = 0.017, p = 0.064). 59% (53%) of TER and 22% (17%) of PRN patients showed no intra- or subretinal fluid on SD-OCT at 12 (24) months. Using TER, the maximum recurrence-free treatment interval increased from 8.9 ± 2.3 weeks at 12 months to 9.8 ± 2.3 and 10.5 ± 2.7 weeks at 18 and 24 months, respectively. The number of injections was significantly higher in the TER than in the PRN group. Conclusions: In CME, due to BRVO/CRVO, TER provides better morphological outcome using more injections than PRN.

Purpose: Bilateral neovascular age‐related macular degeneration (nAMD) causes difficulties in daily life, especially with regard to near‐vision tasks, despite well preserved Early Treatment of Diabetic Retinopathy Study (ETDRS) best corrected visual acuity (BCVA) at distance. Therefore, alternative visual function measures were evaluated in terms of their correlation with vision‐related quality of life scores (QoL). Methods: A prospective cross‐sectional pilot study including patients with a diagnosis of bilateral nAMD having lesions within the central 1 mm ETDRS grid subfield. Standardised testing included a vision‐related QoL assessment (NEI‐VFQ25), best corrected visual acuity (BCVA), low luminance visual acuity (LLVA), Radner maximum reading speed and Pelli‐Robson contrast sensitivity (CS). Results: N = 54. The mean better eye (range) BCVA was 79 (55–96) letters, median (range) LLVA 79.5 (58–97) letters and median (range) CS 1.35 (0–1.65) log units. Mean binocular maximum reading speed was 117.33 ± 28.42 wpm. The best correlations with the near subscale score were found for CS followed by binocular maximum reading speed ( r = 0.59, p = 0.0001; r = 0.36, p = 0.008, respectively). A weaker correlation was observed for the BCVA in the better eye ( r = 0.33, p = 0.02). The correlation between the NEI‐VFQ25 distance subscale and BCVA was weaker ( r = 0.37, p = 0.005) than the correlations with CS ( r = 0.67, p = 0.0001) and LLVA ( r = 0.40, p = 0.003). Conclusions: For patients with a bilateral centre‐involving nAMD, the best correlation with near QoL was the better eye CS followed by maximum binocular reading speed. These measures could be valuable in quantifying vision‐related QoL outcomes in AMD clinical trials.

To report the efficacy and safety of switching to faricimab in a real-world, Swiss cohort of patients with pre-treated neovascular age-related macular degeneration (nAMD). Retrospective, multicenter, longitudinal observational study conducted at 11 centers of the Swiss Retina Research Network. We included 353 eyes of 325 patients who were switched to intravitreal faricimab after prior anti-vascular endothelial growth factor (anti-VEGF) therapy and followed for a minimum of 12 months between May 1, 2022 and October 30, 2024. Demographic characteristics, baseline functional and optical coherence tomography findings, treatment history, and outcomes at 12 months post-switch to faricimab were extracted from the patients' electronic case report forms. Change in best-corrected visual acuity (BCVA), central subfield thickness (CST), presence of retinal fluid (RF) and pigment epithelial detachment, treatment intervals and safety signals. Twelve months after switch, mean BCVA remained unchanged while mean CST decreased from 315.3 μm to 263.9 μm (p<0.01). Fast drying (absence of RF) after 1 faricimab injection was observed in 134 eyes (38%) and correlated positively with the treatment interval at 12 months (r(301)=0.24, p<0.01). After 12 months,169 (47.9%) eyes demonstrated absence of retinal fluid compared to 10.2% at switch. Mean treatment interval increased from 5.8 ± 2.5 weeks at switch to 8.3 ± 4.2 weeks at 12 months, whereas extended treatment intervals (≥12-week) were achieved in 20% of patients. Mild intraocular inflammation was reported in 1.7% of cases. Switching to faricimab in pre-treated nAMD led to sustained anatomical improvements and stabilization of BCVA, with a substantial reduction in RF compared to baseline. Our results suggest the potential benefits of this switch strategy based on real-world data.

Anti-vascular endothelial growth factor (anti-VEGF) therapies have become the standard of care in the treatment of neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME), resulting in a remarkable decrease in disease-related vision loss. However, the need for regular injections places a significant burden on patients, caregivers, and the healthcare system and improvements in vision may not be maintained long term. As a result of its drying potency and duration of action, brolucizumab, an intravitreal anti-VEGF therapy approved for the treatment of nAMD and DME, could decrease injection frequency for patients and provide an efficacious treatment; however, balancing its benefits and risks can be challenging. There have been reports of intraocular inflammation (IOI) in patients treated with brolucizumab, which, if left untreated, may result in severe vision loss. Recent evidence, however, indicates that early recognition of IOI and prompt and aggressive systemic corticosteroid treatment in response to posterior segment involvement can lead to favorable outcomes in these relatively rare but severe cases. A series of consensus meetings were conducted in 2022 between Swiss medical retina experts and diabetologists, discussing the current data for brolucizumab and exploring various challenges to its use, including the associated risk of IOI. The outcome is a collation of practical insights and guidance for ophthalmologists on the use of brolucizumab in patients with nAMD and DME, including patient selection and assessment, treatment regimen and monitoring, and the recognition and management of adverse events.

In patients with neovascular age-related macular degeneration (nAMD) there is often an inconsistency between their subjective visual impairment and a still relatively preserved standard Early Treatment of Diabetic Retinopathy Study (ETDRS) best corrected visual acuity. Therefore, in order to better capture the specific functional defects in nAMD, other tests need to be evaluated. In a previous study, we reported contrast sensitivity of the better eye to best correlate with near distance and distance vision related quality of life in patients with bilateral nAMD. Here, we evaluated Pelli-Robson contrast sensitivity, ETDRS visual acuity, low luminance visual acuity and Radner maximum reading speed and correlated them with several morphologic parameters as measured on fundus autofluorescence imaging, optical coherence tomography and optical tomography angiography in 54 patients. A multiple regression analysis was performed which correlated each visual function parameter with the anatomic features. The results showed the strongest correlations between the total area of macular geographic atrophy as well as the percentage of geographic atrophy in the central 1 mm and contrast sensitivity. Further, the regression model selected the total area of macular geographic atrophy, the photoreceptor inner and outer segments interface disruption score, the presence of subretinal fibrosis in the central 1 mm and the central retinal thickness as the variables that explained 71% of the variation in contrast sensitivity when including all eyes. Hence, our results suggest that among the evaluated measures of vision, contrast sensitivity is best correlated with the morphologic impairment in bilateral nAMD. Thus, contrast sensitivity may complement ETDRS visual acuity in clinical trials and serve as a standard diagnostic tool in clinical practice.