Predictors of Outcome in Patients with Neovascular Age-Related Macular Degeneration Switched from Ranibizumab to 8-Weekly Aflibercept.

PURPOSE: The purpose of this study was to evaluate the outcomes over 12 months in patients with neovascular age-related macular degeneration (nAMD) with insufficient response to ranibizumab who were switched directly to 8-weekly fixed dosing of aflibercept without a loading phase. DESIGN: Retrospective interventional study. PARTICIPANTS: Consecutive patients with nAMD who were switched from pro re nata (PRN) intravitreal ranibizumab to 8-weekly fixed aflibercept because of persistent disease activity from November 1, 2013, to September 30, 2014, were included. METHODS: Demographic data, visual acuity (VA), and spectral-domain optical coherence tomography characteristics over time were evaluated to determine the prognostic indicators of final visual outcome at 12 months. MAIN OUTCOME MEASURES: The VA, central subfield thickness (CST), presence of macular fluid at month 12 compared with baseline, and the definition of prognostic indicators of final visual outcome at month 12. RESULTS: A total of 431 patients (447 eyes) were included in this study. There was no statistically significant difference in VA between baseline and month 12 (P = 0.79), whereas the CST significantly decreased at month 12 compared with baseline (P < 0.001). At the 12-month follow-up, 48.3% of eyes had no macular fluid compared with 8.5% at baseline. The mean number of injections at month 12 was 6.8±1.75. Poor prognostic indicators included increasing age, increasing CST, the presence of intraretinal fluid, pigment epithelial detachment, and subfoveal thickening. CONCLUSIONS: Patients who have not yet "responded" to PRN ranibizumab seem to exhibit retinal dehydration after switching to aflibercept, whereas there was no demonstration of VA benefit. Baseline features at the point of switching can independently predict outcomes.

Unilateral Posterior Uveitis in a Patient Receiving Nivolumab for Malignant Melanoma.

Patients using immunotherapies like immune checkpoint inhibitors (ICIs) can develop ocular immune-related adverse effects (irAEs). Nivolumab (Opdivo®;Bristol-Myers Squibb, New York, NY, USA) is a commonly used ICI used to treat malignancies. A 75-year-old woman presented to our eye clinic with sudden loss in vision in the right eye. She had started nivolumab monotherapy 10 days before the onset of symptoms for the treatment of melanoma. Examination showed low visual acuity (20/170) in the right eye with few reactive cells and macular oedema and swelling in the anterior and posterior segments, respectively. Optical coherence tomography (OCT) of the right eye showed intra-retinal and sub-retinal fluid and multiple hyperreflective inner retinal round foci in the areas of inflammation. The differential diagnoses were infectious uveitis, Vogt-Koyanagi-Harada-like syndrome or masquerade retinopathy. After a full work-up, the patient was diagnosed with unilateral posterior uveitis. The patient responded to topical steroid therapy with improved vision (20/30). Uveitis is listed as an adverse effect on the prescribing list of the drug Opdivo®. Although not reported before, our case demonstrated unilateral involvement. We thus recommend clinicians to be wary after complaints of side effects from their patients; ocular toxicities should be considered.