Changes in flare after intravitreal injection of three different anti-vascular endothelial growth factor medications.

PURPOSE: To compare the change in anterior chamber flare after intravitreal injection of the anti-vascular endothelial growth factor agents bevacizumab, aflibercept, and ranibizumab. METHODS: Sixty-one eyes of 53 patients underwent intravitreal injection with anti-vascular endothelial growth factor medications for exudative age-related macular degeneration, diabetic macular edema, or retinal vein occlusion. There were a total of 26 eyes injected with bevacizumab, 14 eyes injected with aflibercept, and 21 eyes injected with ranibizumab. Anterior segment flare was measured with a laser flare meter (Kowa) before intravitreal injection and 1 day after injection. The change in flare was analyzed. RESULTS: The mean change in flare after 1 day was +2.5 photons per millisecond in patients who received bevacizumab, 0.0 photons per millisecond for aflibercept, and -0.2 photons per millisecond for ranibizumab. There was a statistically significant difference between the 3 medications (P = 0.006). Pairwise analysis of the change in flare showed a statistically significant difference between bevacizumab and ranibizumab (P = 0.002). The change in flare in patients who received aflibercept was not different from that in those who received bevacizumab (P = 0.08) or ranibizumab (P = 0.99). CONCLUSION: There was a statistically significant increase in flare after bevacizumab injection compared with ranibizumab. This difference was small and is not believed to be clinically significant. There was no statistical difference in the change in flare between aflibercept and the other medications, although the number of eyes in the aflibercept group was small.

Patient subjective visual function after corneal collagen crosslinking for keratoconus and corneal ectasia.

PURPOSE: To assess subjective visual function after corneal collagen crosslinking (CXL). SETTING: Cornea and refractive surgery subspecialty practice. DESIGN: Prospective randomized controlled clinical trial. METHODS: Patients completed a subjective questionnaire regarding visual symptoms administered preoperatively and 1 year after CXL. Patients ranked self-reported symptoms of photophobia, difficulty night driving, difficulty reading, diplopia, fluctuations in vision, glare, halo, starburst, dryness, pain, and foreign-body sensation on a scale from 1 to 5. Possible associations of symptoms with changes in corrected distance visual acuity (CDVA) and maximum keratometry were also analyzed. RESULTS: One hundred seven eyes of 76 patients had CXL for keratoconus (n = 71) or ectasia (n = 36). The mean preoperative to 1-year postoperative changes in night driving (3.2 ± 1.5 [SD] to 2.8 ± 1.5), difficulty reading (3.1 ± 1.5 to 2.9 ± 1.3), diplopia (2.5 ± 1.3 to 2.1 ± 1.2), glare (3.1 ± 1.4 to 2.7 ± 1.2), halo (2.9 ± 1.4 to 2.5 ± 1.3), starbursts (2.6 ± 1.5 to 2.4 ± 1.4), and foreign-body sensation (1.8 ± 1.1 to 1.6 ± 0.9) were statistically significant. There were no associations between the change in any symptom and changes in CDVA. There was a weak association between the change in night driving, pain, and foreign-body sensations and the change in maximum keratometry. CONCLUSIONS: After CXL, patients noted subjective improvement in visual symptoms, specifically night driving, difficulty reading, diplopia, glare, halo, starbursts, and foreign-body sensation. These subjective outcomes corroborate quantitative clinical improvements seen after CXL.