Practical implementation of a q4-q16 aflibercept treat-and-extend pathway for the treatment of neovascular age-related macular degeneration: Updated guidance from a UK expert panel.

OBJECTIVES: This report, based on guidance from a panel of UK retina specialists, introduces a revised intravitreal aflibercept (IVT-AFL) treat-and-extend (T&E) pathway for the treatment of neovascular age-related macular degeneration (nAMD). The T&E pathway incorporates the updated IVT-AFL label (April 2021) allowing flexible treatment intervals of 4 weeks to 16 weeks, after three initiation doses and a further dose after 8 weeks. Practical guidance is provided on the clinical implementation of the revised pathway, with the aim of supporting clinical decision-making to benefit patients and addressing capacity issues in nAMD services. METHODS: Three structured round-table meetings of UK retina specialists were held online on 19 May, 16 June and 13 October 2021. These meetings were organised and funded by Bayer. RESULTS: The authors revised the previously published consensus pathway to reflect the changes to the IVT-AFL label and developed guidelines for the implementation of the pathway in UK clinical practice. The guidelines include topics such as recommendations for extending patients with 2- or 4-week adjustments, extending patients to 16-week treatment intervals, managing fellow eye involvement, and reducing treatment intervals for patients with particularly active disease. CONCLUSIONS: The revised IVT-AFL T&E nAMD pathway offers guidance to clinicians seeking to increase the dosing flexibility of IVT-AFL, with 4- to 16-week treatment intervals, in line with the updated IVT-AFL label, to meet the continually evolving demands of nAMD service provision.

Human serum albumin adsorption study on 62-MHz miniaturized quartz gravimetric sensors.

We have designed and fabricated 25-microm-thick quartz resonators operating at a fundamental resonance frequency of approximately 62 MHz. The results show a substantial increase in the mass sensitivity compared to single monolithic commercial resonators operating at lower frequencies in the approximately 5-10-MHz range. The overall performance of the micromachined resonators is demonstrated for the example of human serum albumin protein adsorption from aqueous buffer solutions onto gold electrodes functionalized with self-assembled monolayers. The results show a saturation adsorption frequency change of 6.8 kHz as opposed to 40 Hz for a commercial approximately 5-MHz sensor under identical loading conditions. From the analysis of the adsorption isotherm, the equilibrium adsorption constant of the adsorption of the protein layer was found to be K = 8.03 x 10(6) M(-1), which is in agreement with the values reported in the literature. The high sensitivity of the miniaturized QCM devices can be a significant advantage in both vapor and solution adsorption analyses.

The importance of central corneal thickness measurements and decision making in general ophthalmology clinics: a masked observational study.

BACKGROUND: To assess the impact of knowing central corneal thickness (CCT) on glaucoma management in a United Kingdom district general hospital. METHODS: A masked observational non-interventional study included 304 eyes of 152 consecutive glaucoma cases attending general clinic. CCT was measured using a hand-held pachymeter. IOP, as measured by the Goldmann applanation tonometer (GAT), was adjusted for CCT using a normogram. Two identical study sheets were retrospectively constructed from each subject's case notes: one included the CCT and adjusted IOP information, the other excluded. Study sheets were randomly presented to a single masked observer to decide glaucoma management. The difference in management decision was noted. RESULTS: The mean +/- standard deviation CCT was 561.5 +/- 35.7 microm, 538.9 +/- 41.4 microm, 538.3 +/- 40.3 microm for ocular hypertension (OHT), primary open angle glaucoma (POAG) and normal pressure glaucoma (NPG) subjects respectively. IOP adjustment was greater than +/-2 mmHg in 33.9%(103/304) of eyes. CCT and adjusted IOP information led to different treatment option in 37%(55/152). Of the most important changes 20.4%(31/152) cases would have been commenced on additional IOP-lowering medication, 2.0%(3/152) would have been counselled for trabeculectomy surgery and 3.3%(5/152) of the cohort would have been observed rather than treated. CONCLUSION: CCT and adjusted IOP measurement can influence glaucoma management in a clinical context. It helps attribute risk and hence aids patient management decisions.

Incidence and outcomes evaluation of endophthalmitis management after phacoemulsification and 3-piece silicone intraocular lens implantation over 6 years in a single eye unit.

PURPOSE: To evaluate the incidence and outcomes of management of endophthalmitis following phacoemulsification and 3-piece silicone intraocular lens (IOL) implantation in a single eye unit over a 6-year period. SETTING: Shrewsbury and Telford Hospital, NHS Trust, Shrewsbury, United Kingdom. METHODS: Forty-four cases of endophthalmitis following phacoemulsification and 3-piece silicone IOL implantation were identified between January 1, 1998, and December 31, 2003. All the data related to the endophthalmitis cases were prospectively collected. The total number of cataract surgeries was identified from the hospital information technology department through coding data. RESULTS: There were 44 cases of endophthalmitis following 12 362 phacoemulsification cataract extractions (incidence 0.36%). The incidence of endophthalmitis with a silicone polypropylene IOL (0.67%) was significantly higher (P<.0005) than with a silicone poly(methyl methacrylate) (PMMA) IOL (0.24%). Thirty-six patients (81.8%) had vitreous tap while 8 patients (18.2%) had vitrectomy. Twenty cases (45.5%) were culture positive. Visual acuity was 6/12 or better in 30 patients (68.8%). There was weak correlation between visual acuity at presentation and final visual outcome (Pearson correlation r = 0.33, P = .029). Final visual acuity was not significantly related to culture results (P = .85, Mann-Whitney U test) or type of presentation (P = .52, Mann-Whitney U test). CONCLUSIONS: In this first single-center study to report incidence of endophthalmitis following phacoemulsification and silicone IOL implantations alone, the incidence of endophthalmitis was significantly higher with silicone polypropylene IOLs than with silicone PMMA IOLs and the overall incidence of endophthalmitis following phacoemulsification surgery was higher than most of the published data.