Benefit of intravitreal injections in patients with sub-threshold baseline visual acuity: a retrospective single-centre study.

PURPOSE: To investigate the lower visual acuity threshold for recommending intravitreal injection therapy (IVI). The lower limit of 1.3 logMAR best-corrected visual acuity (BCVA) was adopted in 2006 and has been maintained since then. METHODS: In this retrospective study, data from patients with a logMAR BCVA ≤ 1.3 and 24 months follow-up were analysed. We included patients with neovascular age-related macular degeneration (nAMD), diabetic macular oedema (DME), or retinal vein occlusion (RVO). RESULTS: The data from 164 patients (nAMD: 107; DME: 15; RVO: 42) were analysed. We observed a significant improvement at all time intervals (0 to 6, 6 to 12, 12 to 18, and 18 to 24 months after initiating IVI) compared to baseline. Across all indications, median BCVA improved from 1.4 to 1.0 within the first 6 months and remained stable within 24 months. Patients received a median of 5 and 10 injections within 6 and 24 months, respectively. Median foveal retinal thickness was 594.5 µm at baseline and dropped to 244.5 µm, 235.5 µm, 183 µm, and 180 µm during the four consecutive time intervals. CONCLUSION: Patients with nAMD, DME, and RVO with poor baseline BCVA may also benefit from intravitreal therapy with VEGF-inhibitors. In the present study, we observed functional and morphological improvement over 2 years irrespective of the underlying macular disease. Those patients should not be excluded from therapy.

[Ocular alterations in patients with Alport syndrome-An update]. / Okuläre Veränderungen bei Patienten mit Alport-Syndrom ­ ein Update.

BACKGROUND AND OBJECTIVE: Alport syndrome (AS) is a rare hereditary systemic disease that results in alterations of the kidneys, inner ear, and various structures of the eye. It is caused by mutations in one of the genes encoding collagen type IV. In recent years, new and innovative imaging techniques have added characteristics of ocular alterations in AS and provided new insights, including into the pathogenesis of the disease. The aim of this paper is to provide an overview of the current knowledge of ocular changes in AS, as well as to present the Alport ocular pass. METHOD: Narrative review article. RESULTS: Ocular manifestations of AS include changes in the cornea, lens, and retina. Specifically, posterior polymorphic corneal dystrophy, anterior lenticonus (pathognomonic for AS), and various retinal changes have been described, which have been further characterized in recent years by newer imaging techniques. In particular, foveal changes in AS may present as both a thickened central retina in the context of foveal hypoplasia or a staircase-like thinning of the fovea. Both lesions could provide further insights into the role of type IV collagen in ocular structures. CONCLUSION: The AS can manifest in various structures of the eye. The staircase-like changes of the central retina in AS patients indicate the important role of collagen type IV in the homeostasis and regular function of the inner retinal layers. The often mild foveal hypoplasia may provide clues to the role of collagen type IV in retinal embryogenesis. While anterior lenticonus is pathognomonic for AS and can be treated easily by refractive lens exchange, the only option currently available for retinal alterations is close follow-up and, if necessary, treatment of systemic complications of AS.

[The modified treat and extend scheme with injection blocks in intravitreal injection treatment : Retrospective analysis from the routine clinical application]. / Das modifizierte Treat-and-Extend-Schema mit Injektionsblöcken in der IVOM-Therapie : Retrospektive Analyse aus der täglichen klinischen Anwendung.

BACKGROUND: Regular treatment with intravitreal operative medication injections (IVOM) and the associated frequent check-ups are a major challenge for many patients, which can lead to treatment discontinuation. The aim of the modified treat and extend (TAE) in blocks scheme is to achieve stable retinal and visual outcomes with as few control visits as possible and thus to minimize the burden for the individual patient. METHODS: This monocentric retrospective study examined the treatment courses of 387 patients with neovascular age-related macular degeneration, diabetic macular edema and retinal vein occlusion, who were treated by three blocks of intravitreal injections in the TAE regimen. The primary endpoint was achieving an injection interval of 12 weeks. RESULTS: Intravitreal injections in TAE blocks significantly reduced retinal thickness and improved visual acuity. On average, a treatment interval of 2 months was achieved across the various indications. CONCLUSION: Intravitreal injections in TAE blocks of three injections can reduce patients' burden and lead to stable retinal and visual results.