The authors of this cross-sectional comparative study aimed to evaluate the effects of high myopia on spectral-domain optical coherence tomography (SD-OCT) parameters, as well as on their ability to detect glaucoma.

They divided 93 glaucoma and 86 non-glaucoma patients into highly myopic group (HMG; 90 subjects, ≤–5D and emmetropic (EG; 89 subjects, spherical equivalent ≤1D and ≥1D) groups. They also compared macular ganglion cell complex (GCC) and circumpapillary retinal nerve fiber layer (cpRNFL) measurements obtained from the algorithms of the SD-OCT system. The study authors assessed the effects of refractive errors glaucoma using a generalized linear model, after adjusting for age. Additionally, they constructed a receiver operating characteristic curve for each parameter and compared the areas under the curves (AUCs).

They noted that all cpRNFL measurements were significantly related to both refractive errors and glaucoma, while all GCC parameters were not significantly related to the refractive errors. Also, the authors noted that the AUC for average GCC thickness was similar between the HMG (AUC, 0.935) and EG (AUC, 0.933), while the AUC for average cpRNFL thickness differed significantly (p=0.028) between the HMG (AUC, 0.827) and EG (AUC, 0.939).

Macular GCC parameters showed good ability to detect glaucoma in both groups, whereas the ability of cpRNFL measurement in HMG subjects was inferior to that in EG subjects. Assessment of GCC parameters is a useful technique complementary to cpRNFL thickness assessment, for clinically evaluating patients with concomitant glaucoma and high myopia.

A Swedish prospective study evaluated the efficacy of intraocular injections with bevacizumab over 12 months in patients with macular edema (ME) secondary to central retinal vein occlusion (CRVO). It included a randomized six-month, sham injection-controlled, double-masked clinical trial followed by a six-month, open-label extension and involved 60 patients with ME secondary to CRVO.

At baseline, patients were randomized 1:1 to receive intraocular injections of bevacizumab or sham injections every six weeks for six months. From month six, all patients received intraocular injections of bevacizumab every six weeks for six months. The primary outcome measure was the proportion of patients gaining at least 15 letters at 12 months. Secondary outcome measures included mean change from baseline best-corrected visual acuity (BCVA), change in foveal thickness and development of neovascular glaucoma.

At the end of follow-up, 18 of 30 patients (60.0%) in the bevacizumab/bevacizumab (bz/bz) group had gained ≥15 letters compared with 10 of 30 patients (33.3%) in the sham/bevacizumab (sh/bz) group (p<0.05). The BCVA improved by 16.0 letters at 12 months in the bz/bz group compared with 4.6 letters in the sh/bz group (p<0.05). It was reported that in an unplanned retrospective analysis, patients aged >70 years had a significantly worse outcome when receiving delayed treatment, losing 1.4 letters (95% confidence interval [CI], –9.7 to 8.4) in the sh/bz group compared with a gain of 20.1 letters (95% CI, 13.9–26.3) in the bz/bz group in patients aged <70 years (p<0.003). The mean decrease in central retinal thickness (CRT) was 435 µm in the bz/bz group compared with 404 µm in the sh/bz group (p=not significant). No patients developed iris rubeosis during the six-month, open-label extension period. There were no events of endophthalmitis, retinal tear or retinal detachment during the 12-month treatment period. Moreover, no serious nonocular adverse events were reported.

In conclusion, intraocular injections of bevacizumab given every six weeks for 12 months improve visual acuity and reduce ME significantly. Patients receiving delayed treatment have a limited visual improvement.

Researchers in the UK sought to analyze the benefit of intravitreal ranibizumab over four years for patients with neovascular age-related macular degeneration (AMD).

In their retrospective case note review of all patients who started treatment between August 2007 and September 2009 in their unit, minimum follow-up two years, maximum four years, the main outcome measures were: numbers of patients with different levels of vision; changes in visual acuity; number of treatments and numbers remaining under follow-up.

They reported that 1,086 eyes of 1,017 patients received treatment. They also noted that numbers of patients remaining under follow-up were 892/1,017 (87.71%) at 12 months, 730/1,017 (71.78%) at 24 months, 468/730 (64.11%) at 36 months and 110/217 (50.69%) at 48 months. The main reasons for patients no longer being under follow-up were the consequences of old age or transfer of care. According to the researchers, 50% of patients had 6/18 or better over four years. They documented that patients received on average 5.79 ± 2.53, 9.15 ± 3.79, 11.22 ± 4.92 and 13.7 ± 7.84 injections by 12, 24, 36 and 48 months, respectively.

They suggest that the numbers of patients with a particular level of vision may best reflect the actual benefit of AMD treatment provided by a service. Long-term follow-up is required, as only 72/730 (10%) had been discharged at 36 months, half of whom had good vision of greater than 60 letters. Additionally, 83% and 65% of patients needed treatment in the third and fourth year. Follow-up may be for the rest of the patients' life or at some point they may no longer be well enough to attend.