Eye

ObjectiveTo determine the incidence of ocular surface disease in patients with atopic dermatitis (AD) treated with dupilumab at a tertiary, university hospital. To describe the features of dupilumab-associated ocular surface disease, establish the need for treatment and report any long-term effects on the ocular surface. MethodsA retrospective analysis of consecutive patients treated with dupilumab for AD between January 2017 and August 2019 was undertaken. Data was collected on demographics, incidence and type of ocular disease features, natural history and treatment. Results50% (14/28) patients developed ocular symptoms with a mean time of onset of 6.75 (+/- 6.1) weeks from starting dupilumab. 69% of these (9/13) were diagnosed with conjunctivitis - associated with cicatrisation in two patients and periorbital skin changes in four. Of these nine, four had prior history of atopic keratoconjunctivitis. All were treated with topical steroids; two required additional ciclosporin drops. 67% (6/9) patients developed chronic ocular inflammation requiring maintenance drops at a mean of 16 (+/- 6.9) months of follow up. All patients had improvement in their AD severity; only one patient discontinued dupilumab due to ocular side effects. ConclusionThe rate of dupilumab-associated ocular surface disease was 32%. Periorbital skin changes and conjunctival cicatrisation were noted in association with conjunctivitis. Ocular surface disease improved on topical steroids and ciclosporin but 67% of patients needed on-going treatment. Patients should be referred to an ophthalmologist prior to starting dupilumab as a large proportion develops chronic ocular inflammation.

PURPOSETo evaluate visual acuity (VA) outcomes of intravitreal anti-vascular endothelial growth factor (VEGF) in diabetic macular oedema (DMO). METHODSIn this retrospective cohort study, electronic medical records for all patients undergoing intravitreal injections (IVI) in a tertiary referral centre between March 2013 and October 2018 were analysed. Treatment response in terms of visual acuity outcomes were reported for all eyes over a 4-year observation period. RESULTSOur cohort includes 2616 DMO eyes of 1965 patients over 48 months. Cox proportional hazards modelling identified injection number (hazard ratio [HR] = 1.18), male gender (HR = 1.13), and baseline VA (HR = 1.09) as independent predictors to reach a favorable visual outcome of more than 70 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. Half of our cohort reached 70 letters 1.9 months after starting anti-VEGF therapy. Of those that reached 70 letters, 50% fell below 70 by 14.7 months. CONCLUSIONTo date, this is the largest single centre cohort study and over the longest observation period reporting on real-life outcomes of anti-VEGF in DMO. We have made an anonymised version of our dataset available on an open-source data repository as a resource for all clinical researchers globally. SYNOPSISUsing time-to-event analysis in patients receiving anti-VEGF for DMO: age, baseline visual acuity and injection number are independent predictors of visual outcomes.

BackgroundTo report insights on proliferative-diabetic-retinopathy (PDR) risk modification with repeated anti-vascular endothelial-growth-factor (VEGF) injections for the treatment of diabetic-macular-oedema (DMO) in routine care, and present data-driven PDR screening recommendations for injection clinics. MethodsMulticentre study (27 UK-NHS centres) of patients with non-PDR with and without DMO. Primary outcome was PDR development. Repeated anti-VEGF injections were modelled as time-dependent covariates using Cox regression and weighted cumulative exposure (WCE) adjusting for baseline diabetic retinopathy (DR) grade, age, sex, ethnicity, type of diabetes, and deprivation. A propensity score matched cohort was used to estimate the treatment effect on PDR incidence rates (IR). ResultsWe included 5716 NPDR eyes (5716 patients, 2858 DMO eyes). The WCE method showed a better model fit. Anti-VEGF injections showed a protective effect on risk of PDR during the most recent 4-weeks from exposure which rapidly decreased. There was a 20% reduction in risk of PDR (p0.006) in treated eyes. Severe-NPDR had a 4.6-fold increase in PDR hazards when compared with mild-NPDR (p<0.001). The annual IR of untreated mild-NPDR cases was 2.3 [95%CI 1.57-3.23] per 100 person-years). In NPDR DMO cases treated with anti-VEGF, similar IR would occur with annual review for mild, 6-monthly for moderate, and 3-monthly for severe-NPDR. ConclusionThe WCE method is a better modelling strategy than traditional Cox models for repeated exposures in ophthalmology. Injections are protective against PDR predominantly within the most recent 4 weeks. Based on observed data, we suggest follow-up recommendations for PDR detection according to retinopathy grade at first injection. PrecisThis study describes the impact on PDR risk of anti-VEGF injections for DMO in routine care and data-driven reassessment recommendations of the peripheral retina for people in long term injection clinics. Key messages What is already known on this topic- Clinical trials have shown that intravitreal anti-vascular endothelial growth factor (VEGF) injections reduce the incidence rate of proliferative diabetic retinopathy (PDR). - Repeated intravitreal anti-VEGF injections are the mainstay of treatment for diabetic macular oedema (DMO), however, there is little evidence on how these exposures impact on the risk of PDR in clinical practice. What this study adds- The impact of anti-VEGF on PDR risk varies based on the timing of exposure and the effect is not permanent. - Despite repeated treatments with anti-VEGF injections, patients with DMO may still progress to PDR. How this study might affect research, practice, or policy- Our work underscores the significance of taking into account repeated treatments at varying time intervals in ophthalmology, highlighting the utility of the weighted cumulative exposure method. - Implementing adequate modelling strategies to address the complexities of exposures in clinical settings can improve predictions and patient outcomes. - We provide PDR screening recommendations for DMO patients undergoing anti-VEGF treatments in injection clinics. Implementation would improve the safety and efficiency of treatment pathways.

BackgroundNeovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) represent the leading causes of vision impairment and blindness among the elderly population and people with diabetes, respectively. To reduce disease burden and improve disease management, highly effective therapies and optimal treatment are of major importance. In September 2022, faricimab was approved for the treatment of nAMD and DME in Germany, allowing a treatment approach with dual Ang-2/VEGF-inhibition. This research project was conducted to investigate the clinical care and therapeutic practice in German nAMD and DME patients. Furthermore, by evaluating upload patterns in real-world practice, this study aimed to assess the use of faricimab in treatment-naive patients who received faricimab as a first-line treatment at these centers. Data on visual acuity and drying of the retina was collected in a descriptive manner. MethodsZEUS is a multicenter retrospective analysis of anonymized routinely collected data on patients with nAMD or DME who have been treated with intravitreal injections (IVT) between October 2022 and September 2024. A total of 24 sites (ophthalmologic practices or centers) across Germany reported predominant IVT regimen, drug upload strategies and diagnostic imaging techniques used in the routine care of patients with nAMD and DME in an electronic case report form (eCRF). For the subset of IVT injection-naive patients receiving faricimab data were extracted from patient charts and entered in an anonymized aggregated form into eCRF. Analysis included proportion of IVT injection-naive patients treated with faricimab in first-line, baseline characteristics of these patients/eyes, and reduction of fluid in the macula and changes in visual acuity during faricimab upload phase. ResultsThe majority of sites (62.5%) applied a treat-and-extent (T&E) regimen, regardless of the chosen IVT. In case of faricimab the predominant upload scheme was 4 injections applied by 50% of sites, compared to three injections for other IVTs (58.3%) depending on the disease (nAMD/DME). OCT displayed the standard diagnostic at all sites (100.0%), other diagnostic procedures such as fluorescein angiography (FA, 62.5%) and OCT-A (25%) were applied less often. Out of the 24 sites, more than half initiated faricimab as first-line therapy in [&ge;]20% of patients. More than 20% achieved a CRT reduction of either 40-60%, 20-40% or 0-20% during faricimab upload; a reduction of more than 80% was achieved in 14.4% of nAMD eyes. The majority of DME eyes (43.9%) displayed a CRT reduction of 20-40%. In the faricimab upload phase, absence of IRF was achieved in 67.2% of nAMD eyes, while an absence of only SRF and both IRF and SRF was seen in 65.0% and 56.7% of eyes. Approximately 80% of DME eyes were free of SRF in the upload phase. The main reason for using faricimab as first-line therapy was to achieve an increase in injection intervals and best effectiveness. Discontinuation rates were low. ConclusionThis is the first analysis of general nAMD and DME treatment modalities as well as real-world effectiveness of faricimab in a large cohort of treatment-naive patients in Germany. Sites prefer individual approaches based on patients needs. First-line treatment with faricimab resulted in visual acuity gain during the faricimab upload phase in a real-world setting. These findings may help to better understand treatment strategies and first-line use of faricimab in nAMD and DME in Germany.

BackgroundThe management of macular edema and ocular neovascularization is changing and includes a new group of drugs called anti-vascular endothelial growth factor (anti-VEGF). Intra-vitreal injection of anti-VEGF agents has become the new standard of care for macular edema. However, data on their real world effectiveness and safety of these drugs in African eye care settings are very scarce. ObjectiveTo assess the visual outcome of intravitreal Avastin (IVA) injection at University of Gondar hospital tertiary eye-care and training center. MethodsA retrospective analysis of medical records of patients who received IVA at the center was done. The main outcome measure was visual acuity (VA). ResultsThe study included 37 eyes of 34 study participants with macular edema secondary to diabetic retinopathy, retinal vein occlusions, and neovascular age related macular degeneration (AMD). Mean VA improved from 6/60 (approximate 35 ETDRS letters) at baseline to 6/24 (approximate 55 ETDRS letters) at 2 months follow-up (p=0.0045) and this improvement was maintained at 6 months of follow up. This happened after mean injection of 2.5 times per eye over 6 months period. No major ocular or systemic treatment related adverse events were observed. ConclusionPatients who received IVA as initial therapy for macular edema from diabetic retinopathy, retinal vein occlusions, and neovascular AMD has a significant mean VA improvement which was maintained up to 6 months. Short term results show that IVA is effective and safe.

AimTo capture the direct and indirect cost estimates of dry eye disease (DED), stratified by disease severity, in patients from Canada and to understand the impact of DED on quality of life (QoL) in this group. MethodsA prospective, multi-centre, observational, cross-sectional study was conducted at six optometry and ophthalmology sites across Canada. Eligible patients completed a 20-minute survey on demography, general health, disease severity, QoL, and direct and indirect costs. ResultsA total of 151 patients participated in the study and 146 were included in the analysis. Mean (standard deviation [SD]) age was 49.8 (11.4) years and most patients were female (89.7%). DED was considered moderate or severe by 19.2% and 69.2% of patients, respectively. Sjogrens syndrome was reported by 8.2% of patients. Total mean annual costs of DED were $24,331 (Canadian dollars [CAD]) per patient and increased with disease severity. Mean (SD) indirect costs for mild, moderate, and severe disease were $5,961 ($6,275), $16,525 ($11,607), and $25,485 ($22,879), respectively. Mean (SD) direct costs were $958 ($1,216), $1,303 ($1,574), and $2,766 ($7,161), respectively. QoL scores were lowest in patients with Sjogrens syndrome and those with severe DED. ConclusionsThis study provides important insights into the negative impact of DED in a Canadian setting. Patients with severe DED reported higher direct and indirect costs and lower QoL compared with those with mild or moderate disease. Increased costs and poorer QoL were also evident for patients with DED plus Sjogrens syndrome versus DED alone.

Background/AimsTo provide a comprehensive and internationally standardised Cornea and Ocular Surface Disease (C&OSD) dataset for use in electronic health records (EHRs). MethodsThis was an international consensus study conducted through roundtable discussions involving 35 international experts specialising in the field of C&OSD. The Royal College of Ophthalmologists dataset guidelines were used to articulate initial C&OSD data elements template by curating data elements from validated published datasets obtained through scientific literature searches, and accessing existing international patient clinical and reported outcome recording instruments and registries. These included data elements recommended by the Dry Eye Workshop II, International Meibomian Gland Dysfunction Workshop, Ocular Surface Disease Activity and Damage Indices, the Cicatrising Conjunctivitis Assessment Tool, Limbal Stem Cell Deficiency Clinical and Confocal Grading, Chronic Ocular Manifestations in Patients with Stevens-Johnson Syndrome, and the UK Transplant Registry. Data elements pooled into an independent operational data model. ResultsA comprehensive generic dataset (common to all ophthalmology datasets) and C&OSD specific dataset was developed. Within the C&OSD dataset, several gateway disease datasets, such as atopic or allergic eye diseases, meibomian gland dysfunction, cicatrising conjunctivitis, chemical injury, dry eye, limbal stem cell deficiency, microbial or infectious keratitis, corneal erosion syndrome, and keratoconus, were established to streamline data entry for clinical audit and research purposes. ConclusionA comprehensive C&OSD dataset is provided which can be used by both generalist and specialist ophthalmologists. Adoption of the full dataset by EHR providers will lead to better interoperability and patient care and facilitate international research collaboration.

BackgroundClinical ophthalmological guidelines encourage the assessment of potential benefits and harms when deciding whether to perform elective ophthalmology procedures during the COVID-19 pandemic, in order to minimize the risk of disease transmission. MethodWe performed probability calculations to estimate COVID-19 infection status and likelihood of disease transmission among neovascular age-related macular degeneration patients and health care workers during anti-VEGF procedures, at various community prevalence levels of COVID-19. We then applied the expected burden of COVID-19 illness and death expressed through health-adjusted life-years (HALYs) lost. We compared these results to the expected disease burden of severe visual impairment if sight protecting anti-VEGF injections were not performed. ResultsOur calculations suggest a wide range of contexts where the benefits of treatment to prevent progression to severe visual impairment or blindness are greater than the expected harms to the patient and immediate health care team due to COVID-19. For example, with appropriate protective equipment the benefits of treatment outweigh harms when the chance of progression to severe visual impairment is >0.044% for all scenarios where COVID-19 prevalence was one per thousand, even when the attack rate in the clinical setting is very high (5-43%). ConclusionUnless COVID-19 prevalence is very high, the reduced disease burden from avoiding visual impairment outweighs the expected HALYs lost from COVID-19 transmission. This finding is driven by the fact that HALYs lost when someone suffers severe visual impairment for 5 years are equivalent to nearly 400 moderate cases of infectious disease lasting 2 weeks each.

BackgroundDiabetic macular oedema (DME) is a vision-threatening complication of diabetes mellitus. It is reliably detected using optical coherence tomography (OCT). This work evaluates a deep learning system (DLS) for the automated detection and classification of DME severity from OCT images. MethodsAnonymised OCT images were retrospectively obtained from 950 patients at University Hospital Galway, Ireland. Images were graded by a consultant ophthalmologist to classify the level of DME present (normal, non-centre-involving DME, centre-involving DME) excluding other pathologies. A DLS was trained using cross-validation, then evaluated on a test dataset and an external dataset. The test set was graded by a second ophthalmologist for comparison. ResultsIn detecting the presence of DME, the DLS achieved a mean area under the receiver operating characteristic curve (AUC) of 0.98 on cross-validation. AUCs of 0.94 (95% CI 0.90-0.98) and 0.94 (0.92-0.96) were achieved on evaluation of DME detection for the test dataset when graded by the first and second ophthalmologist respectively. An AUC of 0.94 (0.92-0.96) was achieved on evaluation with the external dataset. When detecting the DME severity, AUCs of 0.98, 0.86 and 0.99 were achieved per class on cross validation. For the test dataset, AUCs of 0.99, 0.89 and 0.98 were achieved when graded by the first ophthalmologist and AUCs of 0.96, 0.89 and 0.95 were achieved when graded by the second ophthalmologist. ConclusionThis study suggests promising results for the use of deep learning in the classification of severity of DME which could be used to automate screening for DME and direct appropriate referrals.

IntroductionThe current management of macular edema (ME) is intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) drugs and this represents an important advance in the treatment of ME. Studies done in the western eye care settings have confirmed that intravitreal injection of Avastin is effective for the treatment of ME. However, data on this drugs efficacy and safety in African eye care settings are very scarce. ObjectiveTo assess the Safety and Effectiveness of intravitreal Bevacizumab (Avastin) injection for the treatment of Macular Edema (ME) due to retina vascular diseases at university of Gondar tertiary eye care and training center, NW Ethiopia. MethodA retrospective study was done on patients who were given intravitreal avastin (IVA) for the treatment of diabetic macular edema (DME), retinal vein occlusion (RVO) and Neovascular Age related macular degeneration (AMD). The main outcome measure was visual acuity (VA) and central macular thickness (CMT) measured by spectral domain OCT. ResultsMedical records of 50 patients (66 eyes) were reviewed of which 46 (69.7%) were males and mean age of 54.2 years (range 20-80). The means of baseline VA and CMT were 1.0logMAR and 379.4 {micro}m respectively. At the end of follow up and after mean injection of 2.5 times per eye, the mean VA improved to 0.7 logMAR (p=0.001) and the mean CMT reduced to 295 {micro}m (p=0.0001). Baseline mean VA was significant prognostic factor for VA improvement (p=0.0001). Baseline mean CMT (P=0.007), number of injection (P=0.009) and diffuse macular edema (P=0.03) were significant factors for CMT reduction. ConclusionsIVA injection for ME edema due to retinal vascular diseases resulted in a significant improvement in mean VA (p=0.001) and CMT (p=0.0001) at the end of follow up. There was no any ocular or systemic complication of IVA injection.

IntroductionOcular surface disorders are prevalent, impacting millions worldwide and causing significant morbidity. Conventional treatments often fall short in addressing refractory cases. Topical insulin has emerged as a potential therapeutic option. ObjectiveThis systematic review aimed to evaluate the safety and efficacy of topical insulin for ocular diseases. MethodsWe conducted a systematic review in major databases including the PubMed, MEDLINE, and EMBASE for studies published from (1976 Jan - 2024 Feb) investigating topical insulin for ocular conditions. Studies were screened and selected based on predefined inclusion/exclusion criteria. Data on safety and efficacy were extracted and analyzed. ResultsTen studies (1 case-control, 3 randomized prospective, 3 retrospective, and 3 double-blind designs) met the inclusion criteria. Studies explored various indications, including neurotrophic corneal ulcers, persistent epithelial defects, recurrent epithelial erosions, dry eye disease, and postoperative corneal wound healing in diabetic patients. Overall, findings suggested promising outcomes with topical insulin: promoting healing of refractory neurotrophic corneal ulcers, accelerating reepithelialization in persistent epithelial defects, reducing recurrence of recurrent epithelial erosions, improving symptoms and reducing corneal staining in dry eye disease, enhancing postoperative corneal epithelial wound healing in diabetic patients. Adverse events were minimal and primarily reported as transient stinging or discomfort. ConclusionThis review provides encouraging evidence for the therapeutic potential of topical insulin in diverse ocular diseases. While methodological limitations exist, particularly in non-randomized studies, the current body of literature suggests topical insulin may offer a safe and effective treatment option for patients with refractory corneal disorders.

Objective or PurposePrimary open-angle glaucoma (POAG) is a highly heritable disease with 127 identified risk loci. Polygenic risks score (PRS) offers a measure of aggregate genetic burden. In this study, we assess whether PRS improves risk stratification in patients with ocular hypertension. DesignA post-hoc analysis of the Ocular Hypertension Treatment Study (OHTS) data. Setting, Participants, and/or Controls1636 participants were followed from 1994 to 2020 across 22 sites. The PRS was computed for 1009 OHTS participants using summary statistics from largest cross-ancestry POAG metanalysis with weights trained using 8,813,496 variants from 488,395 participants in the UK Biobank. Methods, Interventions, or TestingSurvival regression analysis, with endpoint as development of POAG, predicted disease onset from PRS incorporating baseline covariates. Main Outcomes and MeasuresOutcome measures were hazard ratios for POAG onset. Concordance index and time-dependent AUC were used to compare the predictive performance of multivariable Cox-Proportional Hazards models. ResultsMean PRS was significantly higher for POAG-converters (0.24 {+/-} 0.95) than for non-converters (- 0.12 {+/-} 1.00) (p < 0.01). POAG risk increased 1.36% with each higher PRS decile, with conversion ranging from 9.5% in the lowest PRS decile to 21.8% in the highest decile. Comparison of low-and high-risk PRS tertiles showed a 1.8-fold increase in 20-year POAG risk for participants of European and African ancestries (p<0.01). In the subgroup randomized to delayed treatment, each increase in PRS decile was associated with a 0.52-year decrease in age at diagnosis, (p=0.05). No significant linear relationship between PRS and age at POAG diagnosis was present in the early treatment group. Prediction models significantly improved with the addition of PRS as a covariate (C-index = 0.77) compared to OHTS baseline model (C-index=0.75) (p<0.01). One standard deviation higher PRS conferred a mean hazard ratio of 1.25 (CI=[1.13, 1.44]) for POAG onset. ConclusionsHigher PRS is associated with increased risk for, and earlier development of POAG in patients with ocular hypertension. Early treatment may mitigate the risk from high genetic burden, delaying clinically detectable disease by up to 5.2 years. The inclusion of a PRS improves the prediction of POAG onset.

PurposeEvaluating 12-month visual and anatomical outcomes after switching to faricimab in diabetic macular oedema (DMO) patients with sub-optimal response to aflibercept 2mg. Patients and methodsSixty-two eyes of fifty patients were enrolled in this retrospective study at a UK tertiary referral centre. This consisted of DMO patients with sub-optimal response to aflibercept 2mg who were switched to faricimab. Four loading injections of faricimab were given at monthly intervals, followed by a treat-and-extend regime. The sub-optimal response was defined as CST >325 microns or >20% from best CST despite aflibercept 2mg at less than or equal to 8 weekly intervals([&le;]q8w) having completed a loading dose of aflibercept 2 mg (6 injections at monthly intervals). Outcome measures were best-recorded visual acuity (BRVA), central subfield thickness (CST), and treatment intervals. ResultsBaseline BRVA was 67.6 ({+/-}11.8) letters and CST was 406.4 ({+/-}105.9) {micro}m, and the mean treatment interval was 6.5 ({+/-}1.8) weeks. At baseline, 24.2% of eyes were treated every 4 weeks (q4w), 19.4% every 6 weeks (q6w), and 56.5% every 8 weeks (q8w). After the 4th faricimab loading dose, 54 patients continued on treat-and-extend faricimab. BRVA improved to 70.4 ({+/-}12.7) letters (p=0.007) while CST reduced to 372.8 ({+/-}132.0){micro}m (p=0.070). The mean injection interval improved to 7.4 ({+/-}2.6), 95%CI[0.1, 2.9]weeks. Subjects were followed up for 57.1 ({+/-}19.7) weeks, with a mean of 7.92 ({+/-}2.53) faricimab injections. At the latest follow-up, BRVA was stable at 68.7 ({+/-}14.6)(p=0.918) letters. CST had reduced further to 343.1 ({+/-}117.5) {micro}m(p=0.034). Treatment intervals at the latest follow-up were: 3.2% q4w, 9.7% q6w, 30.6% q8w, 3.2% q10w, 11.3% q12w, 1.6% q14w, 6.5% q16w, with 53.2% on [&ge;]q8w. The mean injection interval had also improved to 9.2 ({+/-}3.1) weeks(p=0.122). ConclusionIn this study, DMO patients with sub-optimal response to aflibercept 2mg experienced improved anatomical outcomes and extended treatment intervals while maintaining vision by switching to faricimab.

ObjectivesTo report the reduction in new neovascular age-related macular degeneration (nAMD) referrals during the COVID-19 pandemic and estimate the impact of delayed treatment on visual outcomes at one year. DesignRetrospective clinical audit and simulation model. SettingMultiple UK NHS ophthalmology centres. ParticipantsData on the reduction in new nAMD referrals was obtained from four NHS Trusts in England comparing April 2020 to April 2019. To estimate the potential impact on one-year visual outcomes, a stratified bootstrap simulation model was developed drawing on an electronic medical records dataset of 20,825 nAMD eyes from 27 NHS Trusts. Main outcome measuresSimulated mean visual acuity and proportions of eyes with vision [&le;]6/60, [&le;]6/24 and [&ge;]6/12 at one year under four hypothetical scenarios: no treatment delay, 3, 6 and 9-month treatment delays. Estimated additional number of eyes with vision [&le;]6/60 at one year nationally. ResultsThe number of nAMD referrals at four major eye treatment hospital groups based in England dropped on average by 72% (range 65 to 87%) in April 2020 compared to April 2019. Simulated one-year visual outcomes for 1000 nAMD eyes with a 3-month treatment delay suggested an increase in the proportion of eyes with vision [&le;]6/60 from 15.5% (13.2 to 17.9) to 23.3% (20.7 to25.9), and a decrease in the proportion of eyes with vision [&ge;]6/12 (driving vision) from 35.1% (32.1 to 38.1) to 26.4% (23.8 to29.2). Outcomes worsened incrementally with longer modelled delays. Assuming nAMD referrals are reduced to this level at the national level for only one month, these simulated results suggest an additional 186-365 eyes with vision [&le;]6/60 at one-year with even a short treatment delay. ConclusionsWe report a large decrease in nAMD referrals during the first month of COVID-19 lockdown and provide an important public health message regarding the risk of delayed treatment. As a conservative estimate, a treatment delay of 3 months could lead to a >50% relative increase in the number of eyes with vision [&le;]6/60 and 25% relative decrease in the number of eyes with driving vision at one year.

ObjectiveTo perform a systematic review and meta-analysis of the clinical evidence of the treatment effect of surgical cyclodialysis in the management of intraocular (IOP) in patients with glaucoma. MethodsA comprehensive literature review was conducted of peer-reviewed interventional studies from the PubMed, Cochrane, Web of Science and EMBASE databases of surgical cyclodialysis treatment for the lowering of intraocular pressure in patients with glaucoma. Key outcome measures of treatment success were long-term IOP control, as well as IOP-lowering medication burden and the incidence of intraoperative and postoperative adverse events. The meta-analysis was registered with Prospero ID CRD42025632759 ResultsA total of 40 studies spanning a publication period of more than 100 years of surgical cyclodialysis treatment encompassing data from over 4,082 eyes were included in the analysis. Clinical evidence comprised observational, non-randomized studies, 75% of which involved an ab-externo approach and 25% comprised an ab-interno cyclodialysis intervention. Given the natural evolution of the clinical paradigm over the years, changes in surgical technique, instrumentation and addressable population, the overall analysis was constructed to account for the significant variability in outcomes reporting. Across the final evaluable dataset, the clinical performance of cyclodialysis surgery was characterized by overall qualified success rates of 72.3% on average (range 33%-97%) over a postoperative follow-up period ranging from 6 to 132 months. Depending on surgical technique and disease severity, reported success rates indicate slightly increased efficacy and lower rate of complications with ab-interno intervention. Durability of the cyclodialysis procedure varied significantly, with higher rates of failure in patients with advanced and refractory glaucoma. Specific complications such as persistent hyphema, hypotony and vision loss were reported infrequently. All outcomes, including IOP reduction, ocular safety, and durability, showed significant improvement with the newer interventional ab-interno surgical techniques. ConclusionCyclodialysis remains an enduring surgical intervention and one of the few available surgical options for uveoscleral outflow enhancement in glaucoma patients. The IOP lowering effect of the procedure can be significant, albeit variable, with better clinical performance in mild and moderate glaucoma and with advanced interventional ab-interno surgical approaches. SynopsisResults of a meta-analysis comprising more than 4,000 glaucoma cases of cyclodialysis surgery for the lowering of intraocular pressure demonstrate significant and sustained efficacy of one of the few surgical interventions for uveoscleral outflow enhancement.

ObjectiveRetinal vein occlusion (RVO) is the second most common retinal vascular diseases after diabetic retinopathy. Delay in detection and treatment can result in irreversible visual impairment and blindness. The aim of this study was to assess the magnitude and clinical pattern of patients with RVO presentedd to the retina clinic at University of Gondar Tertiary Eye Care and Training Centre MethodsA hospital based Cross-sectional study was conducted from October 2017 - March 2018 and patients of all ages with RVO seen at our retina clinic during the study period were reviewed. Pertinent ophthalmic history, ophthalmic clinical examination and laboratory tests were done including detailed funducopy for each patient. Data were collected with structured questionnaire, entered to SPSS version 20 and analysed. ResultA total of 38 eyes of 36 new patients with RVOs were seen during the six month study period and reviewed. Twenty four (66%) study patients were males and the mean age was 58 {+/-} 10.87 years. Thirty four (94.4%) patients had unilateral disease. Nineteen (52.78%) had Central retinal vein occlusion (CRVO), 13 (36.11%) had branch retinal vein occlusion (BRVO) and 4 (11.11%) had hemispheric retinal vein occlusion (HRVO). Glaucoma was the commonest risk factor seen in 17 (47.22%) patients followed by systemic hypertension 10 (27.78%) and diabetes mellitus 8 (22%). The commonest complications encountered were macular edema, retinal or optic disc neovascularization and neovascular glaucoma seen in 15 (41.67%), 11 (30.5%) and 4 (11.11%) patients respectively. Over a third of patients 15 (41.67%) presented to our retina clinic after 6 months of onset of the illness and 15 (39.47%) eyes were blind at presentation. ConclusionGlaucoma, hypertension and diabetes mellitus were the most common risk factors identified among study patients. A majority of patients had potentially blinding complications. There was also delay in presentation. Diagnostic and therapeutic facilities of the center should be improved to prevent vision loss from complications. People should be educated to seek health care immediately after the onset of visual symptoms.

This protocol describes the A-EYE Study and provides information about procedures for entering participants. Every care was taken in its drafting, but corrections or amendments may be necessary. These will be circulated to investigators in the Study. Problems relating to this Study should be referred, in the first instance, to the Chief Investigator. This study will adhere to the principles outlined in the UK Policy Framework for Health and Social Care Research (v3.2 10th October 2017). It will be conducted in compliance with the protocol, the UK General Data Protection Regulation and Data Protection Act 2018, and other regulatory requirements as appropriate. DESIGNSingle centre non-interventional study of patients with age-related macular degeneration to develop computational models of disease prediction and treatment outcome involving analysis of macular OCTA scans. AIMSO_ST_ABSPrimary ObjectiveC_ST_ABSO_LITo develop a mathematical model (or in silico model) of blood flow and anti-VEGF transport in the retina that, in combination with AI-based analysis of macular OCTA scans and clinical data, can be used to predict treatment response in patients with neovascular age-related macular degeneration (nAMD). C_LI Secondary objectivesO_LITo apply deep learning models in combination with in silico models of blood flow to OCTA analysis, to confirm diagnosis of nAMD and its clinical subtypes. C_LIO_LITo develop prognostic models to predict treatment outcome based on longitudinal patient follow-up. C_LIO_LIUsing in silico simulations, to understand why certain patients do not respond optimally to anti-VEGF treatment. C_LIO_LITo define and simulate individualised anti-VEGF treatment for optimal response. C_LI OUTCOME MEASURESA validated in silico model of patient response to nAMD and anti-VEGF treatments tailored to individual patients using OCTA scans. O_LIIdentify optimal intravitreal anti-VEGF therapy drug regime for individual patients using in silico models C_LIO_LIImprove on the classification and characterisation of neovascular AMD into its subtypes C_LIO_LIPredict risk factors for poor treatment outcomes such as retinal vascular topology C_LI POPULATION ELIGIBILITYAll patients aged 55 years or more, with a new diagnosis of nAMD in at least one eye, attending the Macular Clinic at Royal Liverpool University Hospital, who have had a macular OCTA scan at baseline i.e. at the time of diagnosis. DURATION48 months Clinical QueriesClinical queries should be directed to Dr Savita Madhusudhan who will re-direct the query to the appropriate person if necessary. SponsorThe University of Liverpool is the research Sponsor for this Study. For further information regarding the sponsorship conditions, please contact: Alex Astor Head of Research Support - Health and Life Sciences University of Liverpool Research Support Office 2nd Floor Block D Waterhouse Building 3 Brownlow Street Liverpool L69 3GL sponsor@liv.ac.uk mailto:Astor@liv.ac.uk FunderEPSRC DTP in AI and Future Digital Health is funding the studentship associated with this study. Mr Remi Hernandez is the PhD candidate holding the studentship and Dr El-Bouri, Prof Zheng, and Dr Madhusudhan are his supervisors.

ObjectiveThis study aimed to evaluate the incidence, patterns, and determinants of ocular hypertension (OH) following Bevacizumab Intravitreal injections for various retinal diseases at KCMC Hospital, Tanzania. MethodsA prospective cohort study was conducted from August 2023 to July 2024, involving 120 participants. OH was defined as an intraocular pressure (IOP) >21 mmHg or an increase >5 mmHg from baseline. Data on demographics, injection history, ocular conditions, and systemic factors were collected. IOP was measured at baseline, immediately post-injection, and at six-week intervals during follow-up. Paired t-tests compared mean IOP differences, Nelson Allan estimator curves assessed cumulative OH risk, and Poisson regression identified associated factors. ResultsParticipants median age was 62 years, with diabetic macular edema (52.5%) being the most common indication. OH incidence was 15%, significantly associated with the number of injections (adjusted hazard ratio [AHR] 2.17, 95% CI 1.56-3.16, p < 0.001) and history of YAG laser capsulotomy (AHR 0.33, 95% CI 0.12-0.88, p = 0.028). Temporary post-injection IOP spikes normalized within 60 minutes. ConclusionThe study revealed a higher incidence of ocular hypertension following Bevacizumab injections compared to other studies. Significant factors included injection frequency and a history of YAG laser capsulotomy, with repeated injections leading to delayed normalization of intraocular pressure and increased spikes during subsequent visits.

AimTo evaluate the four-year outcome of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in an eye unit in sub-Saharan Africa. MethodologyThis retrospective study included 182 eyes of 172 patients managed in the vitreoretinal unit between 2016 and 2019 who were treated with intravitreal anti-VEGF Bevacizumab (1.25 mg/0.05 ml) with at least one year of follow up. The outcome measures were change in best-corrected visual acuity (BCVA) over one year of follow-up, the number of injections taken and complications. ResultsThe mean age was 61.1 {+/-} 16.3 years (M: F of 1:1.1) and about 62.1% were > 60 years. A total of 330 injections were given during the period audited. The mean number of injections was 1.8 {+/-} 0.93. Ninety-four (51.7%) eyes had only one injection while 33 (18.1%), 50 (27.5%) and 5 (2.7%) had 2, 3 and 4 injections, respectively. About 78.5% had moderate-severe visual impairment at baseline and 44.5%, 16.4%,12.6% and 7.1% at 1, 3, 6- and 12-months post injections, respectively. The mean BCVA improved for all eyes from 1.67 {+/-}0.91 logMAR at baseline to 1.50{+/-}1.27 logMAR at one year. The logMAR letters gained was 23 at 1 month and 8.25 at 1 year with a statistically significant association between increasing number of injections and improved visual outcome (p= 0.015). One patient each developed endophthalmitis (0.6%) and inferior retinal detachment (0.6%) post-injection. ConclusionVisual acuity gain was recorded in patients who had at least two intravitreal Anti-VEGF injections in 1 year.

AimTo compare the current indications for intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy, to make recommendations for planning of services. MethodologyThe medical records of 172 patients who had intravitreal anti-VEGF injections from January 2016 to December 2019 were retrieved. Socio-demographic and clinical data were extracted, analysed, and compared with data from the previously published audit report covering 2010 to 2012. ResultsThree hundred and thirty injections were given to 182 eyes in this cohort of patients. The mean age was 61.1 {+/-} 16.3 years (range <1-90 years), with a male to female ratio of 1.1:1. Retinal vein occlusion, 64 (35%) remained the most common indication for anti-VEGF injections in the eyes treated. This was followed by choroidal neovascular membrane/ Wet age-related macular degeneration which accounted for 42 (23%) as reported previously. However, cases of proliferative diabetic retinopathy/ diabetic maculopathy needing anti-VEGF were noticed to have almost doubled from about 8% (10) in the previous study to 15% (27) in the present study. In addition, idiopathic polypoidal choroidal vasculopathy, 18 (10%) ranked above proliferative sickle cell retinopathy in the present study. Retinopathy of prematurity, neovascular glaucoma, retinal artery macro-aneurysm and myopic choroidal neovascular membrane were the new emerging indications. ConclusionThere is an expanding indication for anti-VEGF in the management of retinal vascular diseases in our health facility and adequate measures should be put in place for early diagnosis and management. Patients should be counselled on the availability of this treatment option.