黄斑ジストロフィー

PURPOSE: To evaluate the short-term efficacy of intravitreal aflibercept 8 mg in patients with neovascular age-related macular degeneration (nAMD) who exhibited persistent or recurrent exudation two months after faricimab treatment during the maintenance phase following anti-vascular endothelial growth factor (VEGF) loading therapy. STUDY DESIGN: Retrospective observational study. METHODS: Twenty-seven eyes with nAMD were included. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) biomarkers-including intraretinal fluid (IRF), subretinal fluid (SRF), and sub-retinal pigment epithelium (sub-RPE) fluid at the subfoveal and macular areas-were evaluated before and two months after treatment with faricimab and aflibercept 8 mg. Subgroup analyses were performed according to AMD subtype (typical nAMD vs. polypoidal choroidal vasculopathy [PCV]) and pachychoroid characteristics (pachychoroid vs. non-pachychoroid). RESULTS: BCVA did not show significant changes after either faricimab or aflibercept 8 mg treatment. However, aflibercept 8 mg resulted in a significant reduction in subfoveal SRF (from 44.4% to 11.1%, P = 0.014) and macular SRF (from 85.2% to 29.6%, P < 0.0001), whereas faricimab did not produce significant anatomical improvements. No significant changes were observed in IRF or sub-RPE fluid with either treatment, possibly due to the low prevalence of the fluid at baseline. Subgroup analyses demonstrated no substantial differences in treatment response between typical nAMD and PCV, or between pachychoroid and non-pachychoroid eyes. CONCLUSION: Intravitreal aflibercept 8 mg may provide short-term anatomical benefits, particularly in reducing subretinal fluid, in eyes with nAMD showing persistent or recurrent exudation after faricimab treatment during the maintenance phase, regardless of nAMD subtype or pachychoroid status.

Innovations like teleophthalmology have made great strides in improving access to care for patients with retinal disease by enabling prompt screening and referral, especially in underprivileged areas. This review highlights the growing role of teleophthalmology in addressing the burden of few retinal diseases like diabetic retinopathy (DR), age-related macular degeneration (ARMD), and retinopathy of prematurity (ROP), artificial intelligence (AI), electronic medical records (EMR) and portable imaging technologies have greatly increased the precision of detection and care coordination. Its scalability is further supported by high patient satisfaction and cost-effectiveness. Barriers to implementation, however, include inadequate training, data security concerns, limited infrastructure and upfront investment costs. We offer focused solutions to address existing gaps, drawing primarily on evidence and national teleophthalmology initiatives from India, which is presented as a representative LMIC case study. The findings may guide the development and scale-up of teleophthalmology services in other LMICs settings. Teleophthalmology can become the backbone of equitable retinal disease care delivery with appropriate policy support and standardization of processes involved. These findings have broader implications for teleophthalmology implementation in LMICs that face similar healthcare delivery challenges.

PURPOSE: To evaluate the real-world outcomes of switching to aflibercept 8 mg or faricimab in patients with neovascular age-related macular degeneration (nAMD) who showed resistance to aflibercept 2 mg. METHODS: This retrospective chart review included 159 patients with refractory nAMD who had received at least three consecutive injections of aflibercept 2 mg at 4-6-week intervals before switching therapy. Patients who showed resistance to aflibercept 2 mg were switched to faricimab or aflibercept 8 mg between February 2024 and January 2025. After switching, assessments included best-corrected visual acuity (BCVA), central retinal thickness (CRT), choroidal thickness, maximum height and width of pigment epithelial detachment (PED), choroidal vascularity index (CVI), and the presence of intraretinal or subretinal fluid (IRF/SRF). RESULTS: Over six months, mean BCVA and CRT did not show a significant difference between aflibercept 8 mg group (n = 78) and the faricimab group (n = 81). At month 6, the faricimab group demonstrated significant reductions in CRT, subfoveal choroidal thickness (SFCT), Haller layer thickness, and maximum PED height, whereas the aflibercept 8 mg group did not show significant changes in these parameters. CVI increased significantly after switching to faricimab, whereas no significant change was observed after switching to aflibercept 8 mg. In addition, a lower proportion of eyes with IRF and/or SRF was observed in the faricimab group at month 6. CONCLUSION: In nAMD patients resistant to aflibercept 2 mg, aflibercept 8 mg and faricimab achieved similar BCVA and CRT outcomes. However, faricimab induced greater anatomical changes, characterized by larger reductions in PED height and Haller layer thickness, improved fluid resolution, and a greater increase in CVI. These findings suggest that faricimab may provide additional anatomical benefits, particularly in choroidal structural parameters, in aflibercept 2 mg-resistant nAMD.

PURPOSE: To identify fundus autofluorescence (FAF) characteristics corresponding to incomplete retinal pigment epithelial and outer retina atrophy (iRORA), defined using optical coherence tomography (OCT), and progression of iRORA to complete lesions (cRORA). METHODS: In this GATHER2 (NCT04435366) post hoc analysis, pooled eyes from participants assigned to avacincaptad pegol (2 mg) or sham were analyzed for baseline iRORA beyond the borders of geographic atrophy; each iRORA was assessed for progression to cRORA at months 6, 12, and 18 using OCT. For each OCT-defined lesion at baseline and at each follow-up visit, FAF patterns were defined as none (no autofluorescence abnormalities), not classifiable, increased autofluorescence (IAF), questionably decreased (QDAF), or definite decreased (DDAF). RESULTS: Overall, 153 iRORA from 95 eyes were identified at baseline, and the majority demonstrated none (34.6%; n = 53) or QDAF (34.6%; n = 53) patterns. A smaller proportion of baseline iRORA exhibited a DDAF pattern (7.2%; n = 11). At month 18, the proportion of iRORA manifesting QDAF and DDAF patterns increased to 38.1% and 23.0%, respectively, and the none pattern decreased to 16.8%. The majority of lesions that remained as iRORA at month 18 demonstrated either none (52.8%) or QDAF (49.1%). iRORA that progressed to cRORA by month 18 was more likely to have more advanced FAF abnormalities, with 44.4% having IAF, 30.2% QDAF, and 27.3% DDAF. CONCLUSIONS: Findings from this large study reporting FAF characteristics of iRORA highlight the heterogeneity of these lesions and the association of the multimodal phenotype on progression over time.

PURPOSE: The purpose of this study was to estimate lens opacity (LO) and associated risk factors in patients with ABCA4 associated Stargardt disease (STGD1). METHODS: This is a secondary analysis of the multicenter ProgStar study. Patients with molecularly confirmed STGD1 aged ≥6 years from the United States and Europe were enrolled and followed for 2 years. LO was graded using the Age-Related Eye Disease Study (AREDS) protocol during slit lamp examinations. Baseline prevalence and 2-year incidence of LO were estimated. Logistic regression with generalized estimating equation was used to identify risk factors associated with LO. RESULTS: Of the 259 participants, 54% were women, 86% were Caucasian, and the median age of STGD1 symptom onset was 19 years. At baseline, median age = 31 (interquartile range [IQR] = 21-44, range = 6-68) years; LO prevalence = 14.3% (69/483) of study eyes. Older age and later disease symptom onset were significantly associated with LO prevalence: for every decade older, adjusted odds ratio (adjOR) = 4.6 (95% confidence interval [CI] = 2.6-7.9); adjOR for every decade later in symptom onset = 0.7 (95% CI = 0.4-1.0). Among the 354 eyes without LO at baseline, 2-year incidence was 5.6%. Older age was associated with incidence: adjOR for every decade older = 4.1 (95% CI = 1.8-9.1). Posterior-subcapsular cataract was rare and nuclear cataract was the most prevalent or incident type. CONCLUSIONS: LO prevalence in ProgStar is higher than in age-matched general population. Age and age of symptom onset were risk factors of LO, suggesting both biological and accelerated aging due to retinal degeneration in STGD1. Trials of STGD1 should closely monitor safety in the anterior segment and consider excluding patients expecting cataract surgery soon.