Ophthalmology

Two-year GATHER2: avacincaptad pegol sustains GA-slowing with flexible dosing

In GATHER2, patients with non–center-involving GA received monthly avacincaptad pegol (ACP) 2 mg or sham for one year, then ACP eyes transitioned to monthly or Q8W dosing. Over two years, ACP reduced GA growth versus sham with a 14% reduction for continued monthly dosing and 19% for every-other-month dosing. Ocular treatment-emergent adverse events were more frequent with ACP (64.0%) than sham (48.2%), but no retinal vasculitis, ischemic optic neuropathy, or serious intraocular inflammation occurred. Choroidal neovascularization developed in 11.6% of ACP-treated eyes versus 9.0% with sham, indicating a modest neovascular trade-off with complement C5 inhibition. 1

High-dose aflibercept enables extended-interval monotherapy in PCV

This post hoc PULSAR analysis evaluated 139 participants with ICGA-confirmed PCV treated with aflibercept 8 mg every 12 or 16 weeks versus 2 mg every 8 weeks. Baseline BCVA was similar across groups, approximately 20/63 to 20/80, and most 8 mg–treated patients completed 48 weeks. Eyes on 8 mg received fewer injections, with 87% maintaining dosing intervals of at least 12 weeks while preserving BCVA gains comparable to 2 mg every 8 weeks. These data support aflibercept 8 mg as a monotherapy option that safely extends treatment intervals in PCV without compromising short-term visual outcomes. 2

Nationwide cohort quantifies very low AAC risk after dilation

This claims-based cohort included over 11.4 million patients undergoing 26.5 million pharmacologic dilations to estimate post-dilation acute angle-closure (AAC) risk. AAC incidence was 0.01% using a sensitive definition and 0.004% when requiring subsequent iridotomy, iridectomy, or lens extraction. Older age, Asian race, Hispanic ethnicity, and prior angle-closure diagnosis markedly increased AAC odds, while pseudophakia and higher income were protective. The authors conclude that dilation is highly safe overall, but high-risk groups warrant tailored counseling and readiness for prompt AAC management. 3

Meta-analysis defines incidence of retrobulbar hemorrhage and brainstem anesthesia

This systematic review pooled 22 studies with 196,113 retrobulbar injections to estimate retrobulbar hemorrhage (RBH) and brainstem anesthesia (BA) risks. Pooled RBH incidence was 0.10%, while BA incidence was 0.23%, based primarily on observational data with low-certainty grading. Subgroup analyses suggested higher RBH incidence without orbital compression and differences across single, multiple, and supplemental injection strategies. Needle gauge and publication era did not significantly affect RBH incidence, and BA subgroup analyses were limited by sparse data, underscoring the rarity but seriousness of these events. 4