Ophthalmology

Long-term anti-VEGF injections markedly increase cataract surgery risk in treated eyes

In this fellow-eye–controlled series of 603 phakic patients, unilateral anti-VEGF exposure greatly increased cataract surgery incidence over a median 74 months. Ten-year cumulative cataract surgery incidence was 40.7% in injected eyes versus 7.2% in fellow eyes, with a hazard ratio of 8.17 for injected eyes. Older age further increased cataract surgery risk, independent of injection status. Injected eyes had higher nuclear, cortical, and especially posterior subcapsular opacities at surgery than fellow eyes. 1

Half-dose PDT outperforms anti-VEGF and observation for acute CSC

This PRISMA meta-analysis of 11 comparative studies (464 eyes) evaluated PDT, anti-VEGF, and observation in acute CSC under six months’ duration. Half-dose PDT produced superior visual gains and sustained central macular thickness reductions at 1, 3, and 12 months versus observation. PDT-treated eyes were nearly fourfold more likely to achieve complete subretinal fluid resolution at one month, with this advantage maintained throughout follow-up. Anti-VEGF produced only transient one-month anatomic improvement, without significant or durable visual benefit. 2

Successful first half-dose PDT in chronic CSC yields better seven-year outcomes

This multicenter cohort recalled PLACE and SPECTRA chronic CSC participants for long-term assessment a median of seven years after half-dose PDT. First PDT was successful in 78 patients and unsuccessful in 29, based on early subretinal fluid response in the original trials. Successful first PDT eyes required far fewer additional treatments over follow-up than unsuccessful eyes. BCVA significantly improved and remained higher long term in the successful group, while remaining essentially stable after early follow-up in the unsuccessful group. 3

Trabeculectomy to single-digit IOP slows progression in normal-tension glaucoma

This systematic review and meta-analysis pooled nine observational trabeculectomy series including 270 eyes with progressive normal-tension glaucoma. Mean IOP decreased from 14.77 mmHg preoperatively to 9.82 mmHg postoperatively, representing roughly one-third reduction to sustainable single-digit levels. The mean visual field MD slope improved from -0.91 to -0.25 dB per year, with a pooled MD slope change of 0.59 dB per year. Hypotony-related complications and hyphema were the most common adverse events but were generally transient and had limited impact on long-term visual acuity. 4