The following prospective, longitudinal clinical trial compared the detection of progressive retinal nerve fiber layer thickness (RNFL) atrophy identified using time-domain optical coherence tomography (TD-OCT) with visual field (VF) progression using standard automated perimetry in glaucoma suspect and preperimetric glaucoma patients or perimetric glaucoma patients.

Eligible eyes with two years or more of follow-up underwent TD-OCT and standard automated perimetry every six months. The occurrence of VF progression was defined as the first follow-up visit reaching a significant (p<.05) negative visual field index slope over time. RNFL progression or improvement was defined as a significant negative or positive slope over time, respectively. Specificity was defined as the number of eyes with neither progression nor improvement, divided by the number of eyes without progression. Additionally, Cox proportional hazard ratios were calculated using univariate and multivariate models with RNFL loss as a time-dependent covariate.

A total of 310 glaucoma suspect and preperimetric glaucoma eyes and 177 perimetric glaucoma eyes were included. It was reported that 89 eyes showed VF progression and 101 eyes showed RNFL progression. The average time to detect VF progression in those 89 eyes was 35 ± 13 months, and the average time to detect RNFL progression in those 101 eyes was 36 ± 13 months. In multivariate Cox models, average and superior RNFL losses were associated with subsequent visual field index loss in the entire cohort (every 10-µm loss; hazard ratio, 1.38; p=.03; hazard ratio, 1.20; p=.01; respectively). Among the entire cohort of 487 eyes, 42 had significant VF index improvement and 55 had significant RNFL improvement (specificity, 91.4% and 88.7%, respectively).

Structural progression is associated with functional progression in glaucoma suspect and glaucomatous eyes. Average and superior RNFL thickness may predict subsequent standard automated perimetry loss.

Researchers in Germany performed this nonrandomized, prospective, clinical study to analyze the temporal correlations of vascular endothelial growth factor (VEGF) suppression, morphologic recurrence of choroidal neovascularization (CNV) and visual acuity loss in eyes with exudative age-related macular degeneration (AMD) treated with ranibizumab.

They included 47 eyes of 47 patients with exudative AMD undergoing intravitreal ranibizumab injections and took aqueous humor specimens before each intravitreal ranibizumab injection. They also performed visual acuity testing, spectral domain optical coherence tomography (SD-OCT) and Steadman's fundoscopy before each injection. VEGF A was measured by Luminex multiplex bead analysis (Luminex Inc.). Main outcome measures were intraocular VEGF concentration, recurrence of CNV activity shown by SD-OCT and vision loss.

Ranibizumab resulted in complete VEGF suppression within a mean period of 37.8 days (standard deviation [SD] ± 4.8 days; range, 26–49 days), the researchers noted. They also found that recurrences of CNV activity as determined by SD-OCT occurred 93.7 days (SD ± 69.9 days; range, 57–368 days) after the last ranibizumab treatment. The VEGF levels were never suppressed when a recurrence occurred and functional recurrence (visual acuity) occurred 114.3 days (SD ± 81.4 days; range, 57–398 days) after previous treatment. The researchers also observed that the VEGF levels did not differ significantly between baseline and recurrence (69.3 pg/ml vs. 74.14 pg/ml; 95% confidence interval, –18.87 to 9.12).

In conclusion, a monthly intravitreal injection of 0.5 mg ranibizumab yields a durable VEGF inhibition. The recurrences of CNV as determined by SD-OCT are always preceded by a loss of intraocular VEGF suppression and usually followed by loss of visual acuity in the further course.

The use of intravitreal anti-vascular endothelial growth factor (VEGF) agents in general, and of bevacizumab (Avastin) in particular, has become the common first-line treatment of neovascular age-related macular degeneration (AMD). Several reports addressed the possible elevation of intraocular pressure (IOP) following intravitreal injection of anti-VEGF. The authors of the following Israeli retrospective cohort study aimed to determine the prevalence of sustained IOP elevation following intravitreal bevacizumab injections for neovascular AMD and to identify possible risk factors for the development of increased IOP.

In this study, they included 174 consecutive patients (201 eyes) receiving intravitreal bevacizumab (1.25 mg/0.05 ml) as treatment for neovascular AMD. The authors reviewed the records of the study patients for age, gender, history of glaucoma, phakic status, IOP levels, length of follow-up, total number of injections, intervals between injections and IOP management in eyes that exhibited IOP elevation. Sustained IOP elevation was defined as IOP ≥22 mmHg and a change from baseline of ≥6 mmHg recorded on at least two consecutive visits and lasting ≥30 days. The study authors identified risk factors for an IOP increase from the association between the studied variables and IOP elevations.

They found sustained IOP elevation in 22 of 201 eyes (11%) and they noted that increased IOP was controlled with topical medications in all eyes. Among the variables studied, only male gender [OR = 3.1, 95% CI (1.1, 8.5) p=0.029] and length of interval between injections less than eight weeks [OR = 3.0, 95% CI (1.1, 7.9), p=0.028] emerged as risk factors for IOP elevation in a multivariable model. The prevalence of IOP elevation was significantly higher when the interval between injections was less than eight weeks than when it was eight or more weeks (17.6 and 6%, respectively, p=0.009). Pre-existing glaucoma was not associated with IOP elevation (p=0.9).

Sustained IOP elevations can occur in normotensive eyes undergoing intravitreal bevacizumab treatment for neovascular AMD. This phenomenon was related to shorter intervals between injections, with eight weeks being taken as the cut-off point. AMD eyes that receive intravitreal bevacizumab injections need to be monitored for IOP changes, especially those in which the intervals between injections are less than eight weeks.