The authors of this French retrospective, interventional, consecutive case series sought to investigate the morphological and functional outcomes following intravitreal ranibizumab injections for choroidal neovascularization (CNV) complicating geographic atrophy (GA).

They reviewed the charts of all consecutive patients with GA due to age-related macular degeneration (AMD) who received intravitreal ranibizumab injections for the development of CNV at least 24 months earlier.

Included were 21 treatment-naïve eyes of 21 consecutive patients (four men, 17 women; mean age 86.9 ± 1.6 years). The authors noted that in 95.2% of eyes, a type 2 CNV was present; extrafoveal in 42.8% of cases. They also found that after a mean of 5.0 ± 0.87 (range 1–20) intravitreal ranibizumab injections, best-corrected visual acuity (BCVA) significantly worsened at the 24-month follow-up visit (0.73 ± 0.05 vs. 0.88 ± 0.08 logMAR, respectively; p=0.01). A significant reduction of intraretinal cystic lesions, subretinal fluid and pigment epithelium detachment (p<0.001) and a significant increase of GA area (p=0.003) were present at last visit.

In conclusion, ranibizumab treatment of GA-associated CNVs provides no BCVA improvement at 24 months follow-up despite an anatomic response of CNV. Low effectiveness of ranibizumab in these cases is likely due to GA progression.

To assess the benefit of increased follow-up and treatment with ranibizumab between months 24 and 36 in the Ranibizumab for Edema of the Macula in Diabetes (READ-2) Study, investigators conducted this prospective, interventional, multicenter follow-up.

Patients who agreed to participate between months 24 and 36 (ranibizumab, 28 patients; laser, 22; and ranibizumab + laser, 24) returned monthly and received ranibizumab, 0.5 mg, if foveal thickness (FTH, center subfield thickness) was 250 µm or greater. Improvement in best-corrected visual acuity (BCVA) and reduction in FTH between months 24 and 36 were the main outcome measures.

According to the investigators, mean improvement from the baseline BCVA in the ranibizumab group was 10.3 letters at month 36 vs. 7.2 letters at month 24 (ΔBCVA letters = 3.1, p=.009), and FTH at month 36 was 282 µm vs. 352 µm at month 24 (ΔFTH = 70 µm, p=.006). They reported that changes in BCVA and FTH in the laser group (–1.6 letters and –36 µm, respectively) and the ranibizumab + laser group (+2.0 letters and –24 µm) were not statistically significant. They also noted that the mean number of ranibizumab injections was significantly greater in the ranibizumab group compared with the laser group (5.4 vs. 2.3 injections, p=.008), but not compared with the ranibizumab + laser group (3.3, p=.11).

More aggressive treatment with ranibizumab during year three resulted in a reduction in mean FTH and improvement in BCVA in the ranibizumab group, the investigators concluded. More extensive focal/grid laser therapy in the other two groups may have reduced the need for more frequent ranibizumab injections to control edema. Long-term visual outcomes for treatment of diabetic macular edema with ranibizumab are excellent, but many patients require frequent injections to optimally control edema and maximize vision.

The following retrospective study examined the clinical outcomes of cataract extraction in eyes with primary angle closure and coexisting cataract.

It included 55 eyes of 39 patients with primary angle closure or occludable angles and visually symptomatic cataract. Approximately 61.8% of eyes had received a peripheral iridotomy and 65% had evidence of glaucomatous optic neuropathy (GON).

At 7.2 months after cataract extraction, a statistically significant reduction in intraocular pressure (IOP) was observed in all eyes with primary angle closure (median 3 mmHg, p=<0.0001). The reduction in IOP was significantly greater in eyes with a higher preoperative IOP (p=<0.0001). On average, one less glaucoma medication was in use postoperatively (p=0.01). Eyes with >180 degrees of peripheral anterior synechiae (PAS) preoperatively achieved a significantly greater reduction in IOP postoperatively compared with those with less PAS (7.5 vs. 4.4 mmHg, p=0.03). They observed reduction in IOP in eyes with PAC and GON was significantly greater compared with those without GON (5.6 vs. 2.5 mmHg, p=0.01). Visual acuity was significantly improved after cataract extraction by a mean of –0.23 LogMAR units (p=0.0001).

Contrary to earlier expectations, the observed reduction in postoperative IOP in eyes with PAC was significantly greater in the presence of a higher preoperative IOP, a larger number of glaucoma medication, narrower iridotrabecular angle width, and greater extent of PAS formation and in eyes with evidence of GON. Lens extraction seems to have a beneficial effect on IOP control in PAC, and is especially efficacious in more advanced cases.