OPHTHALMOLOGICA

This month’s issue of Ophthalmologica features a series of articles concerned with polypoidal choroidal vasculopathy (PCV), a variant of AMD. In the first of the articles, Shigeru Honda MD, PhD and associates, explain the phenotypical differences between PCV and typical AMD in terms of its morphology and its generally poorer response to conventional anti-VEGF injection. Their review also cites the results of the recent, randomised controlled trial, the EVEREST study, in which combination therapy with photodynamic therapy (PDT) and intravitreal ranibizumab produced significantly greater improvements in visual acuity than ranibizumab alone in patients with PCV.

S Honda et al., Ophthalmologica, “Polypoidal Choroidal Vasculopathy: Clinical Features and Genetic Predisposition” 2014 (DOI:10.1159/000355488)

PDT plus anti-VEGF combo effective in polypoidal choroidal vasculopathy

The results of a new retrospective study appear to support the results of the EVEREST study, and furthermore indicate that treatment with PDT alone may be better than anti-VEGF treatment alone in patients with PCV. The authors of the study reviewed the case-notes of 62 eyes of 62 patients with PCV. All had at least two years' follow-up after initiating treatment with PDT alone, in 11 eyes, anti-VEGF therapy alone, in 23 eyes and a combination of the two treatments in 20 eyes. At the twoyear follow-up examination, the PDT and combination groups maintained significant visual improvement compared with the baseline (p = 0.041 and p = 0.021), whereas the anti-VEGF alone group failed to do so (p = 0.673).

H.M. Kang et al. Ophthalmologica, “Two- Year Outcome after Combination Therapy for Polypoidal Choroidal Vasculopathy: Comparison with Photodynamic Monotherapy and Anti-Vascular Endothelial Growth Factor Monotherapy” 2014 (DOI:10.1159/000354546).

Monthly ranibizumab preserves vision

The results of a prospective, non-comparative study showed that among 13 eyes of 13 patients with PCV, none lost 15 or more letters of visual acuity and three patients gained 15 or more letters after receiving monthly ranibizumanb for one year. In addition, there was a resolution of subretinal haemorrhage in all nine eyes with the condition, and macular oedema improved in all five eyes with the condition. Furthermore, among nine eyes with subretinal fluid the condition completely resolved in four, decreased in two and increased in three. However, branching vascular networks persisted in all eyes and only five eyes had a decrease in polypoidal complexes.

GT Kokame et al. Ophthalmologica, “Polypoidal Choroidal Vasculopathy Exudation and Haemorrhage: Results of Monthly Ranibizumab Therapy at One Year” 2014 (DOI:10.1159/000354072).

Bevacizumab carries higher cardiovascular risk

This month’s issue of Ophthalmologica also included a review article addressing a growing concern that intravitreal bevacizumab poses a greater risk of strokes and heart attacks than intravitreal ranibizumab. The review’s authors note that, when used systemically, bevacizumab raises the risk of cardiovascular pathologies such as hypertension, arterial thrombosis and cardiomyopathy. Furthermore, retrospective studies have consistently shown a higher risk for stroke among patients receiving intravitreal bevacizumab, compared to those receiving ranibizumab.

A F Cruess et al. Ophthalmologica, “Cardiac Issues of Noncardiac Drugs: The Rising Story of Avastin in Age- Related Macular Degeneration” 2014 (DOI:10.1159/000355569).