The Influence of Prolongation of Interruptions of Preoperative Posturing and Other Clinical Factors on the Progress of Macula-On Retinal Detachment

Vitritis following intravitreal faricimab: a retrospective monocentric analysis

PURPOSE

Intravitreal injections of anti-VEGF agents are considered as safe, with a very low rate of intraocular inflammations (IOI). Faricimab is a novel intravitreal bispecific antibody targeting both VEGF-A and angiopoietin-Tie2 independently. Despite a safe profile in randomized clinical trials, several real-life studies have reported cases of IOI. The aim of this monocentric study was to report the incidence and clinical course of intraocular inflammation following intravitreal faricimab injections.

METHODS

A retrospective analysis was performed in our tertiary care center, based on the observation of cases between December 1, 2023 and April 30, 2024. The incidence of intraocular inflammation occurring following faricimab injections compared to other anti-VEGF agents and dexamethasone implants was assessed over the study period.

RESULTS

Intraocular inflammation was observed in 11 eyes of seven patients, and presented as isolated, painless anterior uveitis with retrocorneal precipitates in three cases and vitritis associated with anterior uveitis in eight cases. The pattern of vitritis appeared distinctive, characterized by dense, grayish vitreous bands observed mainly in the peripheral fundus. The inflammatory phase persisted for 2-10 weeks, and regressed with steroid treatment. The overall incidence of IOI with faricimab was 0.87% (11 out of 1,271 injections), with vitritis specifically observed in 0.63% of cases (8 out of 1,271 injections). In contrast, of the 3,728 injections of other anti-VEGF agents administered (including 1,765 injections of aflibercept, 1,952 injections of ranibizumab) and 43 injections of dexamethasone implants, no cases of intraocular inflammation were reported.

CONCLUSIONS

Our initial experience with faricimab indicates a potentially higher risk of intraocular inflammation, including a distinctive pattern of vitritis, compared to aflibercept and ranibizumab. The benefit/risk ratio should be carefully assessed, particularly in patients with monocular vision or who require simultaneous bilateral injections.

Preoperative Positioning and Progression of Fovea-on Retinal Detachments

PURPOSE

To study the relationship between positioning and rhegmatogenous retinal detachment (RRD) progression before surgery in patients with a fovea-on RRD.

DESIGN

Prospective, single-cohort study.

SUBJECTS

Patients with fovea-on RRD admitted to hospital for bedrest before surgical treatment were recruited.

METHODS

Primary outcome was the shortest distance from the foveal center to the retinal detachment border on OCT. Secondary outcomes were measured with a head-mounted positioning sensor and included measures of head movement (linear acceleration and angular velocity) as well as measures of positioning regimen compliance.

MAIN OUTCOME MEASURES

Distance from the fovea to the retinal detachment border.

RESULTS

Overall, 50 patients with fovea-on positioned before RRD repair. One patient (1/50, 2%) progressed from fovea-on to fovea-off. Of the positioning measures, angular velocity demonstrated the strongest correlation with RRD border movement, whereas measures of positioning compliance showed nonsignificant correlation. After defining 3 movement groups: stable, intermediate, and mobile RRDs, we found that a doubling of head movement (angular velocity) correlated with a median RRD border progression of -6 μm/h, -75 μm/h, and -219 μm/h in the 3 groups, respectively.

CONCLUSIONS

Rhegmatogenous retinal detachment border movement is correlated to angular velocity of the head, whereas compliance with our current positioning regimen does not have a significant impact on RRD border movement. Not all RRDs progress rapidly toward the fovea, but those that do seem to be highly influenced by head movement. For limiting RRD progression, a reduced movement positioning regimen may be superior to our current gravity-based approach.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

INFLUENCE OF PREOPERATIVE POSTURING ON SUBFOVEAL FLUID HEIGHT IN MACULA-OFF RETINAL DETACHMENTS

PURPOSE

To evaluate the effect of preoperative posturing on subfoveal fluid height (SFFH) in macula-off retinal detachment.

METHODS

A prospective study including patients with macula-off retinal detachment with SFFH measurable on optical coherence tomography (OCT) and duration of loss of central vision (LCV) ≤ 7 days. Linear OCT volume scans were performed at baseline, after 1 minute, 1 hour, 4 hours, and on the next morning. For the first hour, all patients remained in an upright position. Patients were then either instructed to posture until the surgery according to the location of the primary retinal break (posturing group) or were not given any instructions (control group).

RESULTS

Twenty-four patients were included in the posturing group and 11 patients in the control group. There was no significant change in SFFH between baseline, 1 minute, 1 hour, and 4 hours. The mean SFFH in the control group increased by 243 µ m from 624 (±268) µ m at baseline to 867 (±303) µ m the next morning ( P < 0.01) but decreased in the posturing group by 150 µ m from 728 (±416) to 578 (±445) µ m ( P = 0.03). There was a significant association of the SFFH the next morning with posturing ( P < 0.01) and SFFH at baseline ( P < 0.01), but not with location of primary break ( P = 0.20). The change in SFFH from baseline to the next morning was significantly associated with posturing and primary break location ( P < 0.01), but not with SFFH at baseline ( P = 0.21).

CONCLUSION

Preoperative posturing is an effective measure to prevent progression of macular detachment in macula-off retinal detachment.

Importance of subfoveal fluid height on visual outcome in macula-off retinal detachments

AIMS

To investigate the effect of subfoveal fluid height (SFFH) on visual outcome after macula-off retinal detachment (RD) repair.

METHODS

Prospective interventional case series of consecutive patients undergoing pars plana vitrectomy with gas tamponade (PPV) for primary macula-off RD with duration of symptomatic loss of central vision (LCV) of ≤1 week. Preoperative SFFH was measured on two occasions an hour apart using optical coherence tomography (OCT) by two independent observers. Postoperative best corrected visual acuity (BCVA) was measured at 3 months.

RESULTS

Sixty-one patients were included. All patients were pseudophakic after RD repair. The mean preoperative and postoperative BCVA (logarithm of the minimum angle of resolution) at 3 months was 1.41 (±0.71) and 0.15 (±0.12, range 0.00-0.70). Twenty-six patients with SFFH of ≤1500 µm were available for repeat OCT measurements. The variation in SFFH was proportional to the SFFH and showed a logarithmic (base 2) association (r=0.50, p=0.01). Patients were therefore grouped according to their SFFH as group 1: 1-100 µm, group 2: 101-300 µm, group 3: 301-700 µm, group 4: 701-1500 µm and group 5: 1501-3100 µm. BCVA at 3 months significantly reduced with increasing SFFH from 0.04 (±0.03) in group 1 to 0.28 (±0.15) in group 5 (p<0.001) but was not associated with age (p=0.77), preoperative BCVA (p=0.39), duration of LCV (p=0.63) or use of perfluorocarbon liquids (p=0.88). Forty-five patients had SFFH ≤1500 µm and achieved 0.10 (±0.07, range 0.00-0.30) logMAR.

CONCLUSION

Visual acuity following PPV for macula-off RD is related to preoperative SFFH regardless of the duration of symptomatic LCV within the first week.

The urgency of surgical treatment for rhegmatogenous retinal detachment

The ideal timing of surgery in patients with rhegmatogenous retinal detachment has been discussed for decades. The study situation has improved in recent years so that recommendations can now be made. When the macula is detached, surgical treatment of the retinal detachment should be undertaken within a few days. When the macula is still attached, the near fovea and bullous superotemporal detachment should be classified as an emergency. When planning the operation environmental factors must also be considered, meaning that the performance of the intervention by an experienced surgical team is usually more important for the final result than the retinal condition alone. Influencing factors are discussed in this article and recommendations for dealing with these emergency patients are discussed.