Alessandro Invernizzi

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Background: To report 5‐year outcomes in a cohort of patients who received anti‐VEGF therapy for macular oedema secondary to central retinal vein occlusion (CRVO) in routine clinical practice. Methods: In this retrospective observational study, 593 treatment‐naïve eyes that commenced anti‐VEGF treatment between 1 January 2010, and 2019 were analysed. Outcome measures included mean changes in visual acuity (VA) and central subfield thickness (CST). Results: In the entire cohort (593), the mean VA changed by +8 letters and the mean CST by −298 μm. The entire cohort includes eyes with completed 5‐year follow‐up and non‐completers who dropped out before the end of the observation period. Eyes that completed the 5‐year follow‐up (202/593, 34%) had a mean VA and CST change of +11 letters and −320 μm with a median of 25.5 injections at 39.5 visits. Non‐completers with a final VA of > 70 letters (95/593; 16%) experienced a change in mean VA of +23 letters. In non‐completers with a final VA between 35 and 70 letters (163/593; 27%), the mean VA increased by 12 letters. In non‐completers with a final VA of < 35 letters (133/593; 22%), the mean VA declined by 12 letters. Conclusion: Patients with macular oedema secondary to CRVO who continue treatment can achieve meaningful improvements in vision over an extended period. Patients with initially poor vision tend to have large improvements but the worst outcomes. In contrast, eyes with very good initial VA can achieve excellent functional results and may even stop treatment at some point with adequate therapy.

Introduction The aim of this study is to characterize the clinical indications, treatment patterns, and outcomes associated with intravitreal dexamethasone implant (DEX implant) in eyes with punctate inner choroidopathy (PIC). Methods This retrospective observational case series included eyes with PIC treated with at least one DEX implant. Eyes were categorized according to the indication for treatment as (1) bridging therapy while initiating systemic immunomodulatory therapy (IMT), (2) adjunctive treatment for recurrent inflammatory activity despite ongoing IMT, or (3) local therapy in patients not receiving systemic IMT. Main outcome measures included best-corrected visual acuity (BCVA), inflammatory control, inflammatory recurrence, retreatment requirements, and safety. Results Twenty-five eyes from 22 patients were included. Mean age at index injection was 56.5 ± 11.1 years, and 18/22 patients (82%) were female. DEX implant was used as bridging therapy in 5 eyes (20%), adjunctive therapy during ongoing IMT in 6 eyes (24%), and local therapy without IMT in 14 eyes (56%). A total of 33 DEX implants were administered during follow-up. Complete resolution of inflammatory activity was achieved in all eyes within 6 months of the first DEX implant. Mean BCVA remained stable, from 0.33 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.34 logMAR at month 6. Inflammatory recurrence occurred in 7/25 eyes (28%) after a mean of 6.0 ± 3.5 months, with no recurrences observed among eyes receiving DEX implant during ongoing IMT. Intraocular pressure elevation occurred in 12/25 eyes (48%) and was successfully controlled with topical therapy. Other ocular adverse events were infrequent and included retinal detachment, peripheral retinal hole, hypotony, and posterior vitreous detachment, each occurring once in a different eye (4% each). Conclusions Intravitreal DEX implant provides effective short-term control of inflammatory activity in PIC and serves multiple complementary roles in clinical practice, including bridging during IMT initiation, adjunctive treatment for breakthrough inflammation, and stand-alone local therapy in selected patients. The absence of recurrences among eyes receiving concomitant IMT and the higher recurrence rate in those cases managed without systemic immunomodulation suggest that DEX implant is most effectively integrated into a broader long-term immunomodulatory strategy for patients with relapsing disease.

It is difficult to pinpoint the precise origin of the term “White Dot Syndromes”. Based on personal communication with Dr. Anita Agarwal, who has continued the academic legacy of Dr. Donald J. Gass...