Jakob Bjerager

Purpose: To estimate the real‐world incidence of intraocular inflammation (IOI) following intravitreal faricimab injections at a large, highly specialized tertiary centre. Methods: Single‐centre, retrospective cohort study with chart review using an electronic injection database and electronic medical records from November 2023 to August 2024. Results: The study included 6054 patients, 7510 eyes and 31 393 injections. During the inclusion period, 42 eyes of 40 patients developed IOI, resulting in 48 IOI events. The incidence of IOI was 0.66% per patient, 0.56% per eye and 0.13% per injection. IOI occurred after a median of 4 faricimab injections (IQR: 2, range: 1–9) and a median of 8.5 days (IQR: 20, range: 0–37) after the last injection. The median disease duration (time from diagnosis to resolution) was 32 days (IQR: 46, range: 6–144). Eighty per cent of patients who developed IOI were females, and females had 2.42–2.66 times higher hazard of developing IOI than males. Most IOI cases were anterior or anterior + intermediate uveitis (47.9% and 33.3%, respectively). All panuveitis cases ( n = 6) underwent vitrectomy, and one had a positive culture, yielding a 0.003% per‐injection incidence of culture‐positive endophthalmitis. Cases rechallenged with faricimab following IOI ( n = 13) had a relapse in 46.15%. The change in median best‐corrected visual acuity between before and after IOI events was not statistically significant. Conclusions: Faricimab demonstrated an acceptable safety profile in our study. The incidence of IOI events was consistent with those observed in other real‐world reports. The IOI events showed a female predominance, varied presentations and durations, but generally had favourable outcomes. Study Registration: ClinicalTrials.gov registration number: NCT06902207, Date of registration: 15/03/2025 retrospectively registered.

Introduction Understanding the durability of faricimab with three monthly loading injections in a real-world clinical setting is important for optimizing treatment intervals and reducing the treatment burden. The aim of this study was to evaluate the durability and visual outcomes of a loading dose regimen consisting of three consecutive monthly faricimab injections in treatment-naïve patients with neovascular age-related macular degeneration (nAMD). Methods This is a retrospective, single-center cohort study using chart review and an electronic injection database, including treatment-naïve patients with nAMD aged 50 years or older who received three monthly faricimab injections between 1 November 2023 and 31 August 2024. Results Overall, 827 eyes of 742 patients were included in the study. Following the loading dose, the median injection-free interval was 15.0 weeks (95% confidence interval [CI] 13.1 to 16.6). The estimated injection-free survival probabilities at 4, 6, 8, 10, 12, 14, 16, and 24 weeks were 90.9%, 81.1%, 79.1%, 75.5%, 57.1%, 51.1%, 48.6%, and 29.4%, respectively. At 180 days, 28.4% (n = 235) of eyes remained injection-free, and 21.6% (n = 179) were discharged from hospital-based care. At 4 weeks post-loading, 42.6% of eyes showed improved best-corrected visual acuity (BCVA), 46.3% were stable, and 11.1% declined. The mean BCVA change was −0.082 logarithm of the minimum angle of resolution (logMAR) (95% CI −0.097 to −0.067; p < 0.001), corresponding to a gain of approximately 4 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters. Conclusions A three-injection loading dose regimen of faricimab demonstrated favorable durability, with most eyes maintaining a long injection-free interval and experiencing visual improvement or stability. A routine follow-up at 4 weeks after loading may be unnecessary in many patients, whereas 8 weeks appear adequate. Treatment after loading can be paused for an extended period in a substantial subset of patients. Faricimab may reduce treatment burden early, while providing stabilization or improvement of visual acuity for the majority of patients with nAMD in clinical practice. Trial Registration ClinicalTrials.gov registration no. NCT06890026; date of registration: 16 March 2025 (retrospectively registered).

Purpose: To investigate the prevalence and clinical characteristics of Charles Bonnet Syndrome (CBS) in patients referred for bilateral cataract surgery. Methods: This prospective, cross-sectional clinical trial included 391 patients attending cataract assessment at a single-center tertiary cataract clinic. After clinical examination, participants were screened for presence of visual hallucinations (VHs). Participants experiencing complex VHs were further questioned regarding characteristics of their hallucinatory experiences to properly determine if they were attributable to CBS. CBS was defined as complex visual hallucinations with retained insight, no medical history or medication known to cause hallucinations and not limited to hypnagogic or hypnopompic states (hallucinations happening shortly before falling asleep and/or shortly after waking up). Results: Nineteen (4.9%) patients experienced complex VHs. Of these, 11 (2.8%) were diagnosed with CBS while 8 (2.1%) had complex hypnagogic and/or hypnopompic VHs. Multivariable logistic regression analysis identified lower best-corrected visual acuity (BCVA) in the better seeing eye as a significant predictor of CBS. When excluding participants with a BCVA>0.3, prevalence of complex VHs rose to 10.0%. Three of the patients with CBS (27.3%) had ocular comorbidities: two had exudative age-related macular degeneration (AMD), and one had drusenoid AMD. In the overall cohort, twenty-four patients (6.1%) reported prior knowledge of CBS. Conclusion: CBS was observed in a clinically relevant minority of cataract patients requiring bilateral surgical intervention. Given the high prevalence of cataract among the elderly, this study highlights the importance of healthcare personnel being aware of CBS and other complex VHs and their potential consequences for cataract patients.

Background: Metal welding generates ultraviolet radiation (UVR) of cataractogenic wavelengths, and UVR emitted during welding has been associated with cataract formation, but results from prior studies are conflicting. Methods: We conducted a systematic review and meta‐analysis of epidemiological studies addressing associations between occupational metal welding and cataract. The literature search was conducted on November 15, 2023, across seven literature databases. Studies comparing age‐adjusted occurrence of cataract among welders and control groups were included. Two reviewers extracted data, which were combined using random‐effects meta‐analyses. Results: We identified nine studies with a total of 5165 welders and 513 026 controls. There was considerable heterogeneity among studies ( I ² statistics: 39), and possible publication bias in favour of higher risk estimates. Stratified meta‐analyses revealed a summary OR of 1.22 ( n = 3, 95% CI 0.79–1.90; p = 0.374) for cataract among welders in high‐income countries, whereas the OR was 2.95 ( n = 9, 95% CI 1.68–5.19; p = 0.00017) in lower‐middle‐income countries. Conclusion: An increased risk of cataract among welders was found in studies from lower‐middle‐income countries, but not in studies from high‐income countries. The disparity could reflect differences in occupational safety adherence and study methodology and may also involve effect modification by cumulative solar UVR. Although a causal link between UVR from metal welding and cataract is biologically plausible, epidemiological evidence is still limited. More studies are needed to quantify the exact risk of cataract among welders in various populations.

The aim of this review was to evaluate the comparative efficacy of intravitreal anti‐vascular endothelial growth factor (anti‐VEGF) therapy for neovascular AMD. We searched 12 literature databases for randomised clinical trials (RCT) on anti‐VEGF therapy for neovascular AMD and extracted data on: change from baseline to 12 months in best‐corrected visual acuity (BCVA) and central retinal thickness (CRT), and cumulative number of injections at 12 months. The reference for comparison was monthly ranibizumab. Comparisons were made using network meta‐analyses. Forty‐nine RCTs including 23 257 eyes of 23 257 patients were included. No anti‐VEGF drug or treatment regimen provided a better BCVA response compared to the reference. For CRT, small but statistically significant improvements over the reference were observed for brolucizumab 3 mg (−27.9 μm) or 6 mg (−38.1 μm) in loading dose (LD) then every 8–12 weeks, aflibercept 8 mg in LD then every 12 (−26.9 μm) or 16 weeks (−32.1 μm), faricimab 6 mg in LD then treat‐and‐extend (−18.1 μm) and aflibercept 2 mg in LD then every 8 weeks (−11.3 μm). For the cumulative number of injections, a range of anti‐VEGF drugs and treatment regimens provided a statistically significant and clinically meaningful reduction compared to the reference. When results are considered simultaneously, faricimab 6.0 mg or aflibercept 8.0 mg in a treatment regimen with an LD followed by either a treat‐and‐extend regimen or a fixed 12‐ or 16‐week regimen appears to provide the optimal balance between visual outcomes, anatomical outcomes and the lowest treatment burden. However, studies of the long‐term efficacy of newer anti‐VEGF drugs are warranted.

Background/Objectives: The automated analyses of optical coherence tomography (OCT) scans of the retina occasionally suggest the presence of tissue deficits when no visual field defects can be detected. This study was made to find the sources of such alerts. Methods: Data from a population-based cohort of 360 participants aged 30–80 years was analysed for the anatomical sources of alerts after the extensive exclusion of participants where any suspicion of abnormality could be raised. An analysis was made of 12 × 9 mm volume scans centred between the disc and the fovea. The exclusions comprised 107 eyes with definite or borderline abnormal visual fields or other potentially confounding characteristics. A statistical analysis of the thickness patterns was made using the manufacturer’s proprietary algorithm. The analysis comprised alerts corresponding to local layer thickness values in the lower 5th percentile of an independent reference population. Results: Of the 613 eligible healthy eyes, thickness deficit alerts were seen in 391. They were related to the angle between the temporal nerve fibre ridges being wider, narrower, or rotated compared to the reference template in 174 eyes and to the variations in the size of the macula in 207 eyes. The source was unidentifiable in 28 eyes. The common sources were a thin papillomacular nerve fibre layer accompanied by arcuate nerve fibre ridges spaced far apart and a thinly, but wider than the normal macular ganglion cell layer. Conclusions: Anatomical variation in the retinal nerve fibre and ganglion cell layers was the source of more than 90% of the thickness deficit alerts in the eyes with normal visual fields.

Purpose: To compare patient‐reported visual function outcomes of immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS).Methods: Single‐center, randomised controlled trial of patients eligible for bilateral cataract surgery allocated to ISBCS or DSBCS. Patients filled out the Catquest‐7SF questionnaire before surgery, 1 week after surgery, and 3 months after surgery.Results: Ninety‐eight patients were included for analysis (ISBCS = 51; DSBCS = 47). In both groups, there was a statistically significant improvement in Catquest‐7SF patient‐reported outcomes after surgery (p < 0.001), and no difference between the ISBCS and DSBCS groups (p ≥ 0.424). At both 1 week and 3 months post‐surgery, a statistically significantly higher proportion of patients were “very satisfied” with the surgical approach in the ISBCS group (94.1% at both 1 week and 3 months) compared to the DSBCS group (55.3% at 1 week and 63.8% at 3 months), both p < 0.001.Conclusions: Both ISBCS and DSBCS are effective options to treat bilateral cataracts with no statistically significant difference in patient‐reported vision outcomes. However, we found postoperative satisfaction with the surgical approach to be higher among ISBCS patients, which suggests that ISBCS‐related benefits, such as fewer health care visits and shorter vision rehabilitation, are compelling to patients.

This case report describes the real-time imaging of a transient retinal embolus in a patient experiencing episodes of monocular vision loss.

Purpose: To report short-term outcomes of treatment switch to faricimab in real-world patients with aflibercept-resistant neovascular age-related macular degeneration (AMD). Methods: Single-center, retrospective cohort study with chart-review using electronic injection database, electronic medical records, and optical coherence tomography (OCT) data from May to September 2023. Results: A total of 50 eyes of 46 patients were analyzed. Faricimab treatment led to absence of fluid in 32% of the eyes and a reduction of fluid in 84% of the eyes. There was a statistically significant decrease in central retinal thickness (CRT) and pigment epithelial detachment (PED) height in those that responded to the switch (median difference: − 31 μm, IQR: 55, p < 0.0001 and median difference: − 21 μm, IQR: 36, p < 0.0001, respectively) and a statistically significant increase in CRT (median difference: + 19 μm, IQR: 20, p = 0.0143) and no change in PED height (median difference: + 22 μm, IQR: 64, p = 0.1508) in those that did not. Best-corrected visual acuity (BCVA) showed marginal decrease with low statistical significance. No ocular or systemic safety events were observed. Conclusions: Our findings suggest that switching to faricimab is generally safe and effective in patients with neovascular AMD who are otherwise difficult to treat and have residual fluid despite frequent injections with aflibercept. We observed a high rate of morphological response to the treatment switch, improvement of anatomical parameters with about one-third of patients having dry macula following a single injection, and a marginal change in BCVA. Sustainability of these results requires further investigation. Study registration: ClinicalTrials.gov registration number: NCT06124677. Date of registration: 09/11/2023, retrospectively registered.