Treatment Outcomes in the Primary Tube Versus Trabeculectomy Study after 5 Years of Follow-up
Trabeculectomy with MMC and tube shunt surgery produced similar IOPs after 5 years of follow-up in the PTVT Study, but fewer glaucoma medications were required after trabeculectomy.
KEY FINDINGS: Trabeculectomy with MMC and tube shunt surgery produced similar IOPs after 5 years of follow-up in the PTVT Study, but fewer glaucoma medications were required after trabeculectomy. No significant difference in the rate of surgical failure was observed between the 2 surgical procedures at 5 years.
BACKGROUND: Aim of this study is to report 5-year treatment outcomes in the Primary Tube Versus Trabeculectomy (PTVT) Study. A total of 242 eyes of 242 patients with medically uncontrolled glaucoma and no previous incisional ocular surgery, including 125 patients in the tube group and 117 patients in the trabeculectomy group.
DETAILS: Patients were enrolled at 16 clinical centers and randomly assigned to treatment with a tube shunt (350-mm2 Baerveldt glaucoma implant) or trabeculectomy with mitomycin C (MMC) (0.4 mg/ml for 2 minutes). The primary outcome measure was the rate of surgical failure, defined as intraocular pressure (IOP) > 21 mmHg or reduced < 20% from baseline, IOP <= 5 mmHg, reoperation for glaucoma, or loss of light perception. Secondary outcome measures included IOP, glaucoma medical therapy, and visual acuity. The cumulative probability of failure after 5 years of follow-up was 42% in the tube group and 35% in the trabeculectomy group (P = 0.21; hazard ratio = 1.31; 95% confidence interval = 0.86-2.01). At 5 years, IOP (mean ± standard deviation) was 13.4 ± 3.5 mmHg in the tube group and 13.0 ± 5.2 mmHg in the trabeculectomy group (P = 0.52), and the number of glaucoma medications (mean ± standard deviation) was 2.2 ± 1.3 in the tube group and 1.3 ± 1.4 in the trabeculectomy group (P < 0.001).
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Source: Gedde, S. J. Feuer, W. J., Lim, K. S. (2023). Treatment Outcomes in the Primary Tube Versus Trabeculectomy Study after 5 Years of Follow-up. Ophthalmology. 2023; 129(12): 1344-1356. Published: February, 2023. DOI: 10.1016/j.ophtha.2022.07.003.
Ophthalmic Artery Doppler May Serve as a Noninvasive Marker of Angiogenic Imbalance in Near-Term Pregnancy
The findings demonstrate a significant relationship between the sFlt-1/PlGF ratio and ophthalmic artery Doppler measurements in near-term pregnancy. In particular, the OA peak systolic velocity ratio appears to reflect underlying angiogenic imbalance. Because OA Doppler is noninvasive, relatively accessible, and inexpensive, it may represent a useful surrogate approach for excluding angiogenic imbalance.
KEY FINDINGS: In 203 nulliparous women assessed at 35+0 to 36+6 weeks, higher sFlt-1/PlGF ratios were associated with higher OA-PSV ratios, lower OA-PI, and higher MAP. An OA-PSV ratio 0.61 identified women with an sFlt-1/PlGF ratio <38 with 90.5% accuracy at a 15% false-positive rate. The findings suggest that OA Doppler, particularly the PSV ratio, may provide a noninvasive and accessible surrogate for angiogenic imbalance near term. Further validation is needed before OA Doppler can replace biochemical assessment in clinical practice.
BACKGROUND: Angiogenic imbalance, reflected by an elevated soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1/PlGF) ratio, is associated with the pathophysiology of pre-eclampsia. Although the sFlt-1/PlGF ratio can help identify angiogenic imbalance, its use may be limited by cost and availability. This study evaluated whether ophthalmic artery (OA) Doppler parameters are associated with the sFlt-1/PlGF ratio and whether OA Doppler could help identify or exclude angiogenic imbalance in near-term pregnancy.
DETAILS: This cross-sectional cohort study was nested within the PE37 randomized controlled trial and included nulliparous women recruited between January 2023 and January 2025. Women underwent sFlt-1/PlGF measurement between 35+0 and 36+6 weeks' gestation. A subsample underwent OA Doppler assessment, including the OA peak systolic velocity (PSV) ratio and pulsatility index (PI), together with measurement of mean arterial pressure (MAP) and mean uterine artery PI. The Doppler operator was blinded to the sFlt-1/PlGF results. The analysis included 203 women, distributed across the lowest, middle, and highest sFlt-1/PlGF ratio tertiles as 62, 71, and 70 women, respectively.
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Increasing sFlt-1/PlGF ratio was associated with progressive changes in OA Doppler measurements. The median OA-PSV ratio increased from 0.45 (IQR, 0.39–0.53) in the lowest tertile to 0.48 (IQR, 0.41–0.58) in the middle tertile and 0.59 (IQR, 0.50–0.66) in the highest tertile (adjusted P<0.001). Conversely, median OA-PI decreased from 2.20 (IQR, 1.92–2.61) to 2.13 (IQR, 1.86–2.37) and 1.86 (IQR, 1.60–2.26), respectively (adjusted P=0.031).
MAP also increased across the sFlt-1/PlGF tertiles, from 87.0 (IQR, 82.7–92.0) mmHg to 88.7 (IQR, 83.7–93.7) mmHg and 94.7 (IQR, 89.3–100.0) mmHg (adjusted P<0.001). In contrast, mean uterine artery PI did not demonstrate a significant trend across the sFlt-1/PlGF tertiles.
For identifying an sFlt-1/PlGF ratio <38, an OA-PSV ratio <0.61 correctly identified 90.5% of women at a 15% false-positive rate. The authors therefore identified OA Doppler, particularly the PSV ratio, as a potentially useful surrogate measure for angiogenic imbalance and a promising approach for ruling out abnormal angiogenic status.
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Source: Tinajero, M. F., Faraci, C., Cuenca, M., et al. Ophthalmic artery Doppler as potential surrogate marker of angiogenic imbalance in near-term pregnancy. Ultrasound in Obstetrics & Gynecology. 2026; 68(2):211–219. Published: August, 2026. DOI: 10.1002/uog.70270.
Modified Delphi Consensus Defines a Practical Intravitreal Treatment Pathway for Centre-Involving Diabetic Macular Oedema
A Delphi panel of medical retina specialists reached consensus on 64/82 statements (78%) supporting personalised CI-DMO management. Early anti-VEGF response assessment at 3-6 months and consideration of corticosteroids after 9-12 months for persistent suboptimal response or high treatment burden may improve treatment consistency, but prospective validation is needed.
KEY FINDINGS: A two-round Delphi consensus involving medical retina specialists achieved agreement on 64/82 statements (78%) for managing CI-DMO. The framework supports personalised treatment, early assessment of anti-VEGF response at 3-6 months, and consideration of corticosteroid therapy after 9-12 months for persistent suboptimal response or high treatment burden. Prospective clinical validation is still required.
BACKGROUND: Management of centre-involving diabetic macular oedema (CI-DMO) can be challenging because treatment response varies and practical guidance on when to modify or switch therapy remains limited. Anti-vascular endothelial growth factor (VEGF) therapy is generally used first-line, while corticosteroids provide an alternative or second-line approach.
DETAILS: A two-round modified Delphi study was conducted among medical retina specialists in the National Health Service in England. A steering group developed 82 statements covering patient-centred care, baseline assessment and monitoring, definitions of treatment response, anti-VEGF switching criteria, corticosteroid use, and treatment stopping or switching criteria. Consensus was predefined as ≥75%.
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Thirty specialists responded in round one and 39 in round two. Overall, consensus was achieved for 64/82 statements (78%). The panel strongly supported personalised treatment and comprehensive baseline assessment, including best-corrected visual acuity, intraocular pressure, and macular optical coherence tomography with central retinal thickness measurement.
The consensus defined non-response as a reduction in central retinal thickness (CRT) by ≤10% and suboptimal response as a 10-20% reduction. A positive response was defined as a ≥20% reduction in CRT with improvement or stabilisation of diabetic macular oedema-related best-corrected visual acuity.
The panel recommended evaluating anti-VEGF response at 3-6 months and after treatment with two different anti-VEGF agents. For patients with persistent suboptimal response or high treatment burden, there was moderate consensus supporting consideration of corticosteroid therapy after 9-12 months.
For patients demonstrating a positive response after 1-2 injections of a short-acting corticosteroid, 63% strongly agreed and 27% tended to agree that transition to a long-acting corticosteroid should be considered. The panel also supported assessing anti-VEGF treatment burden after 9-12 months and considering corticosteroid therapy when treatment burden is high.
The recommendations emphasize that treatment decisions should incorporate anatomical response, visual outcomes, patient factors, treatment preferences, and tolerance. However, the authors noted that the pathway is based on expert consensus rather than prospective clinical validation, and all panellists were from England.
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Source: Gale, R., Bailey, C., Devonport, H., et al. Modified Delphi Expert Consensus on the Optimal Intravitreal Treatment Pathway for Centre Involving Diabetic Macular Oedema Patients Within the National Health Service. BMJ Open Ophthalmology. 2026; 11: ve002787. Published: August 20, 2026. DOI: 10.1136/bmjophth-2026-002787.
ILM Flap Technique May Improve Closure Rates for Large High-Myopic Macular Holes
In 499 eyes with large high-myopic macular holes, the 3-month closure rate was 72.4%. Closure declined with increasing hole size after ILM peeling and ILM flap procedures but not after AMT or ART. BCVA improved across all surgical groups, with a mean final gain of approximately 14.5 ETDRS letters.
KEY FINDINGS: In this large global series, ILM flap techniques demonstrated an important role in the management of large HMMHs and appeared more suitable than conventional ILM peeling as hole size increased. For very large defects, particularly those with a minimum diameter of >1000 µm, AMT or ART may offer an advantage because closure rates appeared less dependent on hole size. Meaningful visual improvement was observed across surgical approaches, supporting active surgical management in these complex cases. Interpretation should consider the retrospective design, variation in surgical practices among centers, and the small numbers of patients treated with AMT and ART.
BACKGROUND: Large high-myopic macular holes (HMMHs) are surgically challenging, and closure rates are lower than those reported in non-highly myopic eyes. The relative effectiveness of conventional internal limiting membrane (ILM) peeling, ILM flap techniques, and tissue-based approaches may vary according to macular hole size.
DETAILS: This global, multicenter, retrospective case series included 499 eyes of 463 patients with large HMMHs, defined by a minimum linear diameter of >=400 µm. Surgeries were performed between 2013 and 2023 by 37 surgeons worldwide, with a minimum follow-up of 3 months and a mean follow-up of 18.8 months. Surgical approaches included ILM peeling (n = 127), ILM flap (n = 285), amniotic membrane transplantation (AMT; n = 19), autologous retinal transplantation (ART; n = 36), and other techniques (n = 32). The primary outcome was macular hole closure at postoperative month 3, while secondary outcomes included changes in best-corrected visual acuity (BCVA). Outcomes were stratified according to the CLOSE Study Group size classification. The overall macular hole closure rate at 3 months was 72.4%. Closure rates decreased significantly as hole size increased following ILM peeling and ILM flap procedures. In contrast, closure rates with AMT and ART were not associated with increasing hole size, suggesting that tissue-based techniques may reduce the effect of defect size on surgical success in the largest HMMHs. Despite differences in anatomic closure across procedures, BCVA improved significantly from baseline at all follow-up time points in all surgical groups, with a mean final improvement of approximately 14.5 ETDRS letters.
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Source: Chau, V. Q., Abreu-Arbaje, N. A., Kitahata, S., et al. Surgical Management and Outcomes of Large High Myopic Macular Holes: Global Macular Hole Multicenter Study 3. Ophthalmology Retina. 2026; 46(8): 1345-1362 Published: August, 2026. DOI: 10.1097/IAE.0000000000004871
Fluocinolone Acetonide Implant as Baseline Therapy for Diabetic Macular Edema
This randomized Phase 4 study found that a fluocinolone acetonide implant-based treatment strategy maintained visual and retinal anatomical outcomes comparable with aflibercept monotherapy while significantly reducing overall injection burden. Although the primary endpoint was not met, the findings suggest that sustained corticosteroid therapy may offer a treatment-burden advantage in appropriately selected patients, with careful monitoring for cataract formation and intraocular pressure elevation.
Summary
Results from the Phase 4 NEW DAY Study
[Posted 16/Jul/2026]
AUDIENCE: Ophthalmology, Internal Medicine
KEY FINDINGS: This randomized Phase 4 study demonstrated that baseline treatment with the fluocinolone acetonide implant achieved visual and anatomic outcomes comparable to aflibercept monotherapy while reducing the total number of intravitreal injections by more than half over 18 months. Although steroid-associated cataract and IOP events occurred more frequently, the overall safety profile was consistent with previous studies, supporting the FAc implant as a potential early treatment strategy for selected patients with DME.
BACKGROUND: Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy remains the standard treatment for diabetic macular edema (DME), but the need for frequent injections and clinic visits can create a substantial treatment burden. The fluocinolone acetonide (FAc) 0.19-mg intravitreal implant provides sustained corticosteroid delivery and has demonstrated efficacy in persistent DME. The Phase 4 NEW DAY study evaluated whether using the FAc implant as baseline therapy, supplemented with aflibercept only when needed, could reduce injection burden while maintaining visual and anatomic outcomes comparable with aflibercept monotherapy.
DETAILS: NEW DAY was a prospective, randomized, single-masked, active-controlled, multicenter, 18-month Phase 4 trial conducted at 42 sites in the United States. A total of 517 participants were screened, and 306 adults with type 1 or type 2 diabetes and center-involving DME were randomized to receive either a 0.19-mg FAc implant (n = 154) followed by rescue aflibercept injections as needed or aflibercept (n = 152) administered as five loading doses every four weeks followed by rescue treatment when required. The primary endpoint was the mean number of rescue supplemental aflibercept injections during the study. Secondary outcomes included total intravitreal injections, time to first rescue injection, best-corrected visual acuity (BCVA), central subfield thickness (CST), cataract procedures, and intraocular pressure (IOP)-related safety outcomes. The primary endpoint was not met, with a similar mean number of rescue aflibercept injections in the FAc and aflibercept groups (2.4 ± 3.2 vs. 2.5 ± 3.1; P = 0.76). However, the FAc strategy substantially reduced overall treatment burden, requiring fewer total injections than aflibercept monotherapy (3.4 ± 3.2 vs. 7.2 ± 3.4; nominal P < 0.001). Time to first rescue injection was significantly longer with the FAc implant (185.4 ± 97.9 days vs. 132.8 ± 94.0 days; nominal P < 0.001). Approximately one-third of participants in both groups required no rescue injections throughout the study (32.5% vs. 30.3%; nominal P = 0.68). Improvements in visual acuity and retinal anatomy were comparable between groups, with mean BCVA changes of 1.8 letters and 5.5 letters (nominal P = 0.08) and mean CST reductions of -119 ± 112 µm and -114 ± 103 µm (nominal P = 0.71) in the FAc and aflibercept groups, respectively. Cataract procedures occurred more frequently with the FAc implant (27.9% vs. 6.6%), and increased IOP was reported in 15.6% of FAc-treated participants compared with 3.3% receiving aflibercept. Despite these steroid-related adverse events, incisional IOP procedures were uncommon, and no new safety signals were identified.
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Source: Singer, M. A., Wykoff, C. C., Riemann, C. D., et al. Fluocinolone Acetonide Implant as a Baseline Therapy for Diabetic Macular Edema. American Academy of Ophthalmology. 2026; 133(7): 837-851. Published: June 22, 2026. DOI: 10.1016/j.ophtha.2026.03.019.
Prompt and Intensive Antiviral Chemoprophylaxis in Nursing Home Influenza Outbreaks
Findings suggest intensive chemoprophylaxis of 70% or more of residents in response to influenza outbreaks in NHs within the first 2 days is associated with a lower 14-day risk of hospitalization among residents, with additional evidence to support a benefit when 60% or more or 80% or more of residents receive chemoprophylaxis. These findings could strengthen evidence-based recommendations to inform best practices in managing influenza outbreaks in NHs.
KEY FINDINGS: Study results suggest that clinicians should initiate antiviral chemoprophylaxis for at least 70% of eligible NH residents within 2 days of outbreak detection to lower risk of hospitalization.
BACKGROUND: Influenza outbreaks in nursing homes (NHs) pose a substantial threat to older adults, often resulting in morbidity and mortality. The Centers for Disease Control and Prevention (CDC) and the Infectious Diseases Society of America (IDSA) recommend prompt postexposure prophylaxis, also termed chemoprophylaxis or prophylaxis with oseltamivir, for all residents who are not ill to limit influenza spread in NHs. Purpose of the study is to examine whether initiating antiviral chemoprophylaxis for 70% or more of eligible NH residents within 2 days of influenza outbreak detection is associated with lower all-cause mortality and hospitalization at 14 and 30 days.
DETAILS: Retrospective cohort study using a sequential cluster-randomized target trial emulation and randomize-censor-weight approach for influenza outbreaks (September 1, 2018-May 31, 2022) in 12 US NH corporations. Eligibility criteria were age 18 years or older, present on the outbreak-detection day, no antiviral use in the preceding 7 days, no influenza in the past 14 days, and complete baseline data. Residents were followed up until hospitalization or death, an NH discharge to a nonacute-care location, or the end of follow-up. Data were analyzed from February 2023 to January 2026.
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Exposures: Intensive antiviral chemoprophylaxis with oseltamivir (>=70% of eligible residents within 2 days of outbreak detection) or nonintensive antiviral chemoprophylaxis (0% to <70% of eligible residents).
Outcomes were all-cause death and hospitalizations within 14 and 30 days of outbreak detection. Discrete-time hazard models with pooled logistic regression were applied to estimate weighted risks, risk differences (RDs), and risk ratios (RRs).
Among 404 outbreaks in 318 NHs, 35,086 resident-trial observations (29,683 residents; median age 78 [IQR, 68- 86] years; 60% women; 81% White; 76% vaccinated) met eligibility criteria. Intensive oseltamivir prophylaxis was randomized to 17,155 observations; 17,931 were randomized to nonintensive care. At 14 days, intensive prophylaxis vs nonintensive yielded an RD of -0.06% (95% CI, -0.73% to 0.93%) and an RR of 0.96 (95% CI, 0.56-1.57) for death, and an RD of -0.96% (95% CI, -1.78% to -0.19%) and an RR of 0.79 (95% CI, 0.64-0.96) for hospitalization. At 30 days, the hospitalization differences persisted but were less precise and there continued to be no difference in death.
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Source: Silva, J. B. B., Hsieh, H. T., Howe, C. J., et al. Prompt and Intensive Antiviral Chemoprophylaxis in Nursing Home Influenza Outbreaks. JAMA Internal Medicine.. 2026; 186(6): 714-722. Published: June, 2026. DOI: 10.1001/jamainternmed.2026.0401
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