American Journal of Ophthalmology最新文献

{"title":"Epidemiologic Study of Pediatric Uveitis and its Ophthalmic Complications Using the Korean National Health Insurance Claim Database","authors":"Eun Hee Hong ,&nbsp;Jiyeong Kim ,&nbsp;Min Ho Kang ,&nbsp;Sung Who Park ,&nbsp;Anh Ngoc Tram Tran ,&nbsp;Irmak Karaca ,&nbsp;Amir Akhavanrezayat ,&nbsp;Chi Mong Christopher Or ,&nbsp;Zheng Xian Thng ,&nbsp;Albert John Bromeo ,&nbsp;Anadi Khatri ,&nbsp;Diana Do ,&nbsp;Quan Dong Nguyen ,&nbsp;Yong Un Shin","doi":"10.1016/j.ajo.2025.03.019","DOIUrl":"10.1016/j.ajo.2025.03.019","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To investigate the incidence and ophthalmic complications of pediatric uveitis using the Korean National Health Insurance (NHI) Service database.</div></div><div><h3>DESIGN</h3><div>Nationwide population-based longitudinal cohort study.</div></div><div><h3>METHODS</h3><div>This study used the NHI database from 2005 to 2021 and included individuals &lt;18 years of age diagnosed with uveitis on at least three separate visits between 2010 and 2014, with a five-year wash-out period and a seven-year follow-up period. All uveitis cases were classified as either anterior or nonanterior on the basis of the diagnostic code. The occurrence of ophthalmic complications during the follow-up period, and the systemic and socioeconomic associations between pediatric uveitis and its ophthalmic complications were investigated. We obtained the incidence of total, anterior, and nonanterior pediatric uveitis between 2010 and 2014; the percentage of ophthalmic complications during the follow-up period; and hazard ratios for ophthalmic complications of anterior and nonanterior uveitis.</div></div><div><h3>RESULTS</h3><div>A total of 9495 cases of pediatric uveitis (8734 cases with anterior and 761 with nonanterior uveitis) were identified, with an average annual incidence (per 10 000 children) of total, anterior, and nonanterior uveitis being 2.0, 1.8, and 0.2, respectively. The most common complications were glaucoma or presumed ocular hypertension, macular disease, and amblyopia. Patients with nonanterior uveitis had a significantly higher risk of ophthalmic complications including retinal detachment, cataract, amblyopia, and glaucoma or presumed ocular hypertension than those with anterior uveitis.</div></div><div><h3>CONCLUSIONS</h3><div>This nationwide analysis of pediatric uveitis in South Korea revealed an average incidence of 2.0 per 10 000 children, highlighting the higher risks of ophthalmic complications associated with nonanterior uveitis.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"275 ","pages":"Pages 1-13"},"PeriodicalIF":4.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Global Consensus on Keratoconus and Ectatic Diseases Agreements Reached on Subclinical Keratoconus.","authors":"J Bradley Randleman, Bianca N Susanna, Bassel Hammoud, Barbara A L Dutra, Giuliano Scarcelli, Marcony R Santhiago, William J Dupps, Douglas D Koch","doi":"10.1016/j.ajo.2025.03.013","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.03.013","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the consensus agreements reached in the Global Consensus on Keratoconus and Ectatic Diseases project for subclinical keratoconus, specifically that posterior corneal elevation abnormalities must be present to diagnose mild or subclinical keratoconus.</p><p><strong>Design: </strong>Literature Review METHODS: Database review (PubMed) was performed on January 2, 2024, to identify studies evaluating the ability of posterior corneal surface metrics to identify subclinical keratoconus using the following search terms: posterior corneal elevation; keratoconus screening; corneal ectasia; subclinical keratoconus; keratoconus suspect; and asymmetric keratoconus. Articles were included for final analysis if they evaluated the ability of the posterior corneal surface to identify subclinical keratoconus compared to anterior corneal surface and/or thickness metrics and reported area under the receiver operating curve (AUROC) data for multiple variables to allow for metric comparison. Metrics evaluated in each manuscript were categorized as anterior surface, thickness, or posterior surface. The relative discriminative performance of anterior surface (A), thickness (T), posterior surface (P), and the multimetric D score (D) metrics were evaluated based on AUROC, sensitivity, and specificity in differentiating subclinical keratoconus from normal controls were evaluated.</p><p><strong>Results: </strong>There were 29 articles identified that met the inclusion criteria and were evaluated. In intra-study comparison, anterior surface metrics (37.9%) and thickness metrics (39.2%) performed best at differentiating subclinical keratoconus from normal corneas, while only 4 out of 29 studies (13.8%) reported posterior metrics outperforming all metrics. In the subgroup analysis including the multimetric D score (n=15), anterior surface metrics performed best (33.3%), followed by the D score (26.7%). In this D subgroup, no paper reported superior posterior metric performance.</p><p><strong>Conclusions: </strong>In aggregate, posterior corneal surface metrics performed worse than anterior corneal and thickness metrics in differentiating subclinical keratoconic eyes from normal controls. These results demonstrate a lack of evidence to support the consensus claim that posterior elevation abnormalities must be present to diagnose subclinical keratoconus.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phase 2 Study of the Anti-High Temperature Requirement A1 (HtrA1) Fab Galegenimab (FHTR2163) in Geographic Atrophy Secondary to Age-Related Macular Degeneration.","authors":"David A Eichenbaum, Nancy Holekamp, Arshad M Khanani, Dante Pieramici, Vrinda Hershberger, Veeral Sheth, Flavia Brunstein, Ling Ma, Yixuan Zou, Vahan B Indjeian, Randall Dere, Mauricio Maia, Joy C Hsu, Simon S Gao, Brian Yaspan, Jeffrey R Willis, Henry Wiley, Phillip Lai, Hao Chen","doi":"10.1016/j.ajo.2025.03.021","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.03.021","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the safety, tolerability, and efficacy of intravitreal injection of galegenimab, an anti-HtrA1 FAb, in patients with geographic atrophy (GA) secondary to age-related macular degeneration (AMD).</p><p><strong>Design: </strong>Phase 2, single-masked, randomized clinical trial.</p><p><strong>Methods: </strong>Eligible GA patients with BCVA letter scores of ≥ 24 letters and baseline GA lesion size 2.54∼25.4 mm² in the study eye were enrolled. Patients were randomized 2:1:2 to receive 20 mg galegenimab every 4 (Q4W) or 8 weeks (Q8W), or sham Q4/8W. The primary endpoint was mean change in GA area from baseline to Week 72 measured by fundus autofluorescence. A data monitoring committee (DMC) conducted periodic unmasked review of cumulative safety/limited efficacy data of the ongoing study.</p><p><strong>Results: </strong>Among 337 patients who received ≥ 1 dose and have at least one post-baseline GA area measurement, the adjusted mean change in GA area from baseline to Week 72 was 2.67, 2.50, and 2.38 mm² for the galegenimab Q4W, galegenimab Q8W, and pooled sham arms, respectively. Differences between the treated and sham groups were not statistically significant. However, the rate of intraocular inflammation was high (7.1%, 16/224 patients) among treated patients. The DMC recommended early termination of the study based on an early benefit/risk analysis.</p><p><strong>Conclusion: </strong>Galegenimab administration did not show a difference in mean change in GA area from baseline to Week 72 compared with sham. Inhibition of HtrA1 with a Fab did not slow down GA progression.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Two-Year Clinical and Patient-Reported Outcome Measures Between Acrysof IQ and Clareon PanOptix Multifocal Intraocular Lenses","authors":"Raimo Tuuminen ,&nbsp;Sohee Jeon","doi":"10.1016/j.ajo.2025.03.017","DOIUrl":"10.1016/j.ajo.2025.03.017","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To compare the 2-year clinical and patient-reported outcome measures of PanOptix multifocal intraocular lenses (MIOLs) based on the lens material.</div></div><div><h3>DESIGN</h3><div>Retrospective matched cohort study.</div></div><div><h3>METHODS</h3><div>A comparison between patients who had undergone bilateral operation with Acrysof IQ versus Clareon PanOptix MIOLs was done by 1-to-1 matching of age, axial length, mean keratometry, and corneal astigmatism. A total of 122 eyes of 122 patients in each group were studied. Main outcome measures analyzed included uncorrected near visual acuity (UNVA) and uncorrected distance visual acuity (UDVA), prediction error in spherical equivalent and postoperative refraction stability, glistening, subsurface nano-glistening (SSNG), Nd:YAG laser posterior capsulotomy rates, the area under the log contrast sensitivity function (AULCSF) under photopic and mesopic conditions, Strehl ratio, and area ratio. Patient-reported outcome measures such as dysphotopsia and modified spectacle-independent Visual Function Index (VF)–14 questionnaire scores were collected at 2 years.</div></div><div><h3>RESULTS</h3><div>Throughout the study period, comparable UNVA, UDVA, and refractive stability were observed between the groups, except for better UNVA among eyes with Clareon than among eyes with Acrysof IQ at 2 years (0.00 ± 0.02 vs 0.02 ± 0.04, <em>P &lt;</em> .001). Clareon implantation resulted in better photopic (1.47 ± 0.19 vs 1.38 ± 0.21 logCWeber units; <em>P &lt;</em> .001), and mesopic (1.16 ± 0.22 vs 1.06 ± 0.19 logCWeber units; <em>P &lt;</em> .001) AULCSF, lower prevalence of glistening (0% vs 88%, <em>P &lt;</em> .001) and SSNG (0% vs 26%, <em>P &lt;</em> .001) and cumulative Nd:YAG laser capsulotomy rates (hazard ratio = 0.632; 95% CI = 0.482-0.830, <em>P &lt;</em> .001) when compared to those with Acrysof IQ. No differences were observed in the incidence of clinically significant glare or halos, but the incidence of starburst (5% vs 16%, <em>P</em> = .002) tended to favor Clareon over Acrysof IQ. Modified VF-14 questionnaire scores were greater for Clareon than Acrysof IQ (93.4 ± 10.3 vs 90.4 ± 13.6 points, <em>P &lt;</em> 0.001). A multivariable regression analysis showed that patient age (beta = –0.394, <em>P &lt;</em> .001; beta = –0.352, <em>P &lt;</em> .001) and glistening grade (beta = –0.163, <em>P = .</em>010; beta = –0.232, <em>P &lt;</em> .001) remained significantly associated with the photopic and mesopic AULCSF, respectively. Furthermore, higher glistening grade (<em>r</em> = –0.144, <em>P = .</em>003; beta = –1.771, <em>P = .</em>001 when age and sex adjusted) were associated with worse modified VF-14 questionnaire scores.</div></div><div><h3>CONCLUSIONS</h3><div>Clareon PanOptix outperformed Acrysof IQ PanOptix in visual quality and spectacle-independent visual function, potentially resulting from a lower prevalence of glistening.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"274 ","pages":"Pages 264-275"},"PeriodicalIF":4.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: Multifocal Vitelliform Paravascular Retinopathy (MVPR): A New Disorder in the Vitelliform Spectrum.","authors":"Camiel J F Boon","doi":"10.1016/j.ajo.2025.01.026","DOIUrl":"10.1016/j.ajo.2025.01.026","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: Pentosan Polysulfate Maculopathy: Final Outcomes From a 4-Year Prospective Study of Disease Progression After Drug Cessation.","authors":"Salih Uzun, Maria Paula Fernandez, Salih Uzun, Fatma Uzun","doi":"10.1016/j.ajo.2025.01.027","DOIUrl":"10.1016/j.ajo.2025.01.027","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unplanned Return to the Operating Room After Cataract Surgery","authors":"Mallory K. Suazo ,&nbsp;Malik Muhammad Hamza Khan ,&nbsp;Anam Akhlaq ,&nbsp;Muhammad Ali ,&nbsp;Oliver D. Schein ,&nbsp;Fasika A. Woreta","doi":"10.1016/j.ajo.2025.03.014","DOIUrl":"10.1016/j.ajo.2025.03.014","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To determine the rate of unplanned return to the operating room (OR) within 90 days of cataract surgery and to identify the most common preoperative and intraoperative risk factors.</div></div><div><h3>DESIGN</h3><div>Retrospective case-control study.</div></div><div><h3>SUBJECTS AND CONTROLS</h3><div>Patients aged ≥40 years undergoing cataract surgery at the Wilmer Eye Institute between 2019 and 2022 with at least 90 days of postoperative follow-up were included. Patients with return to the OR for a reason other than a postoperative complication of cataract surgery in the same eye were excluded. For each case, a time-matched control (cataract surgery within 1 month of the case's surgery) was selected using a random number generator.</div></div><div><h3>METHODS</h3><div>The chi-squared test was used for categorical variables, the student's <em>t</em>-test for continuous variables, and the multivariable logistic regression analysis to assess for associated preoperative and intraoperative factors.</div></div><div><h3>MAIN OUTCOME MEASURES</h3><div>The main outcomes included the rate and the most common reasons for unplanned return to the OR as well as the odds ratios of associated preoperative and intraoperative variables.</div></div><div><h3>RESULTS</h3><div>Among 32,480 eyes, 175 eyes (0.54%) had an unplanned return to the OR within 21 ± 21 days of cataract surgery. The most common reason was retained lens fragments in 88 eyes (50%). Patients with an unplanned return to the OR had a worse mean best-corrected visual acuity preoperatively (Snellen equivalent of ∼20/100 for cases vs 20/50 for controls, p-value &lt; .001) and at last follow-up (cases 20/50, controls 20/30, p-value &lt; .001). There were significantly higher odds of an unplanned return to the OR for patients undergoing complex cataract surgery (odds ratio, 1.80; 95% CI, 1.06-3.05) and for patients with prior tamsulosin use (odds ratio, 2.00; 95% CI, 1.09-3.69).</div></div><div><h3>CONCLUSIONS</h3><div>Patients undergoing complex cataract surgery and those with prior tamsulosin use had significantly higher odds of unplanned return to the OR. Monitoring rates of unplanned return to the OR at the institutional and national levels by using national clinical registries or a multicenter study is needed to assist in quality monitoring and to improve patient surgical outcomes.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"274 ","pages":"Pages 241-248"},"PeriodicalIF":4.1,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143612956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Comment on \"Pentosan Polysulfate Maculopathy: Final Outcomes From a 4-Year Prospective Study of Disease Progression After Drug Cessation\".","authors":"Brian P Hall, Sakshi Shiromani, Emily H Jung, Riley J Lyons, Judith Tribe, Nieraj Jain","doi":"10.1016/j.ajo.2025.03.015","DOIUrl":"10.1016/j.ajo.2025.03.015","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dropped Lens Fragments Retrieval Using Endoscopy-Assisted Pars Plana Vitrectomy in Patients With Corneal Opacity","authors":"Amanda K. Hertel,&nbsp;Martin A. Mainster,&nbsp;Mary Champion,&nbsp;Radwan S. Ajlan","doi":"10.1016/j.ajo.2025.03.012","DOIUrl":"10.1016/j.ajo.2025.03.012","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To characterize the surgical outcomes of endoscopy-assisted pars plana vitrectomy (E-PPV) in dropped lens fragments retrieval in patients with corneal opacity.</div></div><div><h3>BACKGROUND</h3><div>Corneal opacity may delay dropped lens fragment retrieval because of limited fundus view. E-PPV permits posterior segment visualization through corneal opacity. There are limited data on E-PPV use for dropped lens fragments retrieval in the literature.</div></div><div><h3>DESIGN</h3><div>Retrospective cohort study.</div></div><div><h3>METHODS</h3><div>A retrospective chart review was performed of dropped lens fragments retrieval procedures done between 2013 and 2023 at a tertiary referral center. Data were collected on the surgical approach, visual acuity (VA), and intraocular pressure (IOP), as well as complication rates including retinal detachment (RD), cystoid macular edema (CME), and epiretinal membrane formation (ERM). Statistical analysis was performed using <em>t</em> tests and chi-square tests. Statistical significance was defined as a <em>P</em> value of .05.</div></div><div><h3>RESULTS</h3><div>There were 74 patients who met the inclusion criteria (31 patients had E-PPV, and 43 patients had standard pars plana vitrectomy [S-PPV]). Groups were balanced in age and gender. Postoperative CME rate was 25.8% after E-PPV and 25.58% after S-PPV (<em>P</em> = .95). Postoperative RD rate was 0% after E-PPV and 7% S-PPV (<em>P</em> = .13). After 1 year, there was no difference in postoperative VA, IOP, and rates of RD, CME, or ERM between groups. Interval time to dropped lens retrieval did not change the final outcome in either group.</div></div><div><h3>CONCLUSIONS</h3><div>This study showed that performing E-PPV to extract dropped lens fragments through corneal opacity had similar final outcomes compared with S-PPV, regardless of the interval time to surgery after the dropped lens fragments. Removing dropped lens fragments using E-PPV before cornea opacity clearance provided outcomes similar to those of delayed cases. Further studies are needed on the psychological benefit in patients undergoing dropped lens removal sooner than others.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"274 ","pages":"Pages 258-263"},"PeriodicalIF":4.1,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Sustained Suppression of VEGF be Achieved by Topical Ocular Delivery?","authors":"David Bingaman, Tejaswini Appidi, Jahnavi Pejavar, Laura M Ensign","doi":"10.1016/j.ajo.2025.03.016","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.03.016","url":null,"abstract":"<p><strong>Purpose: </strong>Less invasive options for treating pathological blood vessel growth and leakage in the eye are an attractive option pursued by many in the commercial and academic spaces alike. However, achieving safe and effective therapeutic delivery to the posterior segment with a topical eye drop has proven very challenging. In this review, we describe past and ongoing clinical efforts to develop topical ocular therapies for the clinical management of vascular endothelial growth factor (VEGF)-dependent retinal vascular diseases. We further describe recent preclinical efforts toward the development of the next generation drug delivery strategies for biologic, tyrosine kinase inhibitor (TKI), and additional small molecule therapies to treat retinal vascular diseases. The collective knowledge gained to date can pave potential paths forward for successful regulatory approval bringing additional benefit to patients with unmet needs. Further, many of the learnings reviewed may be applicable to classes of organic molecules outside of anti-VEGF compounds for other indications.</p><p><strong>Conclusions: </strong>Future development of topical ocular therapies to treat retinal vascular diseases must consider several key principles that have been highlighted by efforts to date. Both the properties of the small molecule and the drug product formulation are important to enhance delivery to the posterior segment while minimizing ocular surface side effects and systemic exposure. The selection of preclinical animal models and the interpretation of observations in preclinical animal models must be done with care. Clinical trial design is of paramount importance to maximize the opportunity to demonstrate safety and efficacy. Lastly, to truly maximize patient benefit with self-administered topical therapies, remote monitoring of disease must be validated and implemented. We anticipate that a marketed topical ocular therapy for the clinical management of VEGF-dependent retinal vascular diseases is on the horizon.</p><p><strong>Table of contents statement: </strong>While a potentially attractive option for patients, achieving safe and effective therapeutic delivery to the posterior segment with a topical eye drop has proven very challenging. Herein, clinical and preclinical efforts toward the development of topical formulations for achieving sustained suppression of vascular endothelial growth factor (VEGF) for the management of VEGF- dependent retinal vascular diseases are discussed.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}