The edition · Ophthalmology
Pegcetacoplan slowed atrophy by 41% over two years, and acuity still fell
A real-world two-year series on geographic atrophy, consensus definitions that separate leakage from true retinal vasculitis, rising paediatric uveitis, a drop for dim-light vision, and the case for operating on lamellar holes with epiretinal proliferation.
The edition in brief
Today's ophthalmology desk opens with a two-year real-world series of 77 eyes treated with intravitreal pegcetacoplan for geographic atrophy. Square-root lesion growth fell from 0.33 mm/year before treatment to 0.19 mm/year, a 41% reduction, and 71 of 72 eyes maintained or further slowed their growth rate in the second year — yet mean acuity still fell from 63 to 55 letters. An international Delphi panel of 22 independent experts has agreed definitions for eight terms including retinal vasculitis, vascular leakage, retinal perivasculitis and far-peripheral vascular leakage, with second-round agreement of 95.2% to 100%; the purpose is to stop angiographic leakage being reported as vasculitis. A TriNetX analysis of 30.7 million children found non-infectious uveitis in 30,533, with annual incidence rising from 22 to 33 per 100,000 and prevalence from 106 to 226 per 100,000 between 2016 and 2025; glaucoma complicated 8.8% and posterior uveitis carried the highest rate of blindness or low vision at 13.4%. A phase 3 trial of 0.75% phentolamine ophthalmic solution in 145 subjects with dim light disturbances improved mesopic low-contrast acuity in 21% against 3% on placebo by day 15, over a 14-day treatment period. A pearl covers angle closure precipitated by systemic drugs. The edition closes with a meta-analysis of 610 eyes supporting vitrectomy for lamellar macular holes with epiretinal proliferation: pooled acuity gain 0.170 logMAR with no significant change under observation.
Growth slowed, vision still lost: two years of pegcetacoplan
Reserve pegcetacoplan for fast progressors, and tell patients the lesion grows more slowly while the vision still declines.
Leakage is not vasculitis, and now there are words for the difference
Use the consensus terms in your reports and letters, and stop calling far-peripheral angiographic leakage vasculitis.
Paediatric uveitis is being recorded twice as often as a decade ago
Check intraocular pressure at every paediatric uveitis visit, and let the anatomical subtype drive how urgently you follow the child up.
A nightly drop for glare, halos and starburst
There is now a plausible pharmacological option for dim light disturbance, but on 14 days of data it is one to follow, not to prescribe.
The red eye that started after a new tablet or a nebuliser
Check the intraocular pressure and the drug chart in any unexplained painful red eye, and examine the fellow eye while you can still protect it.
Operate on the lamellar hole with epiretinal proliferation if it is symptomatic
Stop deferring surgery by default in symptomatic lamellar macular hole with epiretinal proliferation — the progression risk does not clearly rise and the acuity gain is consistent.
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