Biosimilar anti-VEGF injections matched the originals on vision, retinal thickness and safety across 25 studies

The edition in brief

A meta-analysis of 25 studies comparing biosimilar with reference ranibizumab and aflibercept across neovascular macular degeneration, diabetic macular oedema, retinal vein occlusion and polypoidal choroidal vasculopathy found no difference in final or change in visual acuity, retinal thickness or adverse events over 12 to 64 weeks, with moderate to high certainty. In 80 patients with biopsy-proven giant cell arteritis and 179 with non-arteritic ischaemic optic neuropathy, paracentral acute middle maculopathy on OCT was seen in 28% of arteritis and none of NAION, including some patients without visual symptoms. In 94 treated glaucoma patients, how far and how often home tonometry readings exceeded each patient's target was associated with faster field loss, while in-office pressures were not. A TriNetX cohort found cetirizine, ibuprofen and prednisone use associated with less vision-threatening diabetic retinopathy, with hazard ratios similar to fenofibrate, but this is observational and hypothesis-generating. An Ahmedabad trial of 80 eyes with non-proliferative retinopathy found phacoemulsification at 20 rather than 55 mmHg improved macular vessel density and optic nerve flux at one week and one month. The pearl covers the same-day work-up for suspected arteritic optic neuropathy.