One-year treatment outcomes were reported for the Ahmed versus Baerveldt Study.
Patients aged 18 years or older with uncontrolled glaucoma refractory to medical, laser and surgical therapy were randomized to undergo implantation of an Ahmed-FP7 valve or a Baerveldt-350 implant, and followed for five years. The primary outcome measure was failure, defined as intraocular pressure out of target range (5 to 18 mmHg with ≥20 percent reduction from baseline) for two consecutive visits after three months; vision-threatening complications; additional glaucoma procedures; or loss of light perception.
The two groups’ ocular and demographic characteristics were similar, with the exception of sex. Preoperatively, the study group had a mean IOP of 31.4 ±10.8 mmHg on a mean of 3.1 ±1.0 glaucoma medications with a median Snellen acuity of 20/100.
At one year, the cumulative probability of failure was 43 percent in the Ahmed group and 28 percent in the Baerveldt group (p=0.02). The Ahmed group’s mean IOP was 16.5 ±5.3 mmHg; the Baerveldt group‘s was 13.6 ±4.8 mmHg (p<0.001). The mean number of glaucoma medications required was 1.6 ±1.3 in the Ahmed group and 1.2 ±1.3 in the Baerveldt group (p=0.03). Visual acuity was similar in both groups at all visits in the first year (p=0.66). A similar number of patients experienced postoperative complications in the two groups (45 percent Ahmed, 54 percent Baerveldt, p=0.19), but a greater number of patients in the Baerveldt group required interventions (26 percent Ahmed vs. 42 percent Baerveldt, p=0.009).
Christakis PG, Kalenak JW, Zurakowski D, Tsai JC, et al.
Postop Antibiotics May Not Affect Endophthalmitis Rate
A group at the Medical College of Wisconsin, Milwaukee, reports that the use of postinjection antibiotics appears not to have a significant effect on the rate of endophthalmitis after intravitreal injections administered in a clinical practice setting when aseptic technique is used.
Current endophthalmitis rates after IV injection in the literature are based on studies where patients routinely received postinjection antibiotics. This retrospective chart review compared the rate of endophthalmitis over 12 months in a cohort of patients receiving postinjection antibiotics with that in a group that did not.
The rate of clinically suspected endophthalmitis in the patients receiving postinjection antibiotics after intravitreal injection and that in the cohort that did not was 0.22 percent and 0.20 percent, respectively. One culture-positive case was found overall. The difference between the two groups is not statistically significant (p= 0.75).
Bhatt SS, Stepien KE, Joshi K.
Anti-VEGF Treatment Beneficial But at a High Financial Burden
A Duke University group used Medicare data to assess the increased financial burden of providing care for age-related macular degeneration patients since introduction of anti-VEGF intravitreal injections.
Beneficiaries with new diagnoses of neovascular AMD in 1994 (n=2,497), 2000 (n=3,927), and 2006 (n=6,041) were identified. The number of beneficiaries newly diagnosed with neovascular AMD more than doubled between the 1994 and 2006 cohorts. Overall yearly Part B payments per beneficiary increased significantly from $3,567 for the 1994 to $5,991 for the 2006 cohort (p<0.01) in constant 2008 dollars.
Payments for eye care alone doubled from $1,504 for the 1994 cohort to $3,263 for the 2006 cohort (p<0.01). Most of the increase in payments for eye-care in 2006 reflected payments for anti-VEGF injections, which were $1,609 over one year. Mean annual numbers of visits and imaging studies also increased significantly between the 1994 and 2006 cohort.
Day S, Acquah K, Lee PP, Mruthyunjaya P, Sloan FA.