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Purpose: To evaluate the increase in retinal thickness as a marker in predicting the onset of central retinal artery occlusions., Methods: Retrospective clinical study conducted at one Swiss hospital. Electronic records were filtered for patients with artery occlusions. Optical coherence tomography data, including time between the imaging and ischemic event, were reviewed. Increase in relative retinal thickness was measured, defined as an increase in retinal thickness compared to the unaffected partner eye. This was correlated with the time from symptom onset. A cutoff value of relative increase of < 24.5% was applied, as suggested in previous studies. The results were compared to the time gathered from the electronic records, and sensitivity, specificity, positive predictive value as well as negative predictive value were calculated for predicting an ischemia time of < 4.5 h., Results: Forty-two eyes from 41 patients with central artery occlusions were identified. Fourteen were female. Mean age was 66.4 ± 15.8 years. Initial corrected visual acuity was 2.41 ± 0.68 logMAR, and 2.13 ± 0.87 logMAR at the last follow-up (p > 0.05). Of eyes with a visual acuity of counting fingers (n = 38) or worse, 89.5% showed no improvement during follow-up, while eyes with logMAR 1 or better (n = 4) improved. Thirteen eyes (13 patients) presented within 4.5 h of the ischemic event. Four patients received i. v. thrombolysis, with visual recovery in one. In 12 eyes with an ischemia time of < 4.5 h, relative increase was below 24.5%. In the remaining 29 eyes with > 4.5 h, relative increase was below 24.5% in 4 eyes and above 24.5% in 25 eyes. This yielded a sensitivity of 92.3%, a specificity of 86.2%, with a positive predictive value of 75.0% and a negative predictive value of 96.2%., Conclusion: Central retinal artery occlusion is associated with severe vision loss. There is no current established therapy. Parameters that objectify the presence of a therapeutic window for thrombolysis are gaining in importance as patient history is often imprecise. Relative retinal thickness increase proved a noninvasive imaging parameter demonstrating adequate performance in detecting patients within the therapeutic window of thrombolysis. Further investigation of this parameter in central retinal occlusion is warranted., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Background: To report ophthalmological outcomes and treatment regimen in patients with Susac syndrome., Methods: This is a retrospective analysis of patients with Susac syndrome treated between November 2015 and March 2023. Multimodal imaging findings, ophthalmic examination data, information on neurological and sensorineural involvement, and therapeutic regimen were reviewed. Visual acuity was recorded as the logarithm of the minimum angle of resolution (logMAR). Ophthalmological manifestations and disease severity were assessed using the previously described clinical activity score (CAS)., Results: Ten patients with Susac syndrome m : f = 5 : 5 were identified. The mean follow-up time was 31.2 ± 23.3 months (range 1 to 78 months). The mean age was 41.4 ± 13.8 years (range 21 to 59 years). At baseline, corrected distance visual acuity (CDVA) was 0.03 ± 0.08 logMAR. At the last follow-up, CDVA improved to 0.00 ± 0.03 logMAR (p = 0.029). Three of 20 eyes showed an improvement of 5 letters, while no loss of visual acuity was recorded during the follow-up time. Baseline CAS was 10.65 ± 12.69, and CAS at the last follow-up was 5.15 ± 5.49 (p = 0.068). Except for one patient, all were initially treated with intravenous (i. v.) steroids and subsequent oral tapering. Depending on the treatment response, cyclophosphamide (n = 4), i. v. immunoglobulins (IVIGs) (n = 4), anti-CD20 antibodies (n = 3), or plasmapheresis (n = 1) were applied. All patients under treatment for more than 1 month (n = 9) showed improvement in CAS and CDVA., Conclusion: Susac syndrome is a rare autoimmune vascular endotheliopathy. Treatment of Susac syndrome appears to result in improving CAS and CDVA. The majority of patients, in addition to the systemic steroids, required systemic immunosuppressive agents. Interdisciplinary communication is crucial to reduce the time to diagnosis and initiation of therapy in patients with Susac syndrome., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Competing Interests: D. B. is a consultant and speaker for Novartis and Bayer, and a consultant for Alcon. D. R. M. is a speaker for Bayer and Roche. S. S., R. S., K. F., S. A. Z., and F. B. declare no conflict of interest related to the topic.

Competing Interests: D. B. is a consultant and speaker for Novartis and Bayer, and a consultant for Alcon. D. R. M. is a consultant for Bayer and Roche. B. L. is outside of the submitted work member of the steering committee of HOS, a post-marketing registry for Hunterʼs disease and received honoraria and travel grants by Shire, Takeda, Genzyme-Sanofi, and Alexion for various presentations. None of the declarations represent a conflict of interest related to the presented study. S. S., J. M. G., J. V. M. H., K. F., F. B., and S. A. Z. declare no conflict of interest related to the topic.

Competing Interests: The authors declare that they have no conflict of interest.

Purpose: Proof of concept of ex vivo retinal vessel diameter measurements in human postmortem eyes., Methods: En face near-infrared (IR) images and optical coherence tomography (OCT) of the optic nerve head (ONH) were captured ex vivo with a Heidelberg Engineering Spectralis (Spectralis, version 7.0.4, Image Capture Module, version 1.2.4, Heidelberg Heidelberg, Germany) device, using a custom-made eye chamber holding and positioning the eyes during the image process. Thirty-two formaldehyde-fixated eyes of 16 patients were imaged. In the IR images, two independent graders measured retinal vessel diameters at the intersection of a drawn circle centered on the ONH with diameters of 2.0 mm and 3.4 mm, respectively. The anatomically corresponding measurements between both graders were statistically analyzed using a Wilcoxon signed-rank test., Results: A total of 246 matched measurements of both graders were analyzed across all 32 imaged eyes. Statistically significant differences between the graders were found for arterioles at 2 mm from the ONH. The other measurements did not show statistically significant intergrader differences. The mean values for arteriole diameters were 72.2 µm at 2.0 mm and 61.5 µm at 3.4 mm for grader 1, and 66.4 µm at 2.0 mm and 63.2 µm at 3.4 mm for grader 2. The mean diameter for venules were 75.5 µm at 2.0 mm and 79.3 µm at 3.4 mm for grader 1, and 67.4 µm at 2 mm and 79.1 µm at 3.4 mm for grader 2., Conclusion: To the best of our knowledge, this is the first study to present IR image-based retinal vessel diameters in ex vivo postmortem eyes. Retinal IR/OCT imaging is possible, and measurements are reproducible in formaldehyde-fixated human eyes. Fixation artefacts result in lower image quality, and this can impose challenges in correctly detecting, classifying, and measuring retinal vessels., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Purpose: To evaluate the efficacy of a subthreshold micropulse laser (SML) in patients with central serous chorioretinopathy (CSCR)., Methods: Retrospective clinical study conducted at the Departments of Ophthalmology at a university and a municipal hospital in Zurich, Switzerland. We enrolled acute and chronic CSCR patients with persistent subretinal fluid (SRF) treated with SML. Two treatment protocols (fluorescein/indocyanine green angiography or optical coherence tomography guided) were evaluated for efficacy after 3 and 6 months. The primary outcomes of the study were reduction and percentage of eyes with complete resolution of SRF 3 and 6 months after SML treatment. Secondary endpoints included changes in central subfield thickness (CST) and visual acuity (VA) after 3 and 6 months., Results: The study involved 37 eyes (35 patients, 48.6% chronic). A statistically significant reduction in SRF height and CST could be shown, irrespective of SRF duration, type of CSCR, or chosen guidance after 3 and 6 months: SRF - 40 µm (p < 0.01), CST - 52 µm (p < 0.01). Percentage of eyes with complete resolution of fluid at 3 and 6 months after SML were 24.3 and 21.6%, respectively. No statistically significant functional improvement (VA) could be shown. Multivariable regression and linear mixed regression analyses did not identify statistically significant differences in SRF reduction, CMT change, or VA improvement with respect to the type of CSCR or the treatment plan used (p > 0.05)., Conclusion: The effectiveness of SML in CSCR is under continuous debate. Our study findings demonstrate structural but only little functional changes with SML. In view of the shortage of verteporfin for photodynamic therapy, SML remains an important therapeutic option for CSCR patients., Competing Interests: F. T.: Consultant for Bayer, Roche, Carl Zeiss Meditec; D. R. M.: Consultant for Bayer, Roche; G. M. S.: Consultant for Abbvie, Apellis, Bayer, Carl Zeiss Meditec, Novartis, Roche; S. Z.: Consultant/advisor for Bayer Healthcare Pharmaceuticals, Novartis Pharmaceuticals Corp., Roche, and Carl Zeiss Meditec AG; grant support from Novartis Pharmaceuticals Corp. and Bayer Healthcare Pharmaceuticals. All other authors declare that they have no conflicts of interest., (Thieme. All rights reserved.)

Competing Interests: The authors declare that they have no conflict of interest.

Purpose: To introduce a novel technique of the aseptic manufacture of autologous serum eye drops (ASEDs) with a prefiltered closed system and to analyze the sterility of the produced ophtioles between 2018 and 2022., Methods: This is a prospective single-center study conducted at the Department of Ophthalmology at a Swiss University Hospital between 2018 and 2022. For regulatory reasons, closed systems for manufacturing ASEDs are strongly recommended. We attached an upstream sterile filter (Sterivex PES0.22 µm Burlington, USA) to a commercially available closed system (COL System Modena, Italy) for manufacturing ASEDs. The goal of this novel approach was to reduce the microbiological contamination of the donated autologous blood. Using the presented manufacturing method, we are able to produce, on average, 56 ophtioles per batch, containing either 1.45 mL or 2.5 mL of autologous serum per ophtiole. For each batch of ASEDs, we performed a microbiological analysis by automated blood culture testing (BACTEC). This system examines the presence of bacteria and fungi., Results: We analyzed all manufactured batches between 2018 and 2022. None of the 2297 batches and the resulting 129 060 ophtioles showed bacterial or mycotic contamination. During the analyzed period, two batches were discarded: one due to fibrin-lipid aggregations, further microbiological and histological work-up excluded any contamination; another due to false-positive HIV in serological testing. Overall, the contamination rate was 0%, and the batch discharge rate was 0.09%., Conclusions: The combination of upstream sterile filtration with a commercial closed system for manufacturing ASEDs proved to be effective in ensuring sterility without any contamination over the past 4 years. This is becoming crucial, as the demand for autologous blood products for treating ocular surface disorders, such as refractory dry eyes or nonhealing defects of the corneal epithelium, is on the rise., Competing Interests: D. B. is a consultant and speaker for Novartis and Bayer, and a consultant for Alcon, without conflicts of interest regarding this study. D. R. M. is a speaker for Bayer and Roche, without conflicts of interest regarding this study. F. B., I. M., D. M. P., S. S., D. R. M., S. A. Z., and A. B. declare that they have no conflict of interest related to the topic., (Thieme. All rights reserved.)

Competing Interests: The authors declare that they have no conflict of interest.

Competing Interests: The authors declare that they have no conflict of interest.

Background: It is known that cataract extraction is associated with a significant reduction in intraocular pressure, especially in narrow angled eyes; however, the modifications of anterior segment parameters associated with this phenomenon have still not been completely defined. The purpose of this study was to evaluate changes in anterior segment anatomy and intraocular pressure after cataract surgery in non-glaucomatous eyes., Methods and Material: This retrospective case series study included 64 eyes of 64 consecutive patients who underwent phacoemulsification with intraocular lens implantation. Anterior segment parameters and intraocular pressure were assessed and compared before and 6 months after surgery. Anterior segment imaging was performed using Casia SS-1000 anterior segment optical coherence tomography (Tomey, Nagoya, Japan). Anterior segment measurements included anterior chamber depth, anterior chamber width, anterior chamber volume, angle opening distance at 500 µm anterior to the scleral spur, angle recess area 750 µm from the scleral spur, lens vault, trabecular iris space area at 500 µm from the scleral spur, and trabecular iris angle at 500 µm from the scleral spur. Intraocular pressure was measured using the Goldmann applanation tonometer (Model AT 900 C/M, Haag-Streit, Bern, Switzerland). Anterior segment parameters and the relationship of changes in intraocular pressure were also evaluated., Results: All anterior segment parameters increased significantly after surgery (p < 0.05). Both angle opening distance at 500 µm anterior to the scleral spur and anterior chamber depth changes were positively correlated with the preoperative lens vault. The mean intraocular pressure significantly decreased from 14.91 mmHg (± 2.8 SD) to 12.91 mmHg (± 3.13 SD) (p < 0.001). Changes in intraocular pressure correlated negatively with values for the width of the preoperative anterior chamber (r = - 0.533; p = 0.001)., Conclusion: Cataract surgery led to significant widening of the anterior chamber angle and lowering of intraocular pressure. Further investigations are needed to better understand whether anterior chamber width may be a new independent predictive factor for reduction in postoperative intraocular pressure., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Purpose: To evaluate and compare the long-term results after bilateral implantation of different multifocal intraocular lenses (MIOLs)., Methods: This retrospective comparative study included 42 patients who underwent cataract surgery with bilateral MIOL implantation. Patients were divided into 5 groups: Group 1 received a refractive ReZoom NGX1 IOL (AMO), Group 2 a diffractive Acrysof ReSTOR SA60D3 IOL (Alcon), and Group 3 a diffractive Tecnis ZM900 IOL (AMO). Group 4 and Group 5 were implanted using the mix and match approach with refractive ReZoom-diffractive ReSTOR IOL and refractive ReZoom-diffractive Tecnis ZM900 IOL, respectively. Primary outcome measures were distance, near, and intermediate distance visual acuity measured 6 months (T0) and 10 years (T1) after surgery. Secondary outcomes were defocus curves, contrast sensitivity, patients' satisfaction, and spectacle independence., Results: All patients achieved best-corrected distance visual acuity (BCDVA) greater than 0.11 logMAR and uncorrected distance visual acuity (UCDVA) greater than 0.14 logMAR at both time points. A decrease in contrast sensitivity was evident, particularly at high spatial frequencies; at T1, Group 4 reported statistically higher values than Group 2 at 12 cycles/degree and 18 cycles/degree and statistically higher values than Group 3 at 18 cycles/degree. Great overall satisfaction was reported even in the presence of dysphotopsia. Tecnis ZM900 IOL showed the lowest incidence of posterior capsular opacification., Conclusion: MIOLs could provide adequate functional vision and patient satisfaction, despite the incidence of side effects, in carefully selected patients desiring spectacle independence., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Purpose: To present a case series of rare and severe complications after corneal collagen cross-linking (CXL) of keratoconus patients., Methods: Single-center descriptive case series covering the period of 2012 to 2022 at the Department of Ophthalmology at the University Hospital, Zurich, Switzerland., Results: We present four eyes of four patients that showed severe unusual complications within the first month after CXL. Three patients had been treated with the classical epithelium-off "Dresden" protocol. One patient had been treated with the accelerated epithelium-off protocol. One patient presented with extensive corneal edema due to rubbing the eye after treatment. Two patients showed a bacterial infectious keratitis: one due to Streptococcus pneumoniae and the other due to Staphylococcus hominis, Micrococcus luteus , and Streptococcus epidermidis . The latter of the two patients exhibited extensive infectious crystalline keratopathy. The fourth patient showed a severe ulcerative lesion where no infectious cause could be found. Therefore, an autoimmune keratolytic process had to be suspected. Apart from the corneal edema, which resolved ad integrum , the other complications resulted in permanent corneal scarring and thinning. One patient needed an emergency amniotic transplant., Conclusion: Severe complications after CXL remain rare. Most common causes are complications that are not directly associated with the treatment as such. Those indirect complications occur after the treatment during the healing course of the epithelium. Associations with bandage contact lenses, topical steroids, atopic disease, and inappropriate patient behavior are often suspected. Correctly performed corneal scrapings with repeated microbiological analysis and a detailed patient history are essential for establishing the correct diagnosis, especially in complicated cases that do not respond to a standard therapeutic regimen. This case series supports the efforts that are currently taken to improve the CXL technique in a way that postoperative complications are further reduced. A more efficient epithelium-on technique might be a step in that direction., Competing Interests: The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Competing Interests: D. B. is a consultant and speaker for Novartis and Bayer, and a consultant for Alcon. S. S., D. R. M., S. A. Z., and F. B. declare that they have no conflict of interest.

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Competing Interests: The authors declare that they have no conflict of interest.

Competing Interests: The authors declare that they have no conflicts of interest.

Competing Interests: The authors declare that they have no conflict of interest.

Purpose: We aimed to identify and evaluate possible quantitative changes in retinal and choriocapillary blood flow utilizing optical coherence tomography angiography (OCTA) imaging in healthy study subjects during the Valsalva maneuver (VM)., Methods: OCTA imaging with a ZEISS PlexElite 9000 on one eye was performed. OCTA images were acquired before VM and 5 seconds after. Images were segmented and underwent projection removal using algorithms supplied by the manufacturer. Analysis of vessel density (VD) and vessel length density (VLD) were performed on superficial (SCP) and deep capillary plexus (DCP) layer slabs using ImageJ. ImageJ was also utilized for analyzing flow voids (FVs) in the choriocapillary slabs., Results: Ten (8 right, 2 left) eyes of 10 (5 male, 5 female) healthy study subjects were included. Pre-VM, -VD, and -VLD were 0.428 (± 0.291) and 17.871 mm -1 (± 2.22 mm -1 ) in the SCP and 0.423 (± 0.0213) and 23.850 mm -1 (± 1.023 mm -1 ) in the DCP. Pre-VM and -FV were measured at 19.686 (± 1.959). During VM, VD, and VLD in the SCP were 0.417 (± 0.024) and 17.376 mm -1 (± 2.007 mm -1 ), and in the DCP, 0.426 (± 0.221) and 23.944 mm -1 (± 1.021 mm -1 ), respectively. FV post-VM was 20.440 (± 2.062). A paired samples t-test test revealed no significant changes in any of the observed parameters., Conclusion: We did not observe any significant changes in the VD, VLD, or FV. This might be due to autoregulatory processes in the ocular vasculature. Due to the small sample size, confidence intervals are comparatively large. Further study with more probands might yield different results., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Purpose: Multiple approaches for quantifying parameters such as vessel density (VD) and vessel length density (VLD) in optical coherence tomography angiography (OCTA) en-face segmentations are currently available. While it is common knowledge that data gathered from different methods should not be directly compared to each other, a comparison of the different methods can help to further the understanding of differences between different methods of measurement. Here we compare a common method of semiautomatically quantifying VD and VLD with an automated method supplied by the manufacturer of an OCTA device and report on differences in performance in order to probe for and highlight differences in values gathered by both methods., Methods: OCTA was performed using the swept source PLEX Elite 9000 device, software version 2.0.1.47652 (Carl Zeiss Meditec Inc., Dublin, CA, USA). Scans of 3 mm × 3 mm from healthy volunteers centred on the fovea were acquired by a well-trained certified ophthalmologist. Scans with a signal strength of 8 out of 10 or higher were included. Quantitative parameters of the 3 mm × 3 mm cube scans were automatically generated and segmented into superficial capillary plexus (SCP) and deep capillary plexus (DCP) layers using layer segmentation produced by the instrument software and prototype analysis VD quantification software (Macular Density v.0.7.1, ARI Network Hub, Carl Zeiss Meditec Inc., Dublin, CA, USA) supplied by the manufacturer. An alternative approach of quantitative analysis of VD and VLD was performed manually with ImageJ (National Institutes of Health, Bethesda, Maryland, USA), as previously reported. VD was assessed as the ratio of the retinal area occupied by vessels. VDL was measured as the total length of the skeletonised vessels using 1-pixel centre line extraction of the blood vessels., Results: We report differences in standard deviation (SD) in OCTA parameters obtained using different methods. The standard deviation of VD and VLD measurements was statistically significantly different in VD of 3 mm × 3 mm DCP (p = 0.009), VLD of 3 mm × 3 mm SCP (p = 0.000), and VLD of 3 mm × 3 mm DCP (p = 0.021). No statistically significant differences were found in VD of 3 mm × 3 mm SCP (p = 0.128) or VLD of 3 mm × 3 mm SCP (p = 0.107)., Conclusions: As expected, we were able to demonstrate significant differences in quantitative OCTA parameters gathered from the same images using different methods of quantification. Values gathered using different methods are not interchangeable. In scientific studies and in situations where long-term follow-up is necessary, the same device and the same method of quantification should be used to maintain retrospective comparability of measurements., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Competing Interests: Consultant (C) for Bayer Healthcare Pharmaceuticals, Novartis Pharma AG and Roche Diagnostics. Unrestricted research grants (S) from Bayer Healthcare Pharmaceuticals and Novartis Pharma AG.

Purpose: The spectrum of intraocular and systemic findings in patients with ocular syphilis is described. Persistent visual dysfunction and structural abnormality, in spite of targeted antibiotic therapy, were identified and analysed., Methods: Patients with ocular syphilis who were treated at University Hospital Zurich (USZ) between 2010 and 2018 were included in this study. General characteristics, ocular manifestation and visual function (best-corrected visual acuity [BCVA], visual field) before and after treatment were analysed retrospectively., Results: Ocular syphilis was diagnosed in one female and 16 male patients (median age 42 years, range 22 to 53 years). A bilateral infection was present in 11 cases, and 28 of 34 eyes were affected (82%). Manifestations included anterior (n = 3), intermediate (n = 4), posterior (n = 10) uveitis, as well as panuveitis (n = 5) and papillitis (n = 6). Abnormal liquor findings were present in 8 patients (47%). Six patients were human immunodeficiency virus (HIV) positive. In all patients, intravenous benzyl penicillin was initiated and led to inactivation of intraocular inflammation. Before the initial intravenous treatment, all patients received one dose of steroids orally (Prednisone [PDN] 50 to 70 mg). Seven patients had systemic steroids added over the course of the antibiotic treatment being gradually decreased during and after the antibiotic treatment. The initial median BCVA of all affected eyes (n = 28) of 17 patients was 0.1 logMAR (0.8 decimal), range 2.8 to - 0.1 logMAR (light perception to 1.25 decimal). At the last visit, the median BCVA was 0 logMAR, range 0.4 to - 0.1 logMAR (0.4 to 1.25 decimal). Median follow-up time was 11 months (range 3 to 60 months). At the last visit, BCVA of 4 eyes (3 patients) was ≤ 0.6. Six eyes of 5 patients had a persisting scotoma with central visual field defects. Morphologically, disintegration and irregularities of outer retinal layers after central retinitis (5 eyes) and atrophy of the peripapillary retinal nerve fibre layer (4 eyes) after papillitis correlated with abnormal vision., Conclusions: The spectrum of ocular manifestations in syphilis is broad. Despite targeted antibiotic therapy, more than a third of affected eyes had lasting abnormal vision. Patients with papillitis and retinitis were at an increased risk for persistent visual dysfunction., Competing Interests: Alcon Laboratories, Inc.: Consultant/Advisor; Bayer Healthcare Pharmaceuticals: Consultant/Advisor, Lecture Fees, Grant Support; Novartis Pharmaceuticals Corporation: Consultant/Advisor, Lecture Fees, Grant Support; Allergan: Lecture Fees., (Georg Thieme Verlag KG Stuttgart · New York.)

Competing Interests: The authors declare no conflict of interest.

Background: Randomized controlled phase III studies have shown that intravitreal anti-VEGF therapy is effective for exsudative age-related macular degeneration (AMD) over two years. Recently, the seven-year outcomes in ranibizumab-treated patients of the ranibizumab phase III studies have been published. Only a few other studies with such a long follow-up for intravitreal anti-VEGF therapy in patients with exsudative AMD have been published so far. We report on the outcome of patients receiving intravitreal anti-VEGF therapy for exudative AMD at the Department of Ophthalmology, University Hospital of Zurich with follow-up of 3 to 7 years., Patients: Retrospective chart review of all patients treated at our institution for exudative AMD with begin of treatment since 2006., Results: The numbers of patients with a follow-up of 3 to 4, 4 to 5, 5 to 6, 6 to 7, and more than 7 years were 430, 277, 151, 87, and 47, respectively. Mean follow-up time was 4.9 years, and median was 4.6 years. Changes in visual acuity for these patients were -5.0, -7.8, -11.7, -12.8, and -19.2 ETDRS letters, respectively., Conclusions: Whereas in patients with exudative AMD during the first two years of intravitreal anti-VEGF treatment visual acuity can at least be stabilised, after three and more years visual acuity decreases in spite of continued treatment., (Georg Thieme Verlag KG Stuttgart · New York.)