Structure-function correlation of retinal photoreceptors in PRPH2-associated central areolar choroidal dystrophy patients assessed by high-resolution scanning laser imaging and microperimetry

PURPOSE

High Magnification Module (HMM™, Heidelberg Engineering, Heidelberg, Germany) imaging is a novel technique, designed to visualize the retina at a cellular level. To assess the potential of HMM™-based metrics as endpoints for future trials, we evaluated correlations between structural HMM™ cone metrics, spectral-domain OCT (SD-OCT, Heidelberg Engineering, Heidelberg, Germany) and retinal sensitivity on microperimetry (MP, MAIA, CenterVue, Padova, Italy) in healthy subjects and p.(Arg142Trp) PRPH2-associated Central Areolar Choroidal Dystrophy (CACD) patients.

METHODS

We projected a default 10° MP grid on composite HMM™ images and performed automated cone density (CD), intercell distance (ICD) and nearest neighbour distance (NND) analysis at stimuli located at 3° and 5° retinal eccentricity. We manually measured intrasubject outer retinal thickness on SD-OCT in absolute and relative scotomas, located outside of focal atrophy.

RESULTS

We included 15 CACD patients and five healthy subjects. We found moderate-to-strong correlations of HMM™ metrics and MP sensitivity at 3° eccentricity from the fovea. We found the outer retina at the locations of absolute scotomas to be statistically significant thinner (p = 0.000003, one-sample t-test), as the outer retinal thickness at locations of relative scotomas. Interestingly, HMM™ metrics of these areas did not differ significantly.

CONCLUSIONS

We found significant correlations between structural photoreceptors metrics on HMM™ imaging and retinal sensitivity on MP in healthy subjects and CACD patients. A multimodal approach, combining SD-OCT, MP and HMM™ imaging, allows for detailed mapping of retinal photoreceptor integrity and restitution potential, important data that could serve as biomarkers in future clinical trials.

IMAGING AND CLINICAL FEATURES OF PULSATILE POLYPOIDAL CHOROIDAL VASCULOPATHY

PURPOSE

To investigate the imaging and clinical features of polypoidal choroidal vasculopathy (PCV) with pulsation.

METHODS

The PCV eyes were classified into pulsatile and nonpulsatile PCV groups according to the pulsation on indocyanine green angiography. Imaging features including the dye filling time of the polyp and clinical features were compared.

RESULTS

A total of 75 eyes were classified into the pulsatile PCV (30 eyes) and the nonpulsatile PCV (45 eyes) groups. The initial filling time and complete filling time of the polyp of the pulsatile PCV group (2.59 ± 0.93 and 8.33 ± 3.42 seconds) were shorter than those of the nonpulsatile PCV group (4.11 ± 1.87 and 10.63 ± 3.81 seconds, P < 0.001 and P = 0.010, respectively). The pigment epithelial detachment height of the pulsatile PCV group (414.90 ± 377.15 µ m) was greater than that of the nonpulsatile PCV group (247.81 ± 164.07 µ m, P = 0.030). The pulsatile PCV group showed a higher prevalence of subretinal hemorrhage (43.33%) after intravitreal injection than the nonpulsatile PCV group (13.95%, P = 0.005) during 12 months. The mean number of injections during 12 months of the pulsatile PCV group (5.48 ± 1.46) was greater than that of the nonpulsatile PCV group (4.09 ± 1.21, P < 0.001).

CONCLUSION

Eyes with pulsatile PCV showed shorter filling time of the polyp, greater pigment epithelial detachment height, higher prevalence of subretinal hemorrhage, and more intravitreal injection numbers during 12 months. These might suggest that PCV has distinct imaging and clinical features according to the polyp pulsation.

Association between the arm-to-choroidal circulation time and clinical profile in patients with polypoidal choroidal vasculopathy

PURPOSE

To investigate the association between the arm-to-choroidal circulation time (ACT) on indocyanine green angiography (IA) and clinical profile in patients with polypoidal choroidal vasculopathy (PCV).

STUDY DESIGN

Single-center retrospective study.

METHODS

We included 38 eyes of 38 patients with PCV diagnosed using multimodal imaging and did not undergo previous treatment. All patients were treated with monthly aflibercept injections for 3 months and treat-and-extend regimens for the subsequent 12 months. Posterior vortex vein ACT was assessed on the first visit using Heidelberg IA. The patients were divided into two groups: ACT ≥20 s (L group; eight eyes) and ACT <20 s (S group; 30 eyes). The clinical profiles before and after treatment were analyzed to assess associations with ACT.

RESULTS

The mean ACT was 16.39±3.3 s (L group: 21.25±1.49 s, women:men=2:6, mean age: 77.3±6.5 years; S group: 15.10±2.17 s, women:men=7:23, mean age: 75.5±6.9 years). No significant difference was observed in the mean subfoveal choroidal thickness between the L and the S groups (176±75 μm vs. 230±79 μm, P=0.10). However, there were significant differences between the L and S groups in retinal fluid accumulation and hemorrhage recurrence (eight/eight eyes, 100% vs. 13/30 eyes, 43%, P<0.001), mean aflibercept injections (8.8±1.6 vs. 7.0±1.6, P<0.01) during the 12-month period, and the number of polypoidal lesions (1.8±0.7 vs. 1.3±0.5, P<0.05).

CONCLUSION

Patients with PCV and ACT >20 s are more likely to experience exudative change recurrence in the retina during treatment because they have more polypoidal lesions.

BILATERAL CHOROIDAL DETACHMENTS SECONDARY TO IPILIMUMAB AND PEMBROLIZUMAB USE

PURPOSE

To report the occurrence of bilateral choroidal detachments due to the use of ipilimumab and pembrolizumab immunochemotherapeutics to treat widely metastatic cutaneous melanoma and to raise awareness about this potentially vision-threatening adverse drug event.

METHODS

A 77 year-old man presented with acute onset, painless, and bilateral blurry vision. He had started ipilimumab and pembrolizumab 2 weeks prior for Stage IV metastatic cutaneous melanoma.

RESULTS

Clinical examination revealed bilateral choroidal detachments. After discussion with the patient's medical oncologist, the patient discontinued both medications and began oral prednisone to expedite visual recovery. The choroidal detachments subsequently resolved, and visual acuity improved 2 weeks later.

CONCLUSION

Ipilimumab and pembrolizumab have been reported both in monotherapy and in combination to cause a wide variety of ophthalmic adverse events. This is the first report of choroidal detachments as a complication.

Choroidal structure as a biomarker for visual acuity in intravitreal aflibercept therapy for polypoidal choroidal vasculopathy

PURPOSE

To investigate the relationship between choroidal structure and visual acuity after intravitreal aflibercept therapy for polypoidal choroidal vasculopathy (PCV).

METHODS

We conducted a retrospective, single-centre and observational study including 18 eyes of 18 patients with PCV (73.8 ± 10.2 years of age) who were treated with three monthly intravitreal aflibercept injections followed by additional treatments in a treat-and-extend protocol. The cross-sectional images of the macula were obtained with enhanced depth imaging optical coherence tomography at baseline, at 3 months, and at 12 months. The choroidal layer was divided into luminal or stromal segments by applying binarization processing to calculate these areas. The relationships between age, spherical equivalent, best-corrected visual acuity (BCVA), baseline value, or changes in the luminal or the stromal areas, and the BCVA change at 12 months were analysed using multiple regression analyses and model selection procedures.

RESULTS

Both stromal and luminal areas were decreased at 3 and 12 months compared to baseline areas (5% and 9% at 3 months, 6% and 12% at 12 months, p < 0.0001, p < 0.0001, p < 0.0001 and p < 0.0001, respectively). Greater improvement of visual acuity (VA) at 12 months was significantly associated with younger age, greater spherical equivalent, worse baseline BCVA, greater baseline luminal area, and smaller baseline stromal area.

CONCLUSIONS

Choroidal structure might be useful as a new biomarker for potential Visual outcomes after intravitreal aflibercept therapy for PCV.

Central Serous Chorioretinopathy Complicating Systemic Corticosteroid Therapy

Purpose.

To present evidence that systemic corticosteroid therapy may cause central serous chorioretinopathy.

Methods.

A 20-year-old male with idiopathic thrombocytopenic purpura was examined during systemic treatment with corticosteroids (100 mg daily).

Results.

The patient had central serous chorioretinopathy. Spontaneous recovery accompanied discontinuation of the steroid treatment.

Conclusions.

This case provides further evidence that Cortisol may play a role in the development of central serous chorioretinopathy.

Optical Coherence Tomography Angiography Offers New Insights into Choriocapillaris Perfusion

The choriocapillaris (CC) represents a fundamentally important vascular layer that is subject to physiologic changes with increasing age and that is also associated with a wide range of chorioretinal diseases. So far, information on blood flow in this specific layer has remained limited. With the advent of optical coherence tomography angiography (OCTA), new perspectives and possibilities of CC imaging have begun to evolve. This article shall review the opportunities and challenges of applying OCTA technology to the CC layer and summarize the current clinical efforts in OCTA CC imaging exemplarily in dry age-related macular degeneration and central serous chorioretinopathy.

Diabetic choroidopathy

Early histopathological studies of diabetic choroids demonstrated loss of choriocapillaris (CC), tortuous blood vessels, microaneurysms, drusenoid deposits on Bruchs membrane, and choroidal neovascularization. The preponderance of histopathological changes were at and beyond equator. Studies from my lab suggest that diabetic choroidopathy is an inflammatory disease in that leukocyte adhesion molecules are elevated in the choroidal vasculature and polymorphonuclear neutrophils are often associated with sites of vascular loss. Modern imaging techniques demonstrate that blood flow is reduced in subfoveal choroidal vasculature. Angiography has shown areas of hypofluorescence and late filling that probably represent areas of vascular loss and/or compromise. Perhaps, as a result of vascular insufficiency, the choroid appears to thin in DC unless macular edema is present. Enhanced depth imaging (EDI-SD) OCT and swept source (SS) OCT have documented the tortuosity and loss in intermediate and large blood vessels in Sattler's and Haller's layer seen previously with histological techniques. The risk factors for DC include diabetic retinopathy, degree of diabetic control, and the treatment regimen. In the future, OCT angiography could be used to document loss of CC. Because most of the measurement and imaging are in the posterior pole, the severity of DC may be underappreciated in the published accounts of DC assessed with imaging techniques. However, it is now possible to document DC and quantify these changes clinically. This suggests that DC should be evaluated in future clinical trials of drugs targeting DR because vascular changes similar to those in DR are occurring in DC.

Clinical Features of Pregnancy-associated Retinal and Choroidal Diseases Causing Acute Visual Disturbance

PURPOSE

To report clinical features of patients with retinal and choroidal diseases presenting with acute visual disturbance during pregnancy.

METHODS

In this retrospective case series, patients who developed acute visual loss during pregnancy (including puerperium) and visited a tertiary hospital from July 2007 to June 2015, were recruited by searching electronic medical records. Patients were categorized according to the cause of visual loss. Clinical features and required diagnostic modalities were analyzed in the retinal and choroidal disease group.

RESULTS

Acute visual loss occurred in 147 patients; 49 (38.9%) were classified into the retinal and choroidal group. The diagnoses included central serous chorioretinopathy (22.4%), hypertensive retinopathy with or without pre-eclampsia (22.4%), retinal tear with or without retinal detachment (18.4%), diabetic retinopathy progression (10.2%), Vogt-Koyanagi-Harada disease (4.1%), retinal artery occlusion (4.1%), multiple evanescent white dot syndrome (4.1%), and others (14.3%). Visual symptoms first appeared at gestational age 25.9 ± 10.3 weeks. The initial best-corrected visual acuity (BCVA) was 0.27 ± 0.39 logarithm of the minimum angle of resolution (logMAR); the final BCVA after delivery improved to 0.13 ± 0.35 logMAR. Serious visual deterioration (BCVA worth than 20 / 200) developed in two patients. Differential diagnoses were established with characteristic fundus and spectral-domain optical coherence tomography findings in all cases.

CONCLUSIONS

In pregnant women with acute visual loss, retinal and choroidal diseases are common and could be vision threatening. Physicians should be aware of pregnancy-associated retinal and choroidal diseases and their clinical features. The differential diagnosis can be established with non-invasive techniques.

Nonarteritic Anterior Ischemic Optic Neuropathy Induced Retinal Folds and Deformations

Purpose

We hypothesized that the edema/swelling in the retina due to acute nonarteritic anterior ischemic optic neuropathy (NAION) can induce retinal folds (RF). We determined the pattern and frequency of folds in NAION at presentation and in follow-up, and the relationship between folds and a number of functional and structural parameters over time.

Methods

We prospectively studied eyes with acute NAION by spectral-domain optic coherence tomography (SD-OCT). We used transaxial and en face views to evaluate the presence of peripapillary fluid (PPF), peripapillary wrinkles (PPW), RF, choroidal folds (CF), creases, macular edema, and vitreous traction on the optic disc. Retinal deformations were correlated with the retinal nerve fiber layer (RNFL) thickness, logMAR visual acuity (VA) and mean deviation (MD).

Results

At presentation, 60 eyes had mean RNFL = 224 ± 75 μm, no vitreous traction, and similar VA and MD regardless of the retinal deformation or macular edema. There was PPF in 73%, PPW in 57%, RF in 38%, creases in 20%, and macular edema in 18% of eyes, and no CF. Eyes with retinal deformations had significantly greater RNFL thickness (P< 0.026). At 1 to 2 months, 49 eyes had reduction of the RNFL (112 ± 40 μm, P = 0.001) and unchanged VA and MD that did not correlate with fewer eyes having PPF (15%, P = 0.001), PPW (10%, P = 0.001), RF (10%, P = 0.001), creases (17%), and macular edema (0%, P = 0.007).

Conclusions

RF in NAION reflect stresses and strains due to extracellular fluid without increased pressure in the retrolaminar tissue and subarachnoid space, seen with papilledema. In NAION, the deformations and their resolution do not correlate with vision loss.

Comparison of Clinical Features After 20-Gauge Vitrectomy Versus 23-Gauge Vitrectomy

PURPOSE

To compare the clinical features after 20-gauge (20G) versus 23-gauge (23G) pars plana vitrectomy (PPV).

DESIGN

This was a prospective observational study.

METHODS

Patients who underwent 20G or 23G PPV participated in the study. Sutures were used in all patients who had 20G and as necessary in patients who had 23G. All patients were examined with ultrasound biomicroscopy and tonometry for intraocular pressure (IOP) preoperatively and postoperatively at 1 day, 1 week, 1 month, and 6 months.

RESULTS

Forty-nine eyes underwent 20G PPV and 97 eyes underwent 23G PPV. Hypotony appeared more frequently in the 23G group (9 patients of 97, 9%) than in the 20G group (1 patient of 49, 2%) 1 day after surgery. Mean IOP was statistically significantly lower in the 23G group 1 day after surgery (P = 0.000). Postoperatively, choroidal detachment (CD) was found in both the 23G group (22/97, 23%) and the 20G group (1/49, 2%). In the 23G group, the mean IOP of eyes with CD was significantly lower than those without CD. There was no statistically significant difference in vitreous incarceration between the 2 groups (P = 0.317).

CONCLUSIONS

Choroidal detachment and hypotony were common complications in the early stages after 23G PPV. The incidence of postoperative vitreous incarceration was similar in both groups.

Combined intravitreal anti-VEGF and photodynamic therapy versus photodynamic monotherapy for polypoidal choroidal vasculopathy: a systematic review and meta-analysis of comparative studies

Purpose

The aim of this study was to evaluate the efficacy and safety of photodynamic therapy (PDT) combined with intravitreal vascular endothelial growth factor (VEGF) inhibitors compared to those of PDT alone in the treatment of polypoidal choroidal vasculopathy (PCV).

Methods

A systematic search of Pubmed, Embase, and the Cochrane Library was performed to identify all comparative studies that compared the outcomes of the two approaches. Outcomes of interest included visual outcomes, anatomic variables, and adverse events.

Results

Two randomised controlled trials and nine retrospective studies including a total of 543 cases were identified. At three and six months post-injection, no significant difference in visual acuity was found in the combined therapy group compared with the PDT monotherapy group, with pooled weighted mean differences (WMDs) of 0.074 (−0.021, 0.17) at three months and 0.082 (−0.013, 0.18) at six months. However, the mean changes in visual acuity at month 12 in the combined therapy group were significantly better than those in the PDT monotherapy group, with pooled WMDs of 0.11 (0.012, 0.21). Similar efficacy was found at 24 months (WMD: 0.21; 95%CI: 0.054, 0.36; P = 0.008). Patients in the combined therapy group also might benefit from reduced retinal haemorrhage (OR: 0.32; 95% CI: 0.14, 0.74; P = 0.008). Polyp regression, recurrence of PCV, central retinal thickness reduction, and pigment epithelial detachment resolution did not differ significantly between the two treatments.

Conclusions

Combined treatment appeared to result in better visual acuity and lower retinal haemorrhage. However, combined treatment did not affect the resolution and recurrence of lesions. Given the inherent limitations of the included studies, future well-designed RCTs are awaited to confirm and update the findings of this analysis.

Spontaneous bilateral retinal pigment epithelium rips with good visual acuity

Retinalpigment epithelium (RPE) rips commonly occur in retinochoroidal disorders including age-related macular degeneration, idiopathic polypoid alchoroidal vasculopathy, central serous chorioretinopathy, high myopia andchoroidal neovascularization. Most patients have unilateral involvement and poor visual prognosis. A 55-year-old female presented with decreased vision in her right eye for one week. Her best-corrected visual acuity was 6/12 in the right eye and 6/6-2 in the left. Fundus examination revealed a large juxtafoveal RPE rip in the right eye and multiple small pigment epithelium detachments in the left. No abnormal hyperfluorescent lesions were detected byfundus angiography. High-doseoral antioxidant was prescribed. A pigment epithelium detachment (PED) in the left eye grew larger over the follow-up period. Ultimately, a RPE rip also occurred in the left eye in the 17th week offollow-up. Her best-corrected visual acuity was 6/9. Although reinvestigation was done, no other choroidal abnormalities were demonstrated by optical coherence tomography (OCT) and fundus angiography. During the observation, RPE tears were reattached spontaneously in both eyes. A considerable amount of RPE proliferation, migration, and repopulation was also demonstrated by OCT and fundus autofluorescence. After 2.5 years of follow-ups, her best-corrected visual acuity was 6/9 in the right eye and 6/6 in the left. We hypothesize that the increased surface tension of RPE is the etiology of RPE rips in this case. Furthermore, the underlying chorioretinal abnormality directly affects the visual prognosis and further studies are needed in prevention, pathogenesis and treatment.

Imaging evidence of diabetic choroidopathy in vivo: angiographic pathoanatomy and choroidal-enhanced depth imaging

Purpose

To describe the pathoanatomy of diabetic choroidopathy (DC) in pre-diagnosed diabetic retinopathy (DR) cases and to provide angiographic and optical evidence for DC using indocyanine green angiography (ICGA) and enhanced depth imaging spectral-domain optical coherence tomography (EDI SD-OCT).

Methods

A retrospective analysis of 80 eyes from 40 DR patients was conducted. In Group One, choroidal vascular abnormalities were evaluated by comparing angiographic findings from simultaneous ICGA with those from fundus fluorescein angiography (FFA). In Group Two, EDI SD-OCT was used to evaluate the subfoveal choroidal thickness (SFCT) and define the choroid boundary in order to acquire the bilateral and symmetric choroidal area (CA). Data were then analyzed by Image Pro Plus 6.0.

Results

In Group One, choroidal abnormalities that were evident using ICGA but not FFA included early hypofluorescent spots in 47 eyes (75.81%), late hyperfluorescent spots in 37 eyes (59.68%), and late choroidal non-perfusion regions in 32 eyes (51.61%). In particular, a significant difference between proliferative DR (PDR) in 17 of 23 eyes (73.91%) and non-PDR in 16 of 39 eyes (41.03%) was observed in late choroidal non-perfusion regions. Eighteen of 31 eyes (58.06%) also exhibited “inverted inflow phenomena.” In Group Two, both the SFCT and CA of eyes with diabetic macular edema and serous macular detachment were significantly greater than those in the other eyes. The CA in panretinal photocoagulation (PRP) treated cases was also greater than that in non-PRP treated cases.

Conclusions

Early hypofluorescent spots, late choroidal non-perfusion regions, inverted inflow phenomena, higher SFCT, and larger CA are qualitative and quantitative indexes for DC. Moreover, the late choroidal non-perfusion region is a risk factor for DC with DR. Our study suggests that the supplemental use of ICGA and EDI SD-OCT with FFA is a better choice for DR patients.

[Association of the ARMS2 gene with clinical features in polypoidal choroidal vasculopathy]

Polypoidal choroidal vasculopathy (PCV) exhibits subretinal and sub-pigment epithelial lesions, as wells as classic choroidal neovascularization. From a genetic point of view, variants of age-related maculopathy susceptibility 2 (ARMS2) A69S and CFH I62V are reported to be strongly associated with PCV. We investigated whether these two major genetic variants are associated with funduscopic manifestations of PCV. Although there was no association between CFH I62V variants and clinical expression in PCV, the risk variants of ARMS2 A69S were associated with subretinal hemorrhage, hemorrhagic pigment epithelial detachment (PED), and serous PED. Neither variant was associated with classic CNV. The mean onset age in bilateral patients was significantly lower than in unilateral patients. There was also a significantly higher frequency of risk variants in ARMS2 A69S in bilateral patients than in unilateral patients. The risk variants of ARMS2 A69S were associated with hemorrhagic and sub-pigment epithelial lesions and with bilaterality. Genotyping of ARMS2 A69S is useful in understanding clinical features in PCV.

Comparisons of outcomes with different intervals between adjunctive ranibizumab and photodynamic therapy for polypoidal choroidal vasculopathy

PURPOSE

To determine the optimal time for administration of intravitreal ranibizumab injections before photodynamic therapy (PDT) as combined therapy to treat polypoidal choroidal vasculopathy (PCV).

DESIGN

Retrospective, comparative, interventional case series.

METHODS

The study included 99 eyes (98 patients) with treatment-naïve subfoveal PCV treated with an intravitreal ranibizumab injection followed by PDT. The combination therapy included 1 ranibizumab injection administered 7 days before PDT (7-day group) or 2 days before PDT (2-day group). All eyes were followed for over 12 months.

RESULTS

Intravitreal ranibizumab was administered 7 days before PDT in 59 eyes and 2 days before PDT in 40 eyes. In the 7-day group, the best-corrected visual acuity (BCVA) did not improve significantly at 3 months (P = .086) or 12 months (P = .259) compared with baseline. In the 2-day group, BCVA improved significantly at 3 months (P < .001) and 12 months (P < .001). The polypoidal lesions regressed completely in 46 eyes (78.0%) in the 7-day group and in 34 eyes (85.0%) in the 2-day group; 38 eyes (64.4%) and 35 eyes (87.5%), respectively, did not require additional treatment, which differed significantly (P = .008) between the 2 groups. Subretinal hemorrhages did not develop in either group within 1 month after the combined therapy.

CONCLUSIONS

Administration of an intravitreal ranibizumab injection 2 days before PDT achieves significantly better visual outcomes and requires fewer additional treatments compared with administration of the injection 7 days before PDT.

Five-year follow-up results of photodynamic therapy for polypoidal choroidal vasculopathy

PURPOSE

To evaluate the 5-year efficacy of photodynamic therapy (PDT) in patients with polypoidal choroidal vasculopathy (PCV).

DESIGN

Retrospective study.

METHODS

Forty-two eyes of 36 patients with PCV followed up for at least 60 months after PDT were reviewed. All eyes were primarily treated with PDT. Main outcome measure was best-corrected visual acuity (BCVA; logMAR [logarithm of minimal angle of resolution]) at baseline and at each follow-up visit. We also classified the eyes into 3 groups: improved (improvement ≥0.3 logMAR), decreased (deterioration ≥0.3 logMAR), and stable.

RESULTS

During the mean follow-up duration, 73.64 ± 13.47 months, the mean number of PDT was 2.21 ± 1.62 treatments. Recurrence was noted in 33 eyes (78.6%) during follow-up. The mean baseline BCVA was 0.78 ± 0.48 logMAR (20/120 Snellen equivalent), and the final BCVA at 60 months was 0.67 ± 0.52 logMAR (20/93 Snellen equivalent) (P = .050, paired t test). On the final evaluation at 60 months, the mean BCVA was improved in 14 eyes (33.3%), stable in 23 eyes (54.8%), and decreased in 5 eyes (11.9%).

CONCLUSION

At 60 months after initial PDT, 88.1% of PCV patients showed stable or improved BCVA after PDT. Despite a high recurrence rate, PDT remained effective for 5 years, and represents a good therapeutic approach to PCV.

Photodynamic therapy with or without intravitreal bevacizumab for polypoidal choroidal vasculopathy: two years of follow-up

PURPOSE

To compare the long-term results of the efficacy of photodynamic therapy (PDT) with or without intravitreal bevacizumab (IVB) injections for polypoidal choroidal vasculopathy.

DESIGN

Retrospective, comparative, interventional case series.

METHODS

We included 69 eyes of 69 patients with macula-involved polypoidal choroidal vasculopathy. All patients were followed up for more than 2 years. We compared the treatment outcomes between groups and investigated the factors influencing visual improvement at 24 months of follow-up.

RESULTS

Thirty-six patients received PDT combined with IVB and 33 patients received PDT monotherapy. At 3 months, the mean logarithm of minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA) improved from 0.73 to 0.53 in the combined therapy group (P < .001) and from 0.79 to 0.72 in the PDT monotherapy group (P = .02), with a significant difference in treatment efficacy between the 2 groups (P < .001). However, the improvements in BCVA were not statistically significant after 21 months in the combined therapy group and 15 months in the monotherapy group. The difference in treatment efficacy between the 2 groups was not significant after 6 months. Initial BCVA (P = .005), lesion size (P = .011), patient age (P = .018), and location of polyps (P = .006) significantly predicted the final visual outcome rather than treatment modality (P = .243).

CONCLUSIONS

PDT combined with IVB for symptomatic PCV was temporarily superior to PDT monotherapy, and the treatment efficacy decreased with time. Initial BCVA, lesion size, and location were more significant than treatment modality as the factors influencing final visual improvement.

Treatment of polypoidal choroidal vasculopathy with photodynamic therapy combined with intravitreal injections of ranibizumab

PURPOSE

To evaluate the 1-year efficacy and safety of photodynamic therapy (PDT) combined with intravitreal injections of ranibizumab for polypoidal choroidal vasculopathy (PCV).

DESIGN

Retrospective chart review.

METHODS

We retrospectively reviewed the medical records of 63 consecutive patients (66 eyes) with subfoveal PCV who were treated with PDT combined with intravitreal injections of ranibizumab. Of the 66 eyes, 29 had no history of treatment for PCV, 10 had been treated previously with only intravitreal injections of anti-vascular endothelial growth factor agents, and 27 had been treated previously with PDT. All eyes had a minimal follow-up of 12 months.

RESULTS

The combined therapy reduced substantially the exudative change immediately after initiation of treatment. In treatment-naïve eyes, mean VA before treatment (0.47 ± 0.37 logarithm of the minimal angle of resolution [logMAR]) improved to 0.32 ± 0.30 (P < .01) at 3 months and to 0.29 ± 0.29 (P < .01) at 12 months. Polypoidal lesions were reduced in all eyes and disappeared completely in 79.1% of cases. In eyes treated previously with only anti-vascular endothelial growth factor therapy, some visual improvement was achieved, but in eyes treated previously with PDT, mean visual acuity (0.61 ± 0.45) deteriorated to 0.68 ± 0.52 at 12 months. Of all 66 eyes, 5 showed extensive postoperative subretinal hemorrhage, in 2 of which a vitreous hemorrhage developed, necessitating pars plana vitrectomy.

CONCLUSIONS

PDT combined with ranibizumab led to significant visual recovery in treatment-naïve eyes with PCV, but not in eyes with PCV that had demonstrated recurrence after previous PDT. PDT in combination with ranibizumab still has a risk of the postoperative hemorrhagic complications.

Clinical features and follow-up results of pulsating polypoidal choroidal vasculopathy treated with photodynamic therapy

PURPOSE

 To report on the clinical course of pulsating polypoidal choroidal vasculopathy (PCV) treated with photodynamic therapy (PDT).

METHODS

  A total of 63 eyes of 58 consecutive patients diagnosed with PCV, treated with PDT and followed up for at least 6months were enrolled. Best-corrected visual acuity (BCVA), fluorescein angiography and high-speed indocyanine green angiography (ICGA) using confocal scanning laser ophthalmoscopy (HRA) were performed.

RESULTS

  Of the 63 PCV eyes, 14 eyes (22.2%) of 14 patients were classified as having pulsating PCV. The mean age of pulsating PCV patients was 60.6±7.0years (48-69years), which was younger than non-pulsating PCV patients (65.7years, p=0.035). The mean follow-up period was 23.9±10.7months, and PDT was administered 1.6±0.9 times to pulsating PCV patients. The mean logMAR BCVAs were 0.85±0.47 at presentation and 0.71±0.52 at final examination. Extensive haemorrhagic events were more common in pulsating than in non-pulsating PCV patients (57.1% versus 26.5%, p=0.032). However, the risk of haemorrhage within 3months of PDT was similar for both pulsating PCV and the remaining patients (14.3% versus 20%, p=0.723).

CONCLUSION

  Pulsating PCV showed distinctive features including a relatively younger patient age at presentation, and a haemorrhagic tendency (especially extensive). However, the use of PDT did not directly increase the risk of haemorrhage in pulsating PCV patients.