Two years follow-up outcome of verteporfin therapy for subfoveal choroidal neovascularization in pathologic myopia in Indian eyes.

Context: In India, refractive errors are a major cause of treatable blindness. Population surveys in southern India have shown prevalence of high myopia to be 4.32-4.54%. Photodynamic therapy (PDT) for choroidal neovascularization (CNV) caused by pathologic myopia is beneficial. Aims: To report the 24 months outcome of PDT with verteporfin for subfoveal CNV caused by pathologic myopia in Indian eyes Settings and Design: Prospective case series Materials and Methods: Review of prospectively collected data of Indian patients with pathologic myopia and subfoveal CNV treated with verteporfin therapy between 2001 and 2005 using standard regimen for PDT. Statistical Analysis Used: Wilcoxon signed rank test was used to see the difference in the mean letter acuity at intervals compared to baseline. Kaplan Meier Survival analysis was done to estimate the success rate of verteporfin therapy for CNV caused by pathologic myopia. Results: Fifteen patients (15 eyes) treated with standard fluence PDT and who had completed 24 months follow-up were analyzed. The mean spherical equivalent was -13.36 +/- 5.88 diopter. Five out of 15 eyes in six months, three out of 15 eyes at 12 months and four eyes out of 15 at 24 months had improved vision by > 10 letters. The mean number of treatment session was 2.2 in two years. Conclusions: PDT with verteporfin for subfoveal CNV caused by pathologic myopia in Indian eyes is effective.

Retinal pigment epithelial atrophy following indocyanine green dye-assisted surgery for serous macular detachment.

To report subretinal migration of indocyanine green dye (ICG) and subsequent retinal pigment epithelial (RPE) atrophy during macular surgery for serous macular detachment. A 65-year-old woman presented with residual epiretinal membrane and serous detachment of the macula following vitreoretinal surgery for epiretinal membrane. She underwent resurgery with ICG-assisted internal limiting membrane peeling and intraocular tamponade. Intraoperatively a large area of subretinal ICG was seen with subsequent RPE mottling and atrophy of the macula in the area involved during follow-up. This case demonstrates that subretinal migration of ICG is possible and can be toxic to RPE.

The future implications and indications of anti-vascular endothelial growth factor therapy in ophthalmic practice.

In the last few years anti-vascular endothelial growth factor (VEGF) therapy has changed the paradigm in the treatment of neovascular age-related macular degeneration (ARMD). Besides, its potential use in the treatment of diabetic retinopathy and other possible proliferative vascular disorders has also shown promise. Clinical trial results have shown tremendous beneficial effect of ranibizumab in ARMD. Off-label use of bevacizumab has also shown similar benefit but long-term and clinical trial results do not exist. Some of the potential questions in the use of anti-VEGF are recurring cost, possible long-term effect on physiological function of VEGF and determination of endpoint of treatment. Overall, the use of anti-VEGF therapy in ocular angiogenesis has proven to be beneficial at least now.

Combination therapy of intravitreal triamcinolone and photodynamic therapy with verteporfin for subfoveal choroidal neovascularization.

AIM: To evaluate the six months follow-up outcome of combined intravitreal triamcinolone acetonide (IVTA) and photodynamic therapy (PDT) for subfoveal choroidal neovascularization compared to PDT alone. STUDY DESIGN: Prospective interventional pilot study. MATERIALS AND METHODS: Patients with six months follow-up of IVTA following PDT (Group I, eight eyes) and PDT alone (Group II, eight eyes) were included. Four mg/ 0.1 ml of IVTA was injected 7-10 days following PDT. The patients were reevaluated every month for the first two months and every three months thereafter in both the groups. RESULTS: Group I: The mean age was 65.8+/-11.8 years (range: 47-79 years). Five patients were male. The total treatment sessions in six months were 11 (mean: 1.36). At six months, one eye had >or= 10 letters gain and three eyes had > 10 letters loss. Four eyes had stable vision. Two eyes (25%) developed increased intraocular pressure (>40 mmHg) during follow-up. Group II: The mean age was 58.7+/-11.7 years (range: 46-76 years). Five patients were male. The total treatment sessions in six months were 17 (mean: 2.13). At six months, six eyes had >or= 10 letters gain and none had > 10 letters loss. Two eyes had stable vision. CONCLUSION: The mean number of treatment sessions following combination therapy of IVTA (4 mg) and PDT appears relatively less (1.36 at six months) compared to PDT alone (mean: 2.13). (P =0.02).

Optical coherence tomographic evaluation of macular infarction following dapsone overdose.

A 16-year-old girl had decrease in vision following dapsone overdose. This case demonstrated optical coherence tomography (OCT) evaluation of macular infarction following dapsone poisoning. OCT showed characteristic serial changes as Stage 1: Cystic macular edema, Stage 2: Resolving cystic change and Stage 3: Foveal atrophy. Hence, OCT could show the progression of foveal atrophy from cystic macular edema following dapsone poisoning.

Indocyanine green dye enhanced laser photocoagulation for juxtafoveal choroidal neovascularisation.

PURPOSE: To evaluate the initial results of pilot study of indocyanine green dye enhanced laser photocoagulation for juxtafoveal choroidal neovascularisation (CNV). MATERIALS AND METHODS: The study was conducted on eleven eyes of 11 patients of CNV during the period 2001 and 2002. Two to three minutes after the injection of 5 ml of 25 mgm of indocyanine green (ICG) dye, 810 nm diode laser was used to treat the choroidal neovascular lesions. RESULTS: The age of the patients ranged from 45 to 80 years. All patients completed 12 months of follow-up. Eight eyes (72.7%) had neovascular age related macular degeneration, 2 eyes (18.2%) had myopic CNV and one eye (9.09%) had CNV secondary to angioid streak. The presenting visual acuity was <or=6/60 in seven, 6/36 in one and >or=6/12 in three patients. The final visual acuity at the end of at least 12 months follow-up was 6/12 or better in one eye (9%); 6/18-6/36 in 3 eyes (27.27%) and <or=6/60 in 7 eyes (63.64%). In four patients the vision improved whereas it worsened or remained same in 7 eyes. CONCLUSION: ICG dye enhanced diode laser photocoagulation appears to be a potential option for juxtafoveal CNV.

Role of photodynamic therapy in polypoidal choroidal vasculopathy.

PURPOSE: To evaluate photodynamic Therapy (PDT) with Verteporfin for polypoidal choroidal vasculopathy (PCV) involving the fovea in Indian eyes, through a retrospective interventional case series. MATERIALS AND METHODS: We retrospectively reviewed the records of 9 patients (9 eyes) diagnosed to have PCV with foveal involvement between September 2001 and October 2002. RESULTS: Nine eyes underwent PDT for PCV. Follow-up ranged from 12 to 16 months. Initial visual acuity (VA) ranged from 1/60 to 6/12 and final VA varied from 1/60 to 6/9 at the end of follow-up. VA improved in 4/9 eyes (44.4%) by one line and remained unchanged in 5/9 eyes (55.6%), hence it was considered stabilized in all eyes. No adverse effects or events were observed during or after treatment with verteporfin. CONCLUSION: PDT may be beneficial for PCV with foveal involvement. Its long-term efficacy requires to be evaluated.

PFCL and ILM peeling in macular hole with retinal detachment / 国际眼科杂志(Guoji Yanke Zazhi)

● AIM: To demonstrate the operative technique and surgical outcome of using perfluorocarbon liquids (PFCL) in internal limiting membrane (ILM) peeling of eyes with macular hole associated with retinal detachment.● METHODS: The study consists of 8 consecutive eyes of 8 patients diagnosed to have total retinal detachment (RD) with macular hole between December 2001 and October 2002.The age ranged from 13 to 65 years (mean 39 years). The male female ratio was 5:3. Four eyes were in Non-myopic Group and 4 eyes in Myopic Group. The patients underwent vitrectomy, ICG dye to stain the ILM,PFCL to flatten the retina intraoperatively, ILM peeling,fluid air exchange and endolaser was performed around the peripheral breaks. Tamponade with either silicone oil or C3F8was used.● RESULTS: The follow-up ranged from 6 to 9mo (mean 6.5mo). In Non-myopic Group. Macular hole was completely closed at the end of follow-up in 3 eyes (75%)and decreased size with flat edge in 1 eye (25%). In Myopic Group. All 4 eyes had successful closure of macular hole at the end of the follow-up. Comparing the groups,complete closure of macular hole was achieved in 7 eyes (88%) and open hole with flat edge was seen in 1 eye (12%) at the end of follow-up.● CONCLUSION: Using PFCL is helpful in the peeling of ILM for macular hole associated with retinal detachment.

Verteporfin therapy for myopic choroidal neovascularisation in Indian eyes (one year results).

PURPOSE: To investigate the 12 months' follow-up outcome of photodynamic therapy (PDT) with verteporfin for CNV in pathologic myopia in pigmented eyes of patients from the Indian subcontinent. METHODS: Nine eyes of 9 consecutive patients were included in the study. Patients with a spherical equivalent of - 6 diopter or more and baseline visual acuity of 6/60 or better were included. All patients received ETDRS visual acuity test (including letter acuity) and fluorescein angiography both before and after PDT. All patients had at least 12 months of follow up. RESULTS: The final visual acuity was unchanged 8 eyes (88.8% had VA of 6/30 or better) at the end of 12 months. Six eyes (66.7%) lost < or = 8 letters and three eyes (33.3%) lost < or = 15 letters at the end of 12 months from the baseline. CONCLUSION: Photodynamic therapy with verteporfin for subfoveal choroidal neovascularisation secondary to high myopia tends to stabilise the vision at 12 months follow up in Indian eyes. Longer follow up is necessary to understand the natural history of CNV treated with PDT in high myopia in Indian eyes.

Optical coherence tomographic evaluation of foveal pseudocyst in the formation of macular hole.

Optical coherence tomographic documented progression of foveal pseudocyst in a vitrectomised eye to full thickness macular hole is reported. Muller cell alteration and other centrifugal forces are possible pathomechanisms.