Correlation of 1-year vision outcomes with baseline factors in polypoidal choroidal vasculopathy patients after anti-VEGF treatment / 眼科新进展

Objective To analyze the correlation between baseline factors and the best corrected visual acuity (BCVA) after 3 monthly anti-vescular endothelial growth factor (VEGF) therapy in naive polypoidal choroidal vasculopathy (PCV).Methods This was a retrospective cohort study in 44 naive PCV patients (44 eyes) treated in our hospital between July 2015 and December 2016,and BCVA,optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) + indocyanine green angiography (ICGA) examinations were performed at first.All patients were treated with monthly antiVEGF (including ranibizumab and conbercept) injections for 3 consecutive months,followed by the needed retreatment,and BCVA at the 12th month during follow-up after the first anti-VEGF treatment was recorded,following the comparison with baseline BCVA,and then the patients were divided into improved and unimproved groups according to BCVA changes.Finally,univariate and logistic regression analysis were used to analyze the correlation between the baseline factors and BCVA.Results The univariate analysis showed that the improved group had shorter onset time,smaller greatest linear dimension (P =0.045 and 0.037,respectively).Logistic regression showed the difference in choroidal vascular hyperpermeability and greatest linear dimension was statistically significant,suggesting that they were the independent predictors of visual outcome (regression coefficient =0.963 and 0.001,P =0.010 and 0.012,odds ratios =0.083 and 1.002,95％ confidence interval =0.013-0.549 and 1.001-1.004,respectively).Conclusion Choroidal vascular hyperpermeability may be a predictor for poor visual acuity prognosis in PCV patients after anti-VEGF,and greatest linear dimension and the time of onset are also related to postoperative visual acuity in PCV patients after anti-VEGF.

Delayed Absorption of Subretinal Fluid after Retinal Reattachment Surgery and Associated Choroidal Features

PURPOSE: The aim of this study was to investigate the incidence and associated clinical factors of delayed absorption of subretinal fluid (SRF) after surgery for rhegmatogenous retinal detachment. METHODS: This study involved 36 eyes of 36 consecutive patients who underwent successful surgery for rhegmatogenous retinal detachment. A complete ophthalmologic evaluation, including clinical fundus examination, optical coherence tomography, and indocyanine green angiography, was conducted before and after surgery. Delayed absorption was defined as the presence of residual concave SRF or an SRF bleb at 6 months after surgery. Clinical factors and choroidal features on indocyanine green angiography were compared according to the presence and absence of delayed absorption. RESULTS: Eighteen of 36 eyes (50%) showed delayed absorption. Macular involvement and worse preoperative visual acuity were significantly related to the presence of delayed absorption (p = 0.001 and p = 0.034, respectively). On indocyanine green angiography, preoperative choroidal vascular hyperpermeability was noted in 70% of eyes with delayed absorption and in 14% of eyes without it (p = 0.010). CONCLUSIONS: Delayed absorption of SRF after retinal reattachment surgery was not rare, with a 50% of incidence in this study. Macula-off status was significantly related to the incidence of delayed SRF absorption, and choroidal features such as choroidal vascular hyperpermeability might be responsible in part, possibly through the resultant exudative property of choroid.

Subfoveal Choroidal Thickness in Fellow Eyes of Patients with Central Serous Chorioretinopathy

PURPOSE: To determine the relationship between subfoveal choroidal thickness of fellow eyes and choroidal vascular hyperpermeability in unilateral central serous chorioretinopathy (CSC). METHODS: Thirty patients with unilateral CSC and 28 normal subjects underwent enhanced depth imaging spectral-domain optical coherence tomography to evaluate bilateral subfoveal choroidal thickness. The subfoveal choroidal thickness was measured from the outer RPE border to the inner sclera border. Choroidal vascular hyperpermeability was visualized with indocyanine green angiography (ICGA) and analyzed. RESULTS: The mean subfoveal choroidal thickness in the affected eyes (439.6 +/- 136.5 microm) was significantly thicker than that in fellow eyes (340.0 +/- 103.3 microm, p = 0.002), and both showed statistically significant difference compared with normal subjects (266.5 +/- 111.5 microm, p < 0.001, p = 0.019). The subfoveal choroidal thickness of fellow eyes with choroidal vascular hyperpermeability was 370.0 +/- 176.5 microm, which differed significantly (p = 0.037) from the choroid without choroidal vascular hyperpermeability. The choroidal thickness of acute CSC was 441.6 +/- 118.6 microm, and that of chronic CSC was 454 +/- 166.5 microm, a difference that was not statistically significant (p = 0.676). CONCLUSIONS: The subfoveal choroid with hyperpermeability was thicker than that without hyperpermeability on ICGA in the fellow eyes of patients with unilateral CSC. Enhanced depth imaging spectral-domain optical coherence tomography can indirectly evaluate the effects of choroidal hyperpermeability by noninvasively measuring the choroidal thickness.

Angiographic Findings of Choroidal Lesions in Serous Retinal Detachment

PURPOSE: To study the relationship between the damage of retinal pigment epithelum and the lesion of choroidal vessels in various types of the serous retinal detachment(SRD) on fluorescein angiography(FAG) and indocyanine green angiography(ICGA). METHODS: FAG and ICGA were performed 81 eyes with various types of serous retinal detachment. The series comprised central serous chorioretinopathy(CSC, 63 eyes), toxemia of pregnancy(8 eyes), and Harada's disease(10 eyes). RESULTS: All the eyes showed dye leakage through the retinal pigment epithelium(RPE) by FAG. Of sixty-three eyes with CSC, sixty eyes showed choroidal tissue staining in late phase on ICGA. Delayed filling of ICG dye in early phase was present around the site of leakage on FAG in 48 eyes with CSC. In toxemia of pregnancy and Harada's disease, all the cases showed delayed choroidal circulation and leakage from choroidal vessels on ICGA. As a common feature, ICGA showed choroidal hypoperfusion or delayed choroidal circulation and choroidal vascular hyperpermeability in the three types of SRD. CONCLUSIONS: The authors presume that they might contribute to the damage of RPE. The pathogenesis of SRD may be related to the hypothesis fact that choroidal vascular hyperpermeability probably moves fluid into the subretinal space from the choroid.