Intravitreal Anti-vascular Endothelial Growth Factor for Typical Exudative Age-related Macular Degeneration in Eyes with Good Baseline Visual Acuity

PURPOSE: To investigate 12-month treatment outcomes of anti-vascular endothelial growth factor therapy in eyes with typical exudative age-related macular degeneration with good baseline visual acuity. METHODS: This retrospective observational case series included 18 eyes (18 patients) with typical exudative age-related macular degeneration with a baseline best-corrected visual acuity of 20 / 25 or better. Patients were treated with anti-vascular endothelial growth factor monotherapy during the 12-month follow-up period. Baseline visual acuity and central foveal thickness were compared to the values at 12 months. RESULTS: Patients received an average of 4.4 +/- 1.3 intravitreal anti-vascular endothelial growth factor injections. The mean logarithm of minimum angle of resolution visual acuity was 0.08 +/- 0.04, 0.08 +/- 0.07, 0.12 +/- 0.09, and 0.16 +/- 0.11 at baseline, three months, six months, and 12 months, respectively. Visual acuity at 12 months was significantly worse than the baseline value at diagnosis (p = 0.017), and the mean central foveal thickness at the defined time points was 270.2 +/- 55.6, 204.4 +/- 25.4, 230.1 +/- 56.3, and 216.8 +/- 48.7 microm, respectively. The central foveal thickness at 12 months was significantly less than the baseline value at diagnosis (p = 0.042). CONCLUSIONS: Deterioration in visual acuity was noted in eyes with typical exudative age-related macular degeneration with good baseline visual acuity, suggesting the need for close patient monitoring and prompt treatment even in patients with good baseline visual acuity.

Surgical Outcomes of Idiopathic Epiretinal Membrane with Good Visual Acuity

PURPOSE: To evaluate surgical outcomes of idiopathic epiretinal membrane (ERM) with good visual acuity. METHODS: We evaluated patients who were diagnosed with idiopathic ERM with best corrected visual acuity (BCVA) greater than 20/40 and who were followed-up for 12 months or longer after vitrectomy and membrane removal. BCVA, metamorphopsia, central subfield macular thickness (CSMT), foveal contour, and status of photoreceptor inner/outer segment (IS/OS) junction were retrospectively assessed based on the medical records and optical coherence tomography (OCT) images. RESULTS: Twenty-four eyes were included in the present study. The mean BCVA (log MAR) did not significantly improve from baseline to 12 months after surgery (0.26 +/- 0.06 and 0.25 +/- 0.19, respectively). Six eyes showed improved vision of two or more lines, and six eyes had decreased vision of two or more lines. Metamorphopsia remained in all four eyes with preoperative symptoms until 12 months postoperatively. CSMT decreased significantly from 418 +/- 86 microm at baseline to 343 +/- 45 microm at 12 months (p < 0.01). Among 17 eyes without foveal depression at baseline, 11 eyes recovered a foveal depression at an average of 6.6 months after surgery. IS/OS status at baseline was intact in 19 eyes, attenuated in three eyes, and disrupted in two eyes and did not change significantly at 12 months. CONCLUSIONS: Surgical treatment for idiopathic ERM with good visual acuity resulted in anatomical but not functional improvement. Choosing surgery for idiopathic ERM with good visual acuity should be considered carefully because decreased visual acuity could result in some patients.

Surgical Outcomes of Idiopathic Epiretinal Membrane with Good Visual Acuity

PURPOSE: To evaluate surgical outcomes of idiopathic epiretinal membrane (ERM) with good visual acuity. METHODS: We evaluated patients who were diagnosed with idiopathic ERM with best corrected visual acuity (BCVA) greater than 20/40 and who were followed-up for 12 months or longer after vitrectomy and membrane removal. BCVA, metamorphopsia, central subfield macular thickness (CSMT), foveal contour, and status of photoreceptor inner/outer segment (IS/OS) junction were retrospectively assessed based on the medical records and optical coherence tomography (OCT) images. RESULTS: Twenty-four eyes were included in the present study. The mean BCVA (log MAR) did not significantly improve from baseline to 12 months after surgery (0.26 +/- 0.06 and 0.25 +/- 0.19, respectively). Six eyes showed improved vision of two or more lines, and six eyes had decreased vision of two or more lines. Metamorphopsia remained in all four eyes with preoperative symptoms until 12 months postoperatively. CSMT decreased significantly from 418 +/- 86 microm at baseline to 343 +/- 45 microm at 12 months (p < 0.01). Among 17 eyes without foveal depression at baseline, 11 eyes recovered a foveal depression at an average of 6.6 months after surgery. IS/OS status at baseline was intact in 19 eyes, attenuated in three eyes, and disrupted in two eyes and did not change significantly at 12 months. CONCLUSIONS: Surgical treatment for idiopathic ERM with good visual acuity resulted in anatomical but not functional improvement. Choosing surgery for idiopathic ERM with good visual acuity should be considered carefully because decreased visual acuity could result in some patients.

Factors Predisposing to Good Visual Acuity after Vitrectomy for Proliferative Diabetic Retinopathy

PURPOSE: To determine the incidence and predisposing factors of a visual acuity of 0.5 or better after vitrectomy for proliferative diabetic retinpopathy. METHODS: The factors that could affect visual acuity in 267 eyes of 215 diabetic patients who had undergone vitrectomy for proliferative diabetic retinopathy were calculated retrospectively. The factors were compared between 2 patient groups: postoperative visual acuity of 0.5 or better and of less than 0.5. The statistical significance of differences in factors between the 2 groups was calculated. RESULTS: In 62 (23.2%) of the eyes, postoperative visual acuity was 0.5 or better. Univariate analysis revealed that the patients in the group with better visual acuity were younger, and had no macular detachment, no intraocular tamponade, low level of HbA1c preoperatively, and no cataract surgery (P<0.05). Multivariate analysis revealed that postoperative visual acuity of 0.5 or better was associated with no macular detachment, younger age, and a preoperative visual acuity of 0.1 or better. CONCLUSIONS: The patients who undergo vitrectomy for proliferative diabetic retinopathy complications are more likely to achieve visual acuity of 0.5 or better if they have not had macular detachment, are younger, and have a preoperative visual acuity of 0.1 or better.