Comparison of the efficacy of Conbercept and Ranibizumab for nARMD with fibrovascular pigment epithelial detachment / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the efficacy of conbercept and ranibizumab on neovascular age-related macular degeneration(nARMD)of type 1 macular neovascularization(MNV)with fibrovascular pigment epithelial detachment(fPED).<p>METHODS: Retrospective clinical study. From January 2019 to December 2020, 48 patients(48 eyes)of nARMD type 1 MNV patients with fPED diagnosed in our hospital were included and divided into conbercept group with 26 patients(26 eyes)and ranibizumab group with 22 patients(22 eyes)according to the drugs they received. All patients received treatment of 3+PRN. Followed up for 12mo, the best corrected visual acuity(BCVA)of the two groups was observed, and optical coherence tomography(OCT)was used to measure the macula foveal thickness(CFT)and the regression degree(height, area, volume)of retinal pigment epithelial detachment(PED).<p>RESULTS: There was no significant difference between two groups in BCVA, CFT and PED height, area and volume before treatment(<i>P</i> >0.05). The PED height of the two groups was significantly improved at 3, 6 and 12mo after the first intravitreal injection treatment compared with those before treatment(<i>P</i><0.05). But the PED area and volume were not significantly improved(<i>P</i>>0.05). There was no significant improvement in BCVA between the two groups after treatment compared with those before treatment(<i>P</i>>0.05). The CFT of the conbercept group was significantly improved at 3, 6 and 12mo after treatment compared with those before treatment(<i>P</i><0.05), and the ranibizumab group improved significantly only 3mo after treatment(<i>P</i><0.05). There were no significant differences in BCVA, CFT, and PED height, area and volume between the two groups at 3, 6 and 12mo after treatment(<i>P</i> >0.05).<p>CONCLUSION: The conbercept and ranibizumab have good effects on type 1 MNV with fPED in nARMD, which can reduce the PED height and CFT, and stabilize the visual acuity, PED area and volume. However, conbercept can achieve longer reduction of macular edema.

Diagnostic performance of confocal scanning laser ophthalmoscope imaging and compared with color fundus camera in retinal pigment epithelial detachment of polypoidal choroidal vasculopathy / 中华眼底病杂志

Objective To observe confocal scanning laser ophthalmoscope (cSLO) based retinal imaging and color fundus camera in pigment epithelial detachment (PED) of polypoidal choroidal vasculopathy (PCV).Methods PED of 30 patients (32 eyes) were recruited from June 2016 to June 2017 in the Beijing Tongren Hospital who were detected in high-definition OCT (HD-OCT) and diagnosed as PCV by FFA and ICGA.There were 16 males (17 eyes) and 14 females (15 eyes);aged from 50-83 years,with the mean age of 66.59 years.The photographs of ocular fundus including color fundus camera,cSLO imaging,HD-OCT,FFA and ICGA were analyzed.Multimodal imaging results were regarded as gold standard.Sensitivity and specificity were calculated in serous and hemorrhagic PED diagnosis using color fundus camera and cSLO imaging.The positive number of PED was used to compare between two modes fundus imaging by using x2 test.Results Twenty serous PED eyes,3 hemorrhagic PED eyes and 9 serous/hemorrhagic PED eyes were determined using multimodal imaging.The sensitivity and specificity of color fundus camera were 45％ and 100％ in detecting serous PED and 100％ and 91％ in detecting hemorrhagic PED.The sensitivity and specificity of cSLO imaging were 83％ and 100％ in detecting serous PED and 50％ and 86％ in detecting hemorrhagic PED.The positive number of serous PED in cSLO imaging was significantly higher than color fundus camera (x2=7.752,P=0.011).The positive number of hemorrhagic PED in cSLO imaging shows no obvious difference compared with color fundus camera (x2=1.164,P=0.419).Conclusion The sensitivity and positive number of detecting serous PED with PCV in cSLO fundus imaging were higher than the color fundus camera technology.

High Dose Intravitreal Bevacizumab for Refractory Pigment Epithelial Detachment in Age-related Macular Degeneration

PURPOSE: Intravitreal anti-vascular endothelial growth factor (anti-VEGF) is the first choice of treatment for age-related macular degeneration. However, quite a few eyes treated using conventional dose anti-VEGF (CDAV) have persistent pigment epithelial detachment (PED) on optical coherence tomography. This study investigated the efficacy and safety of high dose anti-VEGF (HDAV) for refractory PED. METHODS: In this retrospective study, 31 eyes of neovascular age-related macular degeneration patients with persistent PED findings despite six or more intravitreal injections of CDAV (bevacizumab 1.25 mg or ranibizumab 2.5 mg) were analyzed. Changes in visual outcome, central foveal thickness, and PED height were compared before and after HDAV (bevacizumab 5.0 mg) for these refractory PED cases. RESULTS: The mean age of patients was 67.7 years. The number of CDAV injections was 12.1. The number of HDAV injections was 3.39. Best-corrected visual acuity in logarithm of the minimum angle of resolution before and after HDAV was 0.49 and 0.41 (p < 0.001), respectively. Central foveal thickness before and after HDAV was 330.06 and 311.10 µm (p = 0.125), respectively. PED height before and after HDAV was 230.28 and 204.07 µm (p = 0.014), respectively. There were no serious adverse reactions in all the eyes. CONCLUSIONS: Increasing the dose of bevacizumab in refractory PED may be a possible treatment option.

A Case of Subretinal Hematoma Secondary to Polypoidal Choroidal Vasculopathy Misunderstood as a Subretinal Mass

PURPOSE: To report a case of subretinal hematoma secondary to polypoidal choroidal vasculopathy (PCV) misunderstood as a subretinal mass. CASE SUMMARY: A 73-year-old man with no specific medical history visited our clinic with decreased vision in the right eye. Slit-lamp examination revealed no specific findings for the anterior segment of the right eye. Upon fundus examination, an elevated macular lesion with some subretinal hemorrhages was observed, and a subretinal mass lesion was found on ultrasonography. After performing fluorescein angiography, indocyanine green angiography, and magnetic resonance imaging, we presumed that this lesion was a subretinal hematoma or ocular tumor and recommended observation. One month later, the subretinal mass had decreased in size. One year later, PCV with large retinal pigment epithelial detachment (RPED) was observed. After the intravitreal bevacizumab injection, RPED and macular edema were improved. CONCLUSIONS: We confirmed PCV with a subretinal hematoma and large RPED which seemed to be a subretinal mass and was difficult to differentiate from ocular tumors.

Retinal pigment epithelial detachment post radiation therapy in metastatic ocular infiltration of non-Hodgkin's lymphoma: a case report / 国际眼科杂志(Guoji Yanke Zazhi)

A 32-year-old lady, diagnosed with anaplastic large cell non-Hodgkin's lymphoma of the mediastinum, presented with bilateral floaters and reduced right eye vision 3 years post chemotherapy. Ophthalmic examination revealed bilateral panuveitis with multiple deep seated choroidal lesions in the left eye. Computed tomography scanning of the orbit showed enhancing and bulky optic nerve sheath at the retrobulbar part of both optic nerves. The patient was treated with involved field radiation therapy of the orbit, with cumulative dose of 30Gy. Eight months post radiation therapy, she developed retinal pigment epithelial detachment at the macula and deep chorioretinal degeneration at superotemporal and inferonasal regions of the right fundus. There was evidence of vitreoretinal traction at the margin of chorioretinal degeneration areas, thus barricade lasers were performed in the affected eye. Her visual acuity remains 6/6 in both eyes. Retinal pigment epithelial detachment is a possible complication of radiation therapy in non-Hodgkin's lymphoma with intraocular metastasis. It is essential to alert the managing ophthalmologists about this rare complication.

Combination Treatment for Choroidal Neovascularization Associated With Large Retinal Pigment Epithelial Detachment

PURPOSE: To evaluate the efficacy of the combination therapy of intravitreal bevacizumab injection and photodynamic therapy in neovascular age-related macular degeneration associated with large retinal pigment epithelial detachment. METHODS: A total of 13 eyes were reviewed, with 9 eyes diagnosed with definite choroidal neovascularization (CNV) and 4 eyes diagnosed with CNV or polypoidal choroidal vasculopathy (PCV) becausethe exact type could not be determined. Photodynamic therapy was performed within 1 week after bevacizumab injection according to indocyanine green angiography (ICGA). Additional bevacizumab injections were performed within a 4 to 6 week interval. Additional photodynamic therapy was performed within 4 months. RESULTS: The visual acuity on final examination had improved in 3 eyes (23.1%), was maintained in 7 eyes (53.8%), and decreased in 3 eyes (23.1%). The change of the PED before and after treatment showed regression in 5 eyes (38.5%), recurrence after regression in 2 eyes (15.4%), persistence in 4 eyes (30.8%), and retinal pigment epithelial tear in 2 eyes (15.4%). The maintained or improved visual acuity rate was 66.7% (6/9) and 100% (4/4) in the CNV and CNV or PCV group, respectively. CONCLUSIONS: The combination therapy in neovascular age-related macular degenerationassociated with large retinal pigment epithelial detachment is a viable alternative treatment in the stabilization and improvement of vision. However, further studies with long-term follow up and controlled studies with anti-vascular endothelial growth factor antibody monotherapy are required.

A Case of Wegener's Granulomatosis with Retinal Pigment Epithelial Detachment and Subretinal Hemorrhage

PURPOSE: To report a case of very limited Wegener's granulomatosis presenting with inflammation of the anterior segment, orbital pseudotumor, retinal pigment epithelial detachment, and subretinal hemorrhage. METHODS: A 54-year-old man who was treated for pachymeningitis was seen in consultation for painful swelling of the left eye and periorbit, and visual loss of the right eye developed 2 days after admission. He was diagnosed with peripheral keratitis, scleritis, anterior uveitis, and pseudotumor of the left eye, and RPE detachment in the macula of the right eye. He was started on treatment with antibiotics, NSAIDs, and steroids. Twelve days later, he had no response to the treatment and developed otitis media and skin ulcer. A skin biopsy was performed. RESULTS: Histological analysis showed a necrotizing inflammation of the small vessels in the skin lesion. The clinical and radiologic findings and the positive antineutrophil cytoplasmic antibody (ANCA) test were consistent with a diagnosis of Wegener's granulomatosis. Treatment with oral steroids and cyclophosphamide improved the systemic and ocular symptoms dramatically. One year later, he developed choroidal neovascularization and subretinal hemorrhage in the right eye. He was started on oral steroids and cyclophosphamide, with a dramatic improvement in his general health and ocular state.