Treatment results at 1 year of ranibizumab therapy for polypoidal choroidal vasculopathy in eyes with good visual acuity.

PURPOSE: To evaluate the efficacy of intravitreal ranibizumab (IVR) for subfoveal polypoidal choroidal vasculopathy (PCV) in eyes with a best corrected visual acuity (BCVA) of 0.6 (logMAR 0.22) or better. METHODS: Fifty eyes with BCVA between 0.6 (logMAR 0.22) and 1.0 (logMAR 0) and subfoveal PCV were treated with IVR for 3 consecutive months. Additional IVR was given at subsequent monthly visits, if needed, up to 11 months after the initial injection. The patients were followed-up prospectively for 12 months, and changes in mean BCVA, central retinal thickness (CRT), serous retinal detachment (SRD), hemorrhage, and number of polypoidal lesions were evaluated. RESULTS: Mean BCVA improved significantly at the 3-, 6-, 9-, and 12-month follow-up visits and CRT decreased significantly at 1, 2, 3, 6, 9, and 12 months after the initial treatment as compared with the baseline. SRD was observed in 10 and 21 eyes at 3 and 12 months. Hemorrhage was observed in 6 eyes at 3 months and 3 eyes at 12 months. All polypoidal lesions had completely regressed in 19 % and the size of network vessels was either unchanged or enlarged in 98 % of the eyes at 12 months. CONCLUSION: Based on the maintenance of vision improvement for at least 12 months, IVR for PCV proved useful for eyes with BCVAs of 0.6 (logMAR 0.22) to 1.0 (logMAR 0), despite a low regression rate of polypoidal lesions and minimal network size reduction.

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

PURPOSE: To evaluate the visual outcomes and changes in abnormal vascular networks and polypoidal lesions of polypoidal choroidal vasculopathy (PCV) 3 years after photodynamic therapy (PDT). METHODS: We studied 43 eyes of 43 patients with PCV for 3 years. Fundus appearance, fluorescein angiography (FA) and indocyanine green angiography (IA) findings, and visual acuity (VA) before the initial PDT were compared with those 3 months, 1 year, 2 years, and 3 years after treatment. RESULTS: In 24 of the 43 eyes, enlargement of the abnormal vascular network continued in a manner similar to that before PDT on IA; in eight eyes, transformation into polypoidal choroidal neovascularization (CNV) with enlargement was detected; and two eyes had the appearance of classic CNV on FA. Polypoidal lesions recurred at 3 years in 33 of the 43 eyes (77%). Mean VA (logarithm of the minimum angle of resolution) of all 43 eyes decreased to below baseline at 3 years after the initial PDT. This decrease can be explained by foveal atrophy after absorption of recurrent hemorrhagic or exudative detachment. CONCLUSION: Long-term visual outcomes were not good owing to the high frequency of recurrent polypoidal lesions, as well as enlargement and neovascular changes involving abnormal vascular networks.

Factors influencing visual outcome of polypoidal choroidal vasculopathy one year after photodynamic therapy.

BACKGROUND: Polypoidal choroidal vasculopathy (PCV) is considered to be a good indication for photodynamic therapy (PDT). We evaluated pre-PDT factors predicting better visual acuity (VA) 1 year after PDT in patients with PCV. METHODS: We evaluated 181 eyes of 181 patients who underwent PDT and were followed up for 1 year. Additional treatments, if needed, were given every 3 months, with a maximum of four PDT sessions, for up to 9 months. We compared best-corrected VA (BCVA) 1 year after PDT with that before PDT. Pre-PDT factors favoring better BCVA 1 year after PDT were evaluated using stepwise multiple regression analysis. RESULTS: Mean BCVA improved from 0.29 +/- 0.15 before PDT to 0.43 +/- 0.32 1 year after PDT (p < 0.001). BCVA improved in 55 eyes (30.4%), and was maintained in 110 (60.8%). Pre-PDT factors predicting better BCVA at 1 year were better initial BCVA (beta = 0.271, p < 0.001) within our eligibility criteria up to 0.6, a relatively small diameter of a network of vessels plus polypoidal lesions on indocyanine green angiography (beta = 0.249, p < 0.001), and the absence of a polypoidal lesion under the fovea (beta = 0.175, p = 0.011). CONCLUSION: Better BCVA can be expected 1 year after PDT in eyes with PCV showing better initial BCVA, relatively small lesions on indocyanine green angiography, and no subfoveal polypoidal lesion before PDT.

Concentration gradient of vascular endothelial growth factor in the vitreous of eyes with diabetic macular edema.

PURPOSE: Vascular endothelial growth factor (VEGF) concentrations in various regions of the vitreous were examined in patients with diabetic macular edema (DME) to explore the possibility of a concentration gradient in the vitreous. METHODS: Vitreous samples were collected during vitrectomy from 71 eyes of 71 patients with DME and without posterior vitreous detachment who had not undergone panretinal photocoagulation. Vitreous samples were collected from the premacular vitreous and mid-vitreous (group A, 35 eyes), and from the premacular vitreous and peripheral cortical vitreous (group B, 36 eyes). Mean foveal thickness was measured by optical coherence tomography (OCT). Ten eyes of 10 patients with stage 3 macular hole (MH) served as controls. Vitreous VEGF levels were measured by enzyme-linked immunosorbent assay. RESULTS: The VEGF concentration (mean +/- SD; pg/mL) was significantly higher in the premacular vitreous (1386.2 +/- 2134.1) than in the peripheral cortical vitreous (1169.7 +/- 1840.3; P = 0.0216) and mid-vitreous (1080.9 +/- 1534.1; P = 0.0017). The mean foveal thickness measured on OCT correlated significantly with VEGF concentrations in the premacular vitreous, peripheral cortical vitreous, and mid-vitreous (R > 0.62, P < 0.0001, for all). In controls, VEGF concentrations in the premacular vitreous, peripheral cortical vitreous and mid-vitreous were all below the detection limit (<20 pg/mL). CONCLUSIONS: In DME, vitreous VEGF concentration correlates with mean foveal thickness measured on OCT. VEGF concentration was higher in premacular vitreous than in mid-vitreous and peripheral cortical vitreous, suggesting diffusion from the macular region to the periphery, and from the posterior to the anterior globe.

Long-term results of photodynamic therapy of polypoidal choroidal vasculopathy.

PURPOSE: This study evaluated the results of photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV) 24 months or more after treatment. METHODS: The study involved 47 eyes of 47 patients with PCV followed for 24 months or more after the first PDT. Fundus appearance, indocyanine green angiographic findings, and visual acuity (VA) were compared before PDT, and then at 3 months, 12 months, and the final visit after the first PDT. RESULTS: At the final visit, VA was preserved or improved in 37 (79%) of the 47 eyes. Recurrence of polypoidal lesions was noted in 30 eyes (64%). An abnormal branching vascular network persisted in all subjects. In 26 of the 30 eyes exhibited recurrence of polypoidal lesions, which appeared in the periphery of the expanded abnormal branching vascular network. CONCLUSION: Patients with PCV need to be followed for long periods of time after PDT because of the high incidence of polypoidal lesion recurrence. However, since polypoidal lesions often recur outside the fovea, and thus have little effect on VA, PDT can be expected to exert long-term efficacy in treating PCV.

[An adult case of ophthalmoplegic migraine with the pseudo-Graefe sign].

PURPOSE: An adult case of ophthalmoplegic migraine is reported. CASE: A 35-year-old man presented at our hospital with a 2-day history of double vision. He had a history of double vision following migraine which completely resolved within a week, occurring every few years since the age of 13. At the first visit, oculomotor nerve palsy with internal ophthalmoplegia was observed in his left eye. Magnetic resonance imaging and magnetic resonance angiography demonstrated no other abnormalities. After 3 months, the oculomotor nerve palsy was completely resolved, except for the pseudo-Graefe sign. RESULTS: Ophthalmoplegic migraine may be occur in adults. Therefore, a detailed history is important for examination of painful ophthalmoplegia. The Pseudo-Graefe sign observed in our case suggested the existence of recurrent oculomotor nerve palsy, which is an important indicator for ophthalmoplegic migraine.

Role of photodynamic therapy in polypoidal choroidal vasculopathy.

PURPOSE: To determine the efficacy of photodynamic therapy (PDT) with verteporfin for polypoidal choroidal vasculopathy (PCV). METHODS: PDT was performed in 35 patients (35 eyes) with PCV. We evaluated the number of treatments and compared visual acuity (VA), ophthalmological findings, and changes in polypoidal lesions and branching vascular networks by measuring lesion diameters using Heidelberg retina angiography before PDT, and then every 3 months for 1 year after PDT. RESULTS: The mean annual number of treatment sessions was 2.2. VA was improved or maintained in 80% of the patients. Retinal pigment epithelium detachment, retinal detachment, hemorrhage, and/or exudates disappeared in 69%, and leakage resolved in 74% of the patients. Polypoidal lesions disappeared completely on indocyanine green angiography in 83% of the patients. All branching vascular networks persisted. Polypoidal lesions had recurred at the termini of the remaining branching vascular networks at 9 months after the first PDT in two eyes and at 12 months in one eye. CONCLUSIONS: PDT with verteporfin for PCV appears to improve or maintain VA for the first posttreatment year. Approximately 70% of PCV cases showed improved ophthalmoscopic findings. However, as polypoidal lesions recur after PDT in some cases, further study is needed to confirm the long-term efficacy of PDT for PCV.

[Sighting dominance in patients with macular disease].

PURPOSE: To study sighting dominance by comparing macular disease patients undergoing surgical treatment with controls. METHODS: We studied visual acuity and sighting dominance in 92 macular disease patients, 27 of whom were assessed for both outcomes. We also studied visual acuity and sighting dominance in 412 controls. Sighting dominance was evaluated using the hole-in-card test. RESULTS: Among the controls, 70% showed right sighting dominance, and 30%, left sighting dominance. On the other hand, in patients with macular disease, right sighting dominance was demonstrated in 51%, and left in 49%; that is, 24% showed sighting dominance of the affected eye and 76%, of the fellow eye. During follow-up, sighting dominance of three of the 27 macular disease patients shifted from the affected eye to the fellow eye, which showed improvement in visual acuity. CONCLUSION: This study raises the possibility of sighting dominance shifting in patients with macular disease. There were differences among cases in the timing of the shift in sighting dominance, indicating that visual acuity may not be the only factor influencing sighting dominance. Further study is needed to confirm the factors contributing to sighting dominance.

[Pulsation in polypoidal choroidal vasculopathy].

PURPOSE: To evaluate the relationship between pulsation and the fundus lesion in polypoidal choroidal vasculopathy (PCV). OBJECTIVE AND METHODS: We studied 26 eyes with PCV by indocyanine green angiography (IA) with a heidelberg retina angiograph(HRA). The 26 eyes were classified into two groups; pulsatile PCV and non-pulsatile PCV. We evaluated the strength and the amplitude of the pulsation, and the frequency of subretinal hemorrhage within one year after the first IA. Seven eyes in the pulsatile PCV group were tested by HRA twice or more to evaluate the relationship between the fundus lesion and the change in the strength and the amplitude of pulsation. RESULTS: Subretinal hemorrhage occurred in 9 of 14 eyes with pulsatile PCV and in 2 of 12 eyes with non-pulsatile PCV (odds ratio : 12.5). The possibility of subretinal hemorrhage was significantly higher in pulsatile PCV than in non-pulsatile PCV. In 3 of the 7 eyes tested twice or more, the fundus lesion worsened as the pulsation strengthened and the area of pulsation enlarged. In 1 of the 7 eyes, the fundus lesion improved as the pulsation weakened and the area of pulsation decreased. CONCLUSION: There is a good possibility that strengthened and extended pulsation is related to increasing subretinal hemorrhage in PCV patients.