Increased incidence and diverse manifestations of multiple evanescent white dot syndrome during the COVID-19 pandemic.

The advent of coronavirus disease 2019 (COVID-19) pandemic has affected the incidence and course of various diseases and numerous studies have investigated ocular involvement associated with COVID-19 and corresponding vaccines. In this study, we compared the incidence of multiple evanescent white dot syndrome (MEWDS) before and during the COVID-19 pandemic at a single center in Korea and analyzed the demographic and clinical features of patients with MEWDS presenting during the COVID-19 pandemic. We categorized patients with MEWDS into two groups according to date of diagnosis. Pre-COVID19 group included patients diagnosed during the pre-pandemic period (between March 11, 2017, and March 10, 2020), whereas post-COVID19 group included patients diagnosed during the pandemic period (between March 11, 2020, and March 10, 2023). 6 and 12 patients were included in pre-COVID19 group and post-COVID19 group, respectively. Among all hospital visits during the pre-pandemic and pandemic periods, 0.011% and 0.030% were due to MEWDS, indicating a significant increase during the pandemic (p = 0.029, B = 2.756). The annual incidence of patients with MEWDS in 2017-2022 were 0.73, 0.75, 0.78, 1.32, 2.49, and 2.07 per 10,000 population, respectively, corresponding to a significant increase (p = 0.039, B = 1.316). Our results imply that the incidence and manifestation of MEWDS are likely to become more diverse in the COVID-19 pandemic era.

Surgical Outcomes of Vitrectomy for Macular Hole-induced Retinal Detachment According To Various Surgical Methods: A Multicenter Retrospective Study.

PURPOSE: To investigate the surgical outcomes of vitrectomy for macular hole-induced retinal detachment(MHRD), with respect to the surgical adjunctive method used. METHOD: We performed retrospective multicenter study of patients who underwent vitrectomy for MHRD. The visual/anatomical outcomes after vitrectomy were analyzed. We also analyzed these outcomes according to surgical method and the presence of persistent macular hole after the vitrectomy. RESULT: Thirty-four patients (34 eyes) from 6 hospitals were included in this study. The mean age of the patients was 64.56 ± 12.23 years; 31 patients (91.2%) were female. The mean LogMAR best-corrected visual acuity (BCVA) significantly improved 6 months after vitrectomy (p < .001). Retinal detachment completely improved in 32 eyes (94.1%). The visual prognoses and macular hole closure rates were not different depending on subretinal fluid drainage site. The presence or absence of a persistent macular hole after vitrectomy did not affect the visual outcomes. However, the recurrence of MHRD was significantly higher in eyes with persistent macular holes(p = .015). CONCLUSION: The surgeries to treat MHRD differed in terms of the procedure depending on the surgeons, but the visual outcomes did not differ depending on the surgical adjunctive method employed. There were no differences in the visual prognoses, regardless of whether there was a persistent macular hole; however, recurrence was significantly higher in eyes with persistent macular holes. Therefore, further surgical treatment might be considered for eyes with persistent macular holes after MHRD surgery.

CHARACTERISTICS OF TYPE 3 NEOVASCULARIZATION LESIONS: Focus on the Incidence of Multifocal Lesions and the Distribution of Lesion Location.

PURPOSE: To evaluate the incidence of multifocal lesions and the distribution of lesion location in Type 3 neovascularization. METHODS: This retrospective, observational study included 148 eyes of 148 patients diagnosed with Type 3 neovascularization. The number of Type 3 neovascularization lesions was counted, and the incidence of multiple lesions in an eye was estimated. In addition, the distance from the fovea to the lesion and the geographic location of the lesion were estimated. Pseudodrusen incidence was compared between eyes with and without multifocal lesions. RESULTS: In total, 169 Type 3 neovascularization lesions were noted. A single lesion was noted in 130 eyes (87.8%), whereas 2 or 3 multifocal lesions were noted in the remaining 18 eyes (12.2%). The mean distance from the fovea to the lesion was 898.8 ± 324.9 µm. The distribution of lesion locations exhibited a fovea-sparing pattern. No lesions were located within 200 µm of the fovea, 20 lesions (11.8%) were located >200 and ≤500 µm away from the fovea, 89 lesions (52.7%) were located >500 and ≤1,000 µm away from the fovea, and 60 lesions (35.5%) were located >1,000 µm away from the fovea. Pseudodrusen incidence was significantly higher in eyes with multifocal lesions (P = 0.024). CONCLUSION: Two or more multifocal lesions were noted in 12.2% of eyes with Type 3 neovascularization, and pseudodrusen incidence was higher in eyes with multifocal lesions. In addition, lesion distribution exhibited a fovea-sparing pattern. These characteristics may be associated with the distinct pathophysiology of Type 3 neovascularization.

Long-term incidence and timing of reactivation in patients with type 3 neovascularization after initial treatment.

PURPOSE: The purpose of the present study was to evaluate the long-term incidence and timing of reactivation in patients with type 3 neovascularization who were treated with three monthly anti-vascular endothelial growth factor (VEGF) injections. METHODS: A total of 179 patients (179 eyes) diagnosed with type 3 neovascularization with dry macula after three monthly anti-VEGF loading injections were included in this retrospective study. After the initial treatment, patients were followed up without further injection until the first reactivation. The incidence and timing of the first reactivation after the initial treatment were recorded, and factors predictive of early reactivation (≤ 6 months after the third anti-VEGF injection) were investigated. RESULTS: During a mean follow-up of 37.5 ± 18.8 months, the first reactivation was noted in 145 patients (81.0%) at a mean of 6.6 ± 4.1 months after the third injection. In 94 eyes (64.8%), reactivation was noted 2-6 months after the third injection, while in 37 eyes (25.5%) it was noted 7-12 months after the third injection. In the remaining 14 eyes (9.7%), the reactivation was noted after this period. The incidence of early reactivation was higher in women (P = 0.014) and patients with thicker choroid (P = 0.026). CONCLUSIONS: In patients with type 3 neovascularization, almost all reactivation was noted within 15 months of the third anti-VEGF injection, suggesting the need for close follow-up and detailed examination during this period. Female patients with thick choroid should be monitored more frequently during this early period.

Abrupt visual loss during anti-vascular endothelial growth factor treatment for type 3 neovascularization.

AIM: To investigate the incidence of abrupt visual loss and its associated factors, during anti-vascular endothelial growth factor (VEGF) treatment for type 3 neovascularization. METHODS: This retrospective study included 137 eyes that were newly diagnosed with type 3 neovascularization. All eyes were treated with anti-VEGF therapy. Abrupt visual loss was defined as loss of 5 or more lines in best-corrected visual acuity (BCVA) in comparison to the previous visit. The incidence and timing of abrupt visual loss as well as the factors associated with it, were determined. In addition, the BCVA at the final follow-up was compared between the eyes with and those without abrupt visual loss. RESULTS: The mean follow-up period was 42.4±18.9mo after diagnosis, and abrupt visual loss was noted in 22 eyes (16.1%) at a mean of 19.6±13.9mo. Abrupt visual loss was found to be associated with subretinal hemorrhage in 11 eyes (50.0%), development of or increase in the height of pigment epithelial detachment with fluid in 8 eyes (36.4%), and tears in the retinal pigment epithelium in 3 eyes (13.6%). The logarithm of minimum angle of resolution (logMAR) mean BCVA at the final follow-up was 2.07±0.67 (Snellen equivalents: 20/2349) and 1.00±0.55 (20/200) in eyes with and without abrupt visual loss, respectively. BCVA was significantly worse in the eyes with abrupt visual loss (P<0.001). CONCLUSION: Abrupt visual loss is noted in 16.1% of patients with type 3 neovascularization and is associated with poor visual outcome. Additional studies are needed to determine how abrupt visual loss can be prevented.

Age-related differences in the prevalence of subtypes of Neovascular age-related macular degeneration in the first diagnosed eye.

PURPOSE: To evaluate age-related differences in the prevalence of subtypes of neovascular age-related macular degeneration (AMD) in the first diagnosed eye. METHODS: This retrospective, observational study included 1099 eyes of 1099 patients diagnosed with neovascular AMD. The neovascular AMD cases were classified into three subtypes: typical neovascular AMD, polypoidal choroidal vasculopathy (PCV), and type 3 neovascularization. The patients were divided into four groups, according to age: > 50 and < 60 years, ≥ 60 and < 70 years, ≥ 70 and < 80 years, and ≥ 80 years. Difference in the prevalence of three AMD subtypes was evaluated among the four age groups. RESULTS: In the age group > 50 and < 60 years, 34 (25.0%) and 102 patients (75.0%) were diagnosed with typical neovascular AMD and PCV, respectively. In the age group ≥ 60 and < 70 years, 90 (28.1%), 206 (64.4%), and 24 patients (7.5%) were diagnosed with typical neovascular AMD, PCV, and type 3 neovascularization, respectively. In the age group ≥ 70 and < 80 years, the corresponding numbers were 200 (41.9%), 197 (41.3%), and 80 (16.8%), respectively; in the age group ≥80 years, the corresponding values were 83 (50.0%), 39 (23.5%), and 44 (26.5%), respectively. A significant difference was observed in the prevalence of the subtypes of neovascular AMD among the four age groups (chi-square test, P < 0.001). CONCLUSION: Subtype prevalence in newly diagnosed neovascular AMD differs significantly according to age. This result suggests that different pathophysiology may be involved in the development of different subtypes of neovascular AMD.

LONG-TERM VISUAL CHANGES IN INITIALLY STRONGER FELLOW EYES IN PATIENTS WITH UNILATERAL TYPE 3 NEOVASCULARIZATION.

PURPOSE: To evaluate long-term visual changes in initially stronger fellow eyes in patients with unilateral Type 3 neovascularization. METHODS: This retrospective study included 102 patients who were newly diagnosed with unilateral Type 3 neovascularization and in whom the best-corrected visual acuity (BCVA) of the fellow eye was initially better than that of the involved eye. All patients were treated with intravitreal anti-vascular endothelial growth factor injections. The BCVAs were compared at diagnosis, 12 months, 24 months, and the final visit. In patients who experienced ≥3 lines of visual deterioration in the BCVA of the fellow eye, the reason for visual deterioration was also verified. RESULTS: The patients were followed for 45.9 ± 18.5 months after diagnosis. At diagnosis, the fellow-eye BCVA was better than that of the initially involved eye in all 102 patients. However, the fellow-eye visual acuity was the same or worse than that of the initially involved eye in 13 patients (12.7%) at 12 months, in 20 patients (19.6%) at 24 months, and in 24 patients (23.5%) at the final visit. At the final visit, 53 patients (51.9%) had experienced ≥3 lines of deterioration in the BCVA of the fellow eye. Fellow-eye neovascularization occurred in 42 patients, and geographic atrophy involving the fovea was noted in the remaining 11 patients. CONCLUSION: Deterioration of the visual acuity of the fellow eye is frequently noted in unilateral Type 3 neovascularization. As a result of this deterioration, the initially stronger fellow eye did not remain stronger in 23.5% of the patients, suggesting the need for long-term strict treatment of the initially involved eye even when the visual acuity of the fellow eye is good.

Prechoroidal Cleft in Type 3 Neovascularization: Incidence, Timing, and Its Association with Visual Outcome.

PURPOSE: To investigate the incidence and timing of prechoroidal cleft development and its association with visual prognosis in type 3 neovascularization. METHODS: This retrospective study included 166 eyes that were diagnosed with type 3 neovascularization. All eyes were treated with antivascular endothelial growth factor therapy. The incidence and timing of prechoroidal cleft development were evaluated. Best-corrected visual acuity (BCVA) at diagnosis and at final follow-up was compared between eyes with (cleft group) and without (no-cleft group) prechoroidal cleft. The incidence of retinal pigment epithelium (RPE) tear and subretinal hemorrhage was also compared between the two groups. RESULTS: During the mean 39.7 ± 18.5 months of follow-up, prechoroidal cleft developed in 37 eyes (22.3%) at an average of 14.6 ± 10.4 months. The BCVA at final follow-up was significantly worse in the cleft group than in the no-cleft group (P=0.024), whereas the difference was not significant at diagnosis (P=0.969). The incidence of RPE tear (P=0.002) and subretinal hemorrhage (P < 0.001) was significantly higher in the cleft group. CONCLUSIONS: Prechoroidal cleft is a frequently observed finding during the treatment course of type 3 neovascularization. Eyes with prechoroidal cleft are at high risk of RPE tear or subretinal hemorrhage and subsequently associated with poor prognosis.

Development of Submacular Hemorrhage in Neovascular Age-related Macular Degeneration: Influence on Visual Prognosis in a Clinical Setting.

PURPOSE: This study aimed to evaluate changes in visual acuity before and after the development of submacular hemorrhage secondary to neovascular age-related macular degeneration (AMD) and to compare the visual outcomes between patients with and without hemorrhage. METHODS: This retrospective observational study included 124 patients with neovascular AMD. Patients who developed a submacular hemorrhage involving the fovea were included in the hemorrhage group (n = 55). Patients with no sign of submacular hemorrhage during the follow-up period were included in the no-hemorrhage group (n = 69). Visual outcomes were compared between the two groups. RESULTS: The logarithm of the minimal angle of resolution best-corrected visual acuity (BCVA) before the development of submacular hemorrhage, once the hemorrhage had developed, and 6 months after the development of hemorrhage was 0.59 ± 0.45, 1.24 ± 0.57, and 0.99 ± 0.64, respectively. BCVA was significantly worse 6 months after the hemorrhage compared to before the hemorrhage (p < 0.001). The BCVA before the development of hemorrhage (measured at a mean of 12.9 months after diagnosis) was comparable to that of the no-hemorrhage group (mean, 0.58 ± 0.37 at a mean of 12.4 months). However, the BCVA 6 months after identification of hemorrhage (mean, 21.5 months) was significantly worse in the hemorrhage group than in the no-hemorrhage group (mean, 0.73 ± 0.44 at mean 21.2 months) (p = 0.018). CONCLUSIONS: Visual acuity was significantly worse after hemorrhage than before hemorrhage, even after treatment. In addition, patients with submacular hemorrhage had markedly worse visual outcomes than patients without hemorrhage. This result suggests that the development of hemorrhage during the treatment course of neovascular AMD has a devastating effect on visual prognosis.

Early Recurrent Hemorrhage in Submacular Hemorrhage Secondary to Type 3 Neovascularization or Retinal Angiomatous Proliferation: Incidence and Influence on Visual Prognosis.

PURPOSE: To evaluate the incidence of early recurrent hemorrhage in submacular hemorrhage secondary to type 3 neovascularization or retinal angiomatous proliferation (RAP) and its influence on visual prognosis. METHODS: This retrospective study included 32 eyes with submacular hemorrhage secondary to type 3 neovascularization or RAP that underwent anti-vascular endothelial growth factor (VEGF) therapy. The eyes exhibiting an increase in the extent of hemorrhage within 6 months after hemorrhage development were included in the early recurrent hemorrhage group, and the remaining eyes were included in the non-early recurrent hemorrhage group. The best-corrected visual acuities (BCVAs) measured at the time of hemorrhage development and at 12 months were compared between the two groups. RESULTS: During the follow-up period, 8 eyes underwent vitrectomy to clear vitreous hemorrhage, and the remaining 24 eyes underwent anti-VEGF monotherapy. In the early recurrent hemorrhage group (n = 12), the mean logarithm of the minimal angle of resolution BCVA at the time of hemorrhage development and after 12 months was 1.17 ± 0.40 (Snellen equivalents: 20/295) and 2.35 ± 0.59 (20/4477), respectively. In the non-early recurrent hemorrhage group (n = 20), the corresponding values were 1.07 ± 0.43 (20/234) and 1.44 ± 0.71 (20/550), respectively. The BCVA at 12 months was significantly worse in the early recurrent hemorrhage group (P = 0.003) despite comparable BCVA at diagnosis between the two groups (P = 1.000). CONCLUSIONS: Early recurrent hemorrhage was noted in 37.5% of eyes with submacular hemorrhage secondary to type 3 neovascularization or RAP and was closely associated with a poor prognosis.

Hyperpigmented spots after treatment for submacular hemorrhage secondary to polypoidal choroidal vasculopathy.

PURPOSE: To investigate the characteristics and clinical course of hyperpigmented spots after submacular hemorrhage secondary to polypoidal choroidal vasculopathy (PCV). METHODS: This retrospective, observational study included 87 eyes initially treated with three anti-vascular endothelial growth factor (VEGF) injections for submacular hemorrhage secondary to PCV. Patients were divided into two groups according to the presence of multiple small, dark-gray or black, pigmented lesions after initial treatment: the hyperpigmented spots group and no-hyperpigmented spots group. Baseline characteristics and re-activation of the lesion were compared between the two groups. RESULTS: The mean follow-up period was 30.6 ± 12.9 months, and 41 eyes (47.1%) were included in the hyperpigmented spots group. The hyperpigmented spots group exhibited greater extent of hemorrhage (P < 0.001) and greater central foveal thickness (P = 0.045) than did the no-hyperpigmented spots group. In the hyperpigmented spots group, re-activation of the lesion was noted in 17 eyes (41.5%) at a mean duration of 15.4 ± 12.7 months after the third anti-VEGF injection. In the no-hyperpigmented spots group, re-activation was noted in 28 eyes (60.9%) at a mean duration of 6.4 ± 4.0 months after the third injection. Kaplan-Meier analysis with log-rank test revealed a significant difference in the re-activation of the lesion between the two groups (P = 0.006). CONCLUSIONS: Hyperpigmented spots were associated with a large amount of submacular hemorrhage in PCV. The low incidence of re-activation and late re-activation of the lesion in eyes with hyperpigmented spots suggest that a novel follow-up and treatment strategy is required for this condition.

Long-Term Outcomes in Patients with Neovascular Age-Related Macular Degeneration Who Maintain Dry Macula after Three Monthly Ranibizumab Injections.

PURPOSE: To evaluate long-term changes in visual acuity and retinal microstructure in patients with neovascular age-related macular degeneration (AMD) who had maintained dry macula after initial treatment. METHODS: This retrospective observational study included 55 eyes that were diagnosed with neovascular AMD, were treated with three monthly ranibizumab injections, and maintained dry macula during a two-year follow-up. Best-corrected visual acuity (BCVA) at three months and at the final follow-up were compared, and the degree of visual improvement was compared between eyes with and without improvement of the ellipsoid zone. In addition, the incidence of improvement of the ellipsoid zone was compared between eyes with different extents of disruption. RESULTS: The mean follow-up period was 30.3 ± 4.1 months. BCVA at three months and at the final follow-up was 0.51 ± 0.46 and 0.45 ± 0.49 (P<0.001). Among 35 eyes that exhibited >200 µm of disruption of the ellipsoid zone, 15 (42.9%) showed improvement of the ellipsoid zone, and the improvement in BCVA was greater in these eyes than that in the remaining 20 eyes (P=0.021). A higher incidence of improvement of the ellipsoid zone was noted in eyes with 200 to 800 µm of disruption than in eyes with >800 µm of disruption (P<0.001). CONCLUSIONS: Long-term improvement in visual acuity was noted in eyes that had maintained dry macula after three ranibizumab injections. The status of the ellipsoid zone at three months was closely associated with visual improvement.

Quantification of retinal changes after resolution of submacular hemorrhage secondary to polypoidal choroidal vasculopathy.

PURPOSE: To evaluate changes in the thickness of retinal layers after resolution of submacular hemorrhage secondary to polypoidal choroidal vasculopathy (PCV). STUDY DESIGN: Retrospective, observational study. METHODS: This study included 21 patients (21 eyes) who had been diagnosed with submacular hemorrhage secondary to PCV and treated using anti-vascular endothelial growth factor monotherapy. After the hemorrhage had resolved, the thicknesses of the retinal layers were measured on horizontal- and vertical-crosshair optical coherence tomography scan images. The thickness of each layer in the region affected by the hemorrhage was compared with the thickness of the layer in the corresponding region in the fellow eye, as well as between an unaffected region in the eye with the hemorrhage and the corresponding region in the fellow eye. RESULTS: Optical coherence tomography (OCT) was performed 5.5±2.8 months after diagnosis. In the horizontal OCT images, the outer plexiform layer (OPL) and outer nuclear layer (ONL) + photoreceptor layer (PRL) were significantly thinner in the affected region than in the corresponding region (P = 0.019 and P <0.001, respectively). In the vertical OCT image, the ONL+PRL was significantly thinner in the affected region than in the corresponding region (P <0.001). The thickness of the retinal layer in the unaffected region did not differ from that in the corresponding region of the fellow eye. CONCLUSIONS: The significant thinning of the outer retinal layers in the regions affected by submacular hemorrhage suggests that the hemorrhage induces marked damage in the outer retinal layers, explaining the poor visual prognosis of submacular hemorrhage.

DIFFERENCE IN TREATMENT OUTCOMES ACCORDING TO OPTICAL COHERENCE TOMOGRAPHY-BASED STAGES IN TYPE 3 NEOVASCULARIZATION (RETINAL ANGIOMATOUS PROLIFERATION).

PURPOSE: To compare 12-month treatment outcomes of Type 3 neovascularization among its different stages as classified using an optical coherence tomography-based method. METHODS: This retrospective observational study included 40 patients (40 eyes) who were newly diagnosed with Type 3 neovascularization. The patients were initially administered 3 monthly anti-vascular endothelial growth factor injections. Repeat treatment was performed when recurrence of fluid was noted. Disease staging was classified using the optical coherence tomography-based method. The best-corrected visual acuity at diagnosis and at 12 months and degree of change in best-corrected visual acuity were compared among the different stages of the disease. In addition, incidence of progression in the disease stages was estimated. RESULTS: Among the 40 patients, 14 (35.0%) were classified as Stage 2 and 26 (65.0%) were classified as Stage 3. The best-corrected visual acuity values at diagnosis and at 12 months were 0.61 ± 0.31 (20/81 Snellen equivalents) and 0.46 ± 0.30 (20/57) in the Stage 2 group and 0.67 ± 0.42 (20/93) and 0.70 ± 0.49 (20/100) in the Stage 3 group, respectively. There was a significant difference in best-corrected visual acuity change between the two groups (P = 0.036). During the follow-up period, 3 retinal pigment epithelium tears and 2 submacular hemorrhages had developed in the Stage 3 group. Progression of the disease from Stage 2 to Stage 3 was noted in 2 patients (14.3%). CONCLUSION: The visual outcome was worse in Stage 3 than in Stage 2, and adverse events that may lead to abrupt visual deterioration developed only in Stage 3. Further studies are needed to reveal whether anti-vascular endothelial growth factor therapy can suppress the progression of the disease stages.

MORPHOLOGIC FEATURES ASSOCIATED WITH FIBROTIC SCARRING AFTER ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY IN POLYPOIDAL CHOROIDAL VASCULOPATHY.

PURPOSE: To investigate morphologic features associated with fibrotic scarring after anti-vascular endothelial growth factor therapy in polypoidal choroidal vasculopathy (PCV). METHODS: This retrospective study included 293 patients who had been diagnosed with PCV and treated with anti-vascular endothelial growth factor monotherapy during a 12-month follow-up period. Associations of morphologic features, including type of PCV, location of the polypoidal lesion, greatest linear dimension, largest polyp diameter, choroidal vascular hyperpermeability, pigment epithelial detachment, intraretinal fluid, and subretinal hyperreflective material (SHRM) with fibrotic scar at 12 months were analyzed. RESULTS: Fibrotic scars were noted in 15 eyes (5.1%). The incidence of fibrotic scars was higher in Type 1 PCV (8 of 76 eyes) than in Type 2 PCV (7 of 217 eyes, P = 0.028). The incidence was also higher in eyes with SHRM (14 of 124 eyes) than in eyes without SHRM (1 of 169 eyes, P < 0.001). In multivariate analysis, SHRM was associated with fibrotic scar (P = 0.005). Among the SHRM cases, the incidence of the scar was 12.9% in eyes with submacular hemorrhage and 8.5% in eyes without hemorrhage. CONCLUSION: Although fibrotic scar is an infrequent finding in PCV, the possibility of scarring should be considered in eyes with SHRM, particularly in submacular hemorrhage cases.

Treatment of Bilateral Retinal Angiomatous Proliferation with Anti-vascular Endothelial Growth Factor: 12-Month Outcome.

PURPOSE: To evaluate the 12-month outcome of intravitreal anti-vascular endothelial growth factor therapy in eyes with bilateral retinal angiomatous proliferation (RAP). METHODS: This retrospective observational study included 38 eyes of 19 patients with stage 1 or 2 bilateral RAP at diagnosis. The eyes of patients who exhibited different baseline best-corrected visual acuity (BCVA) values in both eyes were assigned to one of two groups-the better (n=13) and worse (n=13) visual acuity groups. The BCVA values in both groups were compared to those at baseline and at 12 months. In addition, the 12-month changes in BCVA were compared between the two groups. The association between the optical coherence tomography findings at diagnosis and the 12-month BCVA was also analyzed. RESULTS: The values of mean baseline and 12-month BCVA in the better visual acuity group (13 eyes) were 0.48 ± 0.19 and 0.58 ± 0.29, respectively, and those in the worse visual acuity group (13 eyes) were 0.83 ± 0.20 and 0.90 ± 0.31. The 12-month changes in BCVA were not significantly different between the two groups (p=0.786). Among the six patients with equivalent baseline BCVA in both eyes, four patients (66.7%) exhibited 1 to 2 lines or ≥3 lines of difference in BCVA between eyes at 12 months. Eyes without pigment epithelial detachment (PED) at diagnosis exhibited significantly better BCVA at 12 months than eyes with PED (p=0.021). CONCLUSIONS: Better baseline visual acuity was associated with better BCVA at 12 months posttreatment in patients with bilateral RAP. However, equivalent baseline visual acuity in both eyes might not guarantee similar treatment outcomes. In addition, the absence of PED is predictive of better visual outcome.

Polypoidal Choroidal Vasculopathy with Feeder Vessels: Characteristics, Fellow Eye Findings, and Long-term Treatment Outcomes.

PURPOSE: To evaluate the long-term outcomes of anti-vascular endothelial growth factor (VEGF) therapy for polypoidal choroidal vasculopathy (PCV) with feeder vessels and to investigate fellow-eye findings. METHODS: This retrospective observational study included 14 eyes with treatment-naïve PCV accompanied by feeder vessels that were treated with anti-VEGF monotherapy. The best-corrected visual acuity (BCVA) at baseline was compared with that at the last follow-up. The fellow-eye indocyanine green angiography findings were also analyzed. RESULTS: The mean follow-up period was 28.1 ± 19.2 months (range, 12 to 60 months). During the follow-up period, 5.9 ± 2.5 anti-VEGF injections were administered. The logarithm of the minimal angle of resolution (logMAR) BCVAs at the time of diagnosis, at 3 months, and at the last follow-up were 0.81 ± 0.49, 0.55 ± 0.44, and 0.71 ± 0.54, respectively. Although the BCVA at the last follow-up was not different from the baseline value (p=0.809), an improvement of ≥0.2 logMAR BCVA was observed in seven eyes (50.0%). In 11 eyes that underwent bilateral indocyanine green angiography at diagnosis, PCV, branching vascular networks, and late geographic hyperfluorescence were noted in two (18.2%), five (45.4%), and three (27.3%) fellow eyes, respectively. During the follow-up period, the development of polypoidal lesions in the fellow eye was observed in three patients. CONCLUSIONS: In this study, long-term improvement in BCVA was noted in 50% of the included patients who received anti-VEGF monotherapy. A relatively high incidence of pathological findings in the fellow eye and bilateral involvement suggest the need for bilateral examinations.

Incidence and Timing of the First Recurrence in Neovascular Age-Related Macular Degeneration: Comparison Between Ranibizumab and Aflibercept.

PURPOSE: To compare the incidence and timing of first recurrence between patients who were treated with ranibizumab and aflibercept in neovascular age-related macular degeneration (AMD). METHODS: This retrospective study included 120 patients who received the diagnosis of treatment-naive typical neovascular AMD or polypoidal choroidal vasculopathy (PCV) and were treated using either ranibizumab (n = 73) or aflibercept (n = 47). Recurrence within 10 months of the third injection was compared between the 2 treatment groups. RESULTS: In all 120 patients, there was no difference in recurrence between the ranibizumab and the aflibecept groups (P = 0.846). One hundred five patients completed 12 months follow-up. In typical neovascular AMD, disease recurred in 69.6% (16/23) of patients in the ranibizumab group, with a mean period of 4.4 ± 1.8 months after the third injection. In the aflibercept group, the equivalent values were 68.8% (11/16) and 4.5 ± 1.4 months. In PCV, disease recurred in 72.5% (29/40) of patients in the ranibizumab group, with a mean period of 3.8 ± 1.7 months after the third injection. In the aflibercept group, the equivalent values were 69.2% (18/26) and 4.3 ± 2.0 months. CONCLUSIONS: Although the incidence of recurrence was slightly higher and the duration between the third injection and the first recurrence was slightly shorter in patients treated using ranibizumab, the differences were not significant. Our results require confirmation in further studies.

Characteristics of Submacular Hemorrhages in Age-Related Macular Degeneration.

PURPOSE: The aims of this research are to report the incidence and characteristics of submacular hemorrhage secondary to neovascular age-related macular degeneration (AMD) and to compare the detailed morphologic features of hemorrhages between typical neovascular AMD and polypoidal choroidal vasculopathy (PCV). METHODS: This retrospective observational study included 791 eyes of 791 patients who had newly diagnosed neovascular AMD at a single institution. The incidence and extent of submacular hemorrhage of one disc area or greater were estimated and compared between typical neovascular AMD and PCV. In addition, submacular hemorrhages were classified into groups according to location (location of fovea at the center of the hemorrhage versus at the periphery of the hemorrhage) and morphology (circular versus irregular margin). The proportion of each subtype of neovascular AMD was evaluated according to the aforementioned classification. RESULTS: Among those included, 129 (16.3%) eyes exhibited submacular hemorrhage at initial presentation. Among the 627 eyes with available indocyanine green angiography findings, the incidence of submacular hemorrhage was greater in PCV (23.6%, 78 of 330 eyes) than in typical neovascular AMD (9.4%, 28 of 297 eyes; χ test, P < .001). When divided into four groups according to hemorrhage shape and location (central and circular, central and irregular, peripheral and circular, and peripheral irregular), the proportion of eyes in these groups was significantly different between the two disease groups (χ test, P = .018). CONCLUSIONS: The incidence of submacular hemorrhage was greater in PCV than in typical neovascular AMD. The morphology and location of submacular hemorrhage may provide useful clues to differentiate PCV from typical neovascular AMD.

NATURAL COURSE OF PATIENTS DISCONTINUING TREATMENT FOR AGE-RELATED MACULAR DEGENERATION AND FACTORS ASSOCIATED WITH VISUAL PROGNOSIS.

PURPOSE: To evaluate the 24-month natural course of visual changes in patients discontinuing treatment despite persistent or recurrent fluid and factors predictive of visual prognosis. METHODS: This retrospective, observational study included 35 patients (35 eyes) who initially received anti-vascular endothelial growth factor treatment for neovascular age-related macular degeneration (AMD), but discontinued treatment despite persistent or recurrent fluid. The best-corrected visual acuity (BCVA) at treatment discontinuation was determined and compared with the 24-month BCVA, which was then compared between polypoidal choroidal vasculopathy and other neovascular age-related macular degeneration subtypes. Baseline characteristics predictive of visual outcome and the degree of visual change were also analyzed. RESULTS: The mean number of anti-vascular endothelial growth factor injections before treatment discontinuation was 4.0 ± 1.6. The mean logarithm of minimal angle of resolution of BCVA at treatment discontinuation and that at 24 months were 1.02 ± 0.20 (Snellen equivalents = 20/209) and 1.60 ± 0.56 (20/796), respectively (P < 0.001). The 24-month BCVA was not different between polypoidal choroidal vasculopathy and other neovascular age-related macular degeneration subtypes (P = 0.803). The type of fluid (intraretinal fluid vs. no intraretinal fluid) was predictive of 24-month BCVA (P = 0.004) and the degree of changes in BCVA (P = 0.043). CONCLUSION: Marked deterioration in visual acuity was noted in patients discontinuing treatment, regardless of neovascular age-related macular degeneration subtypes. The presence of intraretinal fluid was associated with worse visual prognosis, suggesting that patients with intraretinal fluid should be strongly warned about their poor prognosis before they decide to discontinue treatment.