An Optical Coherence Tomography-Based Measure as an Independent Estimate of Retinal Function in Retinitis Pigmentosa.

BACKGROUND: With the clinical advances in the field of gene therapy, the development of objective measures of visual function of patients with inherited retinal dystrophies (IRDs) is of utmost importance. Here, we propose one such measure. METHODS: We retrospectively analyzed data from a cohort of 194 eyes of 97 genetically diagnosed patients with retinitis pigmentosa (RP), the most common IRD, followed at the UPMC Vision Institute. The analyzed data included the reflectivity ratio (RR) of the retinal nerve fiber layer (RNFL) to that of the entire retina, visual acuity (VA) and the thickness of the retinal outer nuclear layer (ONL) and the RNFL. RESULTS: There was a strong positive correlation between the RR and VA. Both VA and the RR were negatively correlated with disease duration; VA, but not the RR, was negatively correlated with age. The RR correlated with the ONL but not with the RNFL thickness or the intraocular pressure. Age, RR, disease duration and ONL thickness were found to be independent predictors of VA by multivariate analysis. CONCLUSION: The OCT RR could serve as an independent predictor of visual acuity, and by extension of retinal function, in genetically diagnosed RP patients. Such objective measures can be of great value in patient selection for therapeutic trials.

Challenges in posterior uveitis-tips and tricks for the retina specialist.

PURPOSE: Posterior uveitis is a common chorioretinal pathology affecting all ages worldwide and is a frequent reason for referral to the retina clinic. The spectrum of etiologies for uveitis is very broad and includes infectious and auto-immune diseases. Inflammation can be confined to the eye or may be a part of systemic disease. A useful outline is therefore proposed to aid in the correct diagnosis of these challenging entities. The situation is further complicated by the fact that many neoplastic conditions resemble features of posterior uveitis; they are known as "masqueraders of uveitis". Here, we summarize different posterior uveitides that present with rare findings, along with masqueraders that can be difficult to distinguish. These conditions pose a diagnostic dilemma resulting in delay in treatment because of diagnostic uncertainty. METHODS: An extensive literature search was performed on the MEDLINE/PUBMED, EBSCO and Cochrane CENTRAL databases from January 1985 to January 2022 for original studies and reviews of predetermined diagnoses that include posterior uveitic entities, panuveitis and masquerade syndromes. RESULTS: We described conditions that can present as mimickers of posterior uveitis (i.e., immune check-points inhibitors and Vogt-Koyanagi-Harada-like uveitis; leukemia and lymphoma associated posterior uveitis), inflammatory conditions that present as mimickers of retinal diseases (i.e., Purtscher-like retinopathy as a presentation of systemic lupus erythematosus; central serous chorioretinopathy masquerading inflammatory exudative retinal detachment), and uveitic conditions with rare and diagnostically challenging etiologies (i.e., paradoxical inflammatory effects of anti-TNF-α; post vaccination uveitis; ocular inflammation after intravitreal injection of antiangiogenic drugs). CONCLUSION: This review of unique posterior uveitis cases highlights the overlapping features of posterior uveitis (paradoxical inflammatory effects of anti -TNF α and uveitis; Purtscher-like retinopathy as a presentation of systemic lupus erythematosus, …) and the nature of retinal conditions (ischemic ocular syndrome, or central retinal vein occlusion, amyloidosis, inherited conditions like retinitis pigmentosa, autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV), etc.…) that may mimic them is represented. Careful review of past uveitis history, current medications and recent vaccinations, detailed examination of signs of past or present inflammation, eventually genetic testing and/ or multimodal retinal imaging (like fluorescein angiography, EDI-OCT, OCT-angiography for lupus Purtscher-like retinopathy evaluation, or ICG for central serous retinopathy, or retinal amyloid angiopathy) may aid in correct diagnosis.

Lidocaine Gel Interferes With the Antibacterial Activity of Povidone-Iodine.

BACKGROUND AND OBJECTIVE: Retina specialists use lidocaine gel as a topical anesthetic. We determined the antibacterial interaction between povidone-iodine (PI) and lidocaine gel using corneoscleral tissue as a solid phase medium. MATERIALS AND METHODS: Five pieces of corneoscleral tissue in five trials were inoculated with 1.000 colony-forming units of bacteria isolated from endophthalmitis. Inoculated corneal tissue were overlaid with nothing (control), lidocaine gel, 5% PI, lidocaine gel over 5% PI, and 5% PI over lidocaine gel for 5 minutes prior to placement in growth liquid medium at 37°C. Growth was monitored for 48 hours. RESULTS: Application of lidocaine gel prior to 5% PI application provided for the growth of the five bacterial isolates, whereas 5% PI prior to lidocaine gel prevented growth. CONCLUSION: Using corneoscleral tissue, PI and lidocaine gel appear to have an antagonistic interaction when lidocaine gel is applied initially prior to 5% PI, preventing bactericidal activity of PI. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:S13-S16.].

RELATIVE QUIESCENCE OF EXUDATIVE AGE-RELATED MACULAR DEGENERATION AFTER RESOLUTION OF POSTINJECTION ENDOPHTHALMITIS.

PURPOSE: To evaluate alterations in treatment burden and course of exudative age-related macular degeneration in patients who contracted endophthalmitis from intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. METHODS: Retrospective study at the University of Pittsburgh Medical Center examining frequency of anti-VEGF injections, activity of choroidal neovascularization, and visual acuity before and after endophthalmitis treatment. RESULTS: Twenty-one patients meeting inclusion criteria were identified, of whom 7 (33%) patients did not restart anti-VEGF treatment 12 months after endophthalmitis because of quiescence of exudative age-related macular degeneration without significant visual acuity loss (P > 0.05). Patients who resumed anti-VEGF treatment exhibited 32% and 38% decreases in injection frequency by 12 and 24 months after endophthalmitis, respectively (P < 0.05). On first optical coherence tomography follow-up, 10 patients exhibited quiescence of choroidal neovascularization activity, although there were no measurable changes in macular thickness (P > 0.05). No differences in post-endophthalmitis exudative age-related macular degeneration progression or treatment burden were observed when factoring adjuvant intravitreal steroid therapy, culture results, nor choroidal neovascularization subtypes. CONCLUSION: Endophthalmitis resolution is associated with a decrease in choroidal neovascularization activity and a reduction of anti-VEGF treatment burden in patients with exudative age-related macular degeneration.

Morphological and Angiographic Peripheral Retinal Changes in Patients with Age-Related Macular Degeneration.

OBJECTIVE: To show morphologic and angiographic changes in the peripheral retina in patients with age-related macular degeneration (AMD) using wide-field fundus imaging, and to compare these findings with those from healthy controls. DESIGN: Cross-sectional clinical study. PARTICIPANTS: In total, 152 patients with clinical AMD and 150 healthy controls (without AMD in either macula) were studied. Subjects were ≥50 years of age. Exclusion criteria were diabetic retinopathy, previous retinal surgery, high myopia, or dense cataract, as well as any retinal inflammatory, degenerative, or occlusive disease. METHODS: For both groups of patients, color fundus images were captured with the Optos P200 MA camera (Optos, Dunfermline, Scotland). Image analysis software was used to characterize each image. Angiography was performed on the AMD group only. Morphological and angiographic peripheral retinal changes were studied per the frequency of their occurrence, the affected peripheral retina (clock hours), and the localization of peripheral changes with regard to the eye equator. Statistical significance was defined at a level of P < 0.05. MAIN OUTCOME MEASURES: Peripheral changes in both groups according to their type and frequency (percentage of eyes with detected retinal changes), the number of clock hours of affected peripheral retina, and their localization with regard to the equator of the eye. RESULTS: Drusen, reticular pigmentary changes, and paving stone degeneration occurred more frequently in the AMD group than in controls (P < 0.001, P < 0.001, and P < 0.001 respectively), whereas white without pressure occurred more frequently in the control group (P = 0.027). In both groups, peripheral retinal changes were observed peripheral to the equator in more than 40% of analyzed eyes. In control Croatian subjects, peripheral drusen were seen in 38% of subjects compared with 68% of AMD subjects. CONCLUSION: Drusen, reticular pigmentary change , and paving stone degeneration occur significantly more frequently in subjects with AMD compared with controls. White without pressure degeneration was present in a high percentage of control subjects.

Peripheral Retinal Changes Associated with Age-Related Macular Degeneration in the Age-Related Eye Disease Study 2: Age-Related Eye Disease Study 2 Report Number 12 by the Age-Related Eye Disease Study 2 Optos PEripheral RetinA (OPERA) Study Research Group.

PURPOSE: To compare rates of peripheral retinal changes in Age-Related Eye Disease Study 2 (AREDS2) participants with at least intermediate age-related macular degeneration (AMD) with control subjects without intermediate age-related changes (large drusen). DESIGN: Cross-sectional evaluation of clinic-based patients enrolled in AREDS2 and a prospective study. PARTICIPANTS: Participants from prospective studies. METHODS: The 200° pseudocolor and fundus autofluorescence (FAF) images were captured on the Optos 200 Tx Ultrawide-field device (Optos, Dunfermline, Scotland) by centering on the fovea and then steering superiorly and inferiorly. The montaged images were graded at a reading center with the images divided into 3 zones (zone 1 [posterior pole], zone 2 [midperiphery], and zone 3 [far periphery]) to document the presence of peripheral lesions. MAIN OUTCOME MEASURES: Peripheral retinal lesions: drusen, hypopigmentary/hyperpigmentary changes, reticular pseudodrusen, senile reticular pigmentary changes, cobblestone degeneration, and FAF abnormalities. RESULTS: A total of 484 (951 eyes) AREDS2 participants with AMD (cases) and 89 (163 eyes) controls without AMD had gradable color and FAF images. In zones 2 and 3, neovascularization and geographic atrophy (GA) were present, ranging from 0.4% to 6% in eyes of cases, respectively, and GA was present in 1% of eyes of controls. Drusen were detected in 97%, 78%, and 64% of eyes of cases and 48%, 21%, and 9% of eyes of controls in zones 2 and 3 superior and 3 inferior, respectively (P < 0.001 for all). Peripheral reticular pseudodrusen were seen in 15%. Senile reticular pigmentary change was the predominant peripheral change seen in 48% of cases and 16% of controls in zone 2 (P < 0.001). Nonreticular pigment changes were less frequent in the periphery than in the posterior pole (46% vs. 76%) and negligible in controls. CONCLUSIONS: Peripheral retinal changes are more prevalent in eyes with AMD than in control eyes. Drusen are seen in a majority of eyes with AMD in both the mid and far periphery, whereas pigment changes and features of advanced AMD are less frequent. Age-related macular degeneration may be more than a "macular" condition but one that involves the entire retina. Future longitudinal studies of peripheral changes in AMD and their impact on visual function may contribute to understanding AMD pathogenesis.

Retinal nerve fibre layer thickness measurements after successful retinal detachment repair with silicone oil endotamponade.

AIMS: To measure peripapillary retinal nerve fibre layer thickness (RNFL) by using spectral domain optical coherence tomography (OCT) in patients who underwent successful retinal detachment repair with silicone oil tamponade. METHODS: Sixty patients treated with pars plana vitrectomy and silicone oil tamponade for retinal detachment were prospectively enrolled in a study. Peripapillary RNFL thickness was measured with a Cirrus HD-OCT at 7, 30, 90 and 180 days postoperatively, using an Optic Disc Cube 200×200 protocol. The fellow eye of each study patient served as a control. Median peripapillary RNFL thickness in silicone oil filled eyes was compared with control eyes. RESULTS: The median RNFL thickness in the group of vitrectomised eyes was significantly higher compared with control eyes at every visit. The analysis of variance showed that the median thickness in vitrectomised eyes differed between visits (F=4,3023; p=0.006). There was no time-related trend for RNFL thickness in this group. The analysis of variance of RNFL thickness in the fellow, unoperated eyes showed no difference between visits (F=2,3426; p=0.075). CONCLUSIONS: In patients with silicone oil tamponade, peripapillary RNFL was significantly thicker in comparison with fellow unoperated eyes over a 6-month period. TRIAL REGISTRATION NUMBER: NCT 01255306.

Characterization of pneumatic retinopexy failures and the pneumatic pump: a new complication of pneumatic retinopexy.

BACKGROUND: We review a three-year series of cases with pneumatic retinopexy (PR), specifically evaluating failures and suggesting a new mechanism of failure. METHODS: One hundred and thirty-five consecutive patients who underwent PR for rhegmatogenous retinal detachments were included. The primary outcome measure was the characteristics of PR failures. Secondary outcome measures included preoperative clinical characteristics. RESULTS: Seventy-five percent of the patients had successful results with PR; 100% were ultimately reattached with additional surgery. All but 1 failure (97%) occurred within the first postoperative month and 85% occurred by postoperative Day 10. The most common cause of failure was a new detachment from a new break (23 of 35 failures). Risk factors for failure included presenting visual acuity worse than 20/60 (odds ratio [OR] = 1.89), male gender (OR = 1.52), age >60 years (OR = 1.32), >2 breaks (OR = 1.28), pseudophakia/aphakia (OR = 1.20), and detachments after trabeculectomy (OR = 2.43). Lattice degeneration, high myopia (>-6.00 diopters), left eye, detachment after cataract surgery or yttrium aluminum garnet capsulotomy had minimal influence on outcome (all OR < 1.10). CONCLUSION: Characterization of PR failures will improve patient selection. We have named a new complication secondary to a patient performing the steamroller maneuver five times the "pneumatic pump."

Biocompatible reverse thermal gel sustains the release of intravitreal bevacizumab in vivo.

PURPOSE: We assessed the in vivo release profile of bevacizumab from and biocompatibility of poly(ethylene glycol)-poly-(serinol hexamethylene urethane), or ESHU, a thermoresponsive hydrogel administered intravitreally for drug delivery. METHODS: The technical feasibility of injection was assessed quantitatively via mechanical testing. For in vivo studies, New Zealand White rabbit eyes were injected intravitreally with 0.05 mL of either: ESHU dissolved in 25 mg/mL bevacizumab, ESHU dissolved in PBS, or 25 mg/mL bevacizumab. Clinical examination included IOP measurements and examination with indirect ophthalmoscopy for signs of inflammation. Additionally, eyes were examined histologically following euthanasia. To quantify bevacizumab release, aqueous humor samples were obtained via anterior chamber paracentesis and ELISA was used to determine the concentration of drug weekly. In vitro cytotoxicity testing also was performed using bovine corneal endothelial cells. RESULTS: The ESHU was injected easily through a 31-gauge needle, was well tolerated in vivo, and caused minimal cell death in vitro when compared to other common materials, such as silicone oil. The long-term presence of the gel did not affect IOP, and there was no evidence of inflammation histologically or through indirect observation. The ESHU sustained the release of bevacizumab for over 9 weeks and maintained a drug concentration that averaged 4.7 times higher than eyes receiving bolus bevacizumab injections. CONCLUSIONS: To our knowledge, this is the first report demonstrating sustained bevacizumab release in vivo from an intravitreally injected hydrogel formulation, suggesting that this delivery system may be a promising candidate for ocular drug delivery.

Lutein/zeaxanthin for the treatment of age-related cataract: AREDS2 randomized trial report no. 4.

IMPORTANCE: Age-related cataract is a leading cause of visual impairment in the United States. The prevalence of age-related cataract is increasing, with an estimated 30.1 million Americans likely to be affected by 2020. OBJECTIVE: To determine whether daily oral supplementation with lutein/zeaxanthin affects the risk for cataract surgery. DESIGN, SETTING, AND PATIENTS: The Age-Related Eye Disease Study 2 (AREDS2), a multicenter, double-masked clinical trial, enrolled 4203 participants, aged 50 to 85 years, at risk for progression to advanced age-related macular degeneration. INTERVENTIONS: Participants were randomly assigned to daily placebo; lutein/zeaxanthin, 10mg/2mg; omega-3 long-chain polyunsaturated fatty acids, 1 g; or a combination to evaluate the effects on the primary outcome of progression to advanced age-related macular degeneration. MAIN OUTCOMES AND MEASURES: Cataract surgery was documented at annual study examination with the presence of pseudophakia or aphakia, or reported during telephone calls at 6-month intervals between study visits. Annual best-corrected visual acuity testing was performed. A secondary outcome of AREDS2 was to evaluate the effects of lutein/zeaxanthin on the subsequent need for cataract surgery. RESULTS: A total of 3159 AREDS2 participants were phakic in at least 1 eye and 1389 of 6027 study eyes underwent cataract surgery during the study, with median follow-up of 4.7 years. The 5-year probability of progression to cataract surgery in the no lutein/zeaxanthin group was 24%. For lutein/zeaxanthin vs no lutein/zeaxanthin, the hazard ratios for progression to cataract surgery was 0.96 (95% CI, 0.84-1.10; P = .54). For participants in the lowest quintile of dietary intake of lutein/zeaxanthin, the hazard ratio comparing lutein/zeaxanthin vs no lutein/zeaxanthin for progression to cataract surgery was 0.68 (95% CI, 0.48-0.96; P = .03). The hazard ratio for 3 or more lines of vision loss was 1.03 (95% CI, 0.93-1.13; P = .61 for lutein/zeaxanthin vs no lutein/zeaxanthin). CONCLUSIONS AND RELEVANCE: Daily supplementation with lutein/zeaxanthin had no statistically significant overall effect on rates of cataract surgery or vision loss. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00345176.

Cystoid macular edema in retinitis pigmentosa patients without associated macular thickening.

PURPOSE: To describe the occurrence of cystoid macular edema (CME) in the setting of central foveal thickness (CFT) under 250 µm as measured by optical coherence tomography (OCT) in patients with retinitis pigmentosa (RP). METHODS: Stratus OCT was used to measure CFT in a total of 90 eyes from 46 patients with RP. Cross-sectional OCT images were also evaluated for CME, which was defined as cystoid changes in the macula seen on at least two linear scans. RESULTS: CME was identified in 13 of the 46 patients or in 22 of 90 eyes by OCT. In eyes with macular edema, CFT ranged from 224 to 718 µm (mean = 339 ± 137 µm). In eyes without macular edema, CFT ranged from 99 to 273 µm (mean = 184 ± 40 µm). Bilateral CME occurred in 9 of 13 patients (69%). CFT was considered "normal" in 7 of the 22 eyes (32%) with CME. Two patients had bilateral CME with normal CFTs, under 250 µm. CONCLUSION: We demonstrate the occurrence of CME in RP patients without associated thickening, which has not been described. This concept likely is applicable to other diseases with retinal thinning.

An anti-angiogenic reverse thermal gel as a drug-delivery system for age-related wet macular degeneration.

Reverse thermal gels have numerous biomedical implications, as they undergo physical gelation upon temperature increases and can incorporate biomolecules to promote tissue repair. Such a material is developed for the sustained release of bevacizumab (Avastin), a drug used to treat age-related macular degeneration. The polymer, poly(ethylene glycol)-poly(serinol hexamethylene urethane) (ESHU), forms a physical gel when heated to 37 °C and shows good cytocompatibility with ocular cells. ESHU is capable of sustaining bevacizumab release over 17 weeks in vitro, and the release kinetics can be altered by changing the drug dose and the ESHU concentration. These results suggest that ESHU is biologically safe, and suitable for ocular drug delivery.

Risk factors for conversion to neovascular age-related macular degeneration based on longitudinal morphologic and visual acuity data.

PURPOSE: To use longitudinal quantitative morphologic and visual acuity (VA) data to investigate the risk of choroidal neovascularization (CNV) event occurrence in eyes with dry age-related macular degeneration (AMD). DESIGN: Prospective observational study. PARTICIPANTS: A total of 513 participants (844 eyes) followed longitudinally in one center enrolled in the Age-Related Eye Disease Study (AREDS) or the Prophylactic Treatment of AMD Study (PTAMD). METHODS: We assessed images of previously obtained fundus photographs for the presence of macular pigmentation, drusen area, and drusen distribution (number and size), and fellow eye CNV status at baseline. Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity at each visit and the age of each subject were obtained. We used a longitudinal logistic mixed-effects model with random intercepts fitted to event occurrences to assess risk on a per eye basis. MAIN OUTCOME MEASURES: Odds ratios for CNV event. RESULTS: Thirty-one subjects (6.0%) had events. Only VA changes over time and follow-up interval showed statistically significant effects. Several statistical models that included VA at the previous visit were used. In 2 models, 3 categories of VA were used: ≤ 75 letters, >75 and ≤ 85 letters, and >85 letters. Two categories were used for follow-up: ≤ 3 years versus >3 years or ≤ 1 year versus >1 year. In the first model with categorization at 3 years, a decrease in acuity from the >85 letter category to ≤ 75 letters increased the odds of CNV by 16.9 times (P = 0.022). In the model with categorization at 1 year, a decrease in acuity from the >85-letter category to ≤ 75 letters increased the odds of CNV by 21.4 times (P = 0.0175). Differences between the follow-up intervals were significant (P = 0.043) and indicated a more than 7-fold increase in the odds. Changes in morphologic features of the macula did not show significant effects. CONCLUSIONS: A decrease in VA to ≤ 75 ETDRS letters in an eye with an initial ETDRS baseline acuity of >85 letters increases the likelihood of CNV by approximately 20-fold. This likelihood also increases with aging.

Is drusen area really so important? An assessment of risk of conversion to neovascular AMD based on computerized measurements of drusen.

PURPOSE: To assess the relative risk of an eye's conversion to wet age-related macular degeneration (AMD) based primarily on drusen measurements obtained from analysis of digitized images. METHODS: Four hundred forty-four subjects (820 eyes) enrolled in the Age-Related Eye Disease Study (AREDS I) and 78 subjects (129 eyes) from the Prophylactic Treatment of AMD trial (PTAMD) were studied retrospectively. Drusen size, distribution, drusen area, and hyperpigmentation in two central macular regions on baseline fundus images were determined using an image analysis algorithm. The relative risk for choroidal neovascularization (CNV) based on drusen area, presence of one or five large drusen, hyperpigmentation, and fellow eye status was calculated. RESULTS: Odds ratios (ORs) for measured drusen area within the 1000- and 3000-µm regions were 1.644* (1.251-2.162) and 1.278 (0.927-1.762) for AREDS eyes and 0.832 (0.345-2.005) and 1.094 (0.524-2.283) for PTAMD eyes (*P < 0.05). In the 1000-µm region, respective ORs for the presence of a large druse, hyperpigmentation, and fellow eye affected were 2.60, 1.71, and 6.44* for AREDS eyes and 8.24, 1.37, and 17.56* for PTAMD eyes; for the 3000-µm region, ORs were 3.45*, 3.40*, and 4.59* for AREDS and nonsignificant, 6.58, and 11.62* for PTAMD eyes, respectively. CONCLUSIONS: Total drusen area, presence of large drusen, and the presence of hyperpigmentation were not consistent risk factors for an eye's development of CNV. Risk depended on study cohort as well as location. Having an affected fellow eye was the strongest and most consistent risk factor across all models. A larger drusen area does not necessarily increase an eye's risk of conversion to CNV.

Analysis of the relationship between drusen size and drusen area in eyes with age-related macular degeneration.

BACKGROUND AND OBJECTIVE: To examine the relationship between drusen counts and drusen area in eyes with age-related macular degeneration, and to correlate drusen areas between fellow eyes. PATIENTS AND METHODS: Digital images from 378 patients (756 eyes) were analyzed using a validated drusen detection algorithm. Total drusen area and the number of drusen of various sizes (small: < 62 microns, intermediate: 63-124 microns, large: 125-249 microns, etc) were recorded for the central 1,000- and 3,000-micron diameter macular regions. Correlations were assessed using structural equation models. RESULTS: For the 1,000-micron region, the number of intermediate drusen was more highly correlated to total drusen area than the number of large drusen (R = 0.91 vs 0.82); this difference was statistically significant. The correlation coefficients for drusen area between fellow eyes was 0.73. CONCLUSION: The number of large drusen does not correlate better with total drusen area than drusen of other sizes. The number of large drusen is not necessarily a good surrogate for total drusen area.

Indirect laser treatment and anti-VEGF therapy of a retinal angioma, with resolution of a large serous retinal detachment, macular exudates, and macular edema.

PURPOSE: To report on a novel treatment strategy in an eye with a retinal angioma and macular edema METHODS: Wide-angle angiography was used to characterize the lesion and response to theraphy, while the treatment combined laser photocoagulation with the indirect laser delivery system, and intravitreal injections of pegaptanib and bevacizumab. Treatment was rendered over 21 months' time. RESULTS: The treatment resulted in graduate resolution of marked macular edema and exudation, with a gain in visual acuity. CONCLUSION: A combination of laser photocoagulation and anti-VEGF theraphy can be effective in the treatment of macular exudation and edema from a retinal angioma.