Comparison of pro re nata versus Bimonthly Injection of Intravitreal Aflibercept for Typical Neovascular Age-Related Macular Degeneration.

PURPOSE: The aim of this study was to clarify the 1-year outcomes of pro re nata (PRN) and bimonthly intravitreal injections of aflibercept (IVA) for typical neovascular age-related macular degeneration (tAMD) after the initial 3 monthly IVA. METHODS: We conducted a prospective, interventional study. Fifty-eight treatment-naïve patients with tAMD were randomly assigned to the PRN (30 patients) or the bimonthly (28 patients) treatment group. Both groups initially received 3 monthly IVA. Visual acuity, central macular retinal thickness (CRT), and central choroidal thickness (CCT) were evaluated at 12 months. Subanalysis was performed to identify factors associated with the best-corrected visual acuity (BCVA). RESULTS: BCVA was significantly improved only in the bimonthly group at 12 months. CRT and CCT were significantly decreased in both groups. Subanalysis showed that the only factor associated with BCVA improvement at 12 months was the existence of pigment epithelial detachment at baseline. CONCLUSIONS: BCVA showed significant improvement only in the bimonthly group but not in the PRN group at 12 months.

Characteristics of Hyperautofluorescent Choroidal Vessels within the Macular Atrophic Area Using Spectral-Domain Optical Coherence Tomography.

PURPOSE: The aim of this study was to clarify the characteristic findings in patients with geographic atrophy with or without hyperautofluorescent choroidal vessels within macular atrophic areas on short-wavelength fundus autofluorescence imaging. PROCEDURES: Sixty-seven eyes of 43 consecutive patients with macular atrophic areas were divided into groups with (group 1) and without (group 2) hyperautofluorescent choroidal vessels on fundus autofluorescence imaging and then retrospectively studied using spectral-domain optical coherence tomography. RESULTS: In group 1 (n = 21), the average subfoveal choroidal thickness was 61.5 ± 20.1 µm, and the average foveal retinal thickness was 93.0 ± 51.3 µm. On the other hand, in group 2 (n = 46), the average subfoveal choroidal thickness was 200.7 ± 83.1 µm, and the average foveal retinal thickness was 109.2 ± 58.5 µm. Although retinal thickness did not differ significantly between the two groups (p = 0.28), the difference in choroidal thickness was statistically significant (p < 0.001). CONCLUSIONS: Choroidal thinning might contribute to the hyperautofluorescence of choroidal vessels.

Indocyanine green angiographic and optical coherence tomographic findings support classification of polypoidal choroidal vasculopathy into two types.

PURPOSE: We assessed the characteristic indocyanine green angiographic (ICGA) and spectral domain optical coherence tomographic (SD-OCT) findings of two types of polypoidal choroidal vasculopathy (PCV), distinguishable by different filling patterns on ICGA. METHODS: Thirty-one eyes with PCV were classified into types 1 and 2 based on ICGA findings of either the presence or absence of both a feeder and a draining vessel. Characteristic ICGA findings were evaluated for each type of PCV. Spectral domain optical coherence tomographic images of the 31 eyes were also used to compare the two types of PCV. RESULTS: Both a feeder and a draining vessel were observed in 13 eyes (type 1). Eighteen eyes had neither feeder nor draining vessels (type 2). In PCV type 1, a break in the highly reflective line thought to be Bruch's membrane was detected, corresponding to the feeder vessel in-growth site on SD-OCT. This line was straight. In PCV type 2, the highly reflective line exhibited irregular thickness and had highly reflective substances adhering to its lower portion. It curved downward and became increasingly obscure, ultimately disappearing at a point corresponding to the site at which network vessel filling began. The mean subfoveal choroidal thicknesses in eyes with PCV type 1 and PCV type 2 were 199 ± 65 and 288 ± 98 µm, respectively. CONCLUSIONS: Our observations support the existence of two distinct types of PCV. The first type represents choroidal neovascularization, whilst the second type involves choroidal vasculature abnormalities.

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.

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.

[Surgical removal of choroidal neovascularization in angioid streaks].

PURPOSE: All the studies so far on surgical removal of choroidal neovascularization (CNV) in angioid streaks(AS) were conducted on a small number of cases. Therefore, a definitive evaluation of the surgical method was not available. The present study aimed to evaluate this surgical modality. SUBJECTS AND METHOD: We performed surgical removal of foveal CNV accompanied by AS. Eighteen eyes of seventeen patients were available for follow-up of over 12 months. Surgical indications included foveal CNV, fluorescence leakage from the CNV in late-phase fluorescein angiography, and visual acuity of 0.3 or lower. RESULTS: The best visual acuity was improved in 44% and unchanged in 44%. The final visual acuity was improved in 33% and unchanged in 39%. 22% had a preoperative visual acuity of 0.2 or above; and 44% and 17% achieved best and final visual acuity, respectively, of 0.2 or above. Since all cases developed atrophy of the choriocapillaris in the fovea, none of the cases were capable of fixation within atrophy. The fixation point was localized outside atrophy in 56% and fixation was poor in 44%. The diameter of postoperative atrophy of choriocapillaris was significantly greater (p < 0.05) than the preoperative CNV diameter. CNV recurred in 8 eyes(44%), 88% of which occurred within one year. CONCLUSION: Surgical removal of CNV in AS is an effective method to maintain preoperative visual acuity.

[Utility of laser photocoagulation of choroidal neovascularization in angioid streaks].

PURPOSE: We evaluate the utility of laser photocoagulation of extrafoveal choroidal neovascularization (CNV) in angioid streaks. SUBJECTS AND METHODS: Eleven eyes of 10 patients with extrafoveal CNV secondary to angioid streaks that underwent direct laser photocoagulation were followed for 5 months or more. We performed an intense laser photocoagulation of a CNV area determined by fluorescein angiography. We evaluated CNV diameter, the shortest distance between CNV and the fovea, the best visual acuity, the final visual acuity, existence, period, and region of the recurrence, and changes in fundus findings. RESULT: The logarithm of the minimum angle of resolution (log MAR) final visual acuity in 9 eyes deteriorated more than two levels. The recurrence of CNV was observed in 11 eyes, in 9 eyes CNV expanded and involved the fovea, and in two eyes photocoagulation was performed but caused an atrophic creep and resulted in scar formation including the fovea. CONCLUSION: Based on these results, laser photocoagulation is not a good therapy for CNV in angioid streaks.

A study of laser photocoagulation for polypoidal choroidal vasculopathy.

PURPOSE: To evaluate the efficacy of laser photocoagulation for polypoidal choroidal vasculopathy (PCV) involving the macula. METHODS: The records of 38 patients (47 eyes) undergoing laser photocoagulation for PCV causing serosanguineous detachment involving the fovea were reviewed and the results were evaluated. Ten eyes underwent photocoagulation to induce a fusion scar covering whole lesions consisting of both abnormal vessels and polypoidal lesions. Thirty-seven eyes underwent photocoagulation for only polypoidal lesions. When serosanguineous detachment recurred, additional photocoagulation was performed, targeting the causative lesions. Photocoagulation was performed with an argon dye laser or multicolor krypton laser. Final visual acuity, macular changes at the final visit, and the number of photocoagulations were evaluated. Follow-up period after the first photocoagulation was at least 1 year. RESULTS: Of the 10 eyes undergoing photocoagulation of whole lesions, 9 showed absorption of exudate and/or blood after one photocoagulation, and maintained or improved visual acuity. Of the 37 eyes undergoing laser photocoagulation of only polypoidal lesions, 20 (54%) showed decreased visual acuity because of recurrent or persistent exudation and/or classic choroidal neovascularization or, alternatively, because of atrophy at the fovea; 32 of the 37 eyes had undergone photocoagulation at least twice or more. CONCLUSION: Photocoagulation is recommended only for whole lesions.