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.

[Relationship between retinopathy development and systemic factors in type 2 childhood diabetes].

PURPOSE: To clarify the relationship between systemic factors and the development of retinopathy in patients with type 2 childhood diabetes. SUBJECTS AND METHODS: We evaluated the relationship between retinopathy incidence and systemic factors (i.e., sex, age at diagnosis, and mean HbA(1c)) in 36 patients (11 boys and 25 girls). RESULTS: Ten of the 36 cases (28%) developed retinopathy during a mean observation period of 7 years and 11 months. Retinopathy was found only in female patients. The mean HbA(1c) value correlated significantly with the onset of retinopathy. The incidence of retinopathy in the patients with mean HbA(1c) values less than 8.0% was 0% at 5 and 10 years, and 5% at 15 years. On the other hand, the incidence of retinopathy in the patients with mean HbA(1c) values of 8.0% or more was 44% at 5 years, and 56% at 10 and 15 years after the diagnosis of diabetes. CONCLUSION: As female patients with mean HbA(1c) values of 8.0% or more have a high risk of developing retinopathy, strict blood glucose control and frequent ophthalmologic examinations are necessary.

[Preoperative factors for postoperative resolution of metamorphopsia in idiopathic macular hole surgery].

PURPOSE: To elucidate factors for resolution of metamorphopsia after successful surgery for idiopathic macular hole. PATIENTS AND METHODS: A series of 15 cases of 15 patients with successful surgery for idiopathic macular hole were evaluated for signs of metamorphopsia before and one year after surgery. Preoperative and postoperative assessments included testing of metamorphopsia using M-CHART and optical coherence tomography. The postoperative state of the metamorphopsia was judged to have resolved when the test score was 0.2 or less and to be residual when it was more than 0.2. Classification of preoperative factors in two groups of patients included evaluation of metamorphopsia score, visual acuity, optical coherence tomography findings, and clinical stage of macular hole. RESULTS: Six of 15 eyes (40%) showed postoperative resolution of metamorphopsia. There was no significant correlation of postoperative metamorphopsia score with preoperative score or preoperative visual acuity. Eyes with postoperative resolution of metamorphopsia had a macular hole with a significantly smaller diameter and a significantly thinner retina surrounding the hole. Two eyes with clinical stage 4 macular hole had residual metamorphopsia after surgery. CONCLUSIONS: The diameter of a macular hole and the thickness of the retina surrounding a macular hole are significant preoperative factors for postoperative resolution of metamorphopsia after idiopathic macular hole surgery.

[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.

Vitrectomy for diabetic cystoid macular edema.

PURPOSE: We evaluated visual outcomes following vitrectomy for diabetic cystoid macular edema. METHODS: Visual outcomes and factors possibly influencing final visual acuity were assessed and documented retrospectively in 45 eyes of 40 patients, all of whom were followed up for at least 6 months postoperatively. RESULTS: Compared with the preoperative logarithm of the minimum angle of resolution (logMAR) visual acuity, final logMAR visual acuity improved 0.2 or more in 51% of the eyes, was unchanged in 47%, and decreased 0.2 or more in 2%. A final postoperative visual acuity of 0.5 or better was achieved in 38%. Preoperative visual acuity and the extent of the cystoid space on fluorescein angiography were significantly related to final visual acuity. A final postoperative visual acuity of 0.5 or better was noted in 8% of eyes with a preoperative visual acuity below 0.1, in 50% of eyes with a preoperative visual acuity of 0.1 or better, in 71% of eyes with a cystoid space smaller than 5 disc areas, and in 20% of eyes with a cystoid space of 5 disc areas or more. The state of the posterior vitreous membrane did not influence final visual acuity. There were no complications that decreased visual acuity. CONCLUSIONS: We conclude that diabetic cystoid macular edema is a good indication for vitrectomy, regardless of the state of the posterior vitreous membrane. A preoperative visual acuity of 0.1 or better and/or a cystoid space smaller than 5 disc areas may be indications for surgery aimed at achieving a final postoperative visual acuity of 0.5 or better.

The subclassification and long-term prognosis of preproliferative diabetic retinopathy.

PURPOSE: We followed up 54 patients (95 eyes) with preproliferative diabetic retinopathy (PPDR) for at least 2 years, and then evaluated the proportion developing proliferative diabetic retinopathy (PDR), and the period from diagnosis of PPDR until the development of PDR. METHODS: We divided the 95 eyes affected by PPDR into 75 eyes with mild-type and 20 eyes with moderate-type based on our previously proposed subclassification, and evaluated long-term (2 or more years) prognosis. RESULTS: The proportion developing PDR was 24% in mild-type and 60% in moderate-type. The average period from diagnosis of PPDR until the development of PDR was 6 years and 5 months in mild-type, 2 years in moderate-type. The cumulative occurrence rates of PDR at 2, 5, and 10 years were estimated to be 0%, 14%, and 39% in mild-type and 35%, 58%, and 79% in moderate-type, respectively. The proportion developing PDR was significantly higher and the average period until PDR development significantly shorter in moderate than in mild-type. In mild-type eyes, the rate of progression to moderate-type was 56% and further progression from moderate-type to PDR occurred in 43%. CONCLUSION: The above results again confirm the usefulness of our subclassification, and also provide valuable information about the long-term prognosis of PPDR.