Management of Peripapillary Choroidal Neovascular Membrane in Patients With Idiopathic Intracranial Hypertension.

OBJECTIVE: To report the clinical features and treatment outcomes of patients with peripapillary choroidal neovascular membrane (CNVM) secondary to idiopathic intracranial hypertension (IIH). METHODS: Retrospective, multicenter chart review of patients diagnosed with peripapillary CNVM in the course of the treatment and follow-up of IIH. RESULTS: Records were reviewed from 7 different institutions between 2006 and 2016. Ten patients (13 eyes) with a diagnosis of IIH and at least 3 months of follow-up developed CNVM. Three of the total 10 patients developed bilateral CNVM. The mean time from the diagnosis of IIH to CNVM diagnosis was 41 months. Mean follow-up period was 8 months after diagnosis of CNVM. All patients were treated with acetazolamide for IIH. Seven eyes were observed, and 6 eyes were given anti-vascular endothelial growth factor (anti-VEGF) injections, including bevacizumab, ranibizumab, and aflibercept. All CNVMs regressed with subretinal fibrosis, and visual acuity improved in most patients. Papilledema resolved in only 1 eye, while the other 12 eyes had persistent papilledema at last follow-up. CONCLUSIONS: Peripapillary CNVM, a rare complication of IIH, often resolves spontaneously with treatment of IIH. In vision-threatening and/or persistent cases, intravitreal anti-VEGF treatment may be a safe and effective therapeutic option.

Association of Metformin Treatment with Reduced Severity of Diabetic Retinopathy in Type 2 Diabetic Patients.

PURPOSE: To evaluate effects of long-term metformin on the severity of diabetic retinopathy (DR) in high-risk type 2 diabetic (T2D) patients. METHODS: A retrospective chart review study was conducted involving 335 DR patients with T2D ≥ 15 years from 1990 to 2013. The severity of DR was determined by Early Treatment Diabetic Retinopathy Study scale. The associations between metformin and DR severity were evaluated. Comparison with stratification for the use of sulfonylurea and insulin was performed to identify possible confounding effects. RESULTS: Severe nonproliferative diabetic retinopathy or proliferative diabetic retinopathy (SNPDR/PDR) was more often diagnosed in nonmetformin users (67/142, 47%) versus metformin users (48/193, 25%) (p < 0.001), regardless of gender and race of the patients. The odds ratio of metformin associated with SNPDR/PDR was 0.37 in all cases (p < 0.001), 0.35 in sulfonylurea use cohort (p < 0.05), 0.45 in nonsulfonylurea use cohorts (p < 0.01), and 0.42 in insulin use cohort (p < 0.01). Insulin users had a higher rate of SNPDR/PDR. Metformin had no influence on the occurrence of clinical significant diabetic macular edema. CONCLUSIONS: Long-term use of metformin is independently associated with a significant lower rate of SNPDR/PDR in patients with type 2 diabetes ≥ 15 years.

Management of Choroidal Neovascular Membranes Associated with Choroidal Nevi.

PURPOSE: To evaluate the management options for choroidal neovascular membrane (CNVM) associated with choroidal nevus. DESIGN: Cohort study. PARTICIPANTS: Twenty-four eyes with CNVM associated with choroidal nevus. METHODS: Retrospective review of demographic and clinical features and management and outcome of eyes with CNVM associated with choroidal nevus. MAIN OUTCOME MEASURES: Choroidal neovascular membrane status, subfoveal retinal thickness, and visual outcome. RESULTS: Choroidal neovascular membrane was classic in 20 eyes (83%) and occult in 4 eyes (27%). Of 15 eyes (63%) treated with intravitreal bevacizumab injections, complete regression of CNVM was observed in 6 eyes (40%) and partial regression was achieved in 5 eyes (33%). Visual acuity improved or remained stable in these eyes, and the mean subfoveal retinal thickness decreased significantly from 477 µm to 326 µm. Four eyes (27%) with unresponsive, active CNVM were treated with combined photodynamic therapy (PDT) and bevacizumab therapy; complete or partial regression was observed in 3 eyes with improved or stable visual acuity, and the mean subfoveal retinal thickness decreased from 441 µm to 350 µm. Of 5 eyes (33%) treated with PDT, 4 (80%) showed partial regression. Visual acuity remained stable in these eyes and the mean subfoveal retinal thickness decreased from 370 µm to 334 µm. In 4 eyes with non-vision-threatening CNVM (17%), complete or partial regression was seen in 2 eyes, and CNVM remained active in 2 eyes after observation. Visual acuity remained stable. No significant difference was found between the mean subfoveal retinal thickness at presentation and at the last visit. All choroidal nevi remained stable in thickness and size after a mean follow-up of 30 months. CONCLUSIONS: Intravitreal bevacizumab injection was effective in achieving complete or partial regression of CNVM in 73% of eyes with improved visual acuity and decreased subfoveal retinal thickness. Combined PDT and bevacizumab therapy led to further regression in eyes that had failed treatment with bevacizumab previously. Some cases of choroidal neovascularization associated with choroidal nevi did not seem to threaten the vision.

Nd:YAG membranotomy for preretinal hemorrhage secondary to valsalva retinopathy.

PURPOSE: To report four cases of premacular hemorrhage secondary to valsalva retinopathy treated with Nd:YAG membranotomy and discuss techniques as well as the literature. DESIGN: Retrospective case series. METHODS: A retrospective review was conducted for four patients with vision obstructing hemorrhage secondary to valsalva retinopathy. These patients were all treated with Nd:YAG membranotomy. RESULTS: Four patients with premacular hemorrhage secondary to valsalva retinopathy were treated with Nd:YAG laser creating a membranotomy to drain the hemorrhage. Power settings ranged from 1.7 to 3.8 mJ. Visual acuity at presentation ranged from 20/400 (1 patient) to count fingers (3 patients). Visual acuity improved in three out of four patients after laser treatment. Final visual acuity ranged from 20/20 to 20/30 in these three patients. One patient was lost to follow up after performing laser membranotomy and therefore visual acuity after treatment was not obtained. No complications were noted. CONCLUSION: Nd:YAG membranotomy is a non-invasive, office-based treatment option that may be successfully used to treat premacular hemorrhage secondary to valsalva retinopathy.