Development of polypoidal lesions in age-related macular degeneration.

PURPOSE: To investigate the development of polypoidal lesions using indocyanine green angiography (IA) in eyes with typical age-related macular degeneration (AMD). METHODS: We retrospectively reviewed the medical records of 47 consecutive patients (47 eyes) with typical AMD who had been followed up with IA for at least 2 years. RESULTS: At the initial visit, although all eyes showed classic and/or occult choroidal neovascularization (CNV) associated with AMD, no eyes showed polypoidal lesions by IA. However, during follow-up, 13 (27.7%) of the 47 eyes did show polypoidal lesions. All polypoidal lesions developed at the edge of persistent CNV or, more often, at the terminus of recently progressed CNV. Of 12 eyes with a final lesion area >8 disc area, 7 (58.3%) showed newly developed polypoidal lesions. In the eyes with these newly developed polypoidal lesions, the mean area of the vascular lesion had extended significantly from 10.50 ± 7.88 mm² to 20.87 ± 10.21 mm² during follow-up (P=0.0018). CONCLUSION: The current observation suggests that IA of active AMD sometimes reveals polypoidal lesions if there is progression of the CNV in the subretinal pigment epithelium space.

Prognostic factors for visual outcomes 2-years after intravitreal bevacizumab for myopic choroidal neovascularization.

PURPOSE: To determine the pre-treatment ocular factors significantly associated with the visual outcome 24 months after intravitreal bevacizumab (IVB) for myopic choroidal neovascularization (mCNV). METHODS: A total of 23 eyes of 23 patients with mCNV were treated with IVB followed by as needed therapy. The efficacy of IVB was evaluated by the best-corrected visual acuity (BCVA) at 24 months after the initial treatment. Forward stepwise multiple linear regression analyses were performed to evaluate the influence of pre-treatment factors on the BCVA and the improvement of the BCVA at 24 months. RESULTS: The mean pre-IVB BCVA was 0.74 ± 0.30 logarithm of the minimum angle of resolution (logMAR) units, and it improved to 0.43 ± 0.31 logMAR units after 1 month (P < 0.001, paired t-test). The improvement was maintained at 24 months (0.46 ± 0.40, P < 0.005). The mean number of IVB performed during the 24 months was 1.35 ± 0.71. Forward stepwise regression analysis showed that the pre-IVB CNV size (standardized ß = 0.52, P < 0.01) and BCVA (standardized ß = -0.44, P < 0.05) significantly affected the visual acuity change after 24 months. The CNV size was the only factor that significantly affected the BCVA after 24 months (standardized ß=0.56, P < 0.01). CONCLUSIONS: IVB with as needed therapy for mCNV led to a rapid and sustained visual improvement. Smaller CNV size was a significant prognostic factor that predicts better visual acuity. Patients with lower pre-treatment BCVA had better visual recovery than those with better pre-treatment BCVA, however, this may be due to a ceiling/floor effect.

Intravitreal bevacizumab for type 1 idiopathic macular telangiectasia.

PURPOSE: To evaluate the effect of intravitreal bevacizumab injection for treating type 1 idiopathic macular telangiectasia (IMT). METHODS: Retrospective case series of five eyes of five male patients with type 1 IMT that were treated with 2-3 injections of intravitreal bevacizumab. Best-corrected visual acuity, foveal thickness obtained by optical coherence tomography, and fluorescein angiography (FA) were monitored over a period of up to 12 months. RESULTS: The average follow-up period was 17.0 months (range, 12-21 months). The mean logarithm of the minimal angle of resolution visual acuity was 0.295 at baseline and 0.254 (P=0.194) and 0.311 (P=0.461) at 3 and 12 months, respectively, after the initial injection. At 12 months, visual acuity had improved in one eye, remained stable in three eyes, and decreased in one eye. The mean foveal thickness was 479 microm at baseline; at 1 month after the therapy, marked reduction of macular oedema was seen only in one eye. The mean foveal thickness was 418 microm (P=0.287) and 473 microm (P=0.482) at 3 and 12 months after the initial injection, respectively. At 12 months, the foveal thickness had decreased by >100 microm in one eye, but had increased by >100 microm in two eyes. FA did not show a reduction in late leakage. CONCLUSIONS: Treatment with intravitreal bevacizumab does not appear to improve visual acuity or retinal oedema in type 1 IMT.

Outcomes of 23- and 25-gauge transconjunctival sutureless vitrectomies for idiopathic macular holes.

BACKGROUND/AIMS: To assess the outcomes of 23-gauge sutureless transconjunctival vitrectomies (TSV), as compared with 25-gauge TSV in macular hole surgeries. METHODS: A retrospective, consecutive, interventional case series of 47 eyes with idiopathic macular holes treated by 23- or 25-gauge TSV were analysed. RESULTS: The operative time was 37.2 (SD 8.9) min with 23-gauge TSV and 34.2 (8.7) min with 25-gauge TSV (p = 0.388). The anatomical success rate was 96% with 23-gauge TSV and 92% with 25-gauge TSV (p>0.999). The logarithm of the minimum angle of resolution of best-corrected visual acuity (BCVA) at the sixth postoperative month was 0.19 (0.16) with 23-gauge TSV and 0.19 (0.25) with 25-gauge TSV (p = 0.521). Postoperative improvement in BCVA was comparable between the two TSVs. IOP on postoperative day 1 was lower with 25-gauge TSV (12.3 (4.9) mm Hg) than with 23-gauge TSV (17.4 (5.8) mm Hg) (p = 0.036). Complications included retinal break, intraoperative bleeding and slippage of the infusion cannula with 23-gauge TSV, while retinal detachment and postoperative hypotony occurred in the 25-gauge TSV group (p = 0.570). CONCLUSION: 23-gauge TSV appears to be as safe and effective as 25-gauge TSV in macular hole surgery.

Identifying pathogenic genetic background of simplex or multiplex retinitis pigmentosa patients: a large scale mutation screening study.

BACKGROUND AND PURPOSE: More than half of the retinitis pigmentosa (RP) cases are genetically simplex or multiplex. To date, 37 causative genes of RP have been identified; however, the elucidation of gene defects in simplex or multiplex RP patients/families remains problematic. The aim of our study was to identify the genetic causes of RP in patients with unknown or non-Mendelian inheritance. METHODS AND RESULTS: Since 2003, 52 simplex RP patients, 151 patients from 141 multiplex RP families, and six sporadic patients with retinal degeneration were studied. A total of 108 exons of 30 RP-causing genes that harboured the reported mutations were screened by an efficient denaturing high performance liquid chromatography (dHPLC) based assay. Aberrant fragments were subsequently analysed by automatic sequencing. Twenty-six mutations, including two frameshift mutations, one single amino acid deletion, and 23 missense mutations, were identified in 28 probands (14.07%). Eighteen mutations have not been reported to date. Three pairs of combined mutations in different genes were identified in two sporadic cases and one multiplex family, indicating the possibility of novel digenic patterns. Of the 23 missense mutations, 21 were predicted as deleterious mutations by computational methods using PolyPhen, SIFT, PANTHER, and PMut programs. CONCLUSION: We elucidated the mutation spectrum in Japanese RP patients and demonstrated the validity of the mutation detection system using dHPLC sequencing for genetic diagnosis in RP patients independent of familial incidence, which may provide a model strategy for identifying genetic causes in other diseases linked to a wide range of genes.