Postbiotics: emerging therapeutic approach in diabetic retinopathy.

Diabetic retinopathy (DR) is a prevalent microvascular complication in diabetic patients that poses a serious risk as it can cause substantial visual impairment and even vision loss. Due to the prolonged onset of DR, lengthy treatment duration, and limited therapeutic effectiveness, it is extremely important to find a new strategy for the treatment of DR. Postbiotic is an emerging dietary supplement which consists of the inactivate microbiota and its metabolites. Numerous animal experiments have demonstrated that intervention with postbiotics reduces hyperglycemia, attenuates retinal peripapillary and endothelial cell damage, improves retinal microcirculatory dysfunction, and consequently delays the progression of DR. More strikingly, unlike conventional probiotics and prebiotics, postbiotics with small molecules can directly colonize the intestinal epithelial cells, and exert heat-resistant, acid-resistant, and durable for storage. Despite few clinical significance, oral administration with postbiotics might become the effective management for the prevention and treatment of DR. In this review, we summarized the basic conception, classification, molecular mechanisms, and the advances in the therapeutic implications of postbiotics in the pathogenesis of DR. Postbiotics present great potential as a viable adjunctive therapy for DR.

Evaluation of a new Q-switched Nd:YAG laser on premacular hemorrhage.

BACKGROUND: Premacular hemorrhage is among the causes of sudden deterioration of visual acuity. This study aimed to investigate the therapeutic outcomes of a new Q-switched Nd:YAG laser on premacular hemorrhage. METHODS: Retrospective, case series study of 16 eyes from 16 patients diagnosed with premacular hemorrhage, including 3 cases of Valsalva retinopathy, 8 cases of retinal macroaneurysm, 3 cases of diabetic retinopathy, 1 case of trauma-related hemorrhage and 1 case with leukemia. A 1064nm Q-switched Nd:YAG laser was performed to puncture the posterior hyaloid and inner limiting membrane to drain the hemorrhage. RESULTS: The success rate of 16 patients with premacular hemorrhage drainage was 100% in this study. Improved visual acuity was observed in each patient. CONCLUSIONS: In this case series of 16 patients, the new Q-switched Nd:YAG laser was successful in draining premacular hemorrhage with no serious complications.

Automatic interpretation and clinical evaluation for fundus fluorescein angiography images of diabetic retinopathy patients by deep learning.

BACKGROUND/AIMS: Fundus fluorescein angiography (FFA) is an important technique to evaluate diabetic retinopathy (DR) and other retinal diseases. The interpretation of FFA images is complex and time-consuming, and the ability of diagnosis is uneven among different ophthalmologists. The aim of the study is to develop a clinically usable multilevel classification deep learning model for FFA images, including prediagnosis assessment and lesion classification. METHODS: A total of 15 599 FFA images of 1558 eyes from 845 patients diagnosed with DR were collected and annotated. Three convolutional neural network (CNN) models were trained to generate the label of image quality, location, laterality of eye, phase and five lesions. Performance of the models was evaluated by accuracy, F-1 score, the area under the curve and human-machine comparison. The images with false positive and false negative results were analysed in detail. RESULTS: Compared with LeNet-5 and VGG16, ResNet18 got the best result, achieving an accuracy of 80.79%-93.34% for prediagnosis assessment and an accuracy of 63.67%-88.88% for lesion detection. The human-machine comparison showed that the CNN had similar accuracy with junior ophthalmologists. The false positive and false negative analysis indicated a direction of improvement. CONCLUSION: This is the first study to do automated standardised labelling on FFA images. Our model is able to be applied in clinical practice, and will make great contributions to the development of intelligent diagnosis of FFA images.

Optical Coherence Tomography Angiography-Based Quantitative Assessment of Morphologic Changes in Active Myopic Choroidal Neovascularization During Anti-vascular Endothelial Growth Factor Therapy.

Purpose: To establish quantitative profile of the morphologic changes among patients with active myopic choroidal neovascularization (mCNV) before and after anti-vascular endothelial growth factor (VEGF) therapy using optical coherence tomography angiography (OCTA) to assess the therapeutic response. Methods: Patients with active mCNV who received anti-VEGF injections between February 2017 to October 2020 and fit the study criteria were retrospectively reviewed. Quantitative analysis of their OCTA images were carried out to evaluate the morphologic features and vascular changes of mCNV lesions in response to anti-VEGF therapy. For further quantitative profiling, mCNV area, fractal dimension, vessel area, vessel density, vessel diameter, vessel length, vessel junction, junction density, and vessel tortuosity were obtained by means of advanced skeletonization postprocessing analyses. Results: Thirty-one eyes of 29 consecutive patients with OCTA-positive mCNV lesions (mean spherical equivalent: -12.55 ± 3.24 diopters) were included. The 31 cases were divided into two phenotypes at baseline: organized interlacing pattern (83.87%) and disorganized vascular loops pattern (16.13%). The values of mCNV area, fractal dimension, vessel area, vessel length, vessel junction, and junction density decreased remarkably 1 month after the initial anti-VEGF injection (p < 0.001). Although, vessel density, vessel diameter, and vessel tortuosity increased meanwhile, only vessel diameter displayed statistical significance (p = 0.027). Of note, relative ratio analysis showed that vessel junction was the most sensitive biomarker in response to anti-VEGF therapy, reflecting a mean decrease of 50.36%. Sensitivity lowered successively in biomarkers of vessel length, vessel area, junction density, mCNV area, and fractal dimension. In addition, percent change of mCNV area (r = 0.552, p = 0.002), fractal dimension (r = 0.446, p = 0.017), vessel area (r = 0.518, p = 0.005), and vessel length (r = 0.440, p = 0.019) were moderately associated with that of central retinal thickness. Conclusions: The study showed morphological as well as quantitative changes on OCTA responding to anti-VEGF treatment in mCNV patients, among which vessel junctions might be the most predictive biomarker. OCTA-based analysis, providing intuitive images and a large spectrum of quantitative data at the same time, could promote new insights into the therapeutic response assessment in mCNV patients.

Novel Findings of Retinal and Choroidal Features Utilizing Optical Coherence Tomography Angiography Analysis in Patients With Autoimmune Posterior Uveitis.

Purpose: To analyze the quantitative parameters acquired by optical coherence tomography angiography (OCTA) in patients with autoimmune posterior uveitis. Methods: OCTA images of 65 eyes affected with uveitis and 65 normal control (NC) eyes were obtained. The central macular thickness (CMT), retinal thicknesses, foveal avascular zone (FAZ) area, foveal density 300 µm (FD300), and vascular density (VD) were compared among acute uveitic eyes, chronic uveitic eyes, and NC eyes. VDs were evaluated in the choriocapillaris, outer retina, optic disk, whole and parafovea superficial capillary plexus (SCP), and whole and parafovea deep capillary plexus (DCP). Correlation analysis was used to analyze the relationship between LogMAR best-corrected visual acuity (BCVA) and quantitative parameters from OCTA. Results: Compared with NC eyes, the CMT and retinal thicknesses were increased significantly in eyes with uveitis (p < 0.05, respectively). No significant difference was observed in the FAZ area. FD300, VDs in the optic disk, SCP, and DCP both in whole image and parafovea, choriocapillaris were significantly decreased in uveitis eyes (p < 0.05, respectively) compared with NC eyes, only the acute group had decreased VD of the outer retina and choriocapillaris compared with the NC group (p < 0.05). Moreover, quantitative parameters of OCTA showed a significant correlation with LogMAR BCVA in the patients with uveitis. Whole VD DCP was the best predictive factor for BCVA in the patients with uveitis. Conclusion: Quantitative measurement by OCTA is a promising strategy for objective assessment of autoimmune posterior uveitis.

Prediction of response to anti-vascular endothelial growth factor treatment in diabetic macular oedema using an optical coherence tomography-based machine learning method.

PURPOSE: To predict the anti-vascular endothelial growth factor (VEGF) therapeutic response of diabetic macular oedema (DME) patients from optical coherence tomography (OCT) at the initiation stage of treatment using a machine learning-based self-explainable system. METHODS: A total of 712 DME patients were included and classified into poor and good responder groups according to central macular thickness decrease after three consecutive injections. Machine learning models were constructed to make predictions based on related features extracted automatically using deep learning algorithms from OCT scans at baseline. Five-fold cross-validation was applied to optimize and evaluate the models. The model with the best performance was then compared with two ophthalmologists. Feature importance was further investigated, and a Wilcoxon rank-sum test was performed to assess the difference of a single feature between two groups. RESULTS: Of 712 patients, 294 were poor responders and 418 were good responders. The best performance for the prediction task was achieved by random forest (RF), with sensitivity, specificity and area under the receiver operating characteristic curve of 0.900, 0.851 and 0.923. Ophthalmologist 1 and ophthalmologist 2 reached sensitivity of 0.775 and 0.750, and specificity of 0.716 and 0.821, respectively. The sum of hyperreflective dots was found to be the most relevant feature for prediction. CONCLUSION: An RF classifier was constructed to predict the treatment response of anti-VEGF from OCT images of DME patients with high accuracy. The algorithm contributes to predicting treatment requirements in advance and provides an optimal individualized therapeutic regimen.

Automatic detection of non-perfusion areas in diabetic macular edema from fundus fluorescein angiography for decision making using deep learning.

Vision loss caused by diabetic macular edema (DME) can be prevented by early detection and laser photocoagulation. As there is no comprehensive detection technique to recognize NPA, we proposed an automatic detection method of NPA on fundus fluorescein angiography (FFA) in DME. The study included 3,014 FFA images of 221 patients with DME. We use 3 convolutional neural networks (CNNs), including DenseNet, ResNet50, and VGG16, to identify non-perfusion regions (NP), microaneurysms, and leakages in FFA images. The NPA was segmented using attention U-net. To validate its performance, we applied our detection algorithm on 249 FFA images in which the NPA areas were manually delineated by 3 ophthalmologists. For DR lesion classification, area under the curve is 0.8855 for NP regions, 0.9782 for microaneurysms, and 0.9765 for leakage classifier. The average precision of NP region overlap ratio is 0.643. NP regions of DME in FFA images are identified based a new automated deep learning algorithm. This study is an in-depth study from computer-aided diagnosis to treatment, and will be the theoretical basis for the application of intelligent guided laser.

Multi-label classification of retinal lesions in diabetic retinopathy for automatic analysis of fundus fluorescein angiography based on deep learning.

PURPOSE: To automatically detect and classify the lesions of diabetic retinopathy (DR) in fundus fluorescein angiography (FFA) images using deep learning algorithm through comparing 3 convolutional neural networks (CNNs). METHODS: A total of 4067 FFA images from Eye Center at the Second Affiliated Hospital of Zhejiang University School of Medicine were annotated with 4 kinds of lesions of DR, including non-perfusion regions (NP), microaneurysms, leakages, and laser scars. Three CNNs including DenseNet, ResNet50, and VGG16 were trained to achieve multi-label classification, which means the algorithms could identify 4 retinal lesions above at the same time. RESULTS: The area under the curve (AUC) of DenseNet reached 0.8703, 0.9435, 0.9647, and 0.9653 for detecting NP, microaneurysms, leakages, and laser scars, respectively. For ResNet50, AUC was 0.8140 for NP, 0.9097 for microaneurysms, 0.9585 for leakages, and 0.9115 for laser scars. And for VGG16, AUC was 0.7125 for NP, 0.5569 for microaneurysms, 0.9177 for leakages, and 0.8537 for laser scars. CONCLUSIONS: Experimental results demonstrate that DenseNet is a suitable model to automatically detect and distinguish retinal lesions in the FFA images with multi-label classification, which lies the foundation of automatic analysis for FFA images and comprehensive diagnosis and treatment decision-making for DR.

Multifractal and lacunarity analyses of microvascular morphology in eyes with diabetic retinopathy: A projection artifact resolved optical coherence tomography angiography study.

OBJECTIVE: To evaluate the degree of microvascular impairment in DR using multifractal and lacunarity analyses and to compare the diagnostic ability between traditional Euclidean measures (fovea avascular zone area and vessel density) and fractal geometric features. METHODS: This retrospective cross-sectional study included a total of 143 eyes of 94 patients with different stages of DR. The retinal microvasculature was imaged by projection removed OCTA. We examined the degree of association between fractal metrics of the retinal microvasculature and DR severity. The area under the ROC curve was used to estimate the diagnostic performance. RESULTS: With increasing DR severity, the multifractal spectrum shifted toward the left bottom and exhibited less left skewness and asymmetry. The vessel density, multifractal features, and lacunarity measured from the DCP were strongly associated with DR severity. The multifractal feature D5 showed the highest diagnostic ability. The combination of multifractal features further improved the discriminating power. CONCLUSIONS: Multifractal and lacunarity analyses can be potentially valuable tools for assessment of microvascular impairments in DR. Multifractal geometric parameters exhibit a better discriminatory performance than Euclidean measures, particularly for detection of the early stages of DR.

Changes of corneal tomography in patients with congenital blepharoptosis.

The study aimed to evaluate the effect of drooped eyelid on corneal tomography in congenital blepharoptosis patients. Sixty-four patients with congenital blepharoptosis and 64 age- and sex- matched healthy subjects were included. According to the eyelid margin to corneal light reflex distance (MRD), eyes with congenital blepharoptosis were categorized as mild, moderate, or severe. The eyes were scanned using the rotating Scheimpflug camera. Increased topometric parameters were observed in moderate and severe blepharoptosis. Back corneal elevations at the thinnest point were significant higher for mild (P = 0.009), moderate (P < 0.001), and severe (P < 0.001) congenital blepharoptosis compared with controls. Maximum Ambrósio's relational thickness (ART) was decreased in eyes with severe blepharoptosis (P < 0.001). Fnal D values were significantly higher in moderate (P < 0.001) and severe blepharoptosis (P < 0.001) groups than that of controls. There were significant correlations between MRD and most corneal tomographic parameters. Our findings indicated there was a trend toward subclinical keratoconus-like changes in the corneas of congenital blepharoptosis, with the increase of ptosis severity.

Telemedicine screening of retinal diseases with a handheld portable non-mydriatic fundus camera.

BACKGROUND: We modified and reconstructed a high image quality portable non-mydriatic fundus camera and compared it with the tabletop fundus camera to evaluate the efficacy of the new camera in detecting retinal diseases. METHODS: We designed and built a novel portable handheld fundus camera with telemedicine system. The image quality of fundus cameras was compared to that of existing commercial tabletop cameras by taking photographs of 364 eyes from the 254 patients. In all 800 fundus images taken by two camera types, 400 images per camera, were graded with the four image clarity classifications. RESULTS: Using the portable fundus camera, 63% (252/400) images were graded as excellent overall quality, 20.5% (82/400) were good, 11.75% (47/400) were fair, and 4.75% (19/400) were inadequate. Using the tabletop fundus camera, 70.75% (283/400) images were graded as excellent overall quality, 20.4% (51/400) were good, 13.25% (53/400) were fair, and 3.25% (13/400) were inadequate. Common retinal diseases were easily identified from fundus images obtained from the portable fundus camera. CONCLUSION: The new type of non-mydriatic portable fundus camera was qualified to have professional quality of fundus images. The revolutionary screening camera provides a foundational platform which can potentially improve the accessibility of retinal screening programmes.

Idiopathic Choroidal Neovascularization: Intraocular Inflammatory Cytokines and the Effect of Intravitreal Ranibizumab Treatment.

Idiopathic choroidal neovascularization (ICNV) is a disorder that primarily affecting patients younger than 50 years and can cause severe loss of vision. Choroidal abnormalities, especially choroidal inflammation, have been thought to be involved in the pathophysiology of ICNV. However, the exact pathogenesis of ICNV remains unclear. The aim of our study was investigate the levels of 27 inflammatory cytokines in the aqueous humor of eyes with ICNV, and to determine the effect of intravitreal injection of ranibizumab (IVR) on cytokine levels. Significantly higher levels of IL-2, IL-10, IL-15, IL-17, basic FGF, and GM-CSF were observed in patients with ICNV compared with controls. However, only IL-17 levels were significantly higher in patients with ICNV compared with controls after adjusting for axial length. Furthermore, there were significant correlations between the levels of IL-10, IL-17, GM-CSF, and VEGF and the lesion area. Significant changes in visual acuity and central retinal thickness were observed after IVR. Besides VEGF, IVR also significantly reduced the levels of IL-2, IL-10, basic FGF, and IL-12, however, the IL-6 levels were significantly increased. Our results suggest that there may be an involvement of IL-17-related inflammatory processes in the etiology of ICNV.

Suppression of choroidal neovascularization by Endostar in rats.

Choroidal neovascularization (CNV) is common in various retinal and choroidal diseases, and may result in severe and irreversible loss of vision. Our previous studies suggested that Endostar, a novel recombinant endostatin, is able to inhibit the proliferation and migration of choroid­retinal endothelial cells. To further evaluate the effect of Endostar on the formation of CNV in vivo, a rat model of laser­induced CNV was constructed and Endostar or phosphate­buffered saline treatment was administered intravitreally every other day. Using fluorescein angiography (FA), reduced CNV incidence and leakage grade was observed in the Endostar group. In addition, CNV area and maximal thickness were prominently reduced in the Endostar group measured by choroid flat mounts and sections. Furthermore, vascular endothelial growth factor (VEGF), hypoxia­inducible factor 1α and chemokine C­X­C motif ligand 1 were markedly reduced in the Endostar group as determined by quantitative polymerase chain reaction and downregulation of VEGF was also verified by western blot analysis at the protein level. This study demonstrates that Endostar suppressed CNV in a rat model, which may be largely mediated by the downregulation of VEGF and other angiogenic molecules.

Molecular analysis and phenotypic study in 14 Chinese families with Bietti crystalline dystrophy.

PURPOSE: To investigate the clinical features and cytochrome P450 family 4 subfamily V polypeptide 2 (CYP4V2) gene mutations in 14 Chinese families with Bietti crystalline dystrophy (BCD). METHODS: Seventeen patients from 14 unrelated Chinese families with BCD were recruited for complete clinical ophthalmic examination and genetic study. The 11 exons of CYP4V2 were amplified from genomic DNA of all patients and their family members by polymerase chain reaction (PCR) and then sequenced. Exons of TIMP3 were also sequenced in BCD patient associated with choroidal neovascularization (CNV). One hundred and seventy unrelated healthy Chinese subjects were screened for mutations in CYP4V2. RESULTS: All 17 patients with BCD had mutations in CYP4V2; one of these mutations was novel (c.219T>A, p.F73L) and four other mutations had been reported. The p.F73L mutation was a commonly detected mutation in our study (seven out of 34 alleles), either in the homozygous state or in the heterozygous state. Among the patients, considerable phenotypic variability was detected, both within and between families. Screening of TIMP3 did not find any mutation in the BCD patient associated with CNV. CONCLUSION: The novel CYP4V2 c.219T>A (p.F73L) mutation may be another recurrent mutation in Chinese patients with BCD. Our study expands the mutation spectrum of CYP4V2 and characterizes novel genotype-phenotype associations in Chinese patients with BCD.

Comparison of outcomes between overlapping-spot and single-spot photodynamic therapy for circumscribed choroidal hemangioma.

AIM: To compare the efficacy and safety of photodynamic therapy (PDT) with overlapping multiple spots and single spot for treating circumscribed choroidal hemangioma. METHODS: Twenty-two patients (22 eyes) with symptomatic circumscribed choroidal hemangioma received PDT treatment. Fourteen patients received overlapping spots (two to three spots) PDT, whereas eight patients received single-spot PDT. Laser was used at 50J/cm(2) for 83s in the overlapping-spot group and 50J/cm(2) for 166s in the single-spot group. Clinical examination, funduscopy, fluorescein angiography, and ultrasonography were performed at baseline and after treatment. RESULTS: The mean follow-up time was 28.5±8.0 months in the overlapping-spot group and 27.0±5.0 months in the single-spot group. Nine patients (64.2%) had their vision improved over two lines on the Snellen chart, and five patients showed stable visual acuity in the overlapping-spot group. The mean thickness of tumor decreased from 2.7±0.8mm to 1.2±0.9mm, and the mean greatest tumor linear dimension decreased from 7.4±1.5mm to 4.5±3.5mm after treatment. In the single-spot group, two patients (25%) had their vision improved over two lines on the Snellen chart, and six patients had unchanged stable vision. The mean tumor thickness in this group decreased from 2.5±0.7mm to 1.4±1.0mm, and the mean greatest tumor linear dimension decreased from 7.2±1.3mm to 4.7±3.6mm. No significant differences in visual improvement and tumor regression were found between the two groups. CONCLUSION: Overlapping-spot PDT under appropriate treatment parameters and strategies is as effective and safe as single-spot PDT for treating symptomatic circumscribed choroidal hemangioma. Improved or stabilized visual acuity was achieved as a result of tumor regression.

Adverse reaction in patients with drug allergy history after simultaneous intravenous fundus fluorescein angiography and indocyanine green angiography.

PURPOSE: To examine the safety of outpatient clinic simultaneous intravenous fundus fluorescein angiography (IVFA) and indocyanine green angiography (ICGA) in patients with any/all drug allergy history. METHODS: In a single-center retrospective study conducted from February 2007 to March 2011, 390 consecutive outpatients with drug allergy history and 3426 patients without allergy history underwent simultaneous intravenous IVFA and ICGA. The detailed drug allergy history, the symptoms and time of the adverse reaction during simultaneous IVFA and ICGA were recorded in all the patients. RESULTS: Of the 390 patients with drug allergy history who received IVFA and ICGA, 28 patients (7.2%) had an adverse reaction. In contrast, 145 of the 3426 patients (4.2%) without allergy history had an adverse reaction during simultaneous IVFA and ICGA. Statistical significance in the incidence (P=0.008) and severity (P=0.001) of the adverse reaction was observed between patients with drug allergy history and those without drug allergy history. In 390 patients with drug allergy history, no statistical significance was indicated in the incidence of the adverse reaction among different types of drug allergy (P>0.05). CONCLUSIONS: Simultaneous IFVA and ICGA are generally safe procedures with an acceptable incidence of an adverse reaction. However, patients with drug allergy history may have a higher incidence and greater severity of an adverse reaction.

[Adverse reactions during fluorescence fundus angiography in special patients].

OBJECTIVE: To determine the incidence rate and correlation factors of the adverse reactions during fluorescence fundus angiography (FFA) in special patients. METHODS: 256 special patients were performed FFA with Heidelberg Retinal Angiography. Fluorescein Sodium was given according to the body weight and adverse reactions during FFA were observed. The special patients enrolled in this study include those with drug allergy history, system disease, light adverse reactions such as nausea, vomiting and pruritus during the fist FFA or patients over 80 years old. RESULTS: Adverse reactions were observed in 69 of 256 (27.0%) cases and the majority is at a mild to moderate degree. Nausea, sneezing, vomiting or pruritus occurred in 10 of 73 (13.7%) patients with drug allergy history. Nausea or vomiting occurred in 4 of 78 (5.1%) patients with systemic diseases. Different degrees of adverse reactions occurred in 54 of 56 (94.6%) cases who had nausea, vomiting or pruritus during the first FFA. Nausea occurred in 1 of 49 (2.0%) patients over 80 years old. CONCLUSION: FFA is a safe examination for the above special patients. The incidence rate of adverse reaction due to FFA in these special patients is similar to that in the healthy population. Observing the patients closely and strengthening the containment and salvage measures are important to improve the safety of FFA in these special patients.

[Combination facula photodynamic therapy for circumscribed choroidal hemangioma].

OBJECTIVE: To assess the clinical effect of combination facula photodynamic therapy (PDT) on patients with circumscribed choroidal hemangioma. METHODS: It was a retrospective case series. Ten cases of circumscribed choroidal hemangioma were diagnosed by ophthalmoscopy, fundus fluorescein angiography and B-scanning ultrasound examination. Clinical data of these cases were retrospectively analyzed. All of these patients had undergone combination facula PDT. The best corrected visual acuity before PDT was FC to 0.3. The maximum diameter of the tumor was 5.5-9.9 mm and averaged 6-8 mm. The maximum thickness of the tumor was 1.1-3.8 mm and averaged 2.7 mm. Four patients suffered from retinal detachment The intravenous injection of visudyne (6 mg/m2) was performed in 10 minutes. Five minutes later, laser irradiation (wave length 689 nm) was performed with the parameters of 50 J/cm2, 83 s, and 2 to 3 spots. The follow-up period was 3.0 to 15.0 months (mean 8.5 months). RESULTS: The visual acuity in the last examination after treatment was FC-1.0, which was 2-line increased in 7 patients and was steady in 3 patients. B-scanning ultrasound examination showed that the hemangioma was undetectable in 2 patients, and in the other 8 patients,the hemangioma had the diameter of 4.2 to 8.3 mm (average 6.4 mm) and the thickness was 0.5 to 2.7 mm (average 1.9 mm). Retina detachment disappeared in 2 patients CONCLUSIONS: Combination facula PDT may lead to the shrinking of choroidal hemangioma, disappearance of subretinal fluid, reattachment of retina and the increase or saving of the visual acuity. It is a effective and safe treatment for the macular circumscribed choroidal hemangioma.

[Evaluation of photodynamic therapy in idiopathic choroidal neovascularization].

OBJECTIVE: To evaluate the effectiveness of photodynamic therapy (PDT) in the treatment of idiopathic choroidal neovascularization (CNV). METHODS: Sixty-one cases (61 eyes) of CNV were treated with PDT and the fundus appearance, visual acuity, retina thickness as well as the fundus angiographic imaging were observed before and after the therapy. PDT was performed 1.2 times in average and the follow-up period was 6 - 36 months (mean 19 months). RESULTS: At the last follow up, the visual acuity was improved in 41 eyes (67.2%), unchanged in 15 eyes (24.6%) and slightly decreased in 5 eyes (8.2%). Macular hemorrhage and exudation reduced in all cases after PDT. Fundus angiography showed complete closure of CNV in 38 eyes (62.3%), partial closure in 4 eyes (6.6%), incomplete closure in 14 eyes (23.0%) and recurrence in 5 eyes (8.2%). In 6 eyes CNV was complete closed after single PDT with diminish of macular edema and neuronal retinal epithelial detachment. No recurrent CNV was observed during three years' follow-up and the visual acuity remained stable. Our results also demonstrated that the therapeutic effect decreased with patient's age (t = 0.476, P = 0.016). The decrease of visual acuity averaged 0.008 per year. CONCLUSION: Photodynamic therapy is a potential treatment for idiopathic CNV and better outcomes are achieved in younger patients.