Changes in Retinal Microvasculature and Visual Acuity After Antivascular Endothelial Growth Factor Therapy in Retinal Vein Occlusion.

Purpose: To investigate the changes in the retinal microvasculature during the course of anti-VEGF therapy in eyes with macular edema due to retinal vein occlusion (RVO) and their association with visual outcomes. Methods: The vessel density (VD) and foveal avascular zone (FAZ) area in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were quantitatively measured by optical coherence tomography angiography (OCTA) in 48 consecutive eyes with RVO before and 1, 3, 6, 9, and 12 months after anti-VEGF therapy. Anti-VEGF therapy was performed either with ranibizumab or aflibercept following a pro re nata (PRN) regimen. The correlation between post-treatment best-corrected visual acuity (BCVA) and changes in the retinal microvasculature evaluated by OCTA were assessed. Results: The BCVA improved significantly at 12 months (P < 0.001). Better BCVA at 12 months was significantly associated with a better VD in the SCP and DCP both at baseline (R2 = 0.524, P < 0.001 and R2 = 0.457, P < 0.001, respectively) and at 12 months (R2 = 0.521, P < 0.001 and R2 = 0.662, P < 0.001, respectively). Overall, both VD and FAZ did not change significantly during the 12 months. However, the progression of nonperfusion was observed in the SCP in 6 (13%) eyes and in the DCP in 10 (21%) eyes. The number of macular edema recurrence was significantly associated with a decrease in the VD (P = 0.006 [SCP] and P < 0.001 [DCP]) and less visual gain (P = 0.02) after treatment. Conclusions: Anti-VEGF therapy maintains retinal perfusion in most patients with RVO. Preserving retinal perfusion is crucial for better visual outcomes.

RETINAL MICROVASCULATURE AND VISUAL ACUITY AFTER INTRAVITREAL AFLIBERCEPT IN EYES WITH CENTRAL RETINAL VEIN OCCLUSION: An Optical Coherence Tomography Angiography Study.

PURPOSE: To investigate vascular perfusion and foveal avascular zone area in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) after intravitreal aflibercept therapy in central retinal vein occlusion eyes and their association with best-corrected visual acuity. METHODS: Thirty-five subjects with central retinal vein occlusion and macular edema were evaluated. After macular edema resolution following intravitreal aflibercept, subjects underwent optical coherence tomography angiography to measure SCP and DCP perfusion and the foveal avascular zone within a 3 × 3-mm area. Correlations between best-corrected visual acuity and optical coherence tomography angiography measurements were examined. RESULTS: After intravitreal aflibercept therapy, mean retinal vascular area was 3.41 ± 0.74 mm in the SCP and 3.25 ± 0.91 mm in the DCP. Foveal avascular zone area was 1.03 ± 1.04 mm in the SCP and 1.78 ± 1.73 mm in the DCP. Improved best-corrected visual acuity was significantly associated with better SCP and DCP perfusion (both P < 0.001) and with smaller SCP and DCP foveal avascular zone areas (both P < 0.001). Additionally, SCP and DCP perfusion were negatively correlated with macular edema before treatment (P < 0.05) and ischemia (determined via pretreatment fluorescein angiography, P < 0.05), and positively correlated with photoreceptor integrity (P < 0.001). CONCLUSION: Patients with better retinal perfusion and less retinal ischemia are associated with better visual outcomes after aflibercept in eyes with central retinal vein occlusion.

Retinal Microvasculature and Visual Acuity in Eyes With Branch Retinal Vein Occlusion: Imaging Analysis by Optical Coherence Tomography Angiography.

Purpose: To investigate microvascular changes in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in eyes with resolved branch retinal vein occlusion (BRVO) and their association with best-corrected visual acuity (BCVA). Methods: Eighty-five eyes (82 consecutive patients) with BRVO after resolution of the macular edema were retrospectively evaluated. All patients underwent optical coherence tomography angiography (OCTA) for assessment of microvascular changes, including capillary telangiectasia, microaneurysm, and disruption of the foveal avascular zone (FAZ). The areas of vascular perfusion and FAZ in the SCP and DCP were quantitatively evaluated. Best-corrected visual acuity was measured on the same day as OCTA examination. The correlation between BCVA and OCTA findings was assessed. Results: In eyes with resolved BRVO, the mean vascular perfusion areas in the SCP and DCP within a 3 × 3-mm area were 3.75 ± 0.49 and 3.80 ± 0.55 mm2, respectively. The mean FAZ areas of the SCP and DCP were 0.57 ± 0.36 and 0.76 ± 0.38 mm2, respectively. Better BCVA was significantly associated with a larger vascular perfusion area in the SCP (P < 0.001) and DCP (P < 0.001), and a smaller FAZ area in the SCP (P = 0.025) and DCP (P = 0.017). Stepwise multiple regression analysis revealed that the vascular perfusion area in the DCP was the most important parameter significantly correlated with BCVA (R2 = 0.33, P < 0.001). Conclusions: Preservation of the deep retinal vasculature is crucial for better visual function in BRVO.

Choroidal thickness in eyes with tilted disk syndrome.

PURPOSE: To investigate the choroidal thickness in eyes with tilted disk syndrome within/without posterior staphyloma. METHODS: Twenty-one eyes examined in 16 patients with tilted disk syndrome were included. The thicknesses of the choriocapillaris, the medium-to-large choroidal vessels, and total choroids found 1 mm and 3 mm superior and inferior to the fovea and in the area with the thinnest choroid were measured using enhanced-depth imaging optical coherence tomography or high-penetration optical coherence tomography. The results were compared with the findings on indocyanine green angiography. RESULTS: The mean thicknesses of total choroid found 3 mm and 1 mm inferior (114.3 µm ± 77.8 µm, 145.0 µm ± 85.9 µm) to the fovea were significantly thinner than those found superior (174.5 µm ± 89.7 µm, 145.0 µm ± 85.9 µm) to it. The minimal choroidal thickness of 80.5 µm ± 67.1 µm was obtained at a mean 1.04 mm below the fovea at the upper edge of the posterior staphyloma. The thickness of the layer of choriocapillaris was not significantly different according to the regions but the layer of medium-to-large choroidal vessels found 3 mm and 1 mm inferior to the fovea was significantly thinner than that found superior to the fovea. The ratio of choriocapillaris to medium-to-large vessels found 1 mm superior also was significantly smaller than those found inferior. The diameter of medium-to-large choroidal vessels on ICGA was not significantly different in the areas although less number of vessels were seen around the area inferior to the fovea. CONCLUSION: In the eyes of patients with tilted disk syndrome, the choroid is thinnest at approximately 1 mm inferior to the fovea at the upper edge of the posterior staphyloma rather than at the bottom of the posterior staphyloma. Thinning of the layer of medium-to-large choroidal vessels seems to be associated with the thinning of choroid thickness.

Changes in fundus autofluorescence in polypoidal choroidal vasculopathy during 3 years of follow-up.

PURPOSE: To investigate changes in fundus autofluorescence (FAF) during 3 years of follow-up in patients with polypoidal choroidal vasculopathy (PCV). DESIGN: Retrospective study. METHODS: We retrospectively reviewed the charts of 48 eyes of 47 patients (35 men, 12 women; mean age, 69.9 ± 7.1 years) with treatment-naïve PCV for whom FAF and indocyanine green angiography (ICGA) images were available at baseline and at 3 years ± 3 months follow-up examination. The main outcome measures were the FAF changes during 3 years of follow-up, and the correlation between them and polypoidal lesions and branching vascular networks on ICGA. RESULTS: The FAF of the polypoidal lesions showed three patterns at baseline and changes during 3 years of follow-up: confluent hypoautofluorescence surrounded by a hyperautofluorescent ring (86.1% → 51.4%), confluent hypoautofluorescence without a ring (8.3% → 43.0%), and no marked changes (5.6% → 5.6%). The FAF in 96.2% of resolved polypoidal lesions persisted on images with abnormal FAF during the 3 years of follow-up. The granular hypoautofluorescence at the branching vascular networks at baseline became partially confluent hypoautofluorescence in 41 eyes (85.4%). The mean area with confluent hypoautofluorescence that corresponded to the branching vascular network lesions increased significantly (P < 0.001) from 1.75 mm(2) to 5.10 mm(2) after 3 years of follow-up. CONCLUSION: The FAF changes in PCV during the 3 years of follow-up can indicate that FAF imaging is a useful and clinically beneficial tool for noninvasively evaluating the PCV lesions and disorders of the upper retinal pigment epithelium.

Comparison of macular pigment in three types of macular telangiectasia.

PURPOSE: To compare macular pigment in three types of macular telangiectasia (MacTel). METHODS: Twenty-six eyes of 16 patients (mean age, 62 years) with MacTel were examined. The macular pigment optical density (MPOD) was obtained by autofluorescence spectrometry using two wavelengths (488 nm, 514 nm). The density of the central macular pigment within 0.5 degree around the foveal center (MPODc) was measured from a MPOD map. RESULTS: Eight eyes of seven patients were classified as type 1, 16 eyes of eight patients as type 2, and two eyes of one patient as type 3. The macular pigment signal was seen in the area of fluorescein leakage in type 1 and the occlusive area in type 3; the macular pigment signal decreased in the area of fluorescein leakage in type 2. The mean MPODc (± standard deviation) was 0.40 ± 0.16 density unit (DU) (range, 0.17-0.57) in type 1; -0.08 ± 0.15 DU (range, -0.29-0.25) in type 2; and 0.32 ± 0.08 DU (range, 0.26-0.37) in type 3. Significant differences were seen between types 1 and 2 (P < 0.001) and types 2 and 3 (P = 0.007). There was no significant difference between types 1 and 3 (P = 0.765). In 30 age-matched normal eyes, the MPODc was 0.58 ± 0.11 DU (range, 0.38-0.79). There were significant differences between normal eyes and each MacTel subtype (type 1, P = 0.007; type 2, P < 0.001; type 3, P = 0.043). CONCLUSIONS: The macular pigment values and distributions, including leakage or occlusion, differed in each MacTel type compared with fluorescein angiography findings. The capillary occlusion in type 3 is not associated with reduced MPOD.

Reduced-fluence photodynamic therapy for subfoveal serous pigment epithelial detachment with choroidal vascular hyperpermeability.

PURPOSE: To evaluate the efficacy of reduced-fluence photodynamic therapy (PDT) for treating symptomatic subfoveal serous pigment epithelial detachments (PEDs) with hyperfluorescence on late-phase indocyanine green angiography (ICGA) without choroidal neovascularization (CNV). DESIGN: Retrospective, interventional case series. METHODS: Fifteen eyes of 15 patients (mean age, 55.3 years) with a serous PED were included. Baseline ICGA showed hyperpermeable choroidal vessels but no CNV in any eyes. Reduced-fluence PDT was applied and included treatment of hyperfluorescent areas on late-phase ICGA. We evaluated changes in the PEDs and hyperfluorescence on late-phase ICGA at baseline and 3 months after PDT. We compared the subfoveal choroidal thickness and best-corrected visual acuity (BCVA). RESULTS: The baseline ICGA showed mild to intense hyperfluorescence at the PED with hyperpermeable choroidal vessels. One month after reduced-fluence PDT, the PED resolved in 14 eyes (93%) and decreased in height in 1 eye. The PED flattening continued for more than 3 months. The baseline hyperfluorescence on ICGA decreased at month 3 except for 1 eye. The subfoveal choroidal thickness decreased significantly (P < .0001) from 297 to 238 µm; the BCVA significantly (P = .019) improved from 0.08 to -0.01 between baseline and month 3. The month-3 BCVA was significantly associated with the baseline BCVA and the duration and size of the PED. No PEDs recurred or complications developed, such as secondary CNV or retinal pigment epithelial tears. CONCLUSION: Serous PEDs accompanying hyperfluorescence on ICGA are considered a variant of central serous chorioretinopathy. Reduced-fluence PDT is beneficial for resolving PEDs.

Correlation of indocyanine green angiography and optical coherence tomography findings after intravitreal ranibizumab for polypoidal choroidal vasculopathy.

PURPOSE: To evaluate findings in eyes with polypoidal choroidal vasculopathy on indocyanine green angiography (ICGA) and optical coherence tomography (OCT) over 3 months after ranibizumab treatment. METHOD: Fifty-one eyes from 51 patients with treatment-naive polypoidal choroidal vasculopathy received intravitreal ranibizumab injections. We evaluated changes in polypoidal lesions on ICGA and OCT and their correlation over 3 months. Ranibizumab was injected again based on the presence of residual fluid on OCT. RESULTS: Indocyanine green angiography detected 75 polypoidal lesions. All corresponding OCT lesions showed baseline protrusion of the retinal pigment epithelium. At 3 months, 26 lesions (35%) resolved on ICGA: retinal pigment epithelium protrusion on OCT resolved in 10 lesions (38%), 10 lesions (38%) decreased in height, and 6 lesions (24%) remained unchanged. Forty-nine lesions persisted on ICGA, retinal pigment epithelium protrusion resolved in 2 lesions (4%), decreased in 4 lesions (8%), were stable in 36 lesions (73%), and increased in 7 lesions (15%). Three lesions newly developed. Six eyes (12%) had resolved lesions, and 33 eyes (67%) had persistent lesions on ICGA and OCT. Residual exudative changes were associated with persistent lesions on OCT. CONCLUSION: Indocyanine green angiography and OCT baseline findings of polypoidal lesions in polypoidal choroidal vasculopathy were well correlated; however, a discrepancy was seen during treatment. Polypoidal lesions persisted more often on OCT, although ICGA and OCT showed the efficacy of ranibizumab for some polypoidal lesions.

[Efficacy of intravitreal bevacizumab for age-related macular degeneration].

PURPOSE: To investigate the efficacy of intravitreal bevacizumab (IVB) for neovascular age-related macular degeneration (AMD). METHODS: We conducted a retrospective study of 29 eyes of 29 patients with AMD (19 eyes) and polypoidal choroidal vasculopathy (PCV; 10 eyes), who were followed up at least 1 year after the initial IVB (1.0 mg/0.04 ml). The eyes were classified according to the lesion type and size. Best-corrected visual acuity (BCVA) and central retinal thickness were examined before and 3 months, 6 months and 12 months after the IVB. RESULTS: The mean application times of IVB were 2.1 in 1 year. When classifying the eyes according to the lesion type, BCVA improved in 5 (26.3%) eyes with AMD and 1 (10.0%) eye with PCV by over 0.2 logarithmic minimum angle of resolution (logMAR) units. The BCVA decreased significantly 1 year after the IVB in eyes with PCV (p = 0.032). When classifying the eyes according to the lesion size, BCVA improved by over 0.2 logMAR units in the 4 (50.0%) eyes with a size of less than 1 disc diameter, 1 (10.0%) eye with the size of 1 to 3 disc diameters, and 1 (9.1%) eye with the size of over 4 disc diameters. The BCVA decreased significantly 1 year after the IVB in the eyes with the size of 1 to 3 disc diameters and with the size of over 4 disc diameters (p = 0.028, 0.013, respectively). The central retinal thickness did not change significantly at any time point compared to that before the IVB. CONCLUSIONS: These results suggest that IVB may be efficacious in preserving visual acuity in AMD eyes and in eyes with the size of less than 1 disc diameter.

[Efficacy of treatments on vision-related quality of life in patients with diabetic retinopathy].

PURPOSE: To evaluate changes in the vision-related quality of life in patients with diabetic retinopathy with the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25). Patients were categorized into three groups : without treatment, receiving pan-retinal photocoagulation, and those who had vitrectomy. SUBJECTS AND METHODS: Altogether 327 patients (131 without treatment, [observation group]; 60 receiving pan-retinal photocoagulation, [photocoagulation group]; and 136 patients who had vitrectomy, [vitrectomy group]). The VFQ-25 was recorded at the time of entry and 1 year later. The VFQ-25 score was compared between the time of entry and 1 year later for each group and among the three groups at both the time of entry and 1 year later. RESULTS: VFQ-25 scores (mean +/- standard deviations) at the time of entry and 1 year later were 91.3 +/- 7.8 and 92.2 +/- 7.8 in the observation group, 80.7 +/- 15.7 and 77.6 +/-19.1 in the photocoagulation group, and 67.4 +/-17.3 and 75.4 +/- 17.5 in the vitrectomy group. VFQ-25 scores in the observation group and in the photocoagulation group did not change statistically between the time of entry and 1 year later (p = 0.113, 0.169, respectively), while the score of the vitrectomy group increased statistically (p < 0.001). In addition, although VFQ-25 scores were statistically significant among the three groups at the time of entry (p < 0.05), the scores 1 year later were not statistically different between the photocoagulation group and vitrectomy group. CONCLUSIONS: These results suggest that vitrectomy for diabetic retinopathy may be effective in increasing the quality of life of patients with diabetic retinopathy.

[Efficacy of vitreous surgery for uveal effusion syndrome].

PURPOSE: To evaluate the efficacy of pars plana vitrectomy for uveal effusion syndrome retrospectively. SUBJECTS AND METHODS: Six patients (six eyes) with uveal effusion syndrome(UE) underwent vitrectomy followed by internal drainage of subretinal fluid, fluid-gas exchange, and pan-retinal photocoagulation. Three of these cases with nanophthalmos underwent silicone oil injection. RESULTS: The retina became reattached in all cases. The silicone oil was not removed in two of the three cases with nanophthalmic eyes. Two cases of the three cases with nanophthalmic eyes needed to perform full thickness sclerostomy additionally, and in one case subchoroidal hemorrhage occurred. The visual acuity finally improved in five out of the six eyes. CONCLUSIONS: In cases of uveal effusion without nanophthalmic, vitrectomy hastens quick reattachment of the retina and may result in better visual outcome. But in cases of nanophthalmic eyes, it would be better to perform sclerostomy first.

[Evaluation of the efficacy of intravitreal gas injection for submacular hemorrhages].

PURPOSE: To evaluate the efficacy of intravitreal gas injection for submacular hemorrhages(SMH). PATIENTS AND METHODS: The records of 29 patients with SMH, who were treated by pneumatic displacement with expansile gas, were reviewed retrospectively. RESULT: In observable cases, SMH had started moving within five days after the procedure. After 6 months visual acuity had been improved 2 or more lines in 23 eyes(79%). The causes of SMH were age-related macular degeneration (17 eyes) and microaneurysm (12 eyes). The larger the size of SMH, had the greater the risk of developing vitreous hemorrhage. Twelve eyes of the 29 eyes required vitrectomy owing to vitreous hemorrhage, insufficient removal of SMH, etc. but this pneumatic procedure often eliminated the need for vitrectomy. The visual acuity of the patients with additional vitrectomy was improved with only pneumatic displacement. None of the patients had serious complications with this pneumatic procedure and the vitrectomy. CONCLUSION: The first choice for SMH is intravitreal gas injection which saves foveal function, and improves the prognosis for better vision.

[Influence of vitrectomy for diabetic retinopathy on health-related quality of life].

PURPOSE: To evaluate the vision-related quality of life (QOL) in patients undergoing vitrectomy for diabetic retinopathy with the Japanese version of the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25). SUBJECTS AND METHODS: Subjects were 87 patients undergoing vitrectomy for diabetic retinopathy of vitreous hemorrhage, macular edema, or fibrovascular membrane, only for the subject eye, or for subjects undergoing vitrectomy for the fellow eye within 6 months or later. The VFQ-25 date was recorded one month before and 6 months after the vitrectomy. The VFQ-25 data were compared before and after the vitrectomy. The subjects were classified by the pathological condition: 41 eyes with vitreous hemorrhage, 28 eyes with macular edema, and 18 eyes with fibrovascular membrane. RESULTS: The average VFQ-25 scores of all the patients increased in almost all of the 12 subscales. Vitrectomy for vitreous hemorrhage was most effective in improving the VFQ-25 score, in improving 10 of the 12 subscales in the VFQ-25, and in increasing VFQ-25 scores to almost the same level as in phacoemulsification and foldable intraocular lens implantation for cataract patients in both eyes. CONCLUSION: NEI VFQ-25 quantitatively clarified that vitrectomy for diabetic retinopathy is effective in increasing the QOL of diabetic retinopathy patients.