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1.
Jpn J Ophthalmol ; 68(3): 211-215, 2024 May.
Article in English | MEDLINE | ID: mdl-38609716

ABSTRACT

PURPOSE: To investigate the association between the arm-to-choroidal circulation time (ACT) on indocyanine green angiography (IA) and clinical profile in patients with polypoidal choroidal vasculopathy (PCV). STUDY DESIGN: Single-center retrospective study. METHODS: We included 38 eyes of 38 patients with PCV diagnosed using multimodal imaging and did not undergo previous treatment. All patients were treated with monthly aflibercept injections for 3 months and treat-and-extend regimens for the subsequent 12 months. Posterior vortex vein ACT was assessed on the first visit using Heidelberg IA. The patients were divided into two groups: ACT ≥20 s (L group; eight eyes) and ACT <20 s (S group; 30 eyes). The clinical profiles before and after treatment were analyzed to assess associations with ACT. RESULTS: The mean ACT was 16.39±3.3 s (L group: 21.25±1.49 s, women:men=2:6, mean age: 77.3±6.5 years; S group: 15.10±2.17 s, women:men=7:23, mean age: 75.5±6.9 years). No significant difference was observed in the mean subfoveal choroidal thickness between the L and the S groups (176±75 µm vs. 230±79 µm, P=0.10). However, there were significant differences between the L and S groups in retinal fluid accumulation and hemorrhage recurrence (eight/eight eyes, 100% vs. 13/30 eyes, 43%, P<0.001), mean aflibercept injections (8.8±1.6 vs. 7.0±1.6, P<0.01) during the 12-month period, and the number of polypoidal lesions (1.8±0.7 vs. 1.3±0.5, P<0.05). CONCLUSION: Patients with PCV and ACT >20 s are more likely to experience exudative change recurrence in the retina during treatment because they have more polypoidal lesions.


Subject(s)
Choroid , Fluorescein Angiography , Fundus Oculi , Intravitreal Injections , Polyps , Receptors, Vascular Endothelial Growth Factor , Recombinant Fusion Proteins , Tomography, Optical Coherence , Visual Acuity , Humans , Female , Male , Retrospective Studies , Choroid/blood supply , Choroid/diagnostic imaging , Aged , Fluorescein Angiography/methods , Tomography, Optical Coherence/methods , Polyps/diagnosis , Polyps/drug therapy , Polyps/physiopathology , Receptors, Vascular Endothelial Growth Factor/therapeutic use , Receptors, Vascular Endothelial Growth Factor/administration & dosage , Recombinant Fusion Proteins/administration & dosage , Recombinant Fusion Proteins/therapeutic use , Indocyanine Green/administration & dosage , Follow-Up Studies , Choroidal Neovascularization/drug therapy , Choroidal Neovascularization/diagnosis , Choroidal Neovascularization/physiopathology , Coloring Agents/administration & dosage , Aged, 80 and over , Choroid Diseases/diagnosis , Choroid Diseases/drug therapy , Choroid Diseases/physiopathology , Angiogenesis Inhibitors/administration & dosage , Angiogenesis Inhibitors/therapeutic use , Regional Blood Flow/physiology , Multimodal Imaging , Blood Flow Velocity/physiology , Polypoidal Choroidal Vasculopathy
2.
Retina ; 44(1): 136-143, 2024 Jan 01.
Article in English | MEDLINE | ID: mdl-37748439

ABSTRACT

PURPOSE: To investigate eyes with polypoidal lesions associated with choroidal nevi, their multimodal imaging characteristics, and long clinical follow-up. METHODS: Multicenter, retrospective case series study of patients with polypoidal lesions overlying choroidal nevi. Demographic and clinical information were recorded. Multimodal imaging including color fundus photography, optical coherence tomography, optical coherence tomography angiography, fundus fluorescein angiography, indocyanine angiography, and A- and B-scan ultrasonography were analyzed for nevus and polypoidal lesion characteristics. RESULTS: Fourteen eyes (14 patients; mean age: 70.3 ± 6.7 years) with polypoidal lesions overlying choroidal nevi were included. The mean follow-up duration was 50.0 ± 27.9 months (range 12-108). All nevi were pigmented on color fundus photography, flat on ultrasonography with a mean basal diameter of 3.8 ± 0.4 mm. In all but one eye, optical coherence tomography showed a shallow irregular pigment epithelium detachment overlying the nevus. A total of 11/14 eyes (78.6%) had exudative activity, 9 eyes received intravitreal anti-vascular endothelial growth factor injections, and one eye required intravitreal anti-vascular endothelial growth factor combined with photodynamic therapy. Mean visual acuity was 20/32 at baseline and 20/50 at final visit. CONCLUSION: We present the largest known cohort of eyes with polypoidal lesions associated with choroidal nevi with up to 9 years follow-up. The exudative degree of the polypoidal lesion in this condition is variable and treatment decisions should be taken on an individual basis. We hypothesize that choroidal ischemia because of altered choroidal vasculature rather than Haller layer hyperpermeability plays a role in the formation of polypoidal lesions overlying nevi.


Subject(s)
Choroid Diseases , Choroid Neoplasms , Nevus , Polyps , Humans , Middle Aged , Aged , Retrospective Studies , Endothelial Growth Factors , Choroid Diseases/drug therapy , Choroid/pathology , Choroid Neoplasms/pathology , Tomography, Optical Coherence/methods , Fluorescein Angiography/methods , Polyps/drug therapy , Intravitreal Injections
3.
Surv Ophthalmol ; 69(2): 173-178, 2024.
Article in English | MEDLINE | ID: mdl-37806565

ABSTRACT

Anti-vascular endothelial growth factor (anti-VEGF) injections have revolutionized the field of ophthalmology, and their use in a variety of retinal diseases is growing. One target disease is peripheral exudative hemorrhagic chorioretinopathy, a disease that is uncommon and poorly understood. Despite this, there are numerous studies and case reports outlining the potential role of intravitreal injection of anti-VEGF medicines to treat it. As such, an evidence-based understanding of its risk-benefit profile is vital. We performed a comprehensive search in the PubMed, Google Scholar, and Cochrane databases for published studies and case reports relating to the use of anti-VEGF injections in peripheral exudative hemorrhagic chorioretinopathy. Anti-VEGF was first used in 2010 to aid in the management of peripheral exudative hemorrhagic chorioretinopathy. Since then, it has been increasingly used to manage this disease. Other potential management strategies, including laser photocoagulation, cryotherapy, photodynamic therapy, and vitrectomy are explored and compared with anti-VEGF where possible. Anti-VEGF appears to be an effective therapy in managing peripheral exudative hemorrhagic chorioretinopathy, especially when there is an exudative threat to the macula.


Subject(s)
Choroid Diseases , Macula Lutea , Retinal Diseases , Humans , Endothelial Growth Factors , Vascular Endothelial Growth Factor A , Intravitreal Injections , Retinal Diseases/drug therapy , Choroid Diseases/drug therapy , Angiogenesis Inhibitors/therapeutic use , Retrospective Studies
4.
Eur J Ophthalmol ; 34(1): NP41-NP43, 2024 Jan.
Article in English | MEDLINE | ID: mdl-37345304

ABSTRACT

INTRODUCTION: Tuberculosis can involve any organ in the body including ocular tissue of which the uveal tissue is most commonly infected. Choroidal involvement ranges from choroidal tubercles to granulomas. This is one of the few cases of a solitary choroidal granuloma with no other systemic symptoms in an immunocompetent child. METHOD: A case report. RESULTS: A 12-year-old female, presented with diminution of vision in the left eye for a month. The anterior segment of her left eye was normal. A fundus examination revealed an isolated orangish-yellow choroidal mass, 4 DD in size, involving the posterior pole with overlying subretinal exudation. CT scan of the thorax showed large pulmonary, cervical and pancreatic lymph nodes, along with lytic lesions of the thoracic vertebrae. Excision biopsy of the cervical lymph nodes showed caseating granulomas with no e/o malignancies on histopathology. The patient was started on anti-tubercular therapy. Six months after the treatment, the lesion had reduced in size and her vision had improved. CONCLUSION: Isolated choroidal tuberculomas can be present in eyes with little associated ocular inflammation and no other symptoms of systemic tuberculosis. High suspicion, early diagnosis and rapid initiation of medication are important for the treatment of ocular and systemic tuberculosis.


Subject(s)
Choroid Diseases , Tuberculoma , Tuberculosis, Ocular , Humans , Female , Child , Tuberculosis, Ocular/diagnosis , Tuberculosis, Ocular/drug therapy , Tuberculoma/diagnostic imaging , Tuberculoma/drug therapy , Granuloma/diagnosis , Granuloma/drug therapy , Granuloma/etiology , Choroid , Choroid Diseases/diagnosis , Choroid Diseases/drug therapy , Choroid Diseases/etiology
5.
BMC Ophthalmol ; 23(1): 511, 2023 Dec 14.
Article in English | MEDLINE | ID: mdl-38097999

ABSTRACT

PURPOSE: To evaluate the long-term prognosis of polypoidal choroidal vasculopathy (PCV) treated with anti-vascular endothelial growth factor (anti-VEGF) combined with verteporfin photodynamic therapy (PDT), according to polypoidal lesion regression. METHODS: This study retrospectively reviewed the data of 33 naïve eyes with PCV treated with anti-VEGF combined with verteporfin PDT and followed-up for at least 7 years. The collected data included demographic profile, best-corrected visual acuity (BCVA), central foveal thickness (CFT), PED volume, and presence of submacular hemorrhage. Regression of polypoidal lesion was determined using indocyanine green angiography and optical coherence tomography. All eyes were divided into regression or persistent groups, based on the polypoidal lesion regression one year after the initial combined treatment. RESULTS: BCVA improvement was maintained for 3 years in the regression (p = 0.001) and 1 year in the persistent (p = 0.006) groups, respectively. The mean BCVA of the regression group was better than that of the persistent group over 7 years, but the difference was significant only at 1 year (p = 0.037). The number of eyes which maintained BCVA less than or equal to 0.3 logMAR at 7 years was 11 eyes (64.7%) in regression group and 4 eyes (25.0%) in persistent group (p = 0.022). CONCLUSIONS: Regression of the polypoidal lesion at 1 year after the initial combination treatment was associated with favorable long-term visual prognosis, particularly in terms of maintaining good visual acuity.


Subject(s)
Choroid Diseases , Photochemotherapy , Humans , Verteporfin/therapeutic use , Angiogenesis Inhibitors/therapeutic use , Endothelial Growth Factors/therapeutic use , Photochemotherapy/methods , Vascular Endothelial Growth Factor A , Polypoidal Choroidal Vasculopathy , Retrospective Studies , Choroid Diseases/diagnosis , Choroid Diseases/drug therapy , Fluorescein Angiography , Intravitreal Injections , Tomography, Optical Coherence
6.
Arch Soc Esp Oftalmol (Engl Ed) ; 98(12): 713-717, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37951353

ABSTRACT

We describe one case of polypoidal choroidal vasculopathy with persistent subretinal fluid despite multiple treatment with intravitreal Bevacizumab, Ranibizumab and Aflibercept, as well as Aflibercept associated with photodynamic therapy. The patient reached complete resolution after intravitreal Brolucizumab injection, but experienced recurrence of subretinal fluid 12 weeks after discontinuation. Brolucizumab might be an option in treating subretinal fluid after failure of other anti-VEGF agents associated with photodynamic therapy.


Subject(s)
Choroid Diseases , Photochemotherapy , Humans , Choroid Diseases/drug therapy , Choroid Diseases/complications , Polypoidal Choroidal Vasculopathy
8.
Sci Rep ; 13(1): 4800, 2023 03 23.
Article in English | MEDLINE | ID: mdl-36959460

ABSTRACT

We describe the clinical characteristics of treatment-naïve polypoidal choroidal vasculopathy (PCV) in three tertiary clinic settings in 2 cities (Chicago in the USA and Nishinomiya in Japan). This cohort study was a retrospective, multicenter, consecutive case series. A total of 126 patients with treatment-naïve PCV-46 in Chicago and 80 in Nishinomiya-were identified. The proportion of PCV in patients with neovascular age-related macular degeneration was lower in Chicago (10.8% vs. 36.9%). Patients in Chicago had a significantly higher prevalence of soft drusen (50.0% vs 25.0%, p = 0.006) and intra-retinal cyst (37.0% vs 15.0%, p = 0.008), and a significantly lower prevalence of pachyvessels (41.3% vs 62.5%, p = 0.03). At baseline, presenting vision for patients in Chicago was worse than in Nishinomiya (mean log MAR: 0.609 vs. 0.312, p < 0.001). Ninety-five eyes were followed for more than one year. The Nishinomiya group received a higher rate of combination therapy (61.0%) compared to the Chicago group (5.3%). Vision and central foveal thickness at month 12 were significantly improved from baseline in both Chicago (p = 0.009 and p = 0.01) and Nishinomiya groups (both p < 0.001). Our study highlights interesting differences in the proportion of PCV, clinical findings and treatment responses of PCV, that need to be further evaluated in larger, epidemiologic cohorts.


Subject(s)
Choroid Diseases , Choroidal Neovascularization , Polyps , Retinal Drusen , Humans , Choroid Diseases/drug therapy , Choroid/blood supply , Cohort Studies , Retrospective Studies , Polypoidal Choroidal Vasculopathy , Japan/epidemiology , Fluorescein Angiography , Retinal Drusen/pathology , Tomography, Optical Coherence , Polyps/diagnosis , Polyps/epidemiology , Polyps/pathology , Choroidal Neovascularization/diagnosis , Choroidal Neovascularization/epidemiology , Choroidal Neovascularization/drug therapy
9.
Eur J Ophthalmol ; 33(1): 448-454, 2023 Jan.
Article in English | MEDLINE | ID: mdl-35535409

ABSTRACT

PURPOSE: To compare clinical and imaging features and treatment outcomes between eyes having peripheral polypoidal choroidal vasculopathy (PCV) and macular PCV. METHODS: In this retrospective comparative case series, confirmed cases of peripheral and macular PCV cases on indocyanine green angiography (ICGA) were included. The various demographic features, imaging characteristics and clinical course between cases with peripheral and macular PCV were compared and analysed. RESULTS: Fifteen eyes of 12 patients and 22 eyes of 20 patients were diagnosed with peripheral PCV and macular PCV respectively based on polyps seen on ICGA. Mean age at presentation in peripheral and macular PCV groups were 76.3 ± 8.78 and 69.1 ± 8.64 years respectively (p = 0.038). Mean logMAR visual acuity in the peripheral and macular PCV group was 0.423 ± 0.568 and 0.535 ± 0.513 respectively (p = 0.595). Peripheral subretinal hemorrhage was noted commonly in the peripheral PCV group (n = 10, 66%) and hard exudates were common in the macular PCV (19, 86%) group. Subfoveal choroid was significantly thinner in peripheral PCV group compared to macular PCV group (215.2 ± 39.94 vs 283.3 ± 50.08; p = 0.001). At final follow-up visit, 50% eyes (n = 11) in macular PCV group were still active and 87% (n = 13) eyes in the peripheral PCV showed an inactive disease (p = 0.035). CONCLUSION: Peripheral and macular PCV cases are two separate clinical entities having distinct pathogenesis, clinical and imaging features and treatment outcomes. Further studies are needed for understanding the pathomechanism in these distinct disease entities.


Subject(s)
Choroid Diseases , Choroidal Neovascularization , Polyps , Humans , Polypoidal Choroidal Vasculopathy , Retrospective Studies , Fluorescein Angiography/methods , Choroid , Choroid Diseases/diagnosis , Choroid Diseases/drug therapy , Tomography, Optical Coherence/methods , Polyps/diagnosis , Polyps/drug therapy , Indocyanine Green , Choroidal Neovascularization/diagnosis , Choroidal Neovascularization/drug therapy , Coloring Agents
10.
Retina ; 42(11): 2091-2098, 2022 11 01.
Article in English | MEDLINE | ID: mdl-35963005

ABSTRACT

PURPOSE: To evaluate the predictors of complete polypoidal lesion regression (CPREG) in polypoidal choroidal vasculopathy. METHODS: Post hoc analysis of EVEREST II-a 24-month, multicenter, randomized, controlled clinical trial of 322 patients with polypoidal choroidal vasculopathy, randomized to receive ranibizumab with or without photodynamic therapy. Images of indocyanine green angiography (ICGA) were graded by a central reading center. Multiple logistic regression analysis with significant baseline predictors then was conducted to assess adjusted odds ratios for CPREG at month (M) 12. RESULTS: Baseline ICGA characteristics were comparable between the treatment groups. Patients treated with combination therapy had higher odds of achieving CPREG at M12 (adjusted odds ratio = 4.64; 95% confidence interval, 2.85-7.55; P < 0.001) compared with those in the monotherapy group. Absence of polypoidal lesion pulsation on ICGA was also associated with CPREG at M12 (adjusted odds ratio = 2.62; 95% confidence interval, 1.32-5.21; P = 0.006). The presence of CPREG at M3 had higher odds of maintaining CPREG at M12 (adjusted odds ratio = 6.60; 95% confidence interval, 3.77-11.57; P < 0.001) compared with those with persistent polypoidal lesions. CONCLUSION: At M12, treatment with combination therapy was associated with higher probability of achieving CPREG than with ranibizumab monotherapy. The results contribute to the further understanding of the response of polypoidal lesions to treatment.


Subject(s)
Choroid Diseases , Eye Diseases , Polyps , Humans , Ranibizumab/therapeutic use , Choroid Diseases/diagnosis , Choroid Diseases/drug therapy , Choroid Diseases/pathology , Fluorescein Angiography , Choroid/pathology , Indocyanine Green , Intravitreal Injections , Coloring Agents , Polyps/diagnosis , Polyps/drug therapy , Polyps/pathology , Eye Diseases/pathology
11.
Graefes Arch Clin Exp Ophthalmol ; 260(11): 3533-3542, 2022 Nov.
Article in English | MEDLINE | ID: mdl-35678837

ABSTRACT

PURPOSE: Combined use of photodynamic therapy (PDT) with intravitreal anti-vascular endothelial growth factors (anti-VEGF) agents, such as ranibizumab (IVR) or aflibercept (IVA), has been shown to be effective for treating polypoidal choroidal vasculopathy (PCV). However, it is currently not well established which anti-VEGF agent provides superior outcomes for performing combination therapy. The present study compares the visual outcomes and re-treatment burden of combination therapy of PDT with either IVR or IVA in a European cohort of patients with PCV. METHODS: A retrospective analysis was done on PCV patients who had received combination therapy of PDT with either IVR or IVA. The demographic characteristics, visual outcome, and anti-VEGF re-treatment exposures were analysed and compared. RESULTS: A total of forty-four eyes (n = 11 male, 25%) were included in the analysis: 7 patients received IVR, 19 started with IVR but switched to IVA (IVS), and 18 received IVA, in combination with PDT. The BCVA improved in all three groups at 6-, 12-, 18-, 24-, 30-, and 36-month follow-ups after PDT, although the improvement was not statistically significant in the IVR group. The number of intravitreal anti-VEGF injections required/year after PDT was significantly fewer than before PDT. Significantly less eyes in the IVS group attained a good visual acuity of more than 70 ETDRS letters at the final visit. CONCLUSION: Both IVR and IVA combined with PDT were effective treatments for the European cohort of patients with PCV. In eyes refractory to IVR, performing PDT promptly may be more beneficial than switching to IVA.


Subject(s)
Choroid Diseases , Photochemotherapy , Humans , Male , Ranibizumab , Retrospective Studies , Endothelial Growth Factors/therapeutic use , Angiogenesis Inhibitors , Visual Acuity , Intravitreal Injections , Choroid Diseases/diagnosis , Choroid Diseases/drug therapy , Fluorescein Angiography , Treatment Outcome
13.
Graefes Arch Clin Exp Ophthalmol ; 260(5): 1641-1650, 2022 May.
Article in English | MEDLINE | ID: mdl-34735633

ABSTRACT

PURPOSE: To investigate the clinical features and treatment outcomes of patients with choroidal tuberculoma. METHODS: In this retrospective, observational case series, the medical records of five patients with choroidal tuberculoma who were followed up at a university hospital for at least 6 months were analyzed. RESULTS: Of five patients, one was male and four were female. The overall mean age was 38.0 ± 9.4 years (mean follow-up: 41.2 ± 33.8 months). Tuberculin skin test was performed in three patients, and it was positive in two of them. Interferon-gamma assay was performed in two patients and was positive in all two. Three patients had systemic tuberculosis involving the lung or other organs. Five patients were treated with antitubercular therapy for a period of 9.6 ± 8.6 months. Systemic corticosteroid treatment was performed in 3 patients, with a period of 3.5 ± 0.7 months. One patient with a recurrent vascularized tuberculoma was successfully treated with single intravitreal bevacizumab injection. CONCLUSION: Choroidal tuberculoma can develop without evidence of systemic tuberculosis and can recur despite antitubercular treatment. High index of suspicion is important in early detection, and management of choroidal tuberculoma. In cases of suspected choroidal tuberculoma, positive results on immunological tests would be sufficient to initiate antitubercular therapy even if radiological evidence of systemic tuberculosis is not found. Antitubercular therapy combined with systemic corticosteroids provided favorable results. Intravitreal injection of anti-vascular endothelial growth factor may be considered for highly vascularized choroidal tuberculoma.


Subject(s)
Choroid Diseases , Tuberculoma , Tuberculosis, Ocular , Adult , Antitubercular Agents/therapeutic use , Choroid Diseases/diagnosis , Choroid Diseases/drug therapy , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Tuberculoma/diagnosis , Tuberculoma/drug therapy , Tuberculosis, Ocular/diagnosis , Tuberculosis, Ocular/drug therapy
14.
Eye (Lond) ; 36(10): 1934-1939, 2022 10.
Article in English | MEDLINE | ID: mdl-34584234

ABSTRACT

OBJECTIVES: To describe the real-world outcomes of photodynamic therapy (PDT) as a rescue therapy in eyes with polypoidal choroidal vasculopathy (PCV) refractory to anti-vascular endothelial growth factor (VEGF) monotherapy in a British cohort of patients. METHODS: This is a retrospective chart review of 53 eyes with PCV. Based on the timing of PDT, the eyes were stratified into two groups (9 in the Initial-PDT group, 44 in the Deferred group). The number of anti-VEGF injections/year and the best corrected visual acuity (BCVA) before and after PDT were analysed. Multivariate regression model was created to identify factors predictive of visual outcome and treatment burden after PDT. RESULTS: The Deferred group received a mean of 9.4 injections/year but significantly reduced to 7.2 after PDT (p < 0.001). The Initial-PDT group required significantly fewer injections after PDT compared to the Deferred group (p = 0.004). The Deferred group experienced improvement in BCVA from 58.7 letters at baseline to 63.8 at 18-months follow-up (p < 0.001), but no significant increase was observed in the Initial-PDT group (p = 0.310). Better baseline BCVA is associated with higher likelihood of achieving good BCVA ≥ 70 letters after PDT (Odd Ratio=1.12, 95% CI: 1.03-1.21, p = 0.006), while increased number of anti-VEGF injections/year before PDT reduces the likelihood of easing treatment burden to ≥12 weeks apart between each injection after PDT (Odd Ratio=0.724, 95% CI: 0.58-0.91, p = 0.006). CONCLUSIONS: PDT as a rescue therapy is beneficial in the long-term management of PCV, particularly in eyes that had experienced a significant period of prior exposure to anti-VEGF monotherapy.


Subject(s)
Choroid Diseases , Eye Diseases , Photochemotherapy , Angiogenesis Inhibitors/therapeutic use , Choroid Diseases/diagnosis , Choroid Diseases/drug therapy , Endothelial Growth Factors/therapeutic use , Eye Diseases/drug therapy , Fluorescein Angiography , Humans , Intravitreal Injections , Retrospective Studies , Treatment Outcome , Vascular Endothelial Growth Factor A/therapeutic use , Visual Acuity
15.
Retina ; 42(1): 114-122, 2022 01 01.
Article in English | MEDLINE | ID: mdl-34412103

ABSTRACT

PURPOSE: To evaluate whether optical coherence tomography (OCT) can determine polypoidal lesion (PL) perfusion in polypoidal choroidal vasculopathy eyes after 12 months of aflibercept monotherapy. Polypoidal lesion perfusion status, assessed by indocyanine green angiography, is an important anatomical outcome in polypoidal choroidal vasculopathy management. METHODS: Post hoc data from a prospective randomized, open-label, study in eyes with polypoidal choroidal vasculopathy undergoing monotherapy with aflibercept evaluated PL perfusion status based on indocyanine green angiography (gold standard) and OCT features from baseline to 12 months. RESULTS: Individual PLs (110 in total) from 48 eyes (48 patients) showed at 12 months; 57/110 PLs (51.8%) were closed on indocyanine green angiography. At 12 months, eyes with closed PLs were more likely to have the following OCT features: 1) no subretinal fluid (67.1% vs. 32.9%), 2) smaller pigment epithelial detachment height (67.2 [±43.8] vs. 189.2 [±104.9] µm), 3) densely hyperreflective pigment epithelial detachment contents (84.0% vs. 16.0%), 4) an absence of a hyperreflective ring(64.0% vs. 36.0%), and a 5) indistinct overlying retinal pigment epithelial (71.4% vs. 28.6%) (all P < 0.05). The three highest performing OCT features that differentiated perfused from closed PLs were (1), (3), and (4) (area under the receiver operating characteristic curve 0.85, 0.73, and 0.70, respectively). A combination of these three features achieved an area under the receiver operating characteristic curve of 0.90. CONCLUSION: Polypoidal lesion closure, an important anatomical treatment outcome in polypoidal choroidal vasculopathy typically defined by indocyanine green angiography, can be accurately detected by specific OCT features.


Subject(s)
Choroid Diseases/drug therapy , Choroid/blood supply , Polyps/drug therapy , Receptors, Vascular Endothelial Growth Factor/administration & dosage , Recombinant Fusion Proteins/administration & dosage , Aged , Angiogenesis Inhibitors/administration & dosage , Choroid Diseases/diagnosis , Female , Fluorescein Angiography/methods , Follow-Up Studies , Fundus Oculi , Humans , Intravitreal Injections , Male , Polyps/diagnosis , Prospective Studies , Receptors, Vascular Endothelial Growth Factor/antagonists & inhibitors , Time Factors , Tomography, Optical Coherence/methods
16.
Retina ; 42(1): 123-128, 2022 01 01.
Article in English | MEDLINE | ID: mdl-34292224

ABSTRACT

PURPOSE: To evaluate the flow signals in subretinal hyperreflective material (SHRM) that represents classic choroidal neovascularization (CNV) on fluorescein angiography in eyes with polypoidal choroidal vasculopathy. METHODS: We retrospectively reviewed 20 eyes with polypoidal choroidal vasculopathy that appeared to have classic CNV on fluorescein angiography, accompanied by SHRM on optical coherence tomography (OCT) at the same location. Using OCT angiography (OCTA), we analyzed intrinsic flow signals in the SHRM (cross-sectional B-scans and en face). The possible association between pretreatment OCT angiography findings and fibrotic scar formation after antivascular endothelial growth factor (VEGF) treatment was evaluated. RESULTS: Six of 20 eyes (30%) showed vascular SHRM; the remaining 14 eyes (70%) showed avascular SHRM at the classic CNV site at baseline. The SHRM corresponded with polypoidal lesions seen on indocyanine green angiography in 5 of 6 eyes with vascular SHRM and in all 14 eyes with avascular SHRM. After anti-VEGF treatment, all 6 eyes with vascular SHRM left a fibrotic scar, whereas all 14 eyes with avascular SHRM showed no scar formation (P < 0.001). CONCLUSION: Using OCT angiography, we evaluated the flow signals in SHRM that represented classic CNV in eyes with polypoidal choroidal vasculopathy and successfully differentiated true Type 2 macular neovascularization from pseudo classic CNV.


Subject(s)
Angiogenesis Inhibitors/administration & dosage , Choroid Diseases/diagnosis , Choroid/blood supply , Choroidal Neovascularization/diagnosis , Fluorescein Angiography/methods , Polyps/diagnosis , Tomography, Optical Coherence/methods , Aged , Choroid/diagnostic imaging , Choroid Diseases/complications , Choroid Diseases/drug therapy , Choroidal Neovascularization/drug therapy , Choroidal Neovascularization/etiology , Cross-Sectional Studies , Female , Follow-Up Studies , Fundus Oculi , Humans , Intravitreal Injections , Male , Polyps/complications , Polyps/drug therapy , Retrospective Studies , Visual Acuity
17.
Ophthalmol Retina ; 6(1): 21-28, 2022 01.
Article in English | MEDLINE | ID: mdl-33781929

ABSTRACT

PURPOSE: To understand timing of complete polypoidal regression on indocyanine green angiography (ICGA) after aflibercept injections for polypoidal choroidal vasculopathy (PCV). DESIGN: Multicenter prospective study. PARTICIPANTS: Adults with treatment-naïve PCV. METHODS: After institutional review board approval, participants were enrolled and followed up for 1 year, from Apr 1, 2016, through Dec 30, 2018, at 2 university-based centers in Thailand. Diagnosis of PCV was based on the Efficacy and Safety of Verteporfin Photodynamic Therapy in Combination with Ranibizumab or Alone versus Ranibizumab Monotherapy in Patients with Symptomatic Macular Polypoidal Choroidal Vasculopathy criteria. Eligible eyes received fixed-dose aflibercept injections (3 monthly then every 8 weeks), or monthly if fluid persisted on OCT. Photodynamic therapy (PDT) was administered when fluid persisted despite 6 consecutive injections. Indocyanine green angiography was performed at baseline and then every 8 weeks. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was administered at baseline, 6 months, and 1 year. Two retina specialists reviewed posttreatment ICGA, categorized into: complete regression (complete disappearance of polypoidal lesions), partial regression (reduced in size or number), or no regression. Disagreements were resolved through open adjudication. MAIN OUTCOME MEASURES: Timing of complete regression over 1 year. RESULTS: Final analysis included 40 eyes (39 participants; 100% Thai, 59% women; mean age±standard deviation, 64 ± 8.3 years). At baseline, 90% had 5 or more polypoidal lesions. Ninety-five percent received aflibercept monotherapy, and 5% received rescue PDT per protocol. Polypoidal statuses at 1 year were 55% complete, 40% partial, and 5% no regression. Cumulative rates of complete regression at 2, 4, 6, and 12 months were 28%, 33%, 43%, and 55%. Of 22 eyes with complete regression at 1 year, complete regression was identified first at 2, 4, 6, 8, 10, 12 months in 50%, 9%, 18%, 5%, 9%, and 9%, respectively. Cumulative rates of complete regression among these eyes at 2, 6, and 12 months were 50%, 77%, and 100%, respectively. Median duration of complete regression was 3 months (interquartile range, 2-6 months). Median visual acuity improved from 20/125 (Snellen equivalent) to 20/50; median NEI VFQ-25 scores improved from 80 to 93 from baseline to 1 year. CONCLUSIONS: Complete polypoidal regression could occur as early as 2 months after aflibercept injections. Most PCV eyes with complete polypoidal regression at 1 year already showed complete regression within the first 6 months. These findings support consideration of aflibercept for PCV to achieve both anatomic and visual outcomes.


Subject(s)
Choroid Diseases/drug therapy , Choroid/blood supply , Polyps/drug therapy , Receptors, Vascular Endothelial Growth Factor/administration & dosage , Recombinant Fusion Proteins/administration & dosage , Tomography, Optical Coherence/methods , Visual Acuity , Aged , Angiogenesis Inhibitors/administration & dosage , Choroid Diseases/diagnosis , Disease Progression , Female , Fluorescein Angiography , Follow-Up Studies , Humans , Intravitreal Injections , Male , Middle Aged , Polyps/diagnosis , Prospective Studies , Time Factors , Vascular Endothelial Growth Factor A/antagonists & inhibitors
18.
Br J Ophthalmol ; 106(4): 576-581, 2022 04.
Article in English | MEDLINE | ID: mdl-33355149

ABSTRACT

BACKGROUND/AIMS: To analyse the long-term anatomic and visual outcomes of patients with peripapillary pachychoroid syndrome (PPS), a recently described entity in the pachychoroid disease spectrum. METHODS: This study retrospectively included patients from several retina centres worldwide. Visual acuity (VA), retinal thickness and choroidal thickness at baseline, 6 months and final follow-up were assessed. Temporal trends in VA and anatomic characteristics were evaluated. Visual and anatomic outcomes in eyes that were observed versus those that were treated were analysed. RESULTS: Fifty-six eyes of 35 patients were included with mean follow-up of 27±17 months. Median VA was 20/36 at baseline and remained stable through follow-up (p=0.77). Retinal thickness significantly decreased subfoveally (p=0.012), 1.5 mm nasal to the fovea (p=0.002) and 3.0 mm nasal to the fovea (p=0.0035) corresponding to areas of increased thickening at baseline. Choroidal thickness significantly decreased subfoveally (p=0.0030) and 1.5 mm nasal to the fovea (p=0.0030). Forty-three eyes were treated with modalities including antivascular endothelial growth factor injection, photodynamic therapy, and others. VA remained stable in treated eyes over follow-up (p=0.67). An isolated peripapillary fluid pocket in the outer nuclear layer was characteristic of PPS. CONCLUSION: Patients with PPS experienced decreased retinal oedema and decreased choroidal thickening throughout the course of disease. While some patients experienced visual decline, the overall visual outcome was relatively favourable and independent of trends in retinal or choroidal thickening.


Subject(s)
Choroid Diseases , Tomography, Optical Coherence , Choroid , Choroid Diseases/diagnosis , Choroid Diseases/drug therapy , Fluorescein Angiography , Humans , Retrospective Studies
19.
Sci Rep ; 11(1): 21572, 2021 11 03.
Article in English | MEDLINE | ID: mdl-34732787

ABSTRACT

This retrospective study aimed to evaluate the factors affecting recurrence and visual prognosis in patients with treatment-naïve subfoveal polypoidal choroidal vasculopathy (PCV). Patients who had received three consecutive intravitreal injections of ranibizumab or aflibercept and had reached remission were enrolled. They were divided into a group without recurrence (group 1, 26 eyes) and a group with recurrence (group 2, 121 eyes) and followed up for at least 5 years. Patients in group 2 received additional treatment for worsening. Logistic regression analysis revealed that a young age of onset (P = 0.001), high choroidal vascularity index (CVI; P = 0.019), and presence of choroidal vascular hyperpermeability (CVH; P = 0.037) were associated with a low risk of recurrence. Multiple regression analysis revealed that recurrence (P = 0.001), greatest linear dimension (P = 0.003), and polyp configuration (single or cluster; P = 0.043) were associated with final visual acuity. Patients without recurrence had a lower age of onset and higher CVI than those with recurrence, and they tended to have CVH. In addition, patients with recurrence, large lesion, and cluster polyps had worse final visual acuity than those without these factors. CVI and CVH may be used to predict recurrence of PCV.


Subject(s)
Choroid Diseases/diagnosis , Choroid Diseases/drug therapy , Photochemotherapy/methods , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Aged , Choroid Diseases/physiopathology , Choroidal Neovascularization/pathology , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Permeability , Prognosis , Recurrence , Regression Analysis , Retrospective Studies , Treatment Outcome , Vision Disorders
20.
Sci Rep ; 11(1): 20115, 2021 10 11.
Article in English | MEDLINE | ID: mdl-34635762

ABSTRACT

To provide real-world experiences of treating polypoidal choroidal vasculopathy (PCV) patients with photodynamic therapy (PDT) plus intravitreal injection of ranibizumab or intravitreal injection of aflibercept alone. Retrospective chart review of patients with PCV in a single tertiary referral center in Taiwan. Chart review of PCV patients treated with PDT and injection of ranibizumab or injection of aflibercept. A total of 101 eyes of 101 patients (38 females and 63 males) were reviewed. Of those, 48 and 53 eyes received primary/adjunctive PDT along with injections of ranibizumab or intravitreal injections of aflibercept only, respectively. Initial visual acuity (VA) and central subfield choroidal thickness were similar between the two groups (p > 0.05). In addition, changes in VA at 3, 6, and 12 months post treatment were similar. The central retinal thickness decreased with either treatment (p < 0.01); however, this change did not translate into VA performance (p > 0.05). In the subgroup analysis of pachychoroid and non-pachychoroid patients, better initial VA and post-treatment VA at 3 months and 6 months was noted in the latter group of patients treated with anti-vascular endothelial growth factor monotherapy (p < 0.05). Aflibercept monotherapy is comparable with PDT plus ranibizumab in PCV patients with PCV (pachychoroid and non-pachychoroid patients). In addition, better prognosis regarding VA was observed in non-pachychoroid patients treated with aflibercept monotherapy.


Subject(s)
Choroid Diseases/drug therapy , Choroidal Neovascularization/drug therapy , Photochemotherapy/methods , Polyps/drug therapy , Ranibizumab/therapeutic use , Receptors, Vascular Endothelial Growth Factor/therapeutic use , Recombinant Fusion Proteins/therapeutic use , Aged , Angiogenesis Inhibitors/therapeutic use , Choroid Diseases/pathology , Choroidal Neovascularization/pathology , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Photosensitizing Agents/therapeutic use , Polyps/pathology , Retrospective Studies , Treatment Outcome
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