Three-Year Results of Fluorescein Angiography-Guided Standard Photodynamic Therapy with Multiple Spots for Central Serous Chorioretinopathy.

PURPOSE: To report the long-term results of fluorescein angiography (FA)-guided standard photodynamic therapy (PDT) for central serous chorioretinopathy (CSCR) and its adverse effects. DESIGN: Prospective, noncomparative, interventional study. PARTICIPANTS: Consecutive patients (N = 63 eyes) with acute (39 eyes) or chronic (24 eyes) CSCR. METHODS: All eyes underwent FA-guided conventional PDT, using multiple spots in 1 session if appropriate, and were assessed before PDT, as well as at months 3, 6, and 12 after PDT, and every 6 months thereafter until the end of the 3-year follow-up time. MAIN OUTCOME MEASURES: Primary outcome measures were the resolution of subretinal fluid (SRF) and the improvement of the Snellen best-corrected visual acuity (BCVA) to better than 20/100 at the end of the study. Secondary outcomes were the changes in mean BCVA and central foveal thickness (CFT) during the follow-up time. RESULTS: All 63 eyes with acute or chronic CSCR demonstrated complete resolution of SRF at the end of the study. Of the studied eyes, 51 (80.95%) underwent a single PDT application. The mean CFT improved significantly at all time points in the acute CSCR group (P < 0.001) from 515.13±110.5 µm to 297.75±22.3 µm at 3 years and in the chronic CSCR group from 484.12±62.49 µm to 293.81±16.89 µm. At 3 years, a gain of more than 20/100 in Snellen BCVA was seen in 28 acute and 16 chronic CSCR PDT-treated eyes (71.8% vs. 66.67%; P = 0.779). The mean logarithm of the minimum angle of resolution BCVA improved from 0.349±0.18 at baseline to 0.060±0.06 at the end of the study (P < 0.001) for eyes with acute CSCR and from 0.502±0.28 to 0.198±0.11 correspondingly for the eyes with chronic CSCR (P < 0.001). None of the study eyes demonstrated any serious systemic or ophthalmologic complication related to the use of the standard PDT with verteporfin. CONCLUSIONS: Fluorescein angiography-guided conventional PDT achieved outcomes for acute and chronic CSCR comparable with those reported with modified PDT techniques. We did not identify new safety concerns.

Keratoconus Treatment Algorithm.

Keratoconus management has significantly changed over the last two decades. The advent of new interventions such as cornea cross-linking, intrastromal corneal ring segments, and combined treatments provide corneal clinicians a variety of treatment options for the visual rehabilitation of keratoconus patients. This review summarizes current evidence for these treatments and highlights their place in keratoconus management while new promising emerging therapies are being investigated.

Detection of nonexudative choroidal neovascularization secondary to angioid streaks using optical coherence tomography angiography.

PURPOSE: To present a case of nonexudative choroidal neovascularization secondary to angioid streaks in a patient with pseudoxanthoma elasticum. The lesion was monitored over an 8-month period with the use of optical coherence tomography angiography. METHODS: Case report. RESULTS: The neovascular tissue area increased by 0.160 mm2 over a period of 8 months without any sign of exudation seen on optical coherence tomography or fluorescein angiography. CONCLUSIONS: To our knowledge, this is the first report of a nonexudative choroidal neovascularization secondary to angioid streaks. Given that once a patient with angioid streaks develops choroidal neovascularization in one eye there is a high risk of bilateral involvement within a short amount of time, optical coherence tomography angiography can prove a useful tool for monitoring such lesions over time.