CHANGES IN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY AND DISEASE ACTIVITY IN TYPE 3 NEOVASCULARIZATION AFTER ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT.

PURPOSE: To investigate disease activity in patients with Type 3 neovascularization undergoing anti-vascular endothelial growth factor treatment through image analysis using optical coherence tomography angiography (OCTA). METHODS: Thirty-nine treatment-naive eyes with Type 3 neovascularization were included in the retrospective analysis. All patients were treated with three loading injections of an anti-vascular endothelial growth factor agent, followed by further injections as needed. Changes in the Type 3 lesion were analyzed through OCTA imaging during the 12 months of follow-up. RESULTS: The high-flow signal of Type 3 neovascularization on OCTA images disappeared in 46.2% eyes (19 of 39) and was persistent in 53.8% eyes (20 of 39) after loading injections. A persistent high-flow signal on OCTA after treatment was found at the sub-retinal pigment epithelium in 65.0% eyes (13 of 20), deep vascular plexus in 30.0% eyes (6 of 20), and outer neurosensory retina in 15.0% eyes (3 of 20). Eyes without lesions on OCTA images received significantly fewer injections (3.7 vs. 5.5; P = 0.016) and showed a longer retreatment-free period (mean 7.57 vs. 4.07 months; P = 0.002) during the 12-month follow-up than eyes with a persistent high-flow signal on OCTA. However, no significant between-group difference was observed in terms of improved visual acuity. CONCLUSION: Patients with Type 3 neovascularization who had no lesion on an OCTA scan after anti-vascular endothelial growth factor treatment showed a lower recurrence rate and maintained visual acuity with fewer injections than those with persistent high-flow lesions on an OCTA scan. Optical coherence tomography angiography may provide an additional biomarker for clinical guidance in the treatment and monitoring of disease activity in Type 3 neovascularization.

Beneficial effects of adjuvant intravitreal bevacizumab injection on outcomes of Ahmed glaucoma valve implantation in patients with neovascular glaucoma: systematic literature review.

PURPOSE: We evaluated the effects of adjuvant intravitreal bevacizumab injection on the outcomes of Ahmed glaucoma valve (AGV) implantation in patients with neovascular glaucoma (NVG) through a systematic literature review. METHODS: An extensive search of PubMed, EMBASE, and the Cochrane Library was performed in November 2014 for selection of relevant studies. The weighted mean difference of the percentage of intraocular pressure reduction (IOPR%) from baseline to endpoint was used as the primary efficacy estimate, and Mantel-Haenszel odds ratios and 95% confidence intervals (CIs) of the success rate were used as the secondary efficacy estimates. The incidence of adverse events was also documented through a review of the studies. RESULTS: Six studies involving 252 patients (256 eyes) were included in this systematic review. The differences in the means and 95% CIs of the IOPR% of 6 studies showed that adjuvant bevacizumab treatment tended to be more effective than AGV implantation alone. Comparison of the outcomes of AGV implantation only with those of AGV implantation+adjuvant bevacizumab showed a success rate in favor of AGV implantation+adjuvant bevacizumab. The incidence of bleeding-associated complications such as hyphema, vitreous hemorrhage, and suprachoroidal hemorrhage was lower in association with combination treatment than with AGV implantation only. Combination treatment seemed to be associated with a lower incidence of other adverse effects such as hypotony, flat chamber, choroidal detachment/effusion, tube-associated complications, and corneal decompensation. CONCLUSION: AGV implantation with adjuvant bevacizumab was more effective and had a higher success rate than surgery alone for lowering IOP in patients with NVG. The combined procedure tended to show a lower incidence of bleeding-associated complications, such as hyphema.

Correlation between Optic Nerve Parameters Obtained Using 3D Nonmydriatic Retinal Camera and Optical Coherence Tomography: Interobserver Agreement on the Disc Damage Likelihood Scale.

Purpose. To compare stereometric parameters obtained by three-dimensional (3D) optic disc photography and optical coherence tomography (OCT) and assess interobserver agreement on the disc damage likelihood scale (DDLS). Methods. This retrospective study included 190 eyes from 190 patients classified as normal, glaucoma suspect, or glaucomatous. Residents at different levels of training completed the DDLS for each patient before and after attending a training module. 3D optic disc photography and OCT were performed on each eye, and correlations between the DDLS and various parameters obtained by each device were calculated. Results. We found moderate agreement (weighted kappa value, 0.59 ± 0.03) between DDLS scores obtained by 3D optic disc photography and the glaucoma specialist. The weighted kappa values for agreement and interobserver concordance increased among residents after the training module. Interobserver concordance was the poorest at DDLS stages 5 and 6. The DDLS scored by the glaucoma specialist had the highest predictability value (0.941). Conclusions. The DDLS obtained by 3D optic disc photography is a useful diagnostic tool for glaucoma. A supervised teaching program increased trainee interobserver agreement on the DDLS. DDLS stages 5 and 6 showed the poorest interobserver agreement, suggesting that caution is required when recording these stages.