Photodynamic therapy combined with ranibizumab for polypoidal choroidal vasculopathy: results of a 1-year preliminary study.

BACKGROUND/AIMS: To determine the potential efficacy and safety of combined verteporfin photodynamic therapy (PDT) with ranibizumab for the treatment of polypoidal choroidal vasculopathy (PCV). METHODS: In this prospective, non-comparative, interventional study, 12 eyes from 12 patients that had active PCV were treated with PDT combined with three monthly intravitreal injections of ranibizumab. The patients were then monitored monthly with measurements of best-corrected visual acuity (BCVA) and central retinal thickness quantified by optical coherence tomography for 1 year. Indocyanine green angiography (ICGA) and fluorescein angiography were performed every 3 months. The eyes were re-treated with PDT and a ranibizumab injection, or with solely ranibizumab injection when indicated. RESULTS: At month 12, the mean BCVA change from baseline was +12.3 letters (p=0.04). Eight patients (58.3%, p=0.02) had a BCVA gain of 15 letters or more. One patient (8.3%, p=1.0) had a BCVA loss of 15 letters or more. All patients underwent regression of polyps without recurrence. One patient experienced an insignificant subretinal haemorrhage. No other adverse event that could be attributed to the treatment was observed. CONCLUSIONS: This combination therapy showed encouraging results concerning improving vision, reducing the incidence of subretinal haemorrhage and reducing the recurrence of polyps when compared to previously published data that reported PDT monotherapy for PCV.

Laser in situ keratomileusis results of DOS and windows software versions for the Nidek EC-5000 excimer laser using the same nomogram.

PURPOSE: To compare the results of laser in situ keratomileusis (LASIK) correction for myopia and myopic astigmatism between the previous DOS software version and the Windows software version for the Nidek EC-5000 excimer laser, using the same nomogram. METHODS: This retrospective review included 2021 eyes (980 patients) after LASIK using the Nidek EC-5000 excimer laser. Of these, 1,632 eyes were corrected with the DOS software version and the other 389 eyes were corrected with the Windows software version of the laser. Both groups were treated with the same surgical nomogram. Minimum follow-up time was 6 months. Patients were classified into range of myopia: low, moderate, and high. RESULTS: Postoperative uncorrected visual acuity was not statistically significantly different between the two groups in any range of refractive error. There was no loss of best spectacle-corrected visual acuity for any patient. Uncorrected visual acuity equal to or better than 20/40 was achieved in 96.3% of eyes in the Windows version group and 94.9% in the DOS version. CONCLUSION: Results for the correction of myopia or myopic astigmatism were similar using the Nidek EC-5000 excimer laser with either the DOS software version or Windows software version, with the same surgical nomogram.

Intracameral pilocarpine in topical phacoemulsification.

PURPOSE: To evaluate the efficacy and corneal toxicity of intracameral pilocarpine. METHOD: A randomized, control trial using contralateral eye as control was designed to evaluate the effect of intracameral pilocarpine during phacoemulsification in 30 patients. 0.13 mg/ml pilocarpine in BSS was used as an irrigating solution to remove viscoelastic agents at the end of the operation while BSS was used in the control group. The outcome measurements composed of intraoperative pre and post irrigation pupil diameter, pre and post operative endothelial cell count and corneal thickness. SETTING: Priests Hospital. RESULTS: The pre-irrigation pupil size in the pilocarpine group and the control group was 7.62 +/- 0.75 mm and 7.60 +/- 0.77 mm respectively. The post-irrigation pupil size in the pilocarpine group and the control group was 5.40 +/- 0.79 mm and 7.18 +/- 0.79 mm. There were no statistically differences in pre and post-operative endothelial cell density, central corneal thickness, and the average corneal thickness between the pilocarpine group and the control group during six months follow-up. CONCLUSION: Intracameral pilocarpine in a low concentration (0.13 mg/ml) effectively constricts the pupil without significant changes of corneal endothelium compared to the control group.

Indocyanine-green videoangiography of drusen as a possible predictive indicator of exudative maculopathy.

OBJECTIVE: Recent studies have shown that indocyanine-green videoangiography (ICG-V) is useful to image occult choroidal neovascularization. The authors studied the ICG-V findings in fellow drusen eyes of patients with unilateral exudative age-related macular degeneration (AMD). The authors also studied the occurrence of exudative changes to determine whether ICG-V is useful in predicting future exudative changes in these eyes with only drusen. DESIGN: Cohort study. PARTICIPANTS: The authors studied 432 consecutive patients diagnosed with unilateral exudative AMD in whom the fellow eye had only drusen by clinical fundus examination and fluorescein angiography. All of these eyes had ICG-V performed. Follow-up data were obtained in all eyes with abnormal indocyanine-green (ICG) angiograms and randomly sampled ICG angiograms of normal eyes. MAIN OUTCOME MEASURES: The initial ICG findings were classified as showing normal or abnormal hyperfluorescence. Abnormal hyperfluorescence eyes were subdivided into focal spots (focal areas of hyperfluorescence < 1 disc area in size) and plaques (areas of hyperfluorescence > 1 disc area). The development of exudative changes in eyes with normal and abnormal hyperfluorescence was compared. RESULTS: Of the 432 fellow eyes, 386 (89%) eyes with drusen had a normal ICG-V study, whereas 46 (10 focal spots and 36 plaques) (11%) eyes had an abnormal ICG-V. Exudative changes occurred in 6 (10%) of 58 normal ICG eyes and 9 (24%) of 38 eyes with abnormal ICG findings during a mean follow-up period of 21.7 months. The difference between drusen eyes with normal ICG angiograms and those with plaques on ICG-V regarding future exudative changes (10% vs. 27%, respectively) was statistically significant (P = 0.038). CONCLUSIONS: Abnormal ICG findings were found in 11% of eyes with clinically and fluorescein angiographically nonsuspicious drusen. The subgroup of patients with plaques on ICG-V had a higher chance of having exudative changes develop. Indocyanine-green videoangiography may be a predictive indicator of future exudative changes in eyes with drusen. A much larger prospective study seems justified.

Three-dimensional ophthalmic contact B-scan ultrasonography of the posterior segment.

PURPOSE: A system to produce three-dimensional computer reconstructions of ophthalmic contact B-scan ultrasound was developed and investigated. METHODS: Investigators used ocular phantoms to measure the accuracy and reproducibility of linear, area, and volume measurements. RESULTS: In vitro calibration tests of linear and area measurements demonstrate accurate and reproducible findings throughout the imaged space. Phantom volume tests also show reasonable accuracy and reproducibility. CONCLUSIONS: Three-dimensional ultrasonography is effective in measuring length, area, and volume in an experimental model. The in vitro accuracy and reproducibility of measurements warrants further investigation into the clinical utility of this method in posterior segment tumors and other posterior segment pathology.

Classification of choroidal neovascularization by digital indocyanine green videoangiography.

PURPOSE: The majority of patients with exudative maculopathy due to age-related macular degeneration present with poorly defined or occult choroidal neovascularization (CNV) that cannot be imaged adequately by fluorescein angiography. Digital indocyanine green (ICG) videoangiography is a new technique that allows enhanced imaging of these poorly defined or occult vessels. The authors studied 1000 consecutive cases of occult CNV using digital ICG angiography to describe the various types of neovascularization observed by this technique and to determine the frequency and natural history of the various lesions. MATERIALS AND METHODS: Digital ICG videoangiography was performed as described previously on 1000 consecutive eyes with occult CNV by fluorescein angiography. RESULTS: One thousand consecutive eyes with occult CNV by fluorescein angiography were imaged using digital ICG videoangiography. Three morphologic types of CNV were noted by ICG videoangiography, which included focal spots, plaques (well-defined or poorly defined), and combination lesions (in which both focal spots and plaques are noted). Combination lesions can be subdivided into marginal spots (focal spots at the edge of plaques of neovascularization), overlying spots (hot spots overlying plaques of neovascularization), or remote spots (a focal spot remote from a plaque of neovascularization). The relative frequency of these lesions was as follows: there were 283 cases (29%) of focal spots; 597 cases (61%) of plaques, consisting of 265 cases (27%) of well-defined plaques and 332 cases (34%) of poorly defined plaques; and 84 cases (8%) of combination lesions, consisting of 35 cases (3%) of marginal spots, 37 cases (4%) of overlying spots, and 12 cases (1%) of remote spots. In seven additional cases (1%), a mixture of the above lesions was noted. In 13 additional eyes (1%), no lesions were noted on the ICG angiogram. The studies of 16 eyes were unreadable or unobtainable. CONCLUSIONS: There are three types of CNV that can be observed by digital ICG videoangiography. Plaques are the most common type and have a poor natural history. Focal spots or hot spots are the next most frequently seen lesion and can potentially be treated by ICG-guided laser photocoagulation. Combination lesions, in which both focal spots and plaques are present, are rare. This study of 1000 consecutive cases of eyes with occult neovascularization that were imaged with digital ICG videoangiography serves to classify the various types of neovascularization observed by this technique. Digital ICG videoangiography is an important tool in better delineating eyes with occult CNV. Future studies are necessary to validate our findings.