Surgical Outcomes for Persistent Macular Hole After Ocriplasmin.

BACKGROUND AND OBJECTIVE: To report surgical and visual acuity outcomes in eyes with unresolved full-thickness macular hole (FTMH) after treatment with ocriplasmin who subsequently underwent vitrectomy. PATIENTS AND METHODS: Retrospective case series of four eyes. Vision and anatomy via optical coherence tomography (OCT) were assessed before and after intravitreal ocriplasmin as well as 6 months after subsequent vitrectomy. RESULTS: Initial visual acuity ranged from 20/70 to 20/200. OCT showed focal vitreomacular traction (VMT) with FTMH ranging from 136 to 311 µm in diameter. Following ocriplasmin, VMT released in all four eyes without closure of the FTMH. All FTMHs enlarged over follow-up after ocriplasmin (mean increase 133 µm). Subsequent vitrectomy led to anatomic FTMH closure in all eyes. Final vision improved in all eyes (20/30 to 20/70). CONCLUSION: Initial ocriplasmin treatment of FTMH in this series of patients did not reduce the effectiveness of vitrectomy, which was required for definitive FTMH repair.

Optical coherence tomography-guided facedown positioning for macular hole surgery.

PURPOSE: To use spectral domain optical coherence tomography-guided duration of facedown positioning to study anatomical macular hole closure rates. METHODS: Retrospective review of patients with macular holes undergoing 23-gauge pars plana vitrectomy and intraocular gas tamponade. Spectral domain optical coherence tomography imaging was done on postoperative Day 1. Patients remained facedown for 2 more days if the macular hole was closed or 6 more days facedown if the macular hole was open or indeterminate. RESULTS: There were 8 Stage 2, 12 Stage 3, and 12 Stage 4 macular holes. On postoperative Day 1, 24 holes were closed by spectral domain optical coherence tomography and instructed to remain facedown for two more days. Twenty-three of 24 holes remained closed during the postoperative period. Eight holes were open or indeterminate on postoperative Day 1 and remained facedown for 6 more days. Six of 8 holes (75%) were closed at their last follow-up. The overall closure rate was 29/32 (90.6%). Average follow-up was 334 days. CONCLUSION: Confirming early closure of macular holes with spectral domain optical coherence tomography imaging can serve as an important guide to significantly shorten the duration of prone positioning while maintaining high closure rates.

Anatomic and visual outcomes of vitrectomy for vitreomacular traction syndrome.

BACKGROUND AND OBJECTIVE: To assess anatomic and visual outcomes after pars plana vitrectomy for vitreomacular traction syndrome. PATIENTS AND METHODS: Charts of 746 patients who had vitrectomy surgery with membrane peel between January 2002 and December 2007 were reviewed. Vitreomacular traction syndrome (VMT) was diagnosed based on optical coherence tomography (OCT) appearance. Twenty eyes of 20 patients were found to have had vitrectomy surgery for VMT and were included in the study. RESULTS: Mean visual acuity was 20/122 preoperatively and 20/68 postoperatively (P = .005). Mean foveal thickness was 404.00 microm preoperatively and 250.55 microm postoperatively (P = .001). A subgroup analysis was performed based on preoperative OCT appearance. Improvement in vision was not significant in eyes with lamellar separation between the inner and outer fovea (P = .379), but was significant in eyes with cystoid macular edema (P = .045) or perifoveal traction (P = .040). CONCLUSION: Overall, there was a significant improvement in visual acuity and central foveal thickness postoperatively. Eyes with lamellar separation of the inner and outer foveal layers preoperatively had worse visual results, whereas eyes with cystoid macular edema or perifoveal VMT had better visual results.

Anatomic and visual outcomes of vitrectomy for lamellar macular holes.

BACKGROUND AND OBJECTIVE: To assess anatomic and visual outcomes after pars plana vitrectomy for lamellar macular holes. PATIENTS AND METHODS: Charts of 746 patients who had vitrectomy surgery with membrane peel were reviewed. Preoperative diagnosis of lamellar macular hole was based on optical coherence tomography (OCT) appearance; 16 eyes of 16 patients met the inclusion criteria. RESULTS: Mean acuity was 20/158 preoperatively and 20/118 postoperatively (P = .408). Central macular thickness was 377.06 µm preoperatively and 245.7 µm postoperatively (P = .002). Two eyes (13%) developed full-thickness macular holes postoperatively. Six eyes (38%) continued to have a lamellar macular defect on OCT postoperatively. CONCLUSION: Despite postoperative anatomic improvement in many patients and an overall decrease in foveal thickness on OCT, this retrospective series suggests that vitrectomy for lamellar holes may not improve visual acuity.

Cystoid macular edema without macular thickening: a retrospective optical coherence tomographic study.

BACKGROUND: This is a retrospective observational case series of 37 eyes of 32 patients meeting the inclusion criteria intended to describe the appearance, prevalence, and associated risk factors for cystoid macular edema in eyes with normal foveal thickness and contour as determined by optical coherence tomography (OCT). METHODS: A retrospective review of all patients with macular disease who underwent OCT evaluation at the New England Eye Center from January to March 2007 and met the study inclusion criteria was performed. Optical coherence tomography scans were evaluated for the presence of intraretinal cystic fluid or cystoid macular edema but with normal retinal thickness and foveal contour. Retinal thickness and contour were evaluated using OCT mapping software. The main outcome measures were as follows: OCT-defined entity based on the presence of cystoid spaces within the fovea, "normal" foveal thickness (<252 microm), normal foveal contour, and best-corrected visual acuity on the date of examination. RESULTS: Thirty-seven eyes of 32 patients were determined to have cystoid macular edema with normal foveal thickness and contour on OCT. The overall prevalence within our patient population was 4.9%. Mean foveal thickness (standard deviation) for these patients was 201.4 microm (28.9) compared with normal mean foveal thickness (standard deviation) of 212 microm (20.0). Of the 32 patients, 17 (53.1%) had a primary diagnosis of age-related macular degeneration. The mean visual acuity (Snellen; logarithm of the minimum angle of resolution) was 20/80 (0.60). CONCLUSION: Cystoid macular edema in the setting of normal foveal thickness and contour as determined by OCT has not been extensively described. This entity is not pathognomonic of a single diagnosis and can occur in the setting of several disparate diagnoses as seen in our cohort. Chief among these were age-related macular degeneration and diabetic retinopathy. Acute postcataract cystoid macular edema was absent.

Short-term safety of 23-gauge single-step transconjunctival vitrectomy surgery.

PURPOSE: The purpose of this study was to report the safety profile of the Alcon 23-gauge single-step preloaded transconjunctival vitrectomy system. METHODS: This was a retrospective case series examining 118 eyes of 114 patients that underwent 23-gauge vitrectomy between July and November 2007. Patients were observed postoperatively for a minimum of 6 weeks. Main outcome measures were postoperative intraocular pressure (IOP), intraoperative complications, and postoperative adverse events. RESULTS: The mean postoperative Day 1 IOP was 14.3 +/- 6.6 mmHg (median, 13 mmHg; range, 2-38 mmHg) and Month 1 IOP was 15.8 +/- 5.9 mmHg (median, 15 mmHg; range, 6-52 mmHg). Two eyes (1.7%) developed choroidal effusions. Four eyes (3.4%) developed intraoperative horseshoe tears. No retinal detachments or endophthalmitis occurred. Four eyes (3.4%) had postoperative hypotony. Intraoperative wound leak after cannula removal requiring a sclerotomy suture occurred in 38% of patients: 35 eyes requiring closure of 1 cannula site (29.6%), 8 eyes (6.8%) requiring closure of 2 cannula sites, and 2 eyes (1.7%) requiring closure of all 3 cannula sites. CONCLUSION: The Alcon 23-gauge single step preloaded transconjunctival vitrectomy system has few safety issues. Sclerotomy leaks after cannula removal are common, with 38% of eyes requiring suture closure of at least 1 cannula site.

High-speed ultrahigh resolution optical coherence tomography before and after ranibizumab for age-related macular degeneration.

OBJECTIVE: To evaluate intraretinal anatomy in patients with exudative age-related macular degeneration (AMD) using high-speed ultrahigh resolution optical coherence tomography (hsUHR-OCT) before and 1 month after intravitreal injection of ranibizumab. DESIGN: Retrospective case series. PARTICIPANTS: Twelve eyes of 12 patients. METHODS: A broad bandwidth superluminescent diode laser light source and spectral/Fourier domain signal detection were used to create a prototype hsUHR-OCT instrument with 3.5 mum axial image resolution and approximately 25,000 lines/second acquisition speed. Twelve eyes of 12 patients with exudative AMD were imaged with hsUHR-OCT before and 1 month after intravitreal ranibizumab injection. High pixel density and raster-scanned 3-dimensional (3D) OCT data sets were generated. Three-dimensional imaging software was used to calculate subretinal/retinal pigment epithelium fluid volume and volume of the fibrovascular lesion. MAIN OUTCOME MEASURES: Qualitative and quantitative analysis of hsUHR-OCT images and 3D data sets. RESULTS: All eyes had some degree of normalization of macular contour after intravitreal ranibizumab. The inner/outer photoreceptor segment junction visualized on hsUHR-OCT was discontinuous, overlying the fibrovascular lesion in all 12 of 12 eyes both before and after treatment; 9 of 12 eyes had focal areas of thinning of the outer nuclear layer, which remained after treatment. Volumetric measurements were possible in 8 of 12 eyes with 3D-rendering software. Fibrovascular lesion volume did not change significantly after treatment. CONCLUSIONS: hsUHR-OCT is capable of unprecedented imaging speed and resolution, making it a valuable instrument in measuring in vivo intraretinal pathology. All 12 eyes had some normalization of macular contour. Fibrovascular lesion volume did not change significantly 1 month after treatment, suggesting that ranibizumab does not cause much initial regression of preexisting neovascular tissue. Photoreceptor abnormalities remained in all patients after treatment of wet AMD, suggesting that although ranibizumab improves overall retinal architecture, some photoreceptor damage may be irreversible. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Anatomic and visual outcomes of noninfectious endophthalmitis after intravitreal triamcinolone.

PURPOSE: To describe the anatomic and visual outcomes of patients in whom noninfectious endophthalmitis developed after injection of intravitreal triamcinolone acetonide. DESIGN: Retrospective case series. METHODS: Ophthalmologic evaluations of patients in whom noninfectious endophthalmitis developed after intravitreal triamcinolone took place on the day of injection, at the time of presentation of noninfectious endophthalmitis, at the time of clearance of inflammation, and on follow-up examination. Seventeen eyes of 17 patients were identified from 2 institutions. Noninfectious endophthalmitis was identified based on history of visual loss immediately or soon after injection, lack of ocular pain, hypopyon, anterior or vitreous inflammation, and triamcinolone crystals present in the anterior or posterior chambers. Main outcome measures were Snellen visual acuity (VA) and mean foveal thickness by optical coherence tomography. RESULTS: Mean VA and mean foveal thickness on the day of injection of intravitreal triamcinolone were 20/132 (logarithm of the minimum angle of resolution [logMAR], 0.82 +/- 0.45) and 432 +/- 118 microm, respectively. Mean VA at time of noninfectious endophthalmitis (mean, 1.9 days after injection) was 20/4444 (logMAR, 2.35 +/- 0.98). At last follow-up (mean, 57.6 days), VA and mean foveal thickness were 20/56 (logMAR, 0.44 +/- 0.30) and 301 +/- 71 microm, respectively. CONCLUSIONS: VA and mean foveal thickness in all patients with noninfectious endophthalmitis after intravitreal triamcinolone improved to better than preinjection levels in this series. At last follow-up, no patient had sustained visual loss from noninfectious endophthalmitis. Noninfectious endophthalmitis after intravitreal triamcinolone may not exclude good visual and anatomic prognoses.

Intravitreal bevacizumab (Avastin) as treatment for subfoveal choroidal neovascularisation secondary to pathological myopia.

OBJECTIVE: To evaluate the safety and efficacy of intravitreal bevacizumab (Avastin) as treatment for subfoveal choroidal neovascularisation (CNV) due to pathological myopia. METHODS: Consecutive series of primary or recurrent subfoveal CNV secondary to myopia treated with intravitreal bevacizumab 1.25 mg between August 2005 and January 2006 at the New England Eye Center, Boston, Massachusetts, USA, were reviewed retrospectively. Data from clinical examination, fundus photography, fluorescein angiography, optical coherence tomography and visual acuity were collected. RESULTS: There were 11 eyes of 9 patients. 5 of 11 eyes had been treated previously with photodynamic therapy. Pre-injection visual acuity measured 20/50 to 20/100 in 6 eyes and 20/200 or worse in 5 eyes. After a mean follow-up of 153 (range 35-224) days, post-injection visual acuity measured 20/20 to 20/40 in 7 eyes, 20/50 to 20/100 in 1 eye and 20/200 or worse in 3 eyes. Three eyes received two bevacizumab injections and eight eyes received one injection. Visual acuity improved by a mean of +3.5 (range -1 to +8 lines) lines, and 8 of 11 eyes achieved 20/50 or better at the last follow-up. Central foveal thickness improved from 340 (range 253-664) microm to 234 (range 142-308) microm, representing an average reduction of 103 (range +4 to -356) microm. No injection complications or drug-related side effects were observed. CONCLUSIONS: In this small series of eyes with limited follow-up, intravitreal bevacizumab seems to be safe and potentially efficacious in eyes with subfoveal CNV secondary to pathological myopia.

Ultrahigh-resolution optical coherence tomography of surgically closed macular holes.

OBJECTIVE: To evaluate retinal anatomy using ultrahigh-resolution optical coherence tomography (OCT) in eyes after successful surgical repair of full-thickness macular hole. METHODS: Twenty-two eyes of 22 patients were diagnosed as having macular hole, underwent pars plana vitrectomy, and had flat/closed macular anatomy after surgery, as confirmed with biomicroscopic and OCT examination findings. An ultrahigh-resolution-OCT system developed for retinal imaging, with the capability to achieve approximately 3-microm axial resolution, was used to evaluate retinal anatomy after hole repair. RESULTS: Despite successful closure of the macular hole, all 22 eyes had macular abnormalities on ultrahigh-resolution-OCT images after surgery. These abnormalities were separated into the following 5 categories: (1) outer foveal defects in 14 eyes (64%), (2) persistent foveal detachment in 4 (18%), (3) moderately reflective foveal lesions in 12 (55%), (4) epiretinal membranes in 14 (64%), and (5) nerve fiber layer defects in 3 (14%). CONCLUSIONS: With improved visualization of fine retinal architectural features, ultrahigh-resolution OCT can visualize persistent retinal abnormalities despite anatomically successful macular hole surgery. Outer foveal hyporeflective disruptions of the junction between the inner and outer segments of the photoreceptors likely represent areas of foveal photoreceptor degeneration. Moderately reflective lesions likely represent glial cell proliferation at the site of hole reapproximation. Thin epiretinal membranes do not seem to decrease visual acuity and may play a role in reestablishing foveal anatomy after surgery.

Ultrahigh-resolution optical coherence tomography in patients with decreased visual acuity after retinal detachment repair.

OBJECTIVE: To assess microstructural changes in the retina that may explain incomplete visual recovery after anatomically successful repair of rhegmatogenous retinal detachments (RD) using ultrahigh-resolution optical coherence tomography (UHR OCT). DESIGN: Retrospective observational case series. PARTICIPANTS: Seventeen patients with decreased visual acuity after RD repair. Twelve patients had macula-involving and 5 had macula-sparing RDs. METHODS: The UHR OCT prototype capable of approximately 3 mum axial resolution was developed for clinical use. The UHR OCT images through the center of the fovea in 17 patients with visual complaints after RD surgery were obtained. Patients were either postoperative patients from the New England Eye Center or tertiary referrals. Baseline visual acuity, preoperative lens status, location of retinal detachment, macular involvement, and postoperative visual acuity were recorded. MAIN OUTCOME MEASURES: The UHR OCT images after RD repair. RESULTS: The UHR OCT images were obtained 1 to 84 months (median, 5 months) postoperatively. The mean preoperative logarithm of the minimum angle of resolution (logMAR) visual acuity was 1.37 (Snellen equivalent, 20/390). The mean postoperative logMAR visual acuity was 0.48 (Snellen equivalent, 20/60). Anatomical abnormalities that were detected included distortion of the photoreceptor inner/outer segments (IS/OS) junction in 14 of 17 patients (82%), epiretinal membranes in 10 of 17 patients (59%), residual subretinal fluid in 3 of 17 patients (18%), and cystoid macular edema in 2 of 17 patients (12%). Of the 5 patients with preoperative macula-on detachments, 4 had distortion of the outer retina after RD repair. CONCLUSIONS: The higher resolution of UHR OCT facilitates imaging of the IS/OS junction. Therefore, UHR OCT is able to confirm prior histopathologic findings that damage to photoreceptor outer segments may occur as a consequence of retinal detachment. This may explain poor postoperative visual acuity in eyes with anatomically successful repair.

Redefining lamellar holes and the vitreomacular interface: an ultrahigh-resolution optical coherence tomography study.

OBJECTIVES: To define optical coherence tomographic (OCT) criteria for the diagnosis of a lamellar macular hole, and to increase understanding of lamellar hole pathogenesis by examining fine anatomic features using ultrahigh-resolution optical coherence tomography (UHR OCT). DESIGN: Retrospective observational case series. PARTICIPANTS: Nineteen eyes of 18 patients with lamellar holes were imaged with UHR OCT between 2002 and 2004. METHODS: A UHR OCT system was developed for use in the ophthalmology clinic. All 6 UHR OCT images for each eye imaged were examined. Lamellar holes were diagnosed based on a characteristic OCT appearance. Criteria for the OCT diagnosis of a lamellar hole were as follows: (1) irregular foveal contour; (2) break in the inner fovea; (3) intraretinal split; and (4) intact foveal photoreceptors. From 1205 eyes of 664 patients imaged with UHR OCT, and retrospectively reviewed, 19 eyes of 18 patients were diagnosed with a lamellar hole based on these criteria. All 19 eyes were also imaged with standard resolution OCT. Their charts were retrospectively reviewed. MAIN OUTCOME MEASURES: Standard and ultrahigh-resolution OCT images. RESULTS: On chart review, clinical diagnosis of a lamellar hole was made in only 7 of 19 eyes (37%). Twelve of 19 eyes (63%) had an epiretinal membrane (ERM) on clinical examination. Ten of 19 eyes (53%) had a posterior vitreous detachment. On UHR OCT, 17 of 19 eyes (89%) had ERMs. Eleven ERMs had an unusual thick appearance on UHR OCT. Due to poor visual acuity, 4 eyes underwent vitrectomy. Only 1 of 4 surgeries (25%) was visually and anatomically successful. Another eye improved visually, but a lamellar hole persisted. One eye progressed to a full-thickness macular hole preoperatively, which reopened after surgery. One eye developed a full-thickness hole postoperatively. CONCLUSIONS: The diagnosis of a lamellar hole can be made based on OCT criteria, which could be applied to both standard and ultrahigh-resolution OCT. The increased resolution of UHR OCT sheds light on the pathogenesis of the lamellar hole. Epiretinal membranes were visualized on UHR OCT in the majority of eyes. Many ERMs had an unusual thick appearance on UHR OCT, which may represent either trapped vitreous or posterior hyaloid, and may help stabilize retinal anatomy. Conversely, ERM contraction may play a role in lamellar hole formation. Vitrectomy surgery was anatomically and visually successful in only 1 of 4 patients, suggesting caution when performing vitrectomy on lamellar holes.

Vitrectomy for stage 1 macular holes identified by optical coherence tomography.

BACKGROUND AND OBJECTIVE: To describe a series of patients with decreased vision secondary to stage 1 macular hole confirmed by optical coherence tomography (OCT) that failed to spontaneously resolve with observation. To determine whether current surgical techniques can prevent progression to a full-thickness macular hole and lead to improved visual acuity. PATIENTS AND METHODS: Retrospective, comparative case series presenting patient demographics, duration of symptoms, timing of surgery, preoperative and postoperative vision, and clinical outcome based on examination and OCT. RESULTS: Five eyes of five patients with stage 1 macular holes identified on OCT required surgical repair. All eyes showed anatomic closure and lack of progression to a full-thickness hole confirmed by OCT after one procedure. Mean preoperative visual acuity was 20/102 (range, 20/50 to 20/200) and mean postoperative visual acuity was 20/52 (range, 20/25 to 20/200). Average improvement for all five eyes was 3 Snellen lines, with four of the five (80%) improving 5 lines each. CONCLUSION: In symptomatic eyes with stage 1 macular holes that fail to spontaneously resolve with observation, vitrectomy with intraocular gas tamponade may prevent progression to a full-thickness hole and lead to improved visual acuity.

Comparison of ultrahigh- and standard-resolution optical coherence tomography for imaging macular hole pathology and repair.

PURPOSE: To compare ultrahigh-resolution optical coherence tomography (UHR-OCT) technology to a standard-resolution OCT instrument for the imaging of macular hole pathology and repair; to identify situations where UHR-OCT provides additional information on disease morphology, pathogenesis, and management; and to use UHR-OCT as a baseline for improving the interpretation of the standard-resolution images. DESIGN: Observational and interventional case series. PARTICIPANTS: Twenty-nine eyes of 24 patients clinically diagnosed with macular hole in at least one eye. METHODS: A UHR-OCT system has been developed and employed in a tertiary-care ophthalmology clinic. Using a femtosecond laser as the low-coherence light source, this new UHR-OCT system can achieve an unprecedented 3-mum axial resolution for retinal OCT imaging. Comparative imaging was performed with UHR-OCT and standard 10-mum resolution OCT in 29 eyes of 24 patients with various stages of macular holes. Imaging was also performed on a subset of the population before and after macular hole surgery. MAIN OUTCOME MEASURES: Ultrahigh- and standard-resolution cross-sectional OCT images of macular hole pathologies. RESULTS: Both UHR-OCT and standard-resolution OCT exhibited comparable performance in differentiating various stages of macular holes. The UHR-OCT provided improved imaging of finer intraretinal structures, such as the external limiting membrane and photoreceptor inner segment (IS) and outer segment (OS), and identification of the anatomy of successful surgical repair. The improved resolution of UHR-OCT enabled imaging of previously unidentified changes in photoreceptor morphology associated with macular hole pathology and postoperative repair. Visualization of the junction between the photoreceptor IS and OS was found to be an important indicator of photoreceptor integrity for both standard-resolution and UHR-OCT images. CONCLUSIONS: Ultrahigh-resolution optical coherence tomography improves the visualization of the macular hole architectural morphology. The increased resolution of UHR-OCT enables the visualization of photoreceptor morphology associated with macular holes. This promises to lead to a better understanding of the pathogenesis of macular holes, the causes of visual loss secondary to macular holes, the timing of surgical repair, and the evaluation of postsurgical outcome. Ultrahigh-resolution optical coherence tomography imaging of macular holes that correspond to known alterations in retinal morphology can be used to interpret retinal morphology in UHR-OCT images. Comparisons of UHR-OCT images with standard-resolution OCT images can establish a baseline for the better interpretation of clinical standard-resolution OCT images. The ability to visualize photoreceptors and their integrity or impairment is an indicator of macular hole progression and surgical outcome.

Photodynamic therapy of idiopathic and inflammatory choroidal neovascularization in young adults.

PURPOSE: To evaluate the treatment of subfoveal choroidal neovascularization (CNV) using photodynamic therapy (PDT) with verteporfin (Visudyne; Novartis, Duluth, GA) in young adults. DESIGN: Retrospective noncomparative interventional case series. PARTICIPANTS: Nineteen eyes of 17 patients with classic, subfoveal CNV treated with PDT using verteporfin, excluding eyes with CNV secondary to age-related macular degeneration, angioid streaks, and myopia. MAIN OUTCOME MEASURES: Snellen visual acuity before and after PDT. RESULTS: Nineteen eyes were followed an average of 12.8 months (range, 4-33 months) after PDT. Before treatment, visual acuity measured > or = 20/40 in 0 eyes (0.0%), < 20/40 to > 20/200 in 11 eyes (57.9%), and < or =20/200 in 8 eyes (42.1%). After treatment, visual acuity measured > or =20/40 in four eyes (21.1%), < 20/40 to > 20/200 in eight eyes (42.1%), and < or =20/200 in seven eyes (36.8%). Six eyes (31.6%) underwent retreatment, with only two eyes retreated twice. Four eyes underwent eventual surgical removal of the CNV after PDT. CONCLUSIONS: Photodynamic therapy seems to be useful in stabilizing and improving visual acuity in young adults with subfoveal CNV secondary to idiopathic and inflammatory etiologies.

Photodynamic therapy of polypoidal choroidal vasculopathy.

Polypoidal choroidal vasculopathy is an abnormality of the choroidal vasculature characterized by aneurysmal-like budding of the vessels with exudation and recurrent serosanguinous detachments of the retinal pigment epithelium. Treatment is limited to laser photocoagulation of leaking vessels, which is used when vision is decreased, or exudate and hemorrhage threaten or involve the fovea. This article describes a patient with polypoidal choroidal vasculopathy successfully treated with photodynamic therapy using verteporfin.

Optical coherence tomography findings following photodynamic therapy of choroidal neovascularization.

PURPOSE: To develop an optical coherence tomography (OCT) classification system that monitors the response of eyes treated with photodynamic therapy (PDT) with verteporfin for subfoveal choroidal neovascularization (CNV) from age-related macular degeneration (AMD). DESIGN: Retrospective interventional case series. METHODS: Ninety eyes (88 patients) with AMD and predominantly classic subfoveal CNV treated with PDT using verteporfin were identified by a laser log and retrospectively reviewed. Optical coherence tomography and fluorescein angiography (FA) were performed before treatment and at subsequent follow-up examinations in all eyes. Optical coherence tomography findings were evaluated and compared with corresponding FA. RESULTS: A five-stage OCT classification of eyes treated with PDT was created from the evaluation of 79 total eyes (77 patients). Stage I (two eyes) is recognized within the first week of treatment and demonstrates an acute inflammatory response with increased subretinal fluid. Stage II (28 eyes) represents the restoration of a near-normal fovea contour with diminished subretinal fluid occurring 1 to 4 weeks after treatment. Stage III (79 eyes) occurs between 4 to 12 weeks following treatment and is subdivided into two categories based on the amount of subretinal fibrosis and fluid present. Stage IIIa (15 eyes) contains a greater subretinal fluid to fibrosis ratio indicating an active CNV process. Lesions in stage IIIb (64 eyes) less actively leak and have more prominent fibrosis with minimal intraretinal fluid. Cystoid macular edema defines a stage IV lesion (11 eyes). In stage V lesions (19 eyes) the subretinal fluid resolves with thinning of the retina as well as fibrosis merging with the retinal pigment epithelial layer (RPE). CONCLUSION: Optical coherence tomography appears to be useful in monitoring the retinal changes that occur following PDT of CNV and may assist in understanding the changes observed on angiography.