Changes in fundus autofluorescence after treatments for polypoidal choroidal vasculopathy.

BACKGROUND/AIMS: To evaluate changes in fundus autofluorescence (FAF) after treatments for polypoidal choroidal vasculopathy (PCV). METHODS: Thirty-six eyes of 35 patients with treatment-naive PCV underwent intravitreal injection of ranibizumab, photodynamic therapy, or a combination of both treatments. FAF and indocyanine green angiography (ICGA) at baseline were compared with those obtained 12 months later about the changes at the affected lesion. RESULTS: In the 36 eyes, 88 polyps were detected on ICGA at baseline, and 65 (73.9%) of those showed centred hypoautofluorescence and a circumferential hyperautofluorescent ring on FAF. Twelve months later, ICGA revealed resolution of 42 of those 65 polyps. Of those 42 resolved polyps, 30 hyperautofluorescent rings (71.4%) were eliminated concurrently with the resolution of polyp. Statistical analysis revealed that an elimination of the hyperautofluorescent ring was more frequently observed in association with the resolved polyps than with the persistent polyps (p<0.0001). All the hypoautofluorescent findings corresponding to branching vascular networks at baseline were unchanged during the follow-up period. CONCLUSIONS: Elimination of the hyperautofluorescent ring is highly associated with the resolution of the polyp on ICGA. We propose that FAF has a potential as a non-invasive method of evaluating the therapeutic efficacy of treatments for PCV.

Subfoveal choroidal thickness in retinal angiomatous proliferation.

PURPOSE: To investigate the subfoveal choroidal thickness in patients with retinal angiomatous proliferation (RAP). METHODS: In consecutive patients with RAP, subfoveal choroidal thickness was retrospectively measured by the use of enhanced depth imaging spectral domain optical coherence tomography in comparison with age-matched control subjects. RESULTS: Nineteen eyes of 19 patients with RAP and 32 eyes of 32 control subjects were included in this study. No significant differences were found between the eyes with RAP and the control eyes regarding age, gender, spherical equivalent, and axial length. Mean subfoveal choroidal thickness in 19 eyes with RAP was significantly less than that in the control eyes (129.5 ± 35.8 µm vs. 201.3 ± 55.0 µm, P < 0.0001). The difference in mean subfoveal choroidal thickness between eyes with Stage 2 RAP (132.8 ± 38.2 µm) and eyes with Stage 3 RAP (126.4 ± 36.6 µm) was not significant, though each measurement was significantly less than that in the control eyes (P < 0.001 and P = 0.002, respectively). CONCLUSION: Eyes with RAP had a significantly thinner subfoveal choroid compared with normal eyes. Such morphologic features may be related to the pathologic mechanism of RAP.

Relationship between clinical characteristics of polypoidal choroidal vasculopathy and choroidal vascular hyperpermeability.

PURPOSE: To investigate the relationship between the clinical characteristics of polypoidal choroidal vasculopathy (PCV) and choroidal vascular hyperpermeability seen on indocyanine green angiography. DESIGN: Retrospective, consecutive, interventional case series. METHODS: We reviewed the medical records and the angiograms of 89 patients with PCV. The relationship between choroidal vascular hyperpermeability and background factors, associated clinical manifestations, and treatment responses to intravitreal injections of ranibizumab were evaluated. RESULTS: Of the 89 patients with PCV, 31 patients (34.8%) demonstrated choroidal vascular hyperpermeability. The patients with choroidal vascular hyperpermeability more frequently showed bilateral neovascular membrane than those without choroidal vascular hyperpermeability (P=.009) and had a significant relationship with a history of central serous chorioretinopathy (CSC) (P=.01). Of the 98 eyes with treatment-naïve PCV, 34 eyes with choroidal vascular hyperpermeability demonstrated significantly greater subfoveal thickness than the 64 eyes without choroidal vascular hyperpermeability (P < .001). However, no significant relationship was found between choroidal vascular hyperpermeability and the other biomicroscopic and angiographic phenotypes of PCV. Three monthly intravitreal injections of ranibizumab were performed on 57 patients with treatment-naïve PCV, and the presence of choroidal vascular hyperpermeability was significantly related to the persistent retinal fluid 1 month after the third ranibizumab injection (P=.01). CONCLUSIONS: The patients with PCV associated with choroidal vascular hyperpermeability more frequently demonstrated bilateral neovascular membrane, a history of CSC, a thickened choroid, and poor responses to intravitreal injections of ranibizumab than those without choroidal vascular hyperpermeability.

Subfoveal choroidal thickness after ranibizumab therapy for neovascular age-related macular degeneration: 12-month results.

PURPOSE: To investigate the changes in subfoveal choroidal thickness after intravitreal injections of ranibizumab (IVRs) for neovascular age-related macular degeneration (AMD). DESIGN: Prospective, consecutive, interventional case series. PARTICIPANTS: Eighty eyes (40 affected eyes with neovascular AMD and 40 unaffected fellow eyes) of 40 patients. METHODS: Forty eyes with neovascular AMD were treated with 0.5-mg IVRs monthly for 3 months and received additional IVRs as needed over the following 9-month period. Subfoveal choroidal thickness in all 80 eyes was measured by use of enhanced depth imaging optical coherence tomography images before and after starting the IVRs. MAIN OUTCOME MEASURES: Changes in subfoveal choroidal thickness after treatment by IVRs over a 12-month period. RESULTS: Twenty-three eyes (57.5%) were diagnosed with typical neovascular AMD, 16 eyes (40%) were diagnosed with polypoidal choroidal vasculopathy, and 1 eye (2.5%) was diagnosed with retinal angiomatous proliferation. Fifteen eyes (38%) had received some previous treatments for the neovascular lesion before undergoing the IVRs. The mean best-corrected visual acuity of the affected eyes was improved from 0.54 logarithm of the minimum angle of resolution units at baseline to 0.42 at 12 months (P = 0.020). The mean subfoveal choroidal thickness in the affected eyes decreased from 244±62 µm at baseline to 234±66 µm at 1 month (P = 0.013), 226±68 µm at 3 months (P<0.001), 229±67 µm at 6 months (P = 0.002), and 226±66 µm at 12 months (P = 0.002; the change ratio, 93%), whereas that in the unaffected eyes changed from 237±80 µm at baseline to 238±83 µm at 12 months (P = 0.78). In the affected eyes, the change ratio of subfoveal choroidal thickness at 12 months was not correlated with the number of IVRs (mean, 5.8±2.9). Subfoveal choroidal thickness demonstrated a similar trend toward decreasing during the following period independent of the subtypes of neovascular AMD or the treatment histories. CONCLUSIONS: Subfoveal choroidal thickness decreased after IVRs in eyes with neovascular AMD. Intravitreal injections of ranibizumab may provide a pharmacologic effect not only on the neovascular lesion but also on the underlying choroid.

Fundus autofluorescence in polypoidal choroidal vasculopathy.

PURPOSE: To investigate and compare the characteristics of fundus autofluorescence (FAF) in polypoidal choroidal vasculopathy (PCV) with those in typical neovascular age-related macular degeneration (AMD). DESIGN: Retrospective, observational, consecutive case series. PARTICIPANTS: Ninety-two patients with PCV (92 affected eyes and 86 unaffected fellow eyes) and 31 patients with typical neovascular occult AMD with no classic choroidal neovascularization (31 affected eyes and 24 unaffected fellow eyes). METHODS: All study eyes underwent FAF photography with a fundus camera-based system. The incidence and distribution of hypoautofluorescence, that is, the manifestation of retinal pigment epithelium (RPE) damages, were evaluated. MAIN OUTCOME MEASURES: The characteristic FAF findings in PCV. RESULTS: In the affected eyes with PCV, the sites of the neovascular lesions showed 2 distinct FAF patterns: (1) the confluent hypoautofluorescence at the polypoidal lesions and (2) the granular hypoautofluorescence at the branching choroidal vascular networks. The confluent hypoautofluorescence, most of which was surrounded by a hyperautofluorescent ring, was seen in 74 eyes (80.4%) with PCV but was seen in no eyes with typical neovascular AMD (P < 0.001). The granular hypoautofluorescence was seen in 91 eyes (98.9%) with PCV and 27 eyes (87.1%) with typical neovascular AMD (P = 0.014). In addition, the eyes with PCV more frequently showed hypoautofluorescence outside the macular area than those with typical neovascular AMD (P = 0.021). In the unaffected fellow eyes, the hypoautofluorescence was more frequently observed in patients with PCV than in those with typical neovascular AMD, inside the macular area and in the entire FAF image (P = 0.012, P = 0.003, respectively). CONCLUSIONS: In eyes with PCV, the polypoidal lesions and the branching choroidal vascular networks appeared to affect the RPE and induce peculiar FAF findings. When compared with the patients with typical neovascular AMD, widespread RPE damage was more frequently observed in the patients with PCV, both in the affected eyes and in the unaffected fellow eyes.

Choroidal thickness in inferior staphyloma associated with posterior serous retinal detachment.

PURPOSE: The purpose of the study was to describe the choroidal findings in eyes with posterior serous retinal detachment associated with inferior staphyloma by enhanced depth imaging optical coherence tomography. METHODS: The study involved five eyes of five patients with the inferior staphyloma accompanied by posterior serous retinal detachment. In each case, the upper border of the staphyloma was lying across the macula. Enhanced depth imaging spectral domain optical coherence tomography was performed in a vertical-sectional manner through the fovea, and the choroidal thicknesses at the thinnest point, at the fovea, and at 0.5 mm and 1.0 mm superior and inferior to the thinnest point were measured. Fluorescein angiography and indocyanine green angiography were also performed. RESULTS: In all 5 eyes, the choroid was thinnest at the upper border of the staphyloma (mean, 37.4 µm; SD, 13.5 µm; range, 23-53 µm). Fluorescein angiography showed a band of window defects along the upper border of the staphyloma, where indocyanine green angiography demonstrated persistent hypoperfusion in all 5 eyes. CONCLUSION: The choroid was markedly thin at the upper border of the inferior staphyloma accompanied by posterior serous retinal detachment. Such choroidal abnormality seemed to play an important role in the development of serous retinal detachment.

Predictive factors of resolved retinal fluid after intravitreal ranibizumab for polypoidal choroidal vasculopathy.

BACKGROUND/AIMS: To investigate the predictive factors for the resolution of retinal fluid after intravitreal injections of ranibizumab (IVRs) for polypoidal choroidal vasculopathy (PCV). METHODS: Forty-seven eyes of 45 patients with symptomatic PCV received 0.5 mg of IVR monthly for 3 months. One month after the third IVR, the presence of dry macula, defined as absence of retinal fluid as detected by the use of optical coherence tomography, was retrospectively evaluated and correlated with clinical characteristics at baseline. Most of the eyes were followed for over 6 months. RESULTS: Of the 47 eyes, 31 eyes (66%) achieved the dry macula along with increased best-corrected visual acuity (BCVA) (0.64 to 0.46 logarithm of the minimum angle of resolution units, p<0.0001), while the other 16 eyes without dry macula showed no significant change of BCVA. Univariate analyses of the baseline characteristics identified the smaller size of the largest polyp (p=0.0008) and the absence of serous or haemorrhagic pigment epithelial detachment (p=0.045) as predictive factors for the dry macula. Multivariate logistic regression found the independent predictor for the dry macula to be the smaller size of the largest polyp (p=0.001). No severe systemic or ocular adverse events were observed. CONCLUSIONS: IVR may be helpful for resolution of retinal fluid and increased BCVA in the short term, but larger polyps and pigment epithelial detachments at baseline may be negative prognostic factors for a therapeutic response. Further studies are needed to clarify the long-term efficacy of IVR for PCV.

Subfoveal choroidal thickness in typical age-related macular degeneration and polypoidal choroidal vasculopathy.

PURPOSE: To investigate the subfoveal choroidal thickness in eyes with typical age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV), using enhanced depth imaging optical coherence tomography. METHODS: Retrospective observational case series of 44 eyes of 44 patients (12 females and 32 males) with typical AMD or PCV located in the subfoveal region. Cross-sectional images of the choroid of each of the involved eyes were obtained by a spectral-domain OCT. The choroidal thickness under the fovea was retrospectively studied. RESULTS: Of the 44 eyes involved in this study, 21 eyes were diagnosed as typical AMD and the other 23 eyes were diagnosed as PCV. The difference in subfoveal choroidal thickness between the eyes with typical AMD (245 µm) and those with PCV (293 µm) was statistically significant, even after adjusting for age, spherical equivalent, and gender distribution (P = 0.045). When compared to eyes with subfoveal choroidal thickness less than 300 µm, those with subfoveal choroidal thickness of 300 µm or more were 5.6 times more likely to have PCV (adjusted odds ratio 5.60, 95% confidence interval 1.30-24.0, P = 0.021). CONCLUSIONS: The choroid under the fovea was thicker in eyes with PCV than those with typical AMD. This result suggests that the choroidal vascular lesion seen in PCV may not be just the choroidal neovascularization accompanied by saccular capillary dilations at the border, but may have a significant structural difference in the choroid compared to typical AMD.