玻璃体腔重复注射雷珠单抗对新生血管性AMD视网膜色素上皮萎缩面积及脉络膜厚度的影响

背景 玻璃体腔注射雷珠单抗(IVR)是治疗新生血管性年龄相关性黄斑变性(nAMD)的有效方法,了解IVR对视网膜色素上皮(RPE)和脉络膜产生的可能影响有助于临床上更好地选择重复注射次数和时机.目前对nAMD患者接受IVR后RPE萎缩面积和脉络膜厚度变化的定量研究较少见. 目的 采用频域光相干断层扫描(OCT)技术探讨IVR对nAMD患眼RPE萎缩面积及脉络膜厚度的影响. 方法 采用前瞻性自身对照研究设计,连续纳入2015年1月至2015年6月在武汉大学人民医院就诊的nAMD患者41例41眼.所有患眼均接受0.05 ml雷珠单抗(10 mg/ml)玻璃体腔注射,每个月随访1次,连续随访12个月.分别于IVR前及IVR后3、6、12个月采用频域OCT仪中RPE高级定量分析软件测量患眼黄斑区RPE萎缩面积,采用加强深度扫描OCT(EDI-OCT)技术测量黄斑中心凹下脉络膜厚度,对比分析IVR前后RPE萎缩面积和脉络膜厚度的变化及其之间的关系,评估RPE萎缩面积和脉络膜厚度变化与IVR次数的相关性.结果 所有患者全部配合完成治疗和随访.IVR后患眼视力较IVR前均明显改善,注射前后不同时间点平均视力的总体比较差异有统计学意义(F=7.631,P＜0.001).患眼IVR注射前平均脉络膜厚度值为(264.55±100.95) μm,IVR后3、6、12个月分别为(247.42±105.46)、(246.81± 99.85)和(253.97±101.15) μm,注射前后患眼平均脉络膜厚度值的差异有统计学意义(F=2.030,P＜0.05),注射后各时间点患眼平均脉络膜厚度较注射前均明显变薄,差异均有统计学意义(均P＜0.05).患眼IVR前与IVR后各时间点平均RPE萎缩面积比较差异无统计学意义(F=0.116,P=0.951).患眼RPE萎缩面积减小值与脉络膜厚度降低值呈微弱负相关(r=-0.185),注射次数＞6次组和注射次数≤6次组患眼的RPE萎缩面积减小值和脉络膜厚度降低值间分别呈微弱正相关和负相关(r=0.297、-0.327),但均无统计学意义(P=0.248、0.282、0.103).随访12个月,RPE萎缩面积减小值和脉络膜厚度降低值与IVR次数均呈微弱的线性相关(rs=-0.266、0.342),但均无统计学意义(P=0.148、0.060).结论 IVR可使AMD患者中心凹下脉络膜萎缩变薄,但未发现引起明显的RPE萎缩.多次IVR并不加速RPE或脉络膜萎缩.     

How does anisometropia affect the choroidal vascularity index?

Purpose:To investigate the choroidal vascularity index (CVI) and morphological features of the choroid in anisometropic amblyopia.Methods:In this prospective cross-sectional study, 39 patients with unilateral anisometropic amblyopic patients and 33 eyes of 33 healthy control participants were involved. These participants were examined in terms of axial length (AL), spherical equivalent (SE), central macular thickness (CMT), choroidal thickness (CT), total choroidal area (TCA), luminal area (LA), stromal area (SA), LA/SA ratio, and CVI. All parameters were compared between amblyopic eyes, healthy fellow eyes, and healthy control eyes. The Shapiro–Wilk tests, Chi-square test, the paired t-test, Wilcoxon signed-rank test, Mann–Whitney U test, Kruskal–Wallis test, and Pearson/Spearman correlation tests were used.Results:In the hyperopic patients; SE, subfoveal CT, nasal CT, temporal CT, TCA, LA, SA, and CMT were greater in amblyopic eyes than in healthy fellow eyes and control eyes (P < 0.001, P < 0.001, P < 0.001, P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively), and CVI, LA/SA ratio, and AL were smaller in amblyopic eyes than in healthy fellow eyes and control eyes ([P < 0.001, P = 0.006], P < 0.001, and P < 0.001, respectively). In the myopic patients, subfoveal CT, nasal CT, temporal CT, TCA, LA, SA values were statistically smaller in amblyopic eyes than in healthy eyes and control eyes ([P < 0.001, P = 0.002), [P = 0.004, P = 0.012], [P = 0.012, P = 0.032], [P < 0.001, P = 0.013], [P < 0.001, P = 0.024], and [P < 0.001, P = 0.047], respectively). The differences in the AL and choroidal parameters were due to myopia and hyperopia.Conclusion:The choroidal structural parameters of the amblyopic eyes were different from that of the healthy eyes.     

Evaluation of the Effect of a Novel β3-Adrenergic Agonist on Choroidal Vascularity

PurposeTo determine the effect of the new β₃-agonist (mirabegron), which is used for overactive bladder (OAB) treatment, on central retinal thickness (CRT) and choroidal vascularity.Material and MethodsThe 26 eyes of 26 cases using 50 mg tablet mirabegron once per day for OAB were included in this prospective case control study. The CRT, choroidal thickness (ChT), and choroidal vascularity were measured at baseline, week 1 (W1), month 1 (M1), month 2 (M2), and month 3 (M3). Subfoveal ChT measurement included the total subfoveal choroidal thickness (SFCT), and the small and large choroidal vessel layer (SCVL and LCVL) thickness. The total choroidal area (TCA), lumen area (LA), stromal area (SA), stroma/lumen ratio, and choroidal vascularity index (CVI) were measured with the Image-J software.ResultsThe largest SFCT increase compared to baseline was at M1 (26.8 ± 40.8 µm, P = 0.001). The subfoveal SCVL thickness showed a significant decrease at M2 and M3 (−6.0 ± 8.9 µm, P = 0.002; −7.8 ± 13.4 µm, P = 0.046, respectively). LCVL thickness showed a significant increase at W1, M1, and M2, with the largest at M1. CVI showed a significant increase at M1, M2, and M3 (P < 0.05 for all). The TCA, LA, and SA showed a significant increasing trend at all follow-up periods. LA/SA decreased at W1 because of stromal expansion but increased at M3 with more prominent vascular dilatation. CRT values showed no significant change.ConclusionsMirabegron had a significant effect on choroidal thickness. Choroidal vascular response is in the form of narrowing in the choriocapillaris and enlargement in the Haller''s layer.     

基于EDI-OCT技术观察远视性弱视儿童脉络膜结构的变化

目的:通过增强深度成像光学相干断层扫描(EDI-OCT)技术比较远视性弱视与同龄正常儿童脉络膜结构的差异。方法:选取2021-01/12就诊于我院的远视性弱视儿童35例50眼纳入弱视组,选取同期就诊一般资料相匹配的健康儿童30例51眼纳入对照组,均进行EDI-OCT检查,测量脉络膜厚度(CT),并对图像进行处理后获取总脉络膜面积(TCA)、血管腔面积(LA)、基质面积(SA)、脉络膜血管指数(CVI)。结果:弱视组各区域TCA(下方除外)、SA(外环下方除外)、LA与CT(下方、颞侧除外)均明显大于对照组(P<0.05);除外环颞侧外,两组各区域CVI无明显差异(P>0.05);除鼻侧外,不同远视程度弱视儿童CT无明显差异(P>0.05)。结论:远视性弱视存在脉络膜结构异常,随着远视度数增加,TCA、LA、SA有增大趋势,脉络膜结构改变与远视性弱视有关。     

Natural history of persistent subretinal fluid following the successful repair of rhegmatogenous retinal detachment

AIM: To compare the efficacy of bevacizumab, ranibizumab, and aflibercept in pseudophakic cystoid macular edema (CME, Irvine-Gass Syndrome [IGS]) patients with fellow healthy eyes'' that underwent cataract surgery. METHODS: This study was a retrospective consecutive case series. Those who developed postoperative pseudophakic CME that refractory to topical treatment and treated with anti-VEGF agents were included. Optical coherence tomography (OCT) examination including central macular thickness (CMT), total macular volume (TMV), retinal nerve fiber layer (RNFL), and ganglion cell layer (GCL) and choroidal thickness (ChT) measurements at the baseline, 1st, 3rd and 6th month controls were performed. Mann-Whitney U test was performed for comparison of non-normally distributed quantitative data of two groups. RESULTS: Fifty-nine eyes of 59 patients with CME and other healthy eyes of the patients (Control group) were evaluated. There were 22 eyes of 22 patients in the bevacizumab group (group 1), 19 eyes of 19 patients in the ranibizumab group (group 2), and 18 eyes of 18 patients in the aflibercept group (group 3). There was no difference in terms of age, gender, axial length, IOP, and spherical equivalent values. The baseline subfoveal and mean choroidal thicknesses were higher in IGS group. The difference between the baseline and sixth month values of subfoveal and mean choroidal thicknesses were compared in the CME groups, thinning was observed in all three groups. GCL was thinner in the patient group at the 6th month of treatment. The resolution time of CME was observed faster in group 1. CONCLUSION: All three anti-VEGF agents seem to be effective in CME but bevacizumab appears to be slightly more cost-effective than the other two alternatives.     

颈内动脉狭窄患者的脉络膜厚度和脉管指数的改变

目的:使用扫频光相干断层扫描(SS-OCT)比较无眼部症状的颈内动脉狭窄(ICAS)患者和健康人之间黄斑区脉络膜厚度(SFCT)和脉管指数(CVI)。方法:回顾性研究。纳入2018-03/2019-06我院神经外科确诊ICAS患者40例,取其与颈内动脉狭窄同侧的40眼为ICAS组,另外纳入20例性别年龄相匹配的健康人的双眼作为对照组。所有受试者均于同一时间段用SS-OCT行黄斑扫描,测量SFCT,并将OCT图像以Image J软件二值化处理测量中心凹3mm范围脉络膜的CVI。结果:ICAS组和对照组的SFCT分别为208±66、234±77μm(P=0.27)。ICAS组和对照组的CVI值分别为64.5%±1.7%和66.1%±2.7%(P=0.04)。受试者工作曲线(ROC curve)中CVI的曲线下面积(AUC)为0.76(P=0.005),而SFCT的AUC为0.58(P=0.41)。结论:无眼部症状的ICAS患者CVI低于正常对照组,而SFCT无明显改变,提示对无眼部症状的ICAS患者检测其CVI较SFCT更有助于早期的发现脉络膜血液循环的改变。     

视网膜中央动脉阻塞眼脉络膜结构相关参数的改变

目的 采用频域光学相干断层扫描(SD-OCT)的增强深度成像(EDI)技术分析视网膜中央动脉阻塞(CRAO)眼各项脉络膜结构相关参数的改变.方法 收集2018年10月至2019年12月在首都医科大学附属北京友谊医院眼科确诊为CRAO的21例单眼患者临床资料.选取CRVO患眼及对侧健眼各项脉络膜结构相关参数测量结果进行分...     

玻璃体腔注射康柏西普与阿柏西普治疗厚脉络膜新生血管病变的疗效比较

目的:观察比较玻璃体腔注射康柏西普与阿柏西普治疗厚脉络膜新生血管病变(PNV)的临床疗效及安全性。方法:回顾性病例对照研究。收集2018-02/2022-10于我院确诊为PNV的患者33例35眼,根据玻璃体腔注射药物分为康柏西普组14例14眼,阿柏西普组19例21眼,比较两组患者治疗前,治疗后1、3、6mo的最佳矫正视力(BCVA)、黄斑中心凹下脉络膜厚度(SFCT)、黄斑中心凹视网膜厚度(CMT)、注药次数及临床并发症的情况。结果:治疗后1、3、6mo,两组患者的BCVA、CMT、SFCT较治疗前均明显改善(均P<0.05);在整个随访期间,两组患者玻璃体腔注射次数分别为2(2,3)、2(1.5,2)次,未见明显差异(P=0.423);在应用康柏西普及阿柏西普的治疗过程中,均未发生严重的并发症。结论:玻璃体腔注射康柏西普及阿柏西普均能治疗PNV,在提高视力的同时改善解剖结构,两种药物疗效相似,均能达到较为理想的临床效果。     

Combined photodynamic therapy and intravitreal triamcinolone for nonsubfoveal choroidal neovascularization

PURPOSE: To examine the 12-month results for a group of patients with nonsubfoveal choroidal neovascularization who were treated with combined photodynamic therapy (PDT) with verteporfin and intravitreal triamcinolone acetonide. METHODS: Patients with nonsubfoveal choroidal neovascularization, which was defined as either juxtafoveal or extrafoveal neovascularization, were treated with PDT immediately followed by an intravitreal injection of 4 mg of triamcinolone acetonide. Need for retreatment was based on fluorescein angiographic evidence of leakage at 3-month follow-up intervals. The main outcome measures were visual acuity and the proportion of patients developing subfoveal extension. RESULTS: Of the 15 patients, 9 were women and 6 were men (mean age +/- SD, 80 +/- 7.5 years). The mean baseline visual acuity was almost 20/60 (mean logMAR = 0.46), and 14 of the 15 eyes had juxtafoveal choroidal neovascularization. At 3, 6, and 9 months, the patients had significant improvement in the mean visual acuity (P = 0.002, 0.001, and 0.007, respectively), but at the end of the 12-month follow-up period, the mean visual acuity was slightly worse than 20/40 (mean logMAR = 0.34), which was not statistically significant at an alpha level adjusted for multiple comparisons of .013 (P = .057) as compared with the baseline visual acuity. One patient had subfoveal extension of choroidal neovascularization. The mean number of treatments was 1.9. Three patients (20%) developed an intraocular pressure of >24 mmHg during follow-up, a threshold used to institute pressure reduction therapy. No patient developed endophthalmitis. CONCLUSION: The number of patients in this pilot study was limited; however, the visual acuity response and the low incidence of subfoveal extension suggest that PDT combined with intravitreal triamcinolone for the treatment of nonsubfoveal choroidal neovascularization merits further investigation as a first-line treatment.     

脉络膜厚度测量在糖尿病性视网膜病变治疗中的应用

目的：评价黄斑中心凹下脉络膜厚度测量在糖尿病视网膜病变治疗中的作用。
　　方法：本研究为回顾性研究,共纳入糖尿病视网膜病变患者32例32眼,所有患者均伴有明显的黄斑水肿,且首次接受玻璃体腔内注射雷珠单抗。观察指标包括：治疗前后中心凹下脉络膜厚度、黄斑区视网膜厚度及最佳矫正视力,观察时间为治疗后3 mo。
　　结果：治疗后3mo,患者的平均最佳矫正视力显著优于治疗前,且黄斑水肿程度及中心凹下脉络膜厚度均显著降低;Spearman秩相关系数分析提示,术后最佳矫正视力与治疗前黄斑区下脉络膜厚度呈正相关( rs=0.544, P=0.036)。
　　结论：在糖尿病视网膜病变所致黄斑水肿的治疗中,治疗前黄斑区下脉络膜厚度较厚的患者似乎对治疗更敏感,术后的最佳矫正视力也更好,因此黄斑区下脉络膜厚度可能可以作为评估其预后的新指标。     

Evaluation of choroidal thickness and choroidal vascularity index during pregnancy

ObjectiveTo assess the choroidal structural characteristics in the first and third trimesters in pregnant women using enhanced depth imaging optical coherence tomography and binarization method.DesignProspective study.ParticipantsTwenty-five eyes of 25 pregnant women in the first trimester (group 1) and 25 eyes of 25 pregnant women in the third trimester (group 2) were examined. Healthy age-matched 25 participants were enrolled as a control group (group 3).MethodsThe choroidal thickness (CT) was measured at 3 points; subfoveal, 1500 μm nasal to the fovea, and 1500 μm temporal to the fovea. Total choroidal area, luminal area, stromal area, stroma/lumen ratio, and choroidal vascularity index (CVI) were measured by Image-J software.ResultsThe mean subfoveal and nasal CT were statistically significantly increased in group 1 compared with controls (p = 0.005 and p = 0.004, respectively). The mean temporal CT was statistically significantly increased in group 1 compared with groups 2 and 3 (group 1 vs group 2, p = 0.043; group 1 vs group 3, p = 0.011). The mean total choroidal area, stromal area, and luminal area were significantly increased in groups 1 and 2 compared with control group (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, p = 0.002, p = 0.002, respectively). There were no statistically significant differences among groups in terms of mean stroma/lumen ratio and CVI (p = 0.148 and p = 0.312, respectively).ConclusionsThere was a significant increase in subfoveal, temporal, and nasal CT in the first trimester. Total choroidal, stromal, and luminal areas were significantly increased in the first and third trimesters.     

玻璃体内注射康柏西普对渗出性老年性黄斑变性患者脉络膜厚度的影响

目的　观察玻璃体内注射康柏西普对渗出性老年性黄斑变性（ａｇｅ-ｒｅｌａｔｅｄｍａｃｕｌａｒｄｅｇｅｎｅｒａｔｉｏｎ,ＡＭＤ）患者脉络膜厚度（ｃｈｏｒｏｉｄａｌｔｈｉｃｋｎｅｓｓ,ＣＴ）的影响。方法　确诊为渗出性ＡＭＤ患者４２例４２眼,分为典型ＡＭＤ（ｔｙｐｉｃａｌ-ＡＭＤ,ｔＡＭＤ）组和息肉样血管病变（ｐｏｌｙｐｏｉｄａｌｃｈｏｒｏｉｄａｌｖａｓｃｕｌｏｐａｔｈｙ,ＰＣＶ）组,均行３＋ＰＲＮ方案的玻璃体内注射康柏西普治疗。采用光学相干断层扫描的增强深度成像技术测量治疗前及初次治疗后１个月、２个月、３个月、６个月治疗眼及对侧眼中心凹下脉络膜厚度（ｓｕｂｆｏｖｅａｌｃｈｏｒｏｉｄａｌｔｈｉｃｋｎｅｓｓ,ＳＦＣＴ）及距离中心凹１ｍｍ的鼻侧和颞侧ＣＴ,对比分析康柏西普治疗前后的ＣＴ变化。结果　渗出性ＡＭＤ患眼玻璃体内注射康柏西普后１个月、２个月、３个月、６个月ＳＦＣＴ分别为（２２３．５５±３０．７１）μｍ、（２２１．５２±３３．３７）μｍ、（２１４．４３±３１．８１）μｍ、（２１４．９３±３１．４１）μｍ;治疗后６个月鼻侧ＣＴ从（２２５．４０±４３．９７）μｍ减少至（２０５．７１±４２．２０）μｍ,颞侧ＣＴ从（２３５．２１±４７．２２）μｍ降至（２０３．５２±３９．１５）μｍ;与基线相比,差异均具有统计学意义（均为Ｐ＜０．００１）。其中,ｔＡＭＤ组ＳＦＣＴ从（２３４．０６±４１．０４）μｍ减至（２０９．１９±３２．１４）μｍ,ＰＣＶ组从（２７４．６０±２７．７３）μｍ减至（２３３．３０±２１．０８）μｍ,各随访时间点所测ＳＦＣＴ与基线时相比差异均具有统计学意义（均为Ｐ＜０．０５）,而对侧正常眼６个月各时间点ＳＦＣＴ无明显改变。结论　玻璃体内注射康柏西普会引起渗出型ＡＭＤ（ｔＡＭＤ和ＰＣＶ）ＣＴ降低。     

Intravitreal aflibercept in neovascular age-related macular degeneration previously treated with ranibizumab

AIM: To report the change in visual acuity and central macular thickness (CMT) following treatment with intravitreal aflibercept injections in patients with neovascular age-related macular degeneration (nAMD) with suboptimum response to ranibizumab. METHODS: This was a retrospective study. The inclusion criteria were patients with nAMD who responded poorly to ranibizumab. Patients then received either 3 consecutive aflibercept injections followed by PRN treatment or PRN alone. Primary endpoints were mean change in best-corrected visual acuity (BCVA) and CMT at 12mo. Secondary endpoints were number of injections and adverse events. RESULTS: Forty-nine eyes from 49 patients met the inclusion criteria and completed 12-month follow up on aflibercept. Thirty-eight eyes received 3 consecutive aflibercept injections followed by PRN treatment and 11 eyes received pro re nata (PRN) injections alone. At 12mo, mean BCVA improved by one letters (logMAR 0.56±0.31 to 0.54±0.34) and mean CMT decreased from 303.9±82.1 to 259.2±108.3 µm. Four percent of eyes gained 15 letters or more, 6% lost more than 15 letters and the remaining 90% had stable BCVA. The mean number of aflibercept injections was 6. There was one case of infectious endophthalmitis. CONCLUSION: Intravitreal aflibercept in patients with nAMD with a previous suboptimal response to ranibizumab resulted in an anatomical improvement in macular appearance at 12mo without a corresponding improvement in visual acuity.     

玻璃体内注射雷珠单抗治疗重度非增生型糖尿病视网膜病变伴黄斑水肿后患者脉络膜厚度的变化

目的 观察玻璃体内注射雷珠单抗治疗重度非增生型糖尿病视网膜病变伴黄斑水肿后患者脉络膜厚度的变化情况,明确脉络膜厚度与患者视力之间的相关性.方法 选取在我院确诊为重度非增生型糖尿病视网膜病变伴黄斑水肿患者23例(23眼),每月眼内注射1次雷珠单抗并连续接受3次治疗,记录患者治疗前以及治疗后1个月、2个月、3个月黄斑中心凹下脉络膜厚度,同时记录患者黄斑区视网膜神经上皮厚度和最佳矫正视力.分析黄斑中心凹下脉络膜厚度、黄斑区视网膜神经上皮厚度、最佳矫正视力的动态变化情况以及相关性.结果 玻璃体内注射雷珠单抗后1个月、2个月、3个月黄斑中心凹下脉络膜厚度和黄斑区视网膜神经上皮厚度均连续下降,前两个月与治疗前相比两指标差异均无统计学意义(均为P＞0.05),第3个月时与治疗前相比,差异均有统计学意义(P=0.04、0.01).最佳矫正视力在治疗过程中持续得到改善,前两个月与治疗前相比差异均无统计学意义(均为P＞0.05),第3个月时与治疗前相比,差异有统计学意义(P=0.04).治疗前黄斑中心凹下脉络膜厚度与黄斑区视网膜神经上皮厚度之间存在正相关性(R2 =0.94,P =0.00);与治疗前和治疗后3个月最佳矫正视力之间均存在正相关性(R2 =0.93,P=0.00;R2 =0.82,P =0.00).治疗前黄斑区视网膜神经上皮厚度与治疗后3个月最佳矫正视力之间也存在正相关性(R2=0.83,P=0.00).治疗前最佳矫正视力与治疗后3个月最佳矫正视力之间同样存在正相关性(R2=0.84,P=0.00).结论 黄斑中心凹下脉络膜厚度可以作为评价重度非增生型糖尿病视网膜病变伴黄斑水肿病情变化的有效临床指标,而且可以一定程度上预测抗血管内皮生长因子治疗的效果.     

Prospective evaluation of aflibercept in pigment epithelial detachments secondary to neovascular age related macular degeneration

ObjectiveTo assess the efficacy of intravitreal aflibercept in treating visual loss and structural changes in patients with pigment epithelial detachments (PED) secondary to neovascular age-related macular degeneration (nAMD).MethodsProspective, exploratory, open-label study (ClinicalTrials.gov Identifier: NCT02142296). Participants with PED secondary to nAMD were enrolled and received intravitreal aflibercept injection on a monthly basis for 3 months, followed by injections on a bimonthly basis for another 9 months. Best-corrected visual acuity (BCVA), ophthalmic examinations, optical coherence tomography (OCT) imaging, and fluorescein angiography were performed based on a predetermined schedule.ResultsThirty-six participants (37 eyes) were enrolled. At the end of study, 74.3% eyes demonstrated PED height reduction of 25% or more and 34.3% demonstrated complete resolution. The average reduction in retinal thickness was 128.4 μm. Participant eyes who had at least a 25% reduction in PED height at month 4 were labelled as “responders” (73.0%, n = 27), and those who had less than 25% reduction in PED height were labelled as “partial-responders” (27.0%, n = 10). Responders demonstrated more significant reduction in PED height than partial-responders (p <0.0001). The average gain in BCVA was 10.1 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. Responders demonstrated more gain in BCVA than partial-responders (p = 0.0018). Among the responders, 57.7% demonstrated disease recurrences with increase in PED height during bimonthly dosing.ConclusionsIntravitreal aflibercept injection for patients with PEDs secondary to nAMD has high response rate with few adverse events. Responders demonstrated BCVA gains, as well as structural improvements. However, high recurrence rate was found on bimonthly maintenance dosing.     

Improved thickness measurement method for choroidal hyperpermeability in central serous chorioretinopathy

AIM: To evaluate the efficacy and safety of subthreshold micropulse yellow laser (SMYL) in the treatment of chronic central serous chorioretinopathy (CCSC). METHODS: The medical records of 58 eyes of 58 patients with CCSC were reviewed. A 577-nm SMYL system was used for the treatment. Fundus fluorescein angiography was used as the primary method of identifying CCSC, and resolution of subretinal fluid evaluated by optical coherence tomography (OCT) and fundus autofluorescence. Central macular thickness (CMT), central macular volume (CMV), total macular volume (TMV), subfoveal choroidal thickness (SFCT), subretinal fluid height (SRFH), and subfoveal fluid basement diameter values were measured by SD-OCT for all eyes. RESULTS: The mean age of the patients was 42.4±9.9 (range: 20-72)y. The mean follow-up was 11.4±8.5 (range: 6-37)mo. Median BCVA at at the final follow up after treatment was statistically significant from the baseline. Complete SRF resolution was 12.1% of the eyes in the 1st month, 67.2% of the eyes in the 3rd month and 67.2% of the eyes in the last follow up. The initial median CMT, CMV, TMV, and SFCT values before treatment was significantly higher than 3rd month visit values (P<0.001). In the multivariate analysis performed, age and disease duration were found to be a risk factor for persistent SRF (P=0.017, P=0.016, respectively). CONCLUSION: SMYL treatment provides a significant anatomical and functional improvement and is effective in eliminating SRF in eyes with CCSC.     

Differences in Retinal and Choroidal Vasculature and Perfusion Related to Axial Length in Pediatric Anisomyopes

PurposeThe purpose of this study was to evaluate the interocular differences in choroidal vasculature, choriocapillaris perfusion, and retinal microvascular network, and to explore their associations with interocular asymmetry in axial lengths (ALs) in children with anisomyopia.MethodsRefractive error, AL, and other biometric parameters were measured in 70 children with anisomyopia. Using optical coherence tomography (OCT) and OCT-angiography, we measured the submacular choroidal thickness (ChT), total choroidal area (TCA), luminal area (LA), stromal area (SA), choroidal vascularity index (CVI), choriocapillaris flow deficit (CcFD), retinal vessel density (VD), and foveal avascular zone (FAZ) area.ResultsThe mean interocular differences in spherical equivalent refraction and AL were −2.26 ± 0.94 diopters and 0.95 ± 0.46 mm, respectively. Submacular ChT, TCA, LA, SA, and CVI were all significantly lower in the more myopic (longer AL) eyes than in the less myopic (shorter AL) fellow eyes. In eyes with longer ALs, both the CcFD and FAZ areas were significantly greater, whereas the superficial and deep retinal VDs were significantly less. After adjusting for corneal power and intraocular pressure, interocular differences in LA (β = −0.774), SA (β = −0.991), and CcFD (β = 0.040) were significantly associated with interocular asymmetry in AL (all P < 0.05).ConclusionsIn pediatric anisomyopes, eyes with longer ALs tended to have lower choroidal vascularity and choriocapillaris perfusion than the contralateral eyes with shorter ALs. Longitudinal investigations would be useful follow-ups to test for a causal role of choroidal circulation in human myopia.     

Retinal pigment epithelial tears after intravitreal bevacizumab injection for neovascular age-related macular degeneration

PURPOSE: To study retinal pigment epithelium (RPE) tears after off-label intravitreal bevacizumab (Avastin; Genentech, Inc., South San Francisco, CA) injection for neovascular age-related macular degeneration. Eyes with a vascularized pigment epithelial detachment (PED) that developed an RPE tear were compared with eyes with a vascularized PED but without an RPE tear. METHODS: Nine retina specialists across the United States and in Europe participated in this retrospective case series. All eyes that received intravitreal bevacizumab injection for choroidal neovascularization (CNV) over 12 months (October 2005 to September 2006) were included. Eyes without all three confirmed tests (fluorescein angiography, fundus photography, and optical coherence tomography) were excluded from analysis. Statistical analyses were performed on multiple characteristics of eyes with a vascularized PED that did and did not develop an RPE tear. RESULTS: Among 2,785 intravitreal bevacizumab injections for 1,064 eyes, RPE tears were found in 22 eyes in 22 patients (2.2%). A vascularized PED was present in 21 of 22 eyes that developed an RPE tear (17.1% of PED eyes; 15, 100% occult CNV; 6, predominantly occult CNV). Mean interval from bevacizumab injections to RPE tears was 37.3 days. Mean follow-up time was 124.9 days. Mean subfoveal PED size was larger for eyes with tears than for those without tears (13.97 mm vs 9.9 mm, respectively; P = 0.01; odds ratio, 1.09). There was substantially smaller mean ratio of CNV size to PED size for eyes with tears than for those without tears (27.9% vs 67.6%, respectively; P = 0.005). Mean pre-bevacizumab injection best-corrected Snellen visual acuity was 20/162, and mean post-RPE tear best-corrected visual acuity was 20/160 (P = 0.48). CONCLUSION: Large PED size is a predictor for RPE tears, and a small ratio of CNV size to PED size (<50%) is more common in eyes with RPE tears. Vision may be preserved despite RPE tears.     

Treat-and-extend therapy using intravitreal aflibercept for neovascular age-related macular degeneration: 2-year real-world practice data from Slovenia

Background

To assess visual outcomes over 24?months in patients with neovascular age-related macular degeneration (nAMD) who initiated intravitreal aflibercept therapy under a treat-and-extend (TE) regimen in real-world settings.

Methods

In this retrospective, observational, multicentre study in Slovenia, medical records of all treatment-naïve patients with nAMD who started intravitreal aflibercept therapy between October 2013 and April 2015 were reviewed. The primary outcome measure was change in mean visual acuity (VA) from baseline to 24?months in patients who received the TE regimen for 2?years, assessed by standardised Early Treatment Diabetic Retinopathy Study charts and calculated as least-squares means. Other outcome measures included the numbers of injections and visits at 12?months and 24?months.

Results

The primary analysis included 115 eyes of 105 patients who received TE treatment for 2?years (Group A). The mean VA improved from 57.9?±?14.9 letters at baseline to 64.6?±?15.8 letters (+?6.5 letters, p?<?0.0001) at 12?months and 64.8?±?15.6 letters (+?7.0 letters, p?<?0.0001) at 24?months. The mean number of injections per eye was 8.4?±?1.9 and the mean number of visits was 8.8?±?1.7 at 12?months; these numbers decreased to 6.1?±?2.0 and 6.4?±?1.9, respectively, at 24?months. The additional analysis included 33 eyes of 33 patients who received TE treatment in Year 1, followed by pro re nata treatment in Year 2 (Group B). Compared with Group A whose vision improvement was maintained at 24?months, the VA gain in Group B eyes seen at 12?months (change in mean VA vs baseline: +?6.9 letters, p?=?0.0008) was no longer present at 24?months (change in mean VA vs baseline: +?1.2 letters, p?=?0.5733).

Conclusions

Using the TE regimen in clinical practice, intravitreal aflibercept significantly improved visual outcomes in treatment-naïve patients with nAMD, which were maintained over time. TE therapy with intravitreal aflibercept is a rational long-term strategy that can produce favourable outcomes in clinical practice.

     

Changes on optical coherence tomography angiography and fluorescein angiography in eyes with neovascular age-related macular degeneration

AIM: To evaluate the changes on optical coherence tomography angiography (OCTA) and fluorescein angiography (FA) and their correlation in neovascular age-related macular degeneration (nAMD) before and after intravitreal aflibercept injections (IAIs). METHODS: In 43 treatment-naïve patients with nAMD, choroidal neovascularization (CNV) in OCTA were morphologically and quantitatively analyzed before and after IAIs to determine whether they are correlated with leakage on FA or not. By combining CNV in OCTA and leakage in FA, lesions were characterized as three types: L+C+ (with both CNV and leakage), L-C+ (with CNV but without leakage), or L+C- lesion (with leakage outside CNV). RESULTS: Before IAI, while 27 eyes had L+C+ lesion only, 16 eyes had both L+C+ and L-C+ lesions simultaneously. Tiny capillaries and anastomosis in CNV were more developed in L+C+ lesion, at 86.0% and 58.1%, respectively, relative to 9.3% and 9.3% in L-C+ lesions (P<0.001). After IAIs in 33 eyes, tiny capillaries and anastomosis were decreased in the lesions with cessation of leakage on FA (P<0.001 and P=0.001, respectively). In quantitative analysis, neovascularization length and numbers of junctions and endpoints were also significantly decreased. CONCLUSION: Leakage on FA is associated with CNV morphology in OCTA and remained so after IAIs. Therefore, by carefully assessing the morphological and quantitative changes of CNV in OCTA before and after treatment, activity of nAMD is expected even though CNV on OCTA is not completely matched with fluorescein leakage.