Visual and anatomical outcomes following intravitreal aflibercept in eyes with recalcitrant neovascular age-related macular degeneration: 12-month results

Purpose

To describe the efficacy of intravitreal aflibercept on 12-month visual and anatomical outcomes in patients with neovascular age-related macular degeneration (AMD) recalcitrant to prior monthly intravitreal bevacizumab or ranibizumab.

Methods

Non-comparative case series of 21 eyes of 21 AMD patients with evidence of persistent exudation (intraretinal fluid/cysts, or subretinal fluid (SRF), or both) on spectral domain OCT despite ≥6 prior intravitreal 0.5 mg ranibizumab or 1.25 mg bevacizumab (mean 29.8±17.1 injections) over 31.6±17.4 months who were transitioned to aflibercept.

Results

At baseline, best-corrected visual acuity (BCVA) was 0.42±0.28 logarithm of minimum-angle of resolution (logMAR), central foveal thickness (CFT) was 329.38±102.67 μm and macular volume (MV) was 7.71±1.32 mm³. After 12 months of aflibercept (mean 10.2±1.2 injections), BCVA was 0.40±0.28 logMAR (P=0.5), CFT decreased to 292.71±91.35 μm (P=0.038) and MV improved to 7.33±1.27 mm³ (P=0.003). In a subset of 15 eyes with a persistent fibrovascular or serous pigment epithelial detachment (PED), mean baseline PED greatest basal diameter (GBD) was 2350.9±1067.6 μm and mean maximal height (MH) was 288.7±175.9 μm. At 12 months, GBD improved to 1896.3±782.3 μm (P=0.028), while MH decreased to 248.27±146.2 μm (P=0.002).

Conclusion

In patients with recalcitrant AMD, aflibercept led to anatomic improvement at 12 months, reduction in proportion of eyes with SRF and reduction in PED, while preserving visual acuity.     

Change in subfoveal choroidal thickness in central serous chorioretinopathy following spontaneous resolution and low-fluence photodynamic therapy

Purpose

To assess the change in subfoveal choroidal thickness (SFCT) in central serous chorioretinopathy (CSC) following spontaneous resolution and low-fluence photodynamic therapy (PDT) using the enhanced depth imaging optical coherence tomography (EDI-OCT).

Methods

A total of 36 consecutive eyes of 36 patients were included in this retrospective study: 16 eyes with spontaneously resolved CSC and 20 eyes with PDT-treated CSC. Best-corrected visual acuity and SFCT were evaluated at each visit until complete absorption of the subretinal fluid. SFCT of 32 normal subjects were also measured, as the control group. Wilcoxon''s singed-rank test was used to evaluate the effects of spontaneous resolution and PDT. To compare the SFCT of the eyes with resolved CSC with that of the normal eyes, Mann–Whitney U-test with Bonferroni correction was also employed.

Results

SFCT of patients was 459.16±77.50 μm at the baseline, and decreased to 419.31±54.49μm after a spontaneous resolution (P=0.015). However, SFCT was not normalized in comparison with that of the normal subjects (P<0.001). SFCT in PDT group was also reduced from 416.43±74.01 to 349.50±88.99 μm (P<0.001), with no significant difference with the normal value (P=0.087).

Conclusions

SFCT in patients with CSC decreased both after spontaneous resolution and low-fluence PDT. However, only in the PDT group, after disappearance of subretinal fluid, did it decrease to that of normal subjects.     

Development of polypoidal lesions in age-related macular degeneration

Purpose

To investigate the development of polypoidal lesions using indocyanine green angiography (IA) in eyes with typical age-related macular degeneration (AMD).

Methods

We retrospectively reviewed the medical records of 47 consecutive patients (47 eyes) with typical AMD who had been followed up with IA for at least 2 years.

Results

At the initial visit, although all eyes showed classic and/or occult choroidal neovascularization (CNV) associated with AMD, no eyes showed polypoidal lesions by IA. However, during follow-up, 13 (27.7%) of the 47 eyes did show polypoidal lesions. All polypoidal lesions developed at the edge of persistent CNV or, more often, at the terminus of recently progressed CNV. Of 12 eyes with a final lesion area >8 disc area, 7 (58.3%) showed newly developed polypoidal lesions. In the eyes with these newly developed polypoidal lesions, the mean area of the vascular lesion had extended significantly from 10.50±7.88 mm² to 20.87±10.21 mm² during follow-up (P=0.0018).

Conclusion

The current observation suggests that IA of active AMD sometimes reveals polypoidal lesions if there is progression of the CNV in the subretinal pigment epithelium space.     

Half-dose vs one-third-dose photodynamic therapy for chronic central serous chorioretinopathy

Purpose

To prospectively compare the effects of half-dose verteporfin (3 mg/m²) photodynamic therapy (1/2 PDT) with those of one-third-dose verteporfin (2 mg/m²) PDT (1/3 PDT) for chronic central serous chorioretinopathy (CSC).

Methods

Sixteen eyes of 16 consecutive patients with chronic CSC were enrolled and followed up for a 3-month study period. The first 10 patients received 1/2 PDT and the next 6 patients received 1/3 PDT. The resolution rate of subretinal fluid (SRF) was compared between the two groups. The changes in the choroidal thickness inside and outside the PDT-applied area in both groups were also evaluated.

Results

SRF disappeared in all eyes (100%) in the 1/2 PDT group and in two eyes (33%) in the 1/3 PDT group. In the 1/2 PDT group, choroidal thickness inside and outside the PDT-applied area reduced significantly from the baseline (inside, from 387±24 to 325±25 μm; outside, from 292±25 to 249±19 μm; both P=0.005). In the 1/3 PDT group, choroidal thickness decreased in two eyes where SRF disappeared (inside, 87.2 and 90.9% of the baseline; outside, 91.4 and 92.6% of the baseline), but did not change in the other four eyes where SRF remained (inside, 104.1, 100.0, 105.1, and 100.5% of the baseline; outside, 98.9, 103.0, 100.0, and 99.0% of the baseline).

Conclusions

1/2 PDT is more effective than 1/3 PDT in the resolution of SRF for chronic CSC. Decrease in the choroidal thickness after PDT may be related to the resolution of SRF in chronic CSC.     

Focal choroidal excavation in patients with central serous chorioretinopathy

Purpose

To evaluate the prevalence and clinical features of focal choroidal excavation (FCE) in patients presenting with central serous chorioretinopathy (CSC).

Methods

This is a retrospective consecutive case series of consecutive patients with CSC who were referred for spectral domain optical coherence tomography (SD-OCT) between January 2010 and December 2011. Medical records were reviewed and clinical features including presence of FCE in SD-OCT, fluorescence angiography (FA), and indocyanine green angiography (ICGA) were studied.

Results

Among the 116 CSC patients assessed, FCE was found in 11 eyes of 7 (6.0%) patients. FCE was associated with subretinal fluid in six eyes of six patients and serous pigment epithelial detachment in three eyes of two patients. The mean central subfield retinal thickness of CSC eyes with FCE was 283.7 μm, compared with 377.5 μm for CSC eyes without FCE (Mann–Whitney U-test, P=0.020). Five FCE eyes of five patients had focal leakage on FA. Choroidal hyperpermeability on ICGA was found in seven CSC eyes with FCE, with four eyes showing hypofluorescent spot corresponding to the FCE. After a mean follow-up of 16 months, visual acuity of all 11 eyes with FCE remained stable or improved at the last follow-up.

Conclusion

FCE is not an uncommon feature in patients with CSC and might be associated with choroidal hemodynamic disturbances.     

Transitioning to intravitreal aflibercept following a previous treat-and-extend dosing regimen in neovascular age-related macular degeneration: 24-month results

Purpose:

To evaluate frequency of injections, visual and anatomical outcomes of neovascular age-related macular degeneration (nAMD) patients transitioned to intravitreal aflibercept after failure to extend treatment interval beyond 8 weeks with prior intravitreal bevacizumab or ranibizumab.

Methods:

Retrospective review of patients with nAMD switched to aflibercept following ≥6 prior intravitreal ranibizumab or bevacizumab injections at 4–8-week intervals. Three monthly aflibercept injections were given followed by a treat-and-extend dosing regimen.

Results:

Twenty-one eyes of 18 patients who had received a mean of 23.8±18.8 (mean±SD; range 6–62) prior ranibizumab or bevacizumab injections were included. Over a mean follow-up of 24 months after the transition, 9.2±2.9 (range 4–21) aflibercept injections were required. Interval between aflibercept injections increased to 57.3 days (range 35–133 days), as compared with 37±6.1 days (range 29–54 days) with the prior agents (P=0.01). Mean best-corrected visual acuity was preserved (0.42±0.31 vs 0.42±0.23 logMAR; P=0.2). Mean OCT central subfoveal thickness (292.1±83.2 μm to 283.6±78.6 μm; P=0.4) and mean macular volume (7.9±0.95 mm³ to 7.67±0.94 mm³; P=0.16) remained stable.

Conclusion:

Patients requiring treatment more frequently than every 8 weeks with ranibizumab and bevacizumab were transitioned to >8-week treatment interval with aflibercept while maintaining the anatomic and visual gains.     

Efficacy of half-fluence photodynamic therapy depending on the degree of choroidal hyperpermeability in chronic central serous chorioretinopathy

Purpose

The purpose of this study is to determine the efficacy of half-fluence photodynamic therapy (PDT) depending on the degree of hyperfluorescence based on indocyanine green angiography (ICGA) for treatment of chronic central serous chorioretinopathy (CSC).

Methods

We conducted a prospective study of 30 eyes of 30 patients with chronic CSC. Half-fluence PDT (25 J/cm² for 83 s) with ICGA guidance was applied to the area of choroidal hyperpermeability. The baseline middle-phase ICGA findings were classified as intense or weak hyperfluorescence depending on the degree of hyperpermeability from choriocapillaris. Changes in mean best-corrected visual acuity, resolution of subretinal fluid, recurrence rate, and complications were compared between the two groups.

Results

The baseline ICGA findings showed intense hyperfluorescence in 16 eyes (53.3%) and weak hyperfluorescence in 14 eyes (46.7%). Subretinal fluid showed complete resolution in both the groups 1 month after a single application of half-fluence PDT. Recurrence of subretinal fluid was observed in one of 14 eyes (7.1%) with weak hyperfluorescence and in no eyes (0%) with intense hyperfluorescence. No statistically significant difference in the rate of recurrence was observed between the two groups.

Conclusion

Half-fluence PDT appears to be an effective and safe treatment option for patients with chronic CSC regardless of the degree of hyperfluorescence based on ICGA. According to these findings, choroidal hyperpermeability, rather than dysfunction of retinal pigment epithelium, might be more important as primary pathogenesis of chronic CSC.     

Choroidal thickness in both eyes of patients with unilaterally active central serous chorioretinopathy

Objective

To assess the change in the choroidal thickness of the unaffected eyes in patients with unilateral central serous chorioretinopathy (CSC).

Methods

Thirty eyes with unilateral idiopathic CSC and 30 age-matched normal eyes were included in this study. Choroidal thickness was evaluated from images obtained by enhanced depth image optical coherence tomography. The choroidal thicknesses of the affected eyes, unaffected eyes, and normal eyes were analyzed. Choroidal vascular dilation and hyperpermeability on indocyanine green angiography (ICGA) were analyzed and correlated with the changes in choroidal thickness.

Results

The mean choroidal thicknesses of the affected eyes, unaffected fellow eyes, and normal individuals were 445.58±100.25, 378.35±117.44, and 266.80±55.45 μm, respectively. Compared with normal eyes, subfoveal choroidal thickness was increased significantly in the eyes with active CSC and in the unaffected fellow eyes (P<0.001 in both groups). The choroidal thickness was significantly greater in the eyes with active CSC than in the unaffected fellow eyes (P=0.003). ICGA revealed choroidal vascular hyperpermeability in 28 (93.3%) eyes with CSC and in 23 (73.3%) unaffected fellow eyes. Choroidal vascular dilation was detected in 21 (70.0%) eyes with CSC and in 18 (60.0%) unaffected fellow eyes.

Conclusion

Increased choroidal thickness in patients with unilateral CSC was noted not only in the affected eyes, but also in the unaffected fellow eyes. The results of this study suggest that CSC might be an essentially bilateral disorder.     

Variability of subfoveal choroidal thickness measurements in patients with age-related macular degeneration and central serous chorioretinopathy

Purpose

To evaluate the variability in subfoveal choroidal thickness measurements in patients with age-related macular degeneration (AMD) and central serous chorioretinopathy using enhanced depth imaging optical coherence tomography (EDI-OCT).

Methods

One hundred and sixty eyes of 160 patients who were diagnosed with early AMD (N=40), exudative AMD (N=40), polypoidal choroidal vasculopathy (PCV, N=40), or central serous chorioretinopathy (CSC, N=40) were included in this retrospective observational study. In addition, we included 40 normal eyes of 40 subjects. Subfoveal choroidal thickness was measured manually by two masked observers based on EDI-OCT images. The correlation of choroidal thickness with the absolute value of the difference in the choroidal thickness measurement was estimated for all 200 eyes. Intraobserver and interobserver coefficients of repeatability (CRs) were calculated.

Results

There was a significant positive correlation between subfoveal choroidal thickness and both intraobserver (P<0.001) and interobserver (P<0.001) difference in choroidal thickness measurements. The mean intraobserver CRs in nonexudative AMD, exudative AMD, PCV, CSC, and normal eyes were ∼15–21, 23–29, 24–35, 32–38, and 19–25 μm, respectively. The mean interobserver CRs were ∼24–28, 30–36, 39–45, 46–57, and 26–35 μm, respectively.

Conclusions

Relatively great measurement variability should be considered when investigating eyes with pathologic conditions related to a thick choroid, including PCV or CSC.     

Ocular perfusion pressure and choroidal thickness in eyes with polypoidal choroidal vasculopathy,wet-age-related macular degeneration,and normals

Purpose

To measure the choroidal thickness and ocular perfusion pressure in eyes with polypoidal choroidal vasculopathy (PCV), wet-age-related macular degeneration (AMD), and age-matched normal subjects, and look for a possible association between the two.

Methods

This was a prospective study including 22 eyes with PCV, 33 eyes with wet-AMD, and 35 age-matched normal eyes. Choroidal thickness was measured using enhanced depth imaging (EDI) with spectral-domain optical coherence tomography (SD OCT). Mean ocular perfusion pressure (MOPP) was calculated using the mathematical formula 2/3[DBP+1/3{SBP × DBP}]−IOP (DBP—diastolic blood pressure, SBP—systolic blood pressure, IOP—intraocular pressure). Analyses were carried out using SPSS 14 software and comparisons of mean made using‘t'' tests.

Results

Eyes with PCV showed increased (285.9 μm; subfoveal) choroidal thickness, whereas eyes with wet-AMD (119.4 μm; subfoveal) showed reduced choroidal thickness in comparison with normal eyes (186.77 μm; subfoveal). MOPP in the PCV group was 57.85 mm Hg (P value 0.00), in the wet-AMD group was 52.1 mm Hg (P-value 0.12), and in the normal group was 49.79 mm Hg.

Conclusion

It is postulated that higher MOPP in eyes with PCV could have an etiologic implication in disease manifestation and progression. Larger studies with longer follow-up may help validate these findings.     

Smoking and choroidal thickness in patients over 65 with early-atrophic age-related macular degeneration and normals

Objective

To compare macular choroidal thickness between cigarette smokers, those with a history of smoking, and nonsmokers in patients over 65 years of age with early-atrophic age-related macular degeneration (AMD) and normals.

Methods

Prospective, consecutive, observational case series. Enhanced depth imaging spectral domain optical coherence tomography 12-line radial scans were performed and choroidal thickness manually quantified at 84 points in the central 3 mm of the macula. Data of normals, soft drusen alone, and soft drusen with additional features of early AMD were compared. A multivariate analysis of variance (MANOVA) model, controlling for age, was constructed to evaluate the effect of smoking history and AMD features on choroidal thickness.

Results

A history of smoking was significantly associated with a thinner choroid across all patients via logistic regression (P=0.004; O.R.=12.4). Mean macular choroidal thickness was thinner for smokers (148±63 μm) than for nonsmokers (181±65 μm) among all diagnosis categories (P=0.003). Subgroup analysis of patients with AMD features revealed a similar decreased choroidal thickness in smokers (121±41 μm) compared with nonsmokers (146±46 μm, P=0.006). Bivariate analysis revealed an association between increased pack-years of smoking and a thin choroid across all patients (P<0.001) and among patients with features of early AMD (P<0.001). Both the presence of features of macular degeneration (P<0.001) and a history of smoking (P=0.024) were associated with decreased choroidal thickness in a MANOVA model.

Conclusion

Chronic cigarette smoke exposure may be associated with decreased choroidal thickness. There may be an anatomic sequelae to chronic tobacco smoke exposure that underlies previously reported AMD risk.     

Corneal changes after a single session of selective laser trabeculoplasty for open-angle glaucoma

Purpose

To investigate the changes in endothelial cell count, central corneal thickness (CCT), and refractive error after a session of selective laser trabeculoplasty (SLT) for open angle glaucoma (OAG).

Methods

This prospective cohort study recruited 111 eyes of 66 consecutive subjects with OAG. Subjects received SLT to 360° of the trabecular meshwork. Endothelial cell count, CCT, and spherical equivalent were measured at baseline before SLT as well as at 1 week and 1 month post SLT. A repeated measure nested ANOVA with Tukey''s multiple comparison test was performed to compare the outcome measures before and after SLT.

Results

In 111 eyes of 66 subjects, the mean number of laser applications per treatment was 166.9±41.4 with a mean energy level of 1.0±0.07 mJ. The mean endothelial cell count decreased significantly from 2465.0±334.0 cells/mm² at baseline to 2355.0±387.0 cells/mm² at 1 week (P=0.0004) but increased to baseline levels at 1 month post SLT (2424.0±379.4 cells/mm², P=0.3). The CCT, which decreased from a baseline of 549.4±37.6 to 543.9±40.2 μm at 1 week post SLT (P=0.02), also returned to the baseline level by 1 month (P=0.2). The spherical equivalent was static from baseline. A positive correlation was found between total laser energy and CCT at 1 month post treatment (r=0.3, P=0.005).

Conclusion

The transient reductions in endothelial cell count and CCT following SLT returned to baseline levels 1 month after the procedure. Patients undergoing SLT should be aware of the risk of potential corneal changes.     

Variations in the cone packing density with eccentricity in emmetropes

Aim

To describe the parafoveal cone arrangement in emmetropic subjects and its variations with eccentricity, meridians and change in axial length in Indian eyes.

Methods

We imaged 25 subjects using compact adaptive optics (AO) retinal camera prototype, the rtx1. Imaging was done at 1, 2, and 3° eccentricity from the fovea in four meridians: nasal, temporal, superior, and inferior.

Results

A statistically significant drop in the cone packing density was observed from 2 to 3° (2° eccentricity=25 350/mm² (5300/mm², 8400–34 800/mm²) 3° eccentricity=20 750/mm² (6000 mm², 9000–33 670/mm²)) P<0.05. The spacing correspondingly increased with increase in distance from the fovea (2° eccentricity=6.9 μm (0.70 μm, 5.95–11.6 μm)) and 3°eccentricity=7.80 μm (1.00 μm, 6.5–13.5 μm) P<0.05. As the axial length increases, the cone density significantly decreases. Interocular variations were noted.

Conclusion

With the advent of AO, visualization at the cellular level is now possible. Understanding the photoreceptor mosaic in the parafoveal space in terms of its density, spacing, and arrangement is crucial so as to detect early pathology and intervene appropriately. Newer therapeutic modalitites that are targeted at the cellular level like yellow micropulse laser, stem cells, gene therapy and so on may be better monitored in terms of safety and efficacy.     

High intravitreal TGF-β1 and MMP-9 levels in eyes with retinal vein occlusion

Purpose

Vascular endothelial growth factor is a leading target to reduce macular oedema and improve visual acuity in patients with retinal vein occlusion (RVO), whereas the role of vascular destabilizing and fibroproliferative transforming growth factor (TGF)-β1 and matrix metalloproteinases (MMP)-2 and -9 in pathological manifestations of RVO is anticipated but less studied.

Methods

Undiluted vitreous samples were collected from three central RVO and one branch RVO eyes, all with neovascularization and fibrosis-related sight-threatening complications of RVO. Undiluted vitreous samples of 40 eyes operated due to non-ischemic condition either macular hole or pucker were used as controls. Growth factor and protease concentrations were measured by ELISA and gelatin zymography.

Results

Vitreous concentrations of TGF-β1 (92.0±17.4 pg/ml vs 18.3±27.0 pg/ml, mean±SD; P=0.002) and MMP-9 (847.9±1196.4 AU/ml vs 87.7±174.0 AU/ml; P=0.010) were higher in the eyes with ischemic RVO than in the controls.

Conclusions

High intravitreal levels of TGF-β1 and MMP-9 are found in RVO eyes having neovascular and fibrosis manifestation. Further studies are warranted to elucidate whether targeting TGF-β1 and MMP-9 could be beneficial in patients with ischemic RVO.     

Evaluation of choroidal thickness using enhanced depth imaging by spectral-domain optical coherence tomography in patients with pseudoexfoliation syndrome

Purpose

To investigate the choroidal thickness using optical coherence tomography in the eyes of patients with unilateral and bilateral pseudoexfoliation syndrome and to compare them with healthy controls.

Methods

We studied four groups: (1) affected eyes from 30 patients with unilateral PEX syndrome affecting the right eye of 17 patients and the left eye of 13 patients; (2) clinically unaffected eyes of 30 patients with unilateral PEX syndrome; (3) the eyes of 30 patients with bilateral PEX syndrome; and (4) the eyes of 30 normal healthy subjects. Choroidal thickness was evaluated using high-speed, high-resolution enhanced depth imaging by spectral-domain optical coherence tomography. Optical coherence tomography features were compared in all groups using the statistical package SPSS v 15.0.

Results

The mean subfoveal choroidal thicknesses were 237.35±58.01 μm in group 1; 330.75±47.84 μm in group 2; 206.3±86.75 μm in group 3; and 311.8±51.42 μm in group 4. Significant differences in the mean subfoveal choroidal thickness were found between groups 1 and 2 (P<0.001), groups 1 and 4 (P=0.004), groups 2 and 3 (P<0.001), and groups 3 and 4 (P<0.001).

Conclusion

In this study, it was observed that clinically affected eyes of patients with PEX syndrome have significantly thinner choroids compared with the clinically unaffected eyes of patients with unilateral PEX syndrome and eyes of healthy controls.     

Retinal nerve fiber layer and optic disc measurements by spectral domain OCT: normative values and associations in young adults

Purpose

To determine normative values and associations of retinal nerve fiber layer (RNFL) and optic disc parameters in normal eyes measured by spectral domain optical coherence tomography (OCT).

Methods

In a population-based setting, 1521 young adults were examined as part of the Sydney Adolescent Vascular and Eye Study (SAVES). Their mean age was 17.3±0.6 years. RNFL and optic disc parameter measurements were made using Cirrus HD-OCT 4000.

Results

The average RNFL was found to be 99.4±9.6 μm. RNFL thickness was least for the temporal quadrant (69.9±11.2 μm), followed by the nasal (74.3±12.8 μm), superior (124.7±15.7 μm) and inferior (128.8±17.1 μm) quadrants. The mean disc area in this population was 1.98±0.38 mm² with a mean rim area of 1.50±0.30 mm² and a mean cup/disc ratio of 0.44±0.18. Multivariate-adjusted RNFL thickness was marginally greater in East Asian than in white participants (100.1 μm vs 99.5 μm; P=0.0005). The RNFL was thinner with greater axial length (P<0.0001), less positive spherical equivalent refractions (P<0.0001), smaller disc area and rim area (P<0.0001).

Conclusion

This study documents normative values for the RNFL and optic disc measured using Cirrus HD-OCT in young adults. The values and associations reported in this study can inform clinicians on the normal variation in RNFL and optic disc parameters.     

Evaluation of ocular pulse amplitude and choroidal thickness in diabetic macular edema

Purpose

The aim of this study is to evaluate the ocular pulse amplitude (OPA) and choroidal thickness (CT) measurements in patients with diabetic macular edema (DME) and healthy subjects.

Methods

A total of 34 patients (12 male and 22 female) who had type 2 diabetes mellitus with DME and 34 sex-matched healthy subjects (13 male and 21 female) were included in this prospective study. The intraocular pressure (IOP) and OPA were measured with Dynamic contour tonometer (Pascal DCT, Switzerland). The subfoveal CT was measured using the Cirrus HD-OCT (Carl Zeiss Meditec). The CT at 1500 μm and 3000 μm nasal and temporal to the central fovea was also measured.

Results

The mean IOP values were 18.4±3.5 and 17.1±2.1 mm Hg in DME patients and healthy controls, respectively (P= 0.091). The mean OPA values in patients with DME (2.58±0.96) and controls (3.52±1.03) were statistically different (P<0.001). The mean subfoveal CT value was 273.5±30.2 μm in the eyes with DME and 321.4±36.5 μm in the control group (P< 0.001). In both groups, linear regression analysis showed no significant association between OPA and CT measurements. The IOP showed a significantly positive correlation with OPA in both DME (P=0.002, r=0.526) and controls (P=0.004, r=0.483).

Conclusions

The current study suggests that both pulsatile choroidal blood flow and CT are decreased in patients with DME.     

Chorio-retinal thickness measurements in patients with acromegaly

Purpose

To compare choroidal, foveal, and peripapillary retinal thickness between patients with acromegaly and healthy adults.

Methods

This prospective, cross-sectional, and comparative study included 30 patients with acromegaly (study group) and 30 healthy subjects (control group). The subfoveal choroidal thickness (SFCT), foveal thickness, and peripapillary retinal nerve fibre layer thickness were measured with spectral domain optical coherence tomography.

Results

The mean SFCT in the study group and in the control eyes was 374.4±98.1 and 308.6±77.3 μm, respectively (P<0.001). The mean thinnest foveal thickness value was 233.2±22.4 μm in the acromegaly group and 222.8±13.9 μm in the control group (P=0.003). The mean peripapillary retinal nerve fibre layer thickness did not differ significantly between the groups (P=0.34).

Conclusion

The SFCT and foveal thickness were significantly higher in patients with acromegaly, whereas peripapillary retinal nerve fibre layer thickness was similar between the groups.     

Retention of good visual acuity in eyes with neovascular age-related macular degeneration and chronic refractory subfoveal subretinal fluid

Purpose

To describe the clinical characteristics of a subset of eyes with neovascular age-related macular degeneration (NVAMD) receiving intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy which retain good visual acuity despite chronic, persistent subfoveal subretinal fluid (SRF).

Design

Retrospective, observational case series.

Methods

Study eyes were identified from a consecutive series of 186 patients treated with anti-VEGF therapy seen for regular follow-up over a 3-month period. The clinical histories of 10 eyes of 9 patients with NVAMD, chronic subfoveal SRF despite continuous anti-VEGF therapy, and good long-term visual acuity of 20/40 or greater were reviewed. Demographic factors, baseline and final visual acuity, neovascular lesion type, duration of persistent fluid, baseline and final subfoveal choroidal thickness, presence of geographic atrophy, and number of anti-VEGF injections were analyzed.

Results

The mean age of patients was 78 years (range 55–91). The mean duration of persistent fluid was 5.2 years (range 1.3–11.0). Long-term visual acuities remained stable at 20/40 or better in all eyes. All eyes had type 1 (sub-retinal pigment epithelial) neovascularization. Average baseline subfoveal choroidal thickness was 285.3 μm and the average follow-up subfoveal choroidal thickness was 239.7 μm. No eyes had the presence of geographic atrophy. The mean number of injections was 36.5 (range 17–66).

Conclusion

Some eyes with type 1 neovascularization associated with chronic persistent subfoveal subretinal fluid despite continuous intravitreal anti-VEGF therapy may maintain good long-term visual outcomes. We hypothesize that type 1 neovascularization and greater subfoveal choroidal thickness may exert a protective effect on photoreceptor integrity. Further studies are necessary to assess long-term visual prognosis and predictive factors in patients with type 1 neovascularization leading to persistent subretinal fluid that is recalcitrant to anti-VEGF treatment.     

Changes in choroidal thickness,axial length,and ocular perfusion pressure accompanying successful glaucoma filtration surgery

Purpose

To investigate the changes in choroidal thickness (CT), axial length (AL), and ocular perfusion pressure (OPP) accompanying intraocular pressure (IOP) reduction after trabeculectomy.

Methods

Thirty-nine eyes of 39 patients with primary open-angle glaucoma uncontrolled by medical therapy were included in this prospective and interventional study. All patients underwent a fornix-based trabeculectomy. The CT was measured by enhanced depth imaging-optical coherence tomography. IOP, AL, and systolic/diastolic blood pressure were also measured, and OPP was calculated. All measurements were performed at baseline and 1 month after surgery.

Results

The mean IOP was 25.0±5.8 mm Hg at baseline and 11.7±2.6 mm Hg after trabeculectomy (P<0.001), and the mean subfoveal CT was 295±84 mm Hg at baseline and 331±82 mm Hg after trabeculectomy (P<0.001). The mean AL was 23.64±0.98 mm at baseline and 23.54±0.96 mm after trabeculectomy (P<0.001), whereas the mean OPP was 38.8±6.2 mm Hg preoperatively, and 51.1±7.3 mm Hg postoperatively (P<0.001). The change in CT negatively correlated with the change in IOP (r=−0.785, P<0.001) and AL (r=−0.693, P<0.001), whereas it positively correlated with the change in OPP (r=0.418, P=0.008).

Conclusion

These results suggest that the large IOP decrease following trabeculectomy causes choroidal thickening. In addition, CT changes are associated with IOP and AL reduction as well as OPP increase.