Spectral-domain OCT in anti-VEGF treatment of myopic choroidal neovascularization

Purpose

To evaluate changes in macular morphology due to myopic choroidal neovascularization (CNV), using spectral-domain optical coherence tomography (SD-OCT).

Methods

In all, 22 eyes with recent-onset untreated CNV underwent 1 intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), followed by a pro-re-nata regimen. SD-OCT was performed at baseline (before first administration of anti-VEGF treatment) and month 1, and 2; macular morphologic changes and outer retina characteristics (SD-OCT findings) associated with CNV activity were evaluated. Sensitivity and specificity were calculated for SD-OCT findings using fluorescein angiography (FA) as standard reference.

Results

Mean central retinal thickness (CRT) showed no significant reduction from baseline (284±98 μm) to month 1 (257±74 μm) and month 2 (263±72 μm). A hyper-reflective lesion with fuzzy borders (fuzzy area), and ‘absent or altered'' IS/OS junction were the only SD-OCT findings associated with CNV activity (P<0.0001). Both these SD-OCT findings showed good sensitivity and specificity (95.1 and 96.0% (95% CI: 0.87–0.89), respectively, for the fuzzy area; 87.9 and 66.7% (95% CI: 0.65–0.87), respectively, for ‘absent or altered'' IS/OS junction) when compared with FA leakage (standard reference).

Conclusions

Outer retina characteristics (ie, hyper-reflective lesion with fuzzy borders, and ‘absent or altered'' IS/OS junction) appear more meaningful than CRT in the evaluation of myopic CNV activity. These SD-OCT findings show overall good sensitivity and specificity when compared with FA leakage (standard reference), and could be considered as an alternative diagnostic tool to FA for myopic CNV monitoring.     

Intravitreal dexamethasone implant (Ozurdex) for macular edema secondary to retinitis pigmentosa

Background

To evaluate the anatomical and functional outcomes of intravitreal dexamethasone implant in patients with macular edema (ME) secondary to retinitis pigmentosa (RP).

Methods

Three patients (four eyes), aged 24 to 46 years, presented with refractory ME secondary to RP. Intravitreal dexamethasone implant (Ozurdex) was administered to treat ME. The anatomical (central macular thickness [CMT]) and functional (best-corrected visual acuity [BCVA]) outcomes as well as adverse events were recorded.

Results

All patients completed 6 months follow-up. After intravitreal Ozurdex all patients showed regression of ME. At baseline, mean CMT was 443?±?185 μm (range 213–619 μm); ME improved to 234?±?68 μm (range 142–307 μm) at 1 month, to 332?±?177 μm (range 139–513 μm) at 3 msonth, and to 305?±?124 μm (range 144–447 μm) at 6 months. Recurrent ME was recorded in 2 patients (both patients at 3 months from intravitreal dexamethasone implant). Retreatment with intravitreal Ozurdex was performed in two patients. Mean BCVA improved form 20/160 (range 20/50–20/200) (baseline) to 20/100 (range 20/40–20/125) at 1 month, to ～20/125 (range 20/100–20/200) at 3 months, and to?～?20/125 (range 20/100–20/160) at 6 months. No serious ocular and systemic adverse events were observed during the study period.

Conclusions

Intravitreal dexamethasone implant provides anatomic and functional improvements and may represent a valuable treatment option for patients with ME secondary to RP.     

Vitreomacular traction syndrome: a comparison of treatment with intravitreal plasmin enzyme vs spontaneous vitreous separation without treatment

Purpose

To evaluate the effects of intravitreal autologous plasmin enzyme (APE) in patients with focal vitreomacular traction (VMT).

Methods

APE was obtained by incubation of patient-derived purified plasminogen with streptokinase, and intravitreally injected 5–12 days later. Twenty-four hours after injection, in case of incomplete VMT release, a pars plana vitrectomy was performed. The hyaloid internal limiting membrane adherence and removal of the posterior hyaloid were intraoperatively evaluated.

Results

Thirteen patients were recruited. During preparation of APE, five patients had spontaneous release of VMT. Eight patients received APE injection (2 IU). In five patients, spontaneous resolution of VMT occurred before APE administration. Twenty-four hours after injection, persistence of VMT was detected in all the eight treated patients. Best-corrected visual acuity was 0.51±0.37 LogMAR at baseline, improving to 0.23±0.14 LogMAR at 6 months (P=0.002). Foveal thickness was 464±180 μm at baseline, reducing to 246±59 μm at 6 months (P<0.001). Hyaloid was intraoperatively judged ‘partially detached'' in seven cases and ‘totally detached'' in one case. Hyaloid peeling was evaluated ‘easy'' in six eyes and ‘very easy'' in two eyes.

Conclusions

In the current study, there was a large percentage of spontaneous resolution of VMT before an APE administration. A single intravitreal APE injection seems insufficient to induce a complete posterior vitreous detachment in these patients.     

Choroidal Neovascularization in a Patient with Crohn's Disease

Purpose

To report a case of subfoveal choroidal neovascularization (CNV) in a patient with Crohn''s disease (CD) and to discuss a possible association between these two conditions.

Methods

This is an observational case report.

Results

A 69-year-old male affected by CD was referred to our department because of sudden visual acuity drop in the left eye. A subfoveal CNV was diagnosed based on slit-lamp fundus biomicroscopy and fluorescein angiography. Color fundus photography, infrared autofluorescence and spectral-domain optical coherence tomography imaging of both eyes were also performed. Following six intravitreal ranibizumab injections, visual improvement was obtained with no related adverse events.

Conclusion

We report a case of CNV as a possible rare extraintestinal manifestation of CD. The use of ranibizumab successfully impacted on CNV, while not affecting CD, which remained quiescent.Key words: Choroidal neovascularization, Crohn''s disease, Anti-VEGF, Intravitreal ranibizumab, Fluorescein angiography, Optical coherence tomography     

Laser photocoagulation as treatment of non-exudative age-related macular degeneration: state-of-the-art and future perspectives

Graefe's Archive for Clinical and Experimental Ophthalmology - To give an updated review of laser approaches to non-exudative age-related macular degeneration (AMD). PubMed and Medline database...