INTRODUCTIONThe purpose of this review is to combine the results of existing literature on the natural history of occult choroidal neovascularisation (CNV) associated with age-related macular degeneration (AMD).

MATERIALS AND METHODSPublished reports evaluating eyes with occult CNV in AMD patients were selected for meta-analysis based on a computerised MEDLINE search. Pooled estimates of the proportions of eyes with a vision loss greater than 2 to 3 (moderate vision loss) or 6 lines (severe vision loss) at 1 year and 2 to 3 years, respectively, or developing a classic component on fluorescein angiography at 1 year were measured.

RESULTSThere is no significant heterogeneity among published rates of visual loss and development of classic CNV. The overall pooled estimates (95% confidence limits) of the proportions of eyes with at least moderate or severe vision loss, respectively, were 59% (53% to 64.5%) and 34% (25% to 43%) at 1 year and 70% (64% to 76%) and 47% (40% to 54%) at 2 to 3 years; the overall pooled estimate of the percentage of eyes developing classic CNV at 1 year was 46% (39% to 54%).

CONCLUSIONA substantial number of patients with occult CNV from AMD will develop at least moderate visual loss at 1 year and severe visual loss within 3 years. However, visual acuity may remain stable in up to 30% of patients. These results may help us to understand the exact role of new therapies and in planning future trials.

Choroidal Neovascularization ; complications ; physiopathology ; Humans ; Macular Degeneration ; complications ; physiopathology ; Vision, Low ; etiology

INTRODUCTIONTo review the long-term outcome of photodynamic therapy (PDT) with verteporfin for inflammatory chorioretinal disease with subfoveal choroidal neovascularisation (CNV) over a 1-year period.

MATERIALS AND METHODSRetrospective review of eyes with subfoveal CNV for associated choroiditis that were treated with PDT using verteporfin over a 1-year period.

MAIN OUTCOME MEASUREvisual acuity.

RESULTSFive eyes in 4 patients, with diagnoses including serpiginous choroiditis (2), ocular histoplasmosis syndrome (OHS, 1), and punctate inner choroidopathy (PIC, 2) underwent standard treatment procedure for PDT with verteporfin. Visual acuity, fluorescein angiography and treatment parameters were reviewed. Follow-up ranged from 12 months to 36 months (median, 36 months). Pre-PDT visual acuities ranged from 20/60 to 20/400 (median, 20/200). Post-PDT visual acuities ranged from 20/30 to 20/400 at 1 year (median, 20/300). Visual acuity was stabilised (within 1 line) or improved (greater than 1 line) in 3 eyes at 1 year and 4 of the 5 eyes at last follow-up.

CONCLUSIONPDT for subfoveal CNV may stabilise, but rarely improves, visual acuity in eyes with choroidal neovascularisation secondary to inflammatory chorioretinal disease.

Adult ; Aged ; Choroidal Neovascularization ; drug therapy ; etiology ; Choroiditis ; complications ; Female ; Humans ; Male ; Photochemotherapy ; Photosensitizing Agents ; therapeutic use ; Porphyrins ; therapeutic use

Choroidal Neovascularization ; drug therapy ; etiology ; Humans ; Hyperthermia, Induced ; Myopia, Degenerative ; complications ; epidemiology ; Vascular Endothelial Growth Factor A ; antagonists & inhibitors

The visual results of laser photocoagulation for subfoveal choroidal neovascular membrane (CNVM) has not always been satisfactory. The surgical removal of the neovascular membrane may be another treatment option. To investigate the prognosis and risk factors of this surgery, we analyzed the results of surgical removal of subfoveal CNVM (23 eyes), subfoveal hemorrhage with CNVM (6 eyes), and subfoveal hemorrhage alone (6 eyes). The mean follow-up period was 17.7 months (range 2 to 47 months). The mean preoperative membrane size was 0.89 disc diameter and the mean postoperative retinal pigment epithelial (RPE) defect size was 1.33 disc diameter. Visual improvement was observed in 13 out of the 23 eyes (56.5%) with sufoveal CNVM, four out of the six eyes (66.6%) with subretinal hemorrhage and CNVM, and five out of the six eyes (83.3%) with subretinal hemorrhage only. The visual outcome of subfoveal CNVM surgery was related to the presence of a subfoveal RPE defect (p = 0.005) rather than to the size of the RPE defect. No recurrence of neovascular membrane was observed during the follow up period. In conclusion, surgical removal may be a good alternative treatment for subfoveal CNVM.
Choroidal Neovascularization/surgery* ; Choroidal Neovascularization/diagnosis ; Choroidal Neovascularization/complications ; Comparative Study ; Female ; Fluorescein Angiography ; Fovea Centralis/surgery ; Fovea Centralis/pathology ; Fundus Oculi ; Human ; Laser Coagulation* ; Male ; Middle Age ; Pigment Epithelium of Eye/pathology ; Prognosis ; Retinal Hemorrhage/surgery ; Retinal Hemorrhage/diagnosis ; Retinal Hemorrhage/complications ; Retrospective Studies ; Risk Factors ; Visual Acuity

PURPOSE: To evaluate the functional and anatomic outcomes of photodynamic therapy (PDT) for choroidal neovascularization (CNV) in patients with angioid streaks. METHODS: The authors retrospectively evaluated 6 consecutive patients (6 eyes) with CNV secondary to angioid streaks. All patients were treated with standard PDT with verteporfin protocol. Standardized protocol refraction, visual acuity testing, ophthalmologic examination, color photographs, fluorescein angiograms and indocyanin angiograms were used to evaluate the results of PDT with verteporfin. Main outcome measures were visual acuity and CNV size. RESULTS: Their mean age was 61.3+/-5.50 years (range, 53-68 years). Follow-up time ranged from 12 to 38 months with mean of 20.5+/-10.91 months. The mean visual acuity at baseline was 20/100 (range 20/25-20/500), and the mean visual acuity at the last examination was 20/320(range 20/125-counting finger). The mean greatest linear dimension (GLD) at baseline was 2400+/-766.81 micrometer, and the mean GLD at the last examination was 3483+/-444.59 micrometer. CONCLUSIONS: PDT for CNV associated with angioid streaks seemed to slow down but not prevent the progression of the disease and associated visual loss.
Aged ; Angioid Streaks/*complications/*drug therapy ; Choroidal Neovascularization/*complications/*drug therapy ; Female ; Humans ; Male ; Middle Aged ; *Photochemotherapy ; Photosensitizing Agents/*therapeutic use ; Porphyrins/*therapeutic use ; Retrospective Studies

We report a case of recurrent choroidal neovascularization (CNV) in an eye with chorioretinal coloboma. A 36-year-old woman presented complaining of decreased visual acuity (VA) in her left eye. Best corrected visual acuity (BCVA) was 20/200 and iris coloboma was observed. Funduscopy and fluorescein angiography (FA) showed CNV in the superior extrafoveal region with chorioretinal coloboma reaching just inferior to the optic disc. No other cause for CNV was observed except for the chorioretinal coloboma. BCVA improved to 20/30 after laser photocoagulation. She revisited our clinic for deteriorating VA (20/400) in the same eye 3 years after treatment. Funduscopy and FA demonstrated recurrent CNV with subfoveal hemorrhage. Photodynamic therapy (PDT) was followed by three consecutive intravitreal bevacizumab injections (IVB) for the subfoveally-located CNV. However, the CNV persisted with the appearance of a fresh subretinal hemorrhage. Additional PDT was combined with IVB on the same day 6 months after the initial PDT. The CNV regressed 3 months after treatment and has not recurred as of 8 months after the last treatment. The patient's BCVA improved to 20/60. This case suggests that PDT combined with IVB can be an alternative treatment for the management of recurrent CNV after laser photocoagulation in eyes with chorioretinal coloboma.
Adult ; Angiogenesis Inhibitors/administration & dosage ; Antibodies, Monoclonal/administration & dosage ; Choroid Diseases/*complications/drug therapy/surgery ; Choroidal Neovascularization/diagnosis/*etiology/physiopathology ; Coloboma/*complications/drug therapy/surgery ; Female ; Fluorescein Angiography ; Fundus Oculi ; Humans ; Intravitreal Injections ; Laser Coagulation ; Photochemotherapy ; Recurrence ; Visual Acuity

A 56-year-old Korean woman presented with decreased visual acuity of the right eye. She had a history of two photodynamic therapy treatments for choroidal neovascularization (CNV) due to angioid streaks in her left eye with central scarring and low visual acuity. She was diagnosed with subfoveal CNV due to angioid streaks in her right eye and treated with six intravitreal bevacizumab (1.25 mg / 0.05 mL) injections over one year. Best corrected visual acuity improved from 20 / 125 at baseline to 20 / 50 at the final visit. The area of CNV had changed into a fibrotic scar by the final visit, and fluorescein angiography and indocyanine green angiography revealed no evidence of leakage. Optical coherence tomography showed that central macular thickness decreased from 311 microm at baseline to 203 microm with complete resolution of subretinal and intraretinal fluid at the final visit. Intravitreal bevacizumab for CNV associated with angioid streaks prevented the progression of disease and resulted in the improvement of visual acuity after one year of follow-up in our patient.
Angiogenesis Inhibitors/*administration & dosage ; Angioid Streaks/*complications ; Antibodies, Monoclonal/*administration & dosage ; Choroidal Neovascularization/*drug therapy/*etiology/physiopathology ; Female ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Macula Lutea/drug effects/pathology ; Middle Aged ; Tomography, Optical Coherence ; Visual Acuity/drug effects

PURPOSE: To evaluate the changes in multifocal electroretinogram (mfERG) and optical coherence tomography (OCT) after intravitreal bevacizumab injection in the treatment of age-related macular degeneration (AMD). METHODS: Twenty-one eyes with choroidal neovascularization secondary to AMD were studied before and after intravitreal bevacizumab injection for best corrected visual acuity (BCVA), OCT, and mfERG. RESULTS: The BCVA improved, while central macular thickness and total macular volume in OCT decreased after intravitreal bevacizumab injection (p = 0.03, 0.01, and 0.01, respectively). In mfERG, the amplitude of P1, and implicit time of P1 and N1 indicated a statistically significant improvement of retinal response after intravitreal bevacizumab injection. CONCLUSIONS: There is a potential role for mfERG in evaluating the effect on retinal function of intravitreal bevacizumab injection.
Adult ; Aged ; Angiogenesis Inhibitors/*administration & dosage ; Antibodies, Monoclonal/*administration & dosage ; Choroidal Neovascularization/*drug therapy/*etiology ; Electroretinography/*methods ; Eyeglasses ; Humans ; Intravitreal Injections ; Macular Degeneration/*complications/diagnosis/physiopathology ; Middle Aged ; Retina/drug effects/physiopathology ; Tomography, Optical Coherence ; Visual Acuity

INTRODUCTIONThis study reports a case of bevacizumab administered to treat choroidal neovascularisation in a woman later discovered to be pregnant.

CLINICAL PICTUREA 25-year-old pregnant woman developed myopic choroidal neovascularisation in both eyes.

TREATMENTBoth eyes were treated with a total of 3 intravitreal injections of bevacizumab sequentially.

OUTCOMEVision improved significantly in both eyes. There were no evident pregnancy-related complications at 1 year postpartum.

CONCLUSIONAlthough anti-vascular endothelial growth factor (VEGF) therapy did not result in any detectable short-term adverse event in this mother and baby, the potential toxicity of these agents must be carefully considered in pregnant patients.

Adult ; Angiogenesis Inhibitors ; administration & dosage ; pharmacology ; therapeutic use ; Antibodies, Monoclonal ; administration & dosage ; pharmacology ; therapeutic use ; Antibodies, Monoclonal, Humanized ; Bevacizumab ; Choroidal Neovascularization ; drug therapy ; Female ; Humans ; Pregnancy ; Pregnancy Complications ; drug therapy ; Treatment Outcome

OBJECTIVETo investigate the efficacy of Chinese medicine Huangban Bianxing Recipe (HBR) for treatment of choroidal neovascularization (CNV).

METHODSEighty patients (97 eyes) suffered from CNV were assigned to two groups, the treated group treated by HBR orally taken one dose every day and the control group treated with ginkgo leaf tablet 1 tablet (19.2 mg) thrice a day, all for 3 months. The best corrected visual acuity (BCVA), fundus hemorrhagic area were measured; the neo-genetic vascular leakage area determined by fluorescent fundus angiography (FFA); and the out-layer high reflective band thickness (OHRBT) estimated by optical coherent tomography (OCT) were recorded before and after treatment.

RESULTSAfter treatment, in the treated group, BCVA was improved, with an effective rate of 67.12%, while in the control group, it was 33.33%, the former was better than the latter significantly (P < 0.05). The effective rate in reducing fundus hemorrhagic area in the two groups (85.11% vs 47.62%) and that in the CNV closure showed by FFA (67.50% vs 37.50%) were also superior in the treated group (P < 0.05). Besides, OCT showed that the OHRBT reduced significantly after treatment in the treated group (P < 0.01).

CONCLUSIONHBR can improve the vision, reduce the CNV leakage in the macular region, and advance the absorption of fundus hemorrhage in CNV patients.

Adult ; Aged ; Aged, 80 and over ; Choroidal Neovascularization ; drug therapy ; etiology ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Macular Degeneration ; complications ; drug therapy ; Male ; Middle Aged ; Phytotherapy ; Visual Acuity ; drug effects ; Young Adult