PURPOSE: The author used optical coherence tomography (OCT) in the identification and classification of choroidal neovascularization to evaluate the potential of this imaging technique for better defining choroidal neovascularization. METHODS: Optical coherence tomography was performed on 20 eyes of 20 patients with the clinical diagnosis of choroidal neovascularization. Its result was compared with fluorescein angiography and indocyanine green angiography RESULTS: Of the 20 eyes, 6 eyes (30%) were identified as classic choroidal neovascularization on fluorescein angiography. Of the 6 eyes, 5 cases were identified as well-demarcated choroidal neovascularization on indocyanine green angiography and optical coherence tomography. One case was identified as fibrovascular pigment epithelial detachment on optical coherence tomograpphy. Of the 13 eyes identified as occult choroidal neovascularization on fluorescein angiography, 6 eyes were identified as well-demarcated choroidal neovascularization on indocyanine green angiography and 7 eyes were identified as well-demarcated choroidal neovascularization on optical coherence tomography. Of the 20 eyes identified as choroidal neovascularization on fluorescein angiography, 3 eyes were missed as choroidal neovascularization on optical coherence tomography. Optical coherence tomography was useful to identify the position and the size of choroidal neovascularization. CONCLUSIONS: OCT was able to distinguish the cross-sectional morphology of various lesions accompanying choroidal neovascularization. This study suggests that OCT may have potential in diagnosing and managing choroidal neovascularization.
Angiography ; Choroid* ; Choroidal Neovascularization* ; Classification* ; Diagnosis* ; Fluorescein Angiography ; Humans ; Indocyanine Green ; Tomography, Optical Coherence*

Choroidal neovascularization(CNV) secondary to age-related macular degeneration(AMD) occurs in the majority of patients with exudative maculopathy. Using an Indocyanine-green (ICG) angiography system, the authors obtained 24 ICG angiograms with CNV in AMD, and compared them with fluorescein angiograms. CNV was classic in 3 eyes(12.5%) and occult in 21 eyes(87.5%) on fluorescein angiography. The location of the CNV was extrafoveal in 12 eyes(50%), juxtafoveal in 6 eyes(25%) and subfoveal in 6 eyes(25%). Occult CNV was diagnosed in 21 eyes. Of these eyes, 8(38%) had solitary or multifocal hot spot by ICG angiography. Plaques were seen in 13(62%) of these eyes. Occult CNV with pigment epithelial detachment was diagnosed in 7 eyes. In 5 eyes, we were able to detect a well-defined CNV underlying a subretinal hemorrhage. Sixty-seven percentage of eyes with occult CNV could be reclassified as having well-delinated CNV by virtue of the additional findings provided by ICG angiography. But thirty-three percentage of eyes with occult CNV remained ill defined on the ICG angiography. ICG angiography is especially useful in delineating occult neovascularization, neovascularization with overlying subretinal hemorrhage or serosanguineous fluid, and neovasularization associated with pigment epithelial detachments. The results of this study suggest that ICG angiography is a safe test and an important test in evaluation, classification, and laser treatment of patients with occult CNV secondary to AMD.
Angiography* ; Choroid* ; Choroidal Neovascularization* ; Classification ; Diagnosis* ; Fluorescein Angiography* ; Fluorescein* ; Hemorrhage ; Humans ; Indocyanine Green* ; Macular Degeneration* ; Virtues

PURPOSE: To evaluate long-term treatment outcomes of intravitreal aflibercept monotherapy for polypoidal choroidal vasculopathy (PCV). METHODS: A retrospective review of medical records was performed with 46 patients who were diagnosed with PCV and treated with aflibercept monotherapy for 24 months. Best-corrected visual acuity (BCVA) values measured at diagnosis, 3 months, 12 months, and 24 months were compared. Baseline morphological factors associated with the 24 month BCVA were additionally investigated. RESULTS: The mean age of the patients was 65.8 ± 7.9 years. The patients were treated with a mean of 7.0 ± 2.3 aflibercept injections. The mean logarithm of the minimal angle of resolution (logMAR) BCVA at diagnosis, 3 months, 12 months, and 24 months was 0.56 ± 0.40, 0.36 ± 0.36, 0.45 ± 0.42, and 0.52 ± 0.47, respectively. When compared with baseline values, the BCVA was significantly improved at 3 months (p < 0.001) and 12 months (p = 0.022). However, the value at 24 months was not significantly different (p = 1.000). The BCVA was improved or maintained in 35 eyes (76.1%). Extrafoveal polypoidal lesions were associated with a better 24 month visual outcome than subfoveal/juxtafoveal lesions. CONCLUSIONS: Aflibercept monotherapy was found to be an effective method to maintain or improve long-term visual acuity in PCV patients. The location of polypoidal lesions was a predictive factor for long-term visual outcomes.
Choroid ; Choroidal Neovascularization ; Diagnosis ; Humans ; Macular Degeneration ; Medical Records ; Methods ; Retrospective Studies ; Treatment Outcome ; Visual Acuity

PURPOSE: To evaluate the characteristics of patients aged ≥ 90 years who were diagnosed with neovascular age-related macular degeneration (AMD). METHODS: A retrospective review of medical records was performed for 44 patients aged ≥ 90 years diagnosed with neovascular AMD. History of cerebrovascular or cardiovascular disorder and visual acuity at diagnosis were assessed. Fellow eye visual acuity data were also collected. When the fellow eye visual acuity was worse than 0.5, the primary reason for the visual deterioration was identified. RESULTS: The mean patient age was 91.5 ± 1.5 years (range: 90–95 years). Ten (22.7%) patients had histories of cerebrovascular or cardiovascular disorders. The mean logarithm of the minimal angle of resolution (logMAR) of visual acuity was 1.11 ± 0.51 and the visual acuity was worse than 0.1 in 20 eyes (45.5%). The fellow eye visual acuity was worse than 0.5 in 26 eyes (59.1%). The primary reason was neovascular or atrophic AMD in 23 eyes (88.5%). CONCLUSIONS: The incidence of cerebrovascular or cardiovascular disorders was relatively high in patients aged ≥ 90 years. Patients also had poor visual acuity at diagnosis and a high incidence of fellow eye visual deterioration. These systemic conditions should be considered when treating these patients. Additionally, a regular ophthalmic examination is recommended for the early detection of these disorders.
Choroidal Neovascularization ; Diagnosis ; Humans ; Incidence ; Macular Degeneration ; Medical Records ; Retrospective Studies ; Visual Acuity

Chronic central serous chorioretinopathy[CSC], which also has been termed diffuse retinal pigment epitheliopathy, is defined as a sensory retinal detachment associated with areas of RPE atrophy and pigment mottling. Fluorescein angiographic finding includes areas of granular hyperfluo-rescence and one or many subtle leaks. In older age group, choroidal neo-vascularization[CNV]may develop as a complication. We investigated the clinical features and performed fluorescein angiography[FAG], indocyanine green[ICG]angiography in 10 patients with CNV among 32 patients with chronic CSC. The location of CNV was extrafoveal[3 eyes]and juxtafoveal[7 eyes]. Associated fundus findings were RPE atrophy[8 eyes], PED[5 eyes], serous RD[4 eyes], subretinal hemorrhage[4eyes]. ICG findings were hypo-fluorescence[8 eyes], choroidal hyperpermeability[7 eyes], choroidal delayed filling[5 eyes]. Choroidal neovascularization was identified only with ICG angiography in 6 out of 10 cases. Laser photocoagulation was performed using ICG angiography in 6 cases. Visual acuity was improved in 4 out of 10 cases, and unchanged in 3 out of 10 cases. Therefore, we suggest that ICG angiography may be used as an important device for the diagnosis and management of CNV in patients with chronic CSC. Visual prognosis of CNV in chronic CSC seems to be relatively good.
Angiography ; Atrophy ; Central Serous Chorioretinopathy* ; Choroid* ; Choroidal Neovascularization ; Diagnosis ; Fluorescein ; Humans ; Light Coagulation ; Prognosis ; Retinal Detachment ; Retinaldehyde ; Visual Acuity

PURPOSE: To evaluate the long-term treatment outcomes of bevacizumab therapy in patients with myopic choroidal neovascularization (CNV). METHODS: A retrospective review was performed of medical records regarding 43 eyes with myopic CNV that were treated with intravitreal bevacizumab injection. Visual acuity at diagnosis was compared with that measured at the final follow-up; the incidence and timing of re-activation were evaluated. In addition, factors associated with final follow-up were analyzed. RESULTS: Mean patient age was 39.3 ± 12.9 years and mean spherical equivalent (SE) was −11.9 ± 4.4 diopters. Patients were followed-up at a mean of 42.1 ± 17.0 months. Re-activation of the lesion was noted in 17 eyes (39.5%). The mean time to first re-activation was 19.5 ± 15.4 months from the time that resolution of subretinal fluid/retinal fluid was confirmed after initial treatment. The mean visual acuity (the logarithm of the minimal angle of resolution) was 0.40 ± 0.25 at diagnosis and 0.26 ± 0.31 at the final follow-up. Visual acuity at the final follow-up was significantly improved when compared with the baseline value (p = 0.005). Patient age (p < 0.001), SE (p = 0.003), and visual acuity at diagnosis (p < 0.001) were significantly associated with visual acuity at the final follow-up. CONCLUSIONS: Bevacizumab therapy was a useful method for long-term treatment of myopic CNV. The observation of relatively late re-activation after the initial treatment suggests a need for continuous long-term follow-up.
Bevacizumab ; Choroid ; Choroidal Neovascularization ; Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Medical Records ; Methods ; Myopia ; Retrospective Studies ; Visual Acuity

OBJECTIVETo establish the diagnostic criteria for polypoidal choroidal vasculopathy (PCV) based on spectral-domain optical coherence tomography (SD OCT) by evaluating the sensitivity and specificity of SD OCT in differentiating PCV from wet age-related macular degeneration (wAMD).

METHODSThe clinical data were reviewed for 62 patients (63 eyes) with the initial diagnosis of PCV or wAMD between August, 2012 and June, 2016. Twenty-four patients (25 eyes) were diagnosed to have PCV and 38 (38 eyes) had wAMD based on findings by fundus photography, fluorescein angiography (FFA) and indocyanine green angiography (ICGA). Among the 6 features of SD OCT, namely a sharp RPED peak, double-layer sign, multiple RPED, an RPED notch, a hyporeflective lumen representing polyps, and hyperreflective intraretinal hard exudates, findings of the first two features and at least one of the other features sufficed the diagnosis of PCV; in the absence of the first two features, the diagnosis of PCV was also made when at least 3 of the other features were present simultaneously. The sensitivity and specificity of SD OCT-based diagnosis were estimated by comparison with the gold standard ICGA-based diagnosis.

RESULTSIn the 25 eyes with an established diagnosis of PCV, 23 eyes (92.0%) met the diagnostic criteria based on SD OCT findings; in the 38 eyes with the diagnosis of wAMD, only 4 eyes (10.5%) met the criteria. The sensitivity and specificity of SD OCT-based diagnosis of PCV was 92.0% and 89.5%, respectively.

CONCLUSIONs We established the diagnostic criteria for PCV based on SD OCT findings with a high sensitivity and specificity. SD OCT shows a strong capacity for differentiating PCV from wAMD.

Choroid ; diagnostic imaging ; Choroidal Neovascularization ; diagnostic imaging ; Diagnosis, Differential ; Fluorescein Angiography ; Humans ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, Optical Coherence

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 12-month outcome of intravitreal anti-vascular endothelial growth factor therapy in eyes with bilateral retinal angiomatous proliferation (RAP). METHODS: This retrospective observational study included 38 eyes of 19 patients with stage 1 or 2 bilateral RAP at diagnosis. The eyes of patients who exhibited different baseline best-corrected visual acuity (BCVA) values in both eyes were assigned to one of two groups—the better (n=13) and worse (n=13) visual acuity groups. The BCVA values in both groups were compared to those at baseline and at 12 months. In addition, the 12-month changes in BCVA were compared between the two groups. The association between the optical coherence tomography findings at diagnosis and the 12-month BCVA was also analyzed. RESULTS: The values of mean baseline and 12-month BCVA in the better visual acuity group (13 eyes) were 0.48 ± 0.19 and 0.58 ± 0.29, respectively, and those in the worse visual acuity group (13 eyes) were 0.83 ± 0.20 and 0.90 ± 0.31. The 12-month changes in BCVA were not significantly different between the two groups (p=0.786). Among the six patients with equivalent baseline BCVA in both eyes, four patients (66.7%) exhibited 1 to 2 lines or ≥3 lines of difference in BCVA between eyes at 12 months. Eyes without pigment epithelial detachment (PED) at diagnosis exhibited significantly better BCVA at 12 months than eyes with PED (p=0.021). CONCLUSIONS: Better baseline visual acuity was associated with better BCVA at 12 months posttreatment in patients with bilateral RAP. However, equivalent baseline visual acuity in both eyes might not guarantee similar treatment outcomes. In addition, the absence of PED is predictive of better visual outcome.
Bevacizumab ; Choroidal Neovascularization ; Diagnosis ; Endothelial Growth Factors* ; Humans ; Macular Degeneration ; Observational Study ; Ranibizumab ; Retinaldehyde* ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity

PURPOSE: To evaluate the long-term outcomes of anti-vascular endothelial growth factor (VEGF) therapy for polypoidal choroidal vasculopathy (PCV) with feeder vessels and to investigate fellow-eye findings. METHODS: This retrospective observational study included 14 eyes with treatment-naïve PCV accompanied by feeder vessels that were treated with anti-VEGF monotherapy. The best-corrected visual acuity (BCVA) at baseline was compared with that at the last follow-up. The fellow-eye indocyanine green angiography findings were also analyzed. RESULTS: The mean follow-up period was 28.1 ± 19.2 months (range, 12 to 60 months). During the follow-up period, 5.9 ± 2.5 anti-VEGF injections were administered. The logarithm of the minimal angle of resolution (logMAR) BCVAs at the time of diagnosis, at 3 months, and at the last follow-up were 0.81 ± 0.49, 0.55 ± 0.44, and 0.71 ± 0.54, respectively. Although the BCVA at the last follow-up was not different from the baseline value (p=0.809), an improvement of ≥0.2 logMAR BCVA was observed in seven eyes (50.0%). In 11 eyes that underwent bilateral indocyanine green angiography at diagnosis, PCV, branching vascular networks, and late geographic hyperfluorescence were noted in two (18.2%), five (45.4%), and three (27.3%) fellow eyes, respectively. During the follow-up period, the development of polypoidal lesions in the fellow eye was observed in three patients. CONCLUSIONS: In this study, long-term improvement in BCVA was noted in 50% of the included patients who received anti-VEGF monotherapy. A relatively high incidence of pathological findings in the fellow eye and bilateral involvement suggest the need for bilateral examinations.
Angiography ; Choroid* ; Choroidal Neovascularization ; Diagnosis ; Endothelial Growth Factors ; Follow-Up Studies ; Humans ; Incidence ; Indocyanine Green ; Macular Degeneration ; Observational Study ; Ranibizumab ; Retrospective Studies ; Visual Acuity