PURPOSE: To evaluate the 12-month outcome of anti-vascular endothelial growth factor (VEGF) treatment for extrafoveal polypoidal choroidal vasculopathy (PCV). METHODS: This retrospective observational study included 32 eyes of 32 patients newly diagnosed with extrafoveal PCV (polyps located more than 500 microm from the center of the fovea). Patients were treated with intravitreal ranibizumab, bevacizumab, or both. The best-corrected visual acuity (BCVA) and central foveal thickness (CFT) at diagnosis and at 12 months were compared. Eyes were divided into two groups according to the presence of submacular hemorrhage. The BCVA in each group was compared at baseline and at 12 months. RESULTS: During the 12-month study period, patients received an average of 4.0 +/- 1.1 anti-VEGF injections. The BCVA at baseline, three-month post-diagnosis, and 12-month post-diagnosis was 0.59 +/- 0.40, 0.34 +/- 0.38, and 0.38 +/- 0.38, respectively. The BCVA at 12 months was significantly better than the baseline value (p = 0.002). The CFT at baseline, three-month, and 12-month post-diagnosis was 477.1 +/- 194.2 microm, 214.5 +/- 108.8 microm, and 229.8 +/- 106.1 microm, respectively. The CFT at 12 months was significantly lower than the baseline value (p < 0.001). A significant improvement in BCVA was noted in eyes with and without submacular hemorrhage (n = 13, p = 0.032 and n = 19, p = 0.007, respectively). CONCLUSIONS: Anti-VEGF therapy was beneficial in extrafoveal PCV, regardless of the presence of submacular hemorrhage.
Aged ; Angiogenesis Inhibitors/*therapeutic use ; Bevacizumab/therapeutic use ; Choroidal Neovascularization/diagnosis/*drug therapy/physiopathology ; Female ; Fluorescein Angiography ; Fovea Centralis/pathology ; Humans ; Intravitreal Injections ; Male ; Microscopy, Confocal ; Middle Aged ; Polyps/diagnosis/*drug therapy ; Ranibizumab/therapeutic use ; Retrospective Studies ; Tomography, Optical Coherence ; Treatment Outcome ; Vascular Endothelial Growth Factor A/*antagonists & inhibitors ; Visual Acuity/drug effects/physiology

BACKGROUNDPhotodynamic therapy (PDT) has been recommended as a main treatment for idiopathic choroidal neovascularization (I-CNV). But the visual results of PDT were inconsistent and variable, and PDT may bring severe damage to the retinal pigment epithelium and choriocapillaries. In recent years, intravitreal ranibizumab therapy, showing favorable visual outcomes, has developed as an advanced treatment for choroidal neovascularization (CNV). Although both methods have been reported to be effective in treating I-CNV, there is no detailed comparative report between the two methods. This study aimed to compare visual outcomes, retinal and choroidal thickness between intravitreal ranibizumab therapy and PDT in the treatment of I-CNV, and investigate the correlation of visual outcomes with retinal and choroidal thickness in each of the two groups.

METHODSThirty-seven eyes of 37 patients with I-CNV were involved in this study; 19 eyes were treated with intravitreal ranibizumab therapy and 18 eyes were treated with PDT. The best corrected visual acuity (BCVA) was recorded before and at each follow-up visit after treatments (logMAR). Enhanced-depth imaging optical coherence tomography (EDI-OCT) was used to evaluate the retinal structural changes, and to measure central retinal thickness (CRT) and central choroidal thickness (CCT).

RESULTSMean BCVA was 0.64 ± 0.27 in PDT group and 0.69 ± 0.22 in ranibizumab group at baseline (P = 0.55). When compared with the baseline, mean BCVA in PDT group was improved significantly at 3-month after PDT (0.41 ± 0.16, P = 0.002), then changed little (0.42±0.25 at 12-month, P = 0.88). Whereas mean BCVA in Ranibizumab group was improved significantly at each follow-up visit. It improved much more obviously in the first month and then remained stable. The mean BCVA in the ranibizumab group was significantly better at each follow-up visit than that in PDT (P < 0.05). When compared with the baseline, mean CRT in PDT group decreased significantly since 3-month visit, whereas mean CRT in ranibizumab group decreased significantly from 1-month visit. Mean CRT at 1-month and 3-month decreased much more in ranibizumab group than that in PDT group, almost in the same period as BCVA improving. When compared with the baseline, mean CCT did not change significantly at each follow-up visit in each group (P > 0.05). The CCT difference was not statistically significant between the two groups at each same time visit (P > 0.05). Mean BCVA was correlated with CRT, but was not correlated with CCT.

CONCLUSIONSBoth intravitreal ranibizumab therapy and PDT are effective for the treatment of I-CNV. It is obvious that ranibizumab therapy is significantly superior to PDT in improving BCVA and decreasing CRT. CRT decreases much more rapidly in ranibizumab group than in PDT group, simultaneously with visual improvement. CRT reduction has significant correlation with the visual outcomes in the recovery of I-CNV, whereas BCVA prognosis may have no correlation with CCT. CCT is not changed significantly after each of the treatments. Both PDT and ranibizumab therapy may have no significant effect on choroid.

Antibodies, Monoclonal, Humanized ; administration & dosage ; therapeutic use ; Choroidal Neovascularization ; drug therapy ; therapy ; Female ; Humans ; Intravitreal Injections ; Male ; Photochemotherapy ; methods ; Ranibizumab ; Retina ; drug effects ; pathology ; Visual Acuity ; drug effects

PURPOSE: To investigate which spectral domain optical coherence tomography (SD-OCT) findings predict visual outcome after anti-vascular endothelial growth factor (VEGF) treatment in neovascular age-related macular degeneration (NV-AMD). METHODS: We reviewed the medical records of patients with treatment-naive NV-AMD who underwent three or more consecutive anti-VEGF injections. The patients were divided into three groups according to their changes of visual acuity (VA); improved (group I), static (group S), or worsened (group W). We assessed the incidences and values of all available SD-OCT findings of these groups, compared these findings between the three groups and compared the initial values with the post-treatment values. RESULTS: Better initial VA and longer external limiting membrane (ELM) length were associated with less change in VA after anti-VEGF treatment. The initial VA was mildly correlated with initial photoreceptor inner and outer segment junction (IS/OS) length and initial ELM length. The final VA was also mildly correlated with the final IS/OS length and the final ELM length. VA was significantly changed after anti-VEGF treatment in groups W and I. With regard to incidence, disruption of the IS/OS (IS/OS-D), disruption of the ELM (ELM-D) and ELM length differed significantly between the three groups, particularly ELM-D. The incidences of IS/OS-D and ELM-D in group I were significantly lower than those in groups S and W, and those in group S were also lower than those in group W. The ELM length in group I was significantly longer than it was in groups S and W, and the ELM length in group S was longer than that for group W. However, these three findings did not change after the anti-VEGF treatment. CONCLUSIONS: Initial IS/OS-D, ELM length and particularly ELM-D can be useful predictors of the visual outcome after anti-VEGF treatment in NV-AMD patients.
Aged ; Aged, 80 and over ; Angiogenesis Inhibitors/*therapeutic use ; Choroidal Neovascularization/*drug therapy/physiopathology ; Female ; Humans ; Intravitreal Injections ; Male ; Middle Aged ; Ranibizumab/*therapeutic use ; Retinal Photoreceptor Cell Inner Segment/pathology ; Retinal Photoreceptor Cell Outer Segment/pathology ; Tomography, Optical Coherence ; Vascular Endothelial Growth Factor A/antagonists & inhibitors ; Visual Acuity/*physiology ; Wet Macular Degeneration/*drug therapy/physiopathology

PURPOSE: The goal of the present research was to study post-treatment changes in polypoidal choroidal vasculopathy (PCV) shown by optical coherence tomography (OCT). METHODS: The study included 12 patients with naive PCV. Photodynamic therapy and 3 consecutive intravitreal bevacizumab injections at 6-week intervals were given. Best corrected visual acuity, subretinal fluid (SRF), pigment epithelium detachment (PED), central macular thickness (CMT), and total macular volume (TMV) were measured before and after treatment as assessed by Stratus OCT3. RESULTS: After treatment, the SRF height decreased earlier than the PED height. The SRF diameter decreased with statistical significance. However, the PED diameter did not show a statistically significant improvement, persisting at pre-treatment levels. Both CMT and TMV decreased significantly after treatment. CONCLUSIONS: After PCV treatment, SRF and PED stabilized, as shown by OCT. However, the PED treatment response was both delayed and refractory compared to the SRF response. The small change in post-treatment PED diameter may suggest the possibility of PCV recurrence.
Aged ; Choroid/*pathology ; Choroid Diseases ; Choroidal Neovascularization/diagnosis/*drug therapy ; Disease Progression ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Humans ; Male ; Photochemotherapy/*adverse effects ; Prognosis ; Retinal Detachment/diagnosis/*etiology ; Retinal Pigment Epithelium/*pathology ; Retrospective Studies ; *Subretinal Fluid ; Time Factors ; Tomography, Optical Coherence ; Visual Acuity

PURPOSE: To evaluate the outcome of a combined photodynamic therapy and intravitreal injection of bevacizumab in choroidal neovascularization secondary to age-related macular degeneration. METHODS: Photodynamic therapy (PDT) was administered to 28 eyes followed by 3 consecutive bevacizumab injections. Patients were followed-up for more than 12 months. At baseline, 1, 3, 6, and 12 months post PDT, visual acuity (VA) and central macular thickness were measured using optical coherence tomography. RESULTS: The mean VA was significantly improved from logarithm of the minimal angle of resolution 0.86 at baseline to 0.69 at 1 month (p = 0.011), 0.63 at 3 months (p = 0.003), 0.64 at 6 months (p = 0.004) and 0.60 at 12 months (p < 0.001). Central macular thickness decreased significantly from 328.3 microm at baseline to 230.0 microm at 6 months and 229.9 microm at 1 year (p < 0.001). Reinjection mean number was 0.4 for 6 months and 0.8 for 12 months. By 1 year, retreatment was performed in 10 eyes (36%). CONCLUSIONS: PDT combined with three consecutive intraviteal bevacizumab injections was effective in improving VA and reducing central macular thickness.
Aged ; Angiogenesis Inhibitors/*administration & dosage ; Antibodies, Monoclonal, Humanized/*administration & dosage ; Choroidal Neovascularization/diagnosis/*drug therapy/etiology ; Dose-Response Relationship, Drug ; Drug Therapy, Combination ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Humans ; Intravitreal Injections ; Macula Lutea/drug effects/*pathology ; Macular Degeneration/*complications/diagnosis/drug therapy ; Male ; Photochemotherapy/*methods ; Photosensitizing Agents/administration & dosage ; Porphyrins/*administration & dosage ; Retrospective Studies ; Tomography, Optical Coherence ; Treatment Outcome ; 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

OBJECTIVE: To determine the effect of photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV). METHODS: Eleven patients (11 eyes) with PCV who were diagnosed by fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optic coherence tomography (OCT) were given PDT. The changes of best corrected visual acuity (BCVA), fundus photography, FFA and ICGA before and after the PDT were compared. Follow-up time varied from 6 to 30 months. RESULTS: One month after the PDT, the BCVA was stable in 3 eyes, increased in 1 line in 3 eyes, increased in 2 lines in 2 eyes, and decreased in 2 lines in 3 eyes. FFA and ICGA showed no leakage in 5 eyes, leakage reduced in 3 eyes, and slight leakage in 3 eyes. At the last follow-up, the BCVA was stable in 5 eyes, increased in 1 line in 2 eyes, increased in 2 lines in 2 eyes, and decreased in 2 lines in 2 eyes. FFA and ICGA showed no leakage in 6 eyes, leakage reduced in 3 eyes, and slight leakage in 2 eyes. No severe systemic or local adverse effect was found during or after the PDT, except that 1 eye had vitreous hemorrhage 2 months after the PDT. CONCLUSION PDT may stop or reduce leakage of the lesion, facilitate the absorption of hemorrhage, edema and exudates, and stabilize or increase the patients' visual acuity. It could be a choice for PCV.
Adult ; Aged ; Choroid ; blood supply ; pathology ; Choroid Diseases ; drug therapy ; Choroidal Neovascularization ; drug therapy ; Female ; Humans ; Male ; Middle Aged ; Peripheral Vascular Diseases ; diagnosis ; drug therapy ; Photochemotherapy ; Photosensitizing Agents ; adverse effects ; therapeutic use ; Porphyrins ; therapeutic use ; Verteporfin ; Visual Acuity

We report a case of serous retinal detachment following combined photodynamic therapy (PDT) and intravitreal bevacizumab injection in subfoveal choroidal neovascularization (CNV).
Administration, Oral ; Angiogenesis Inhibitors/administration & dosage/*adverse effects ; Antibodies, Monoclonal/administration & dosage/*adverse effects ; Choroidal Neovascularization/*drug therapy/pathology ; Diagnosis, Differential ; Female ; Fluorescein Angiography ; Fundus Oculi ; Glucocorticoids/administration & dosage ; Humans ; Injections ; Middle Aged ; Photochemotherapy/*adverse effects ; Retinal Detachment/*chemically induced/diagnosis/drug therapy ; Tomography, Optical Coherence ; Triamcinolone/administration & dosage ; Vascular Endothelial Growth Factor A ; Vitreous Body

OBJECTIVETo evaluate the influence of Chinese drugs for cooling blood and dissolving stasis (CBDS) in different concentrations on morphology of krypton laser induced choroidal neovascularization (CNV) in brown Norway (BN) rats.

METHODSForty-eight rats received laser irradiation (659 nm) on fundus of one eye (power 360 mW, spot diameter 50 microm, time 0.05 s). They were divided into four groups equally: the control group (A) treated with normal saline, and the three CBDS groups treated respectively with high (B, 5.0 g/kg), median (C, 2.5 g/kg) and low (D, 1.25 g/kg) dosage of CBDS, twice every day via gastric perfusion for 21 successive days. Fundus fluorescein angiography (FFA) on 4 selected rats in each group was performed at the 7th, 14th and 21st day after photocoagulation, and histopathologic examination using light microscope with immuno-histochemical stain was conducted on them as well.

RESULTSFFA showed that CNV was firstly appeared on day 7 after photocoagulation, in Group A, it expanded gradually and reached the peak on day 21, but showed no significant expansion in the three CBDS groups. The fluorescein leakage in Group C (52343.13 +/- 12973.92 dots) and D (66252.78 +/- 20659.71 dots) was significantly less than that in Group A (91457.19 +/- 29309.11 dots) and B (95973.40 +/- 53950.43 dots) on day 21, all showing statistical significance (P<0.05). The variation of CNV in thickness showed that in Group A it increased gradually from day 7 and reached the peak on day 21 (55.3383 +/- 8.5036 microm); but in the CBDS groups, the peak was reached on day 14, then became thinned gradually, on day 21, it was 40.0913 +/- 13.3448 microm in Group B, 38.8473 +/- 7.9862 microm in Group C and 38.9372 +/- 5.1728 microm in Group D, all thinner than that in Group A significantly (P<0.05).

CONCLUSIONCDBS can effectively suppress the krypton laser induced CNV proliferation and prevent the CNV leakage in BN rats.

Animals ; Choroidal Neovascularization ; drug therapy ; pathology ; Disease Models, Animal ; Drugs, Chinese Herbal ; administration & dosage ; pharmacology ; Fluorescein Angiography ; Male ; Rats ; Rats, Inbred BN

PURPOSE: To determine the influence of clinical features and Indocyanine green (ICG) angiographic features on the visual outcome of patients with myopic sub-foveal choroidal neovascularization (CNV) who received photodynamic therapy (PDT). METHODS: Thirty-six consecutive patients (39 eyes) with myopic CNV who were followed up for more than one year after PDT were enrolled in this study. Clinical features included age, gender, refractive error, great linear dimension, and subretinal hemorrhage. ICG features included the lesion size, lacquer cracks, hypofluorescence surrounding the CNV (dark rim), peripapillary atrophy size, and visible prominent choroidal veins under the macula. Linear regression analysis was performed using the change in visual acuity (delta logMAR) as the dependent variable and the above factors as independent variables. RESULTS: At one-year follow-up after PDT, a younger age (p=0.002) and the presence of a dark rim (p=0.002) were significantly correlated with an improvement of visual acuity (decrement in logMAR) after PDT. Other factors had no significant influence on changes in visual acuity. CONCLUSIONS: Younger patients and patients with a dark rim on ICG angiography had a higher chance of visual improvement after PDT in myopic CNV.
Visual Acuity ; Retrospective Studies ; Prognosis ; *Photochemotherapy ; Myopia/*complications/pathology ; Middle Aged ; Male ; Indocyanine Green/*diagnostic use ; Humans ; Fundus Oculi ; Fovea Centralis/*pathology ; Follow-Up Studies ; Fluorescein Angiography/*methods ; Female ; Coloring Agents/*diagnostic use ; Choroidal Neovascularization/complications/drug therapy/*pathology ; Aged ; Adult