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

PURPOSE: To evaluate the influence of axial length on the recurrence of wet age-related macular degeneration (AMD) after anti-vascular endothelial growth factor therapy. METHODS: A retrospective review of the medical records for 45 eyes of 45 patients, who were diagnosed with neovascular AMD and treated with three ranibizumab injections per month, was performed. Axial length was compared between eyes with (recurrence group) and without (no recurrence group) recurrence of fluid during a 12-month follow-up period. In eyes with recurrence, the association between axial length and the time between the third injection and the first recurrence was also evaluated. RESULTS: The axial length was measured at a mean of 20.6 ± 10.1 months after the diagnosis of neovascular AMD. The mean axial length at that time was 23.33 ± 0.90 mm. The mean axial length was 23.29 ± 0.96 mm in the recurrence group (n = 30) and 23.40 ± 0.79 mm in the no-recurrence group (n = 15). There was no difference in the axial length between the two groups (p = 0.709). In the recurrence group, the period between the third injection and the first recurrence was not associated with axial length (p =0.582). CONCLUSIONS: There was no significant difference in axial length between eyes with and without recurrence after initial treatment for wet AMD. In addition, the time to first recurrence was not significantly associated with axial length. Because the present study was retrospective and the sample size was small, further prospective studies with a better design are needed to more accurately assess the influence of axial length.
Choroidal Neovascularization ; Diagnosis ; Endothelial Growth Factors ; Follow-Up Studies ; Humans ; Macular Degeneration ; Medical Records ; Prospective Studies ; Ranibizumab ; Recurrence ; Retrospective Studies ; Sample Size

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

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

PURPOSE: To evaluate the clinical course of patients who had completed 14 ranibizumab or aflibercept monocular treatments. METHODS: Retrospective medical record analysis was performed to 24 patients who were diagnosed with monocular neovascular age-related macular degeneration and had completed 14 ranibizumab or aflibercept monocular injections, allowed by the Korean National Health Care system. Time to completion was measured along with the percentage and timing of medication switch. Best-corrected visual acuity (BCVA) was measured at the time of diagnosis, after 3-loading injections, and the time of completion. Additionally, we searched for any other factors that had influenced the time to completion. RESULTS: The average time to completion of 14 injections was 32.3 ± 6.2 months (21–48 months). The switching was performed in 17 eyes (70.8%), and it was done after 9.4 ± 2.1 injections (4–14 injections) with prior medication. After 14 injections, the BCVA improved in 6 eyes (25.0%), unchanged in 8 eyes (33.3%), and worsened in 10 eyes (41.7%). Complete resolution of intraretinal fluid and subretinal fluid after 3 loading injections were observed in 20 eyes, and it was significantly related to time to the first recurrence and time to the completion of 14 injections (p = 0.007, r = 0.583). CONCLUSIONS: The average time to completion of 14 injections was 32.3 months, and switching of medication was performed in 70.8%. Longer time to the first recurrence was related to longer completion time. This study will provide useful facts when informing the patients their future treatment plans under the Korean Health Care system.
Choroidal Neovascularization ; Delivery of Health Care ; Diagnosis ; Endothelial Growth Factors* ; Humans ; Macular Degeneration* ; Medical Records ; Ranibizumab ; Recurrence ; Retrospective Studies ; Subretinal Fluid ; Visual Acuity

PURPOSE: To evaluate 12-month outcomes of anti-vascular endothelial growth factor (VEGF) therapy for polypoidal choroidal vasculopathy (PCV) with grape-like polyp clusters. METHODS: This retrospective observational study included 23 eyes of 23 patients who were newly diagnosed with PCV with grape-like polyp clusters, and who were subsequently treated with anti-VEGF monotherapy. The study compares the best-corrected visual acuity (BCVA) of the patients at diagnosis, at 3 months, and at 12 months after diagnosis. In addition, 12-month changes in BCVA values were compared between cases with subfoveal or juxtafoveal polyps and cases with extrafoveal polyps. RESULTS: The baseline, 3-month, and 12-month logarithm of the minimal angle of resolution BCVA was 0.62 ± 0.35, 0.50 ± 0.43, and 0.58 ± 0.48, respectively. Compared to the baseline, patient BCVA was not significantly different at 12 months after diagnosis (p = 0.764). Six eyes (26.1%) gained ≥0.2 logarithm of the minimal angle of resolution BCVA. In cases with subfoveal or juxtafoveal polyps, BCVA values at baseline and at 12 months after diagnosis were 0.66 ± 0.37 and 0.69 ± 0.53, respectively. In cases with extrafoveal polyps, the values were 0.54 ± 0.33 and 0.37 ± 0.31, respectively. Changes in BCVA values were significantly different between the two groups (p = 0.023). CONCLUSIONS: Although anti-VEGF therapy has favorable short-term efficacy for treating PCV with grape-like polyp clusters, long-term visual improvements are generally limited in the majority of afflicted eyes. The presence of subfoveal or juxtafoveal polyps may suggest unfavorable treatment outcomes.
Aged ; Angiogenesis Inhibitors/*administration & dosage ; Choroid/blood supply/*diagnostic imaging ; Choroidal Neovascularization/diagnosis/*drug therapy ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Humans ; Intravitreal Injections ; Male ; Polyps/diagnosis/*drug therapy ; Retrospective Studies ; Tomography, Optical Coherence ; Vascular Endothelial Growth Factor A/*antagonists & inhibitors

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

No abstract available.
Aged ; Cataract Extraction ; Choroidal Neovascularization/diagnosis/*etiology ; Epiretinal Membrane/*surgery ; Female ; Fluorescein Angiography ; Humans ; Iatrogenic Disease ; Tomography, Optical Coherence ; Visual Acuity ; Vitrectomy/*adverse effects