Factors associated with the development of exudation in treatment-naive eyes with nonexudative macular neovascularization.

PURPOSE: To identify the predictive factors for development of exudation in patients with treatment-naïve nonexudative macular neovascularization (MNV). METHODS: We retrospectively analyzed 61 treatment-naïve patients with nonexudative MNV who had not received treatment for nonexudative MNV before the exudation developed. Baseline characteristics and changes in MNV were evaluated using multivariate modeling to determine the potential risk factors for exudative conversion. RESULTS: Exudation development was identified in 31.1% (19/61 eyes) of the study eyes during the 46.2 ± 8.2-month mean follow-up period. The mean period of development of exudation from the baseline was 21.5 ± 6.7 months. Multivariate Cox regression analysis identified that older age (hazard ratio [HR] of 1.380, 95% confidence interval [CI] 1.129-1.688, P = 0.008), larger MNV area at baseline (HR of 1.715, CI 1.288-2.308; P = 0.006), increase of MNV area by doubling (HR of 4.992, CI 1.932-9.246; P = 0.002), and retinal pigment epithelium (RPE) elevation more than 100 µm (HR of 1.017, CI 1.006-1.233; P = 0.015) were associated with increased risk of the development of exudation. CONCLUSION: Older age, larger MNV area, increasing MNV area, and higher RPE elevation were associated with an increased risk of exudative conversion in patients with treatment-naïve nonexudative MNV. Identifying these risk factors may be helpful in establishing treatment strategies and monitoring patients.

CHARACTERISTICS PREDICTIVE OF FELLOW-EYE GEOGRAPHIC ATROPHY WITHOUT NEOVASCULARIZATION IN UNILATERAL TYPE 3 MACULAR NEOVASCULARIZATION.

PURPOSE: To evaluate the predictive characteristics of fellow-eye geographic atrophy (GA) without neovascularization in patients with unilateral Type 3 macular neovascularization. METHODS: This retrospective study included 84 patients who were diagnosed with unilateral Type 3 macular neovascularization. Patients who developed fellow-eye neovascularization and those exhibiting GA without neovascularization at the final follow-up were included in the neovascularization and GA groups, respectively. The patient demographics and baseline fellow-eye characteristics were compared between the two groups. RESULTS: The mean follow-up period was 40.5 ± 11.5 months after diagnosis. Patients included in the GA group (n = 28) were significantly older (mean 77.4 ± 5.2 years vs. 74.2 ± 5.8 years, P = 0.016), had significantly thinner subfoveal choroidal thickness (mean 109.4 ± 36.8 µ m vs. 173.1 ± 77.6 µ m, P < 0.001), and had a significantly higher incidence of baseline GA (39.3% vs. 16.1%, P = 0.019) than those included in the neovascularization group (n = 56). In the multivariate analysis, subfoveal choroidal thickness showed a close negative association with the risk of GA rather than neovascularization ( P = 0.004, ß = 0.982, 95% confidence interval = 0.970-0.994). CONCLUSION: In patients with unilateral Type 3 macular neovascularization, older age, the presence of GA, and a thin choroid in the fellow eye were found to be indicative of a higher probability of progression toward fellow-eye GA instead of neovascularization may be potential candidates for future complement inhibitor treatments targeting fellow-eye GA.

Difference in characteristics and lesion reactivation between type 3 macular neovascularization with and without subretinal fluid at baseline.

PURPOSE: To compare the characteristics and incidence rates of lesion reactivation after anti-vascular endothelial growth factor (VEGF) treatment in type 3 macular neovascularization (MNV) with and without subretinal fluid (SRF) at baseline. METHODS: This retrospective study included 95 patients diagnosed with type 3 MNV. After the initial loading injections, re-treatment was performed when lesion reactivation occurred defined as the re-accumulation of subretinal or intraretinal fluid or the new development of a retinal/subretinal hemorrhage. The differences in the baseline characteristics and the incidence rates of lesion reactivation were compared between patients with SRF (SRF group, n = 42) and those without SRF (non-SRF group, n = 53). RESULTS: At diagnosis, the mean visual acuity was worse (0.68 ± 0.41 vs 0.50 ± 0.36; P = 0.032), mean central retinal thickness was greater (515.4 ± 145.9 µm vs 383.8 ± 105.5 µm; P < 0.001), and the incidence of focal retinal hemorrhages was higher (90.5% vs 66.0%; P = 0.005) in the SRF group than in the non-SRF group. In the SRF group, the first lesion reactivation was noted in 89.7% at a mean of 5.8 ± 4.4 months after the third injection. In the non-SRF group, the first lesion reactivation was noted in 70.6% at a mean of 6.1 ± 3.8 months. There was a significant difference in lesion reactivation between the two groups (P = 0.019). CONCLUSIONS: The difference in the baseline characteristics and incidence of lesion reactivation between type 3 MNV with and without SRF suggests that the presence of SRF may be indicative of more advanced disease with a high risk of visual deterioration. This result also suggests the need for more active treatment to preserve vision in patients with SRF.

Influence of lesion location on lesion reactivation after initial treatment in neovascular age-related macular degeneration.

PURPOSE: We aim to evaluate the factors associated with the incidence of lesion reactivation after initial loading injections in patients with neovascular age-related macular degeneration (AMD). METHODS: This retrospective study included patients diagnosed with treatment-naïve neovascular AMD who received three loading injections of either ranibizumab or aflibercept. After the initial treatment, patients were followed up every 1-2 months during the first year and the follow-up interval was extended to 4 months during the second year. Retreatment was administered on an as-needed basis. The incidence and timing of lesion reactivation at 24 months after diagnosis were identified. In addition, Cox's proportional hazard model was used to evaluate the association of baseline factors with lesion reactivation. Lesion reactivation was defined re-accumulation of subretinal fluid/intraretinal fluid or the development of subretinal/intraretinal hemorrhage. RESULTS: A total of 284 patients (173 men and 111 women) were included in the study. The mean age of the patients was 70.5 ± 8.8 years. During the 24-month follow-up period, lesion reactivation was observed in 216 eyes (76.1%) at a mean of 8.2 ± 4.4 months after diagnosis. The incidence of lesion reactivation was 62.5% in extrafoveal macular neovascularization (MNV), 75.0% in juxtafoveal MNV, and 79.5% in subfoveal MNV. The extrafoveal MNV showed significantly lower incidence of lesion reactivation than subfoveal MNV (P = 0.041, hazard ratio = 0.64). CONCLUSIONS: Extrafoveal MNVs showed a lower incidence of lesion reactivation after initial treatment than subfoveal MNVs. This result should be considered when interpreting the results of clinical trials with different eligibility criteria regarding lesion location.

INCIDENCE AND TIMING OF PIGMENT EPITHELIAL DETACHMENT AND SUBRETINAL FLUID DEVELOPMENT IN TYPE 3 MACULAR NEOVASCULARIZATION ASSOCIATED WITH AGE-RELATED MACULAR DEGENERATION.

PURPOSE: To evaluate the incidence and timing of pigment epithelial detachment (PED) and subretinal fluid (SRF) development in type 3 macular neovascularization. METHODS: This retrospective study included 84 patients who were diagnosed with treatment-naïve type 3 macular neovascularization who did not show SRF at diagnosis. All patients were initially treated with three loading injections of ranibizumab or aflibercept. After the initial loading injections, as-needed regimen was performed for retreatment. The development of either PED or SRF was identified. The incidence and timing of PED development in patients without PED at diagnosis and that of SRF development in patients with PED at diagnosis were evaluated. RESULTS: The mean follow-up period was 41.3 ± 20.7 months after diagnosis. Among the 32 patients without serous PED at diagnosis, PED developed in 20 (62.5%) at a mean of 10.9 ± 5.1 months after diagnosis. PED development was noted within 12 months in 15 patients (46.8%; 75.0% among the PED development cases). In 52 patients with serous PED and without SRF at diagnosis, 15 developed SRF (28.8%) at a mean of 11.2 ± 6.4 months after diagnosis. SRF development was noted within 12 months in nine patients (17.3%; 66.6% among the SRF development cases). CONCLUSION: PED and SRF developed in a substantial proportion of patients with type 3 macular neovascularization. The average period of development of these pathologic findings was within 12 months of diagnosis, suggesting the need for active treatment during the early treatment period to improve treatment outcomes.

SUBRETINAL FLUID ASSOCIATED WITH DRUSENOID PIGMENT EPITHELIAL DETACHMENT.

PURPOSE: To analyze the clinical characteristics of drusenoid pigment epithelial detachment (PED) with subretinal fluid (SRF) and to evaluate the impact of SRF on the long-term visual and anatomical outcomes. METHODS: Forty-seven eyes with drusenoid PED (47 patients) who completed >24 months of follow-up were retrospectively analyzed. Intergroup comparisons of the visual and anatomical outcomes with and without SRF were made. RESULTS: The mean duration of follow-up was 32.9 ± 18.7 months. The group with drusenoid PED with SRF (14 eyes) showed significantly higher PED height (468 ± 130 µ m vs. 313 ± 88 µ m, P < 0.001), larger PED diameter (2,328 ± 953 µ m vs. 1,227 ± 882 µ m, P < 0.001), and larger PED volume (1.88 ± 1.73 mm 3 vs. 1.12 ± 1.35 mm 3 , P = 0.021) than that in the group with drusenoid PED without SRF (33 eyes) at baseline. No significant intergroup difference was found regarding the best-corrected visual acuity at the final visit. In addition, the incidence of complete retinal pigment epithelial and outer retinal atrophy (cRORA; 21.4%) and the development of macular neovascularization (MNV; 7.1%) for the group with drusenoid PED with SRF showed no difference compared with those (39.4% for cRORA development and 9.1% for MNV development) with drusenoid PED without SRF. CONCLUSION: The size, height, and volume of drusenoid PED were associated with the development of SRF. The SRF in drusenoid PED did not affect the visual prognosis or the development of macular atrophy during long-term follow-up.

Incidence of early complications requiring treatment plan changes after vitreoretinal surgery: a single-center study in South Korea.

BACKGROUND: Information regarding incidence of treatment plan changes may be useful when discussing postoperative treatment plans for patients. Moreover, it may help establish a standardized postoperative treatment plan. This study aimed to evaluate the incidence of early complications requiring treatment plan changes in patients following vitreoretinal surgery and investigate its risk factors. METHODS: This single-center retrospective study included 465 patients who had undergone vitreoretinal surgery. The reasons, incidence, and timing of treatment plan changes within 14 days of surgery were identified. Potential factors associated with the changes, such as patient demographics, surgeon's experience, diagnoses, and type of surgery were also analyzed. RESULTS: The treatment plan was changed in 76 patients (16.3%) at a mean of 4.0 ± 3.2 days after vitreoretinal surgery. The reasons for the plan changes were increased intraocular pressure (IIOP) in 66(86.8%), intraocular inflammation in 2(2.6%), corneal edema in 3(3.9%), leakage from the sclerotomy wound in 3(3.9%) patients, and combined IIOP and intraocular inflammation in 2(2.6%). The date of discharge was postponed because of treatment plan changes in 17 patients (22.4%). The incidence of plan changes was higher in patients who underwent gas or oil tamponade (P < 0.001) and those who underwent surgery performed by less experienced surgeons (P = 0.034). CONCLUSIONS: Treatment plan was changed in 16.3% of patients after vitreoretinal surgery. The risk of treatment plan changes was associated with the surgeon's experience in vitreoretinal surgery and the type of surgery. These results should be considered when establishing standardized care plans for patients who require vitreoretinal surgery.

Development of subretinal hemorrhage after treatment discontinuation for neovascular age-related macular degeneration and polypoidal choroidal vasculopathy.

PURPOSE: To investigate the incidence, risk factors, and their influence on visual outcomes of subretinal hemorrhage (SRH) in patients with neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy(PCV) who discontinue treatment. METHODS: This retrospective study included 148 patients with nAMD and PCV who discontinued treatment. The development of a 3-disc area or greater extent of SRH after treatment discontinuation was identified. Visual acuity at the final visit was compared between patients with and those without SRH. Factors associated with SRH were then analyzed. RESULTS: During the mean 56.8 ± 18.2 months of follow-up, treatment was discontinued at a mean 24.1 ± 16.3 months after diagnosis. SRH developed in 24 (16.2%) patients at a mean 21.5 ± 17.6 months after treatment discontinuation. The visual acuity at the final follow-up was significantly worse in patients with SRH than in those without SRH (P < 0.001). There was a significant difference in the incidence of SRH among the different types of macular neovascularization (MNV) (P = 0.024). In particular, the incidence of type 3 MNV was relatively high (36.0%). CONCLUSIONS: The development of SRH may lead to very poor visual prognosis in patients who discontinue treatment. The high risk of SRH in type 3 MNV suggests the need for caution when choosing treatment discontinuation in cases of type 3 MNV.

Nonexudative morphologic changes of neovascularization on optical coherence tomography angiography as predictive factors for exudative recurrence in age-related macular degeneration.

PURPOSE: To evaluate morphologic changes of choroidal neovascularization (CNV) on optical coherence tomography angiography (OCTA) during the nonexudative period and to correlate the features and timing of recurrence in neovascular age-related macular degeneration. (AMD). METHODS: Two hundred thirty-eight eyes with type 1 CNV were retrospectively reviewed. For cases with exudative recurrence, OCTA images were tracked for analysis between the recurrences. Qualitative parameters of morphologic changes of CNV on OCTA, including tiny branching vessels, anastomotic loops, peripheral vascular arcade, and perilesional halo, were correlated with the features of exudative recurrence. RESULTS: Exudative recurrence was identified in 163 cases, and among them, nonexudative morphological changes in CNV were identified using OCTA in 45 cases. For the cases with nonexudative changes on OCTA, exudative recurrence eventually developed within 0.5-3.5 months (mean, 2.3 ± 2.0 months) after identifying morphologic changes OCTA. The following changes in CNV were revealed on OCTA: tiny branching vessels in 53.3% (24/45) of cases, anastomotic loops in 40.0% (18/45), peripheral vascular arcades in 44.4% (20/45), and perilesional halo in 35.6% (16/45). Among the morphologic parameters, development of tiny branching vessels was significantly associated with early exudative recurrence (1.5 ± 1.2 months, p = 0.019), higher incidence of intraretinal fluid (IRF) (p = 0.016), and subretinal or subretinal pigment epithelial hemorrhage (p = 0.023) at recurrence, compared with other morphologic changes. CONCLUSION: Development of tiny branching vessels of CNV on OCTA during the nonexudative period was associated with early exudative recurrence, including IRF or hemorrhage. Identifying the nonexudative changes of CNV on OCTA might predict exudative recurrence and provide additional parameters for monitoring neovascular AMD.

BACILLARY LAYER DETACHMENT IN A KOREAN COHORT WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

PURPOSE: To evaluate the incidence and characteristics of bacillary layer detachment (BALAD) in neovascular age-related macular degeneration. METHODS: This retrospective study was performed at Kim's Eye Hospital in South Korea. Patients who were diagnosed with neovascular age-related macular degeneration between January 2017 and December 2017 were included. The incidence of BALAD was compared among different types of macular neovascularization (MNV). The best-corrected visual acuity and central retinal thickness at diagnosis were compared between patients showing BALAD at diagnosis and those who did not. RESULTS: Among the 442 patients included, BALAD was observed in 20 patients (4.5%). There was a significant difference in the incidence of BALAD between Type 1 MNV (2.7%), Type 2 MNV (12.5%), and Type 3 MNV (0%) (P < 0.001). The best-corrected visual acuity was significantly worse (mean 1.26 ± 0.79 vs. 0.62 ± 0.50, P = 0.001), and the central retinal thickness was significantly greater (mean 648.2 ± 211.1 µm vs. 464.0 ± 175.5 µm, P < 0.001) in patients with BALAD than in those without it. After antivascular endothelial growth factor therapy, all BALADs resolved. CONCLUSION: This study first reported the incidence of the BALAD in neovascular age-related macular degeneration in a Korean population. The incidence of BALAD was the highest in Type 2 MNVs. Bacillary layer detachment generally develops in eyes with great macular thickness and poor visual acuity.

Characteristics of spontaneous reattachment of rhegmatogenous retinal detachment: optical coherence tomography features and follow-up outcomes.

PURPOSE: To investigate the clinical features of spontaneous reattachment of rhegmatogenous retinal detachment (SRRRD) with diffuse retinal pigmentary changes. METHODS: This retrospective study included patients diagnosed with SRRRD. The diagnosis of SRRRD was made based on characteristic fundus findings, such as diffuse retinal pigmentary clumpings, retinal pigmentary atrophy, and convex lesion margins. The clinical features of SRRRD were also evaluated. In addition, optical coherence tomography (OCT) images and follow-up data were analyzed. RESULTS: Twenty patients were included in the study. All the patients showed unilateral involvement. SRRRD predominantly involved the inferior or temporal retina (90.0%). On OCT, severe disruption of the outer retinal layers was noted in the region of SRRRD. A subretinal gliosis band was noted in 11 patients (55.0%), and an epiretinal membrane (ERM) was noted in nine patients (45.0%). In 18 patients, a mean follow-up of 24.9 ± 29.2 months was performed. During the follow-up period, no definite retinal changes were noted on fundus examination or OCT. CONCLUSIONS: SRRRD usually involves the inferior or temporal retina. Although severe disruption of the retinal microstructure is noted in the involved region, the condition is likely to be stable. However, long-term follow-up is required to identify progression of the ERM.

Difference in treatment burden of neovascular age-related macular degeneration among different types of neovascularization.

PURPOSE: To evaluate the difference in the treatment burden among different types of neovascular age-related macular degeneration (AMD). METHODS: This retrospective, observational study included 431 patients who were diagnosed with neovascular AMD. Patients were divided into three groups: type 1 or 2 neovascularization group (n = 167), type 3 neovascularization group (n = 50), and polypoidal choroidal vasculopathy (PCV) group (n = 214). The number of hospital visits per year and the number of anti-vascular endothelial growth factor (VEGF) injections per year were compared among these groups. Furthermore, the incidence of bilateral involvement during the follow-up period was compared among the groups. RESULTS: The mean follow-up period was 50.6 ± 11.3 months. The number of hospital visits per year was significantly higher in the type 1 or 2 neovascularization group (mean: 6.1 ± 1.5) and type 3 neovascularization (6.6 ± 1.6) than in the PCV group (6.0 ± 1.5) (P < 0.001). The number of anti-VEGF injections per year was significantly higher in type 3 neovascularization group (3.1 ± 1.7) than in the type 1 or 2 neovascularization group (2.3 ± 1.5) or the PCV group (2.3 ± 1.2) (P = 0.042). There was a significant difference in the incidence of bilateral involvement among patients in type 1 or 2 neovascularization group (20.4%), type 3 neovascularization group (46.0%), and the PCV group (15.4%) (P < 0.001). CONCLUSIONS: The high frequency of hospital visits and that of anti-VEGF injections in patients with type 3 neovascularization suggests high treatment burden in these patients. The high incidence of bilateral involvement could be one of the primary reasons for high treatment burden in patients with type 3 neovascularization.

LONG-TERM COURSE AND VISUAL OUTCOMES OF PRECHOROIDAL CLEFT IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION AND POLYPOIDAL CHOROIDAL VASCULOPATHY.

PURPOSE: To evaluate the regression of prechoroidal cleft, its influence on visual outcomes, and differences in visual outcomes between neovascular age-related macular degeneration and polypoidal choroidal vasculopathy. METHODS: This retrospective study included 61 patients exhibiting prechoroidal cleft who were treated with antivascular endothelial growth factors. The patients were divided into two groups according to the following categories: 1) regression of prechoroidal cleft: regression group versus nonregression group and 2) type of neovascularization: neovascular age-related macular degeneration group versus polypoidal choroidal vasculopathy group. Changes in the visual acuity during the follow-up period were also compared between the two groups. RESULTS: During the 52.4 ± 17.4-month follow-up period, regression of prechoroidal cleft was noted in 17 patients (27.9%) at a mean of 25.7 ± 18.3 months after the first identification. The degree of the logarithm of the minimum angle of resolution of visual deterioration was greater in the nonregression group (0.59 ± 0.56, n = 17) than that in the regression group (0.25 ± 0.61, n = 44) (P = 0.007) and in the neovascular age-related macular degeneration group (0.56 ± 0.61, n = 51) than that in the polypoidal choroidal vasculopathy group (0.18 ± 0.33, n = 10) (P = 0.034). CONCLUSION: Approximately 27.9% of prechoroidal cleft cases eventually regressed, in conjunction with relatively favorable visual outcomes. Considering the poor visual prognosis in neovascular age-related macular degeneration accompanied by prechoroidal cleft, more caution is required for this condition.

LONG-TERM CHANGES IN CHOROIDAL THICKNESS IN EYES WITH TYPE 3 MACULAR NEOVASCULARIZATION.

PURPOSE: To evaluate the long-term changes in subfoveal choroidal thickness (SCT) in eyes with Type 3 macular neovascularization that underwent anti-vascular endothelial growth factor therapy. METHODS: This retrospective study was performed with 47 patients diagnosed with Type 3 macular neovascularization and treated with anti-vascular endothelial growth factor therapy. All the patients initially received three loading injections. The SCT was compared at diagnosis, 3 months, 12 months, and at the final follow-up visit. The velocity of changes in SCT was also compared between each period. RESULTS: The mean follow-up period was 52.1 ± 11.0 months. The mean SCT was 143.3 ± 51.2 µm at diagnosis, and it had significantly decreased to 128.6 ± 47.4 µm at 3 months (P < 0.001), 123.2 ± 45.7 µm at 12 months (P < 0.001), and 110.0 ± 43.0 µm at the final follow-up (P < 0.001). The mean velocity of the decrease in SCT was 4.9 ± 3.9 µm per month during the first 3 months, 0.6 ± 1.2 µm per month between the 3rd and the 12th months, and 0.3 ± 0.3 µm per month between the 12th month and the final follow-up. The velocity of the decrease was significantly greater during the first 3 months than during the 3rd to 12th month (P < 0.001) and 12th month to final follow-up (P < 0.001) periods. The difference was not significant between the 3rd to 12th month and 12th months to final follow-up (P = 0.836) periods. CONCLUSION: Subfoveal choroidal thickness continuously decreased over time, with a significant decrease of 23% noted in eyes with Type 3 macular neovascularization. The thickness rapidly decreased during the initial loading phase. Subsequently, a continuous but gradual decrease in the thickness was noted.

Long-term switching between ranibizumab and aflibercept in neovascular age-related macular degeneration and polypoidal choroidal vasculopathy.

PURPOSE: To investigate the rate and timing of switching between ranibizumab and aflibercept and to evaluate the difference in the switching rates among the different subtypes of neovascularization. METHODS: This retrospective study included 386 patients (386 eyes) who had been diagnosed with neovascular age-related macular degeneration (AMD) or polypoidal choroidal vasculopathy (PCV) and treated with ranibizumab (ranibizumab group, n = 260) or aflibercept (aflibercept group, n = 126). The rate and timing of switching from ranibizumab to aflibercept or vice versa were evaluated. Within the ranibizumab and the aflibercept groups, the switching rates were compared among the 3 subtypes of neovascularization: PCV, type 1 or 2 neovascularization, and type 3 neovascularization. RESULTS: During the mean 44.9 ± 15.9 months of follow-up period, switching rate was significantly higher in the ranibizumab group (28.8%, 75 patients) than in the aflibercept group (9.5%, 12 patients) (P < 0.001). No difference was observed in the mean duration between the diagnosis and switching among the ranibizumab (18.7 ± 14.6 months) and the aflibercept groups (14.8 ± 14.5 months) (P = 0.379). In the ranibizumab group, the switching rate was markedly higher in PCV (39.6%) than in type 1 or 2 neovascularization (17.6%) or in type 3 neovascularization (13.3%) (P < 0.001). In the aflibercept group, there was no significant difference in the switching rates among the subtypes of neovascularization (P = 0.811). CONCLUSIONS: Although the timings of switching were similar, switching rate was higher in patients undergoing ranibizumab therapy than in those undergoing aflibercept therapy. The switching rate was especially higher in PCV patients undergoing ranibizumab therapy.

Long-term natural history of the idiopathic epiretinal membrane in children and young adults.

PURPOSE: To evaluate the natural history of the idiopathic epiretinal membrane (ERM) in children and young adults. METHODS: This retrospective study included 52 patients younger than 40 years who had been diagnosed with idiopathic ERM. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) measured at diagnosis were compared with those at the final visit. Incidence and factors predictive of the spontaneous release of ERM were additionally investigated. Moreover, the proportion of eyes that eventually underwent surgery was identified. RESULTS: The mean age of the patients was 32.5 ± 6.7 years, and the mean follow-up duration was 34.5 ± 23.4 months. The mean logarithm of the minimal angle of resolution BCVA (0.05 ± 0.10, Snellen equivalents = 20/22) and CRT (340.6 ± 61.6 µm) at diagnosis were not different from BCVA (0.06 ± 0.10, 20/23) (P = 0.928) and CRT (326.6 ± 70.8 µm) (P = 0.079) at the final follow-up. Two lines or greater deterioration in the BCVA was noted in 2 eyes (3.8%). Spontaneous release of ERM was noted in 14 eyes (26.9%). The release of ERM was more frequently noted in eyes without cystoid intraretinal edema or retinoschisis (P = 0.020) or eyes with loss of foveal concavity at diagnosis (P = 0.008). During the follow-up period, 5 eyes (9.6%) underwent surgery. CONCLUSIONS: The natural history of the idiopathic ERM in children and young adults was generally favorable with definite deterioration in visual acuity noted only in a limited proportion of patients. Baseline retinal morphology may be predictive of the spontaneous release of ERM.

Intravitreal aflibercept for submacular hemorrhage secondary to neovascular age-related macular degeneration and polypoidal choroidal vasculopathy.

PURPOSE: To evaluate the efficacy of intravitreal aflibercept monotherapy for submacular hemorrhage secondary to neovascular age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). METHODS: This prospective, phase 4 clinical trial included 29 patients diagnosed with fovea-involving submacular hemorrhage secondary to neovascular AMD (7 patients) or PCV (22 patients). Patients were initially administered 3 monthly aflibercept injections, followed by 1 injection every 2 months. The primary outcome measure was changes in Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) during the 56-week study period. Other key outcome measures were the proportion of patients who exhibited changes in BCVA of ≥ 15 ETDRS letters from baseline and changes in central retinal thickness (CRT). RESULTS: The mean size of hemorrhage was 6.2 ± 4.8-disc-diameter area. The mean BCVA significantly improved from 52.9 ± 17.8 ETDRS letters at week 0 (baseline) to 71.8 ± 16.1 letters at week 56 (P < 0.001). At week 56, improvement in BCVA of ≥ 15 letters was noted in 16 patients (55.2%), whereas none of the patients experienced a loss of ≥ 15 letters. The mean CRT significantly decreased from 498.9 ± 194.2 µm at week 0 to 248.3 ± 45.0 µm at week 56 (P < 0.001). During the study period, retinal break developed in one patient. CONCLUSIONS: Intravitreal aflibercept administered every 2 months after the 3 initial monthly doses was found to be an effective and safe treatment method for submacular hemorrhage secondary to neovascular AMD.

INFLUENCE OF FELLOW-EYE EXAMINATION INTERVAL ON VISUAL ACUITY AT FELLOW-EYE NEOVASCULARIZATION IN UNILATERAL TYPE 3 NEOVASCULARIZATION.

PURPOSE: To evaluate the influence of the fellow-eye examination interval on visual acuity at fellow-eye neovascularization in unilateral Type 3 neovascularization. METHODS: This retrospective, observational study included 55 patients who were initially diagnosed with unilateral Type 3 neovascularization and subsequently developed fellow-eye neovascularization during the follow-up period. The fellow-eye examination interval was defined as the hospital visit interval between fellow-eye neovascularization detection and immediately before neovascularization detection. The primary outcome measures were the associations between the fellow-eye examination interval and fellow-eye best-corrected visual acuity (BCVA) at fellow-eye neovascularization detection and degree of deterioration in fellow-eye BCVA. RESULTS: After the initial diagnosis of the first-involved eye, fellow-eye neovascularization was noted after a period of 22.7 ± 17.5 months. The mean fellow-eye examination interval was 4.8 ± 2.2 months (range, 2-10 months). The mean logarithm of the minimum angle of resolution BCVA in the fellow eye was 0.22 ± 0.18 (Snellen equivalents, 20/33) immediately before neovascularization and 0.52 ± 0.26 (20/66) at neovascularization. There were significant associations between the fellow-eye examination interval and fellow-eye BCVA when neovascularization was detected (P = 0.005, r = 0.371) and at degree of deterioration in fellow-eye BCVA (P = 0.001, r = 0.428). CONCLUSION: A longer fellow-eye examination interval was associated with poor visual acuity and greater visual deterioration of the fellow eye at neovascularization. These results suggest the need for frequent fellow-eye examination in patients with unilateral Type 3 neovascularization.

CHARACTERISTICS OF TYPE 3 NEOVASCULARIZATION LESIONS: Focus on the Incidence of Multifocal Lesions and the Distribution of Lesion Location.

PURPOSE: To evaluate the incidence of multifocal lesions and the distribution of lesion location in Type 3 neovascularization. METHODS: This retrospective, observational study included 148 eyes of 148 patients diagnosed with Type 3 neovascularization. The number of Type 3 neovascularization lesions was counted, and the incidence of multiple lesions in an eye was estimated. In addition, the distance from the fovea to the lesion and the geographic location of the lesion were estimated. Pseudodrusen incidence was compared between eyes with and without multifocal lesions. RESULTS: In total, 169 Type 3 neovascularization lesions were noted. A single lesion was noted in 130 eyes (87.8%), whereas 2 or 3 multifocal lesions were noted in the remaining 18 eyes (12.2%). The mean distance from the fovea to the lesion was 898.8 ± 324.9 µm. The distribution of lesion locations exhibited a fovea-sparing pattern. No lesions were located within 200 µm of the fovea, 20 lesions (11.8%) were located >200 and ≤500 µm away from the fovea, 89 lesions (52.7%) were located >500 and ≤1,000 µm away from the fovea, and 60 lesions (35.5%) were located >1,000 µm away from the fovea. Pseudodrusen incidence was significantly higher in eyes with multifocal lesions (P = 0.024). CONCLUSION: Two or more multifocal lesions were noted in 12.2% of eyes with Type 3 neovascularization, and pseudodrusen incidence was higher in eyes with multifocal lesions. In addition, lesion distribution exhibited a fovea-sparing pattern. These characteristics may be associated with the distinct pathophysiology of Type 3 neovascularization.

Long-term incidence and timing of reactivation in patients with type 3 neovascularization after initial treatment.

PURPOSE: The purpose of the present study was to evaluate the long-term incidence and timing of reactivation in patients with type 3 neovascularization who were treated with three monthly anti-vascular endothelial growth factor (VEGF) injections. METHODS: A total of 179 patients (179 eyes) diagnosed with type 3 neovascularization with dry macula after three monthly anti-VEGF loading injections were included in this retrospective study. After the initial treatment, patients were followed up without further injection until the first reactivation. The incidence and timing of the first reactivation after the initial treatment were recorded, and factors predictive of early reactivation (≤ 6 months after the third anti-VEGF injection) were investigated. RESULTS: During a mean follow-up of 37.5 ± 18.8 months, the first reactivation was noted in 145 patients (81.0%) at a mean of 6.6 ± 4.1 months after the third injection. In 94 eyes (64.8%), reactivation was noted 2-6 months after the third injection, while in 37 eyes (25.5%) it was noted 7-12 months after the third injection. In the remaining 14 eyes (9.7%), the reactivation was noted after this period. The incidence of early reactivation was higher in women (P = 0.014) and patients with thicker choroid (P = 0.026). CONCLUSIONS: In patients with type 3 neovascularization, almost all reactivation was noted within 15 months of the third anti-VEGF injection, suggesting the need for close follow-up and detailed examination during this period. Female patients with thick choroid should be monitored more frequently during this early period.