Structural and clinical changes in previously treated type 1 macular neovascularization in non-responder AMD eyes switched to brolucizumab.

PURPOSE: To examine structural and clinical changes in previously treated type 1 macular neovascularization (MNV) in non-responder age-related macular degeneration (nAMD) eyes switched to brolucizumab. Subretinal hyper-reflective material (SHRM), intraretinal (IRF) and subretinal fluid (SRF) presence, fibrovascular-pigment epithelium detachment (PED) height and central macular thickness (CMT) variation were analyzed using optical coherence tomography (OCT). METHODS: In this prospective study all patients underwent a complete ophthalmological evaluation including structural OCT at baseline (T0), one month (T1), three (T2), four (T3) and six months after switching to brolucizumab treatment (T4). Non-responder criterion was the persistence of IRF and SRF. Moreover, CMT and BCVA had shown worsening or no improvement before switching to brolucizumab. Clinical function and structural activity biomarkers were measured at each visit and changes were analyzed. P value <0.05 was considered statistically significant. RESULTS: Twenty eyes of twenty patients were enrolled. All the structural variables examined during the follow-up showed significant reductions. Decreases in IRF, SRF and PED were already significant at T1 (p < 0.05). SHRM was significantly reduced at T2 (p < 0.05). Structural biomarkers were absent at T3. At T4, all biomarkers remained stable while SHRM was no longer detectable in 18 patients. Changes in visual acuity from baseline to T4 were not significant. CONCLUSION: This short-term experience highlights that brolucizumab might be considered an effective treatment option in nAMD with type 1 MNV, as it can promote a reduction of structural activity biomarkers.

Management of presumed candida endophthalmitis during the COVID-19 pandemic: Case report and review of the literature.

PURPOSE: To report the management of a case of candida endophthalmitis following intubation for SARS-CoV-2 ARDS, during the first lockdown, underlining consequently the limited access to the gold standard of care. METHODS: Case report. RESULTS: We have described the case of a 56-year-old Hispanic man who developed bilateral Candida endophthalmitis after one month of hospitalization in the intensive care unit for severe SARS-CoV-2 pneumonia. Multimodal imaging was obtained. Full serological screening for infection was done resulting negative. A diagnostic vitrectomy was impossible due to the limited access at the surgery room. Diagnosis of presumed candida endophthalmitis was made, according to a highly qualified center, and therapy with intravenous liposomal amphotericin B was administered. At three months, we observed lack of vitreous opacities and atrophic scars with no active lesions. CONCLUSIONS: Diagnosis of candida endophthalmitis was a challenge in this pandemic scenario, given the impossibility of performing a diagnostic vitrectomy. Therefore, it was mainly based on patient's clinical manifestations, multimodal imaging and on unanimity of collegiality between our hospital and the highly specialized center.

Real-life patient journey in neovascular age-related macular degeneration: a narrative medicine analysis in the Italian setting.

OBJECTIVES: To investigate the real-life experience of patients affected by neovascular age-related macular degeneration (nAMD), in the healthcare pathway for the management of the disease, using a "patient journey" and narrative method approach. METHODS: The patient journey of subjects affected by nAMD was designed using a process-mapping methodology involving a team from 11 Italian centres. Subsequently, narratives were collected from nAMD patients and family members. The interviews were analyzed using the narrative medicine methodology. RESULTS: Eleven specialized retina centres across Italy were involved and 205 narratives collected. In 29% of cases, patients underestimated their symptoms or attributed them to non-pathological causes, thus delaying the specialist consultation. The delay in accessing to care was due to a lack of awareness of this disease (50% of the participants didn't know what nAMD is) and to critical issues faced at first visit (long waiting lists, failed diagnosis, underestimation of the problem). Despite anti-VEGF therapies were perceived as effective in improving or stabilizing vision in 91% of narratives collected, 77% of patients still reduced or ceased daily activities such as reading and driving. Within the pathway of care there was not a multidisciplinary approach, and the patients were treated just by the ophthalmologist. CONCLUSIONS: nAMD may significantly affect the quality of life of affected patients, both from a functional and psychological point of view. The narrative medicine approach highlights some critical points in the healthcare journey of nAMD patients and represents a useful background in implementing patient management algorithms and pathways of care.

Choroidal cleft simulating choroidal caverns in neovascular age-related macular degeneration.

The authors report a case of a female patient affected by neovascular age-related macular degeneration (AMD). In particular, multiple sub-retinal hyperreflective infiltrates were found on optical coherence tomography. Optical coherence tomography examination of her right eye displayed the presence of sub-retinal pigment epithelium hyporeflective spaces located beneath a hyperreflective fibrotic neovascularization. This case highlights the importance of differentiating choroidal clefts from choroidal caverns.

Intravitreal Anti-Vascular Endothelial Growth Factor Drugs for Retinal Angiomatous Proliferation in Real-Life Practice.

PURPOSE: To describe the outcomes of intravitreal anti-vascular endothelial growth factor (VEGF) in the treatment of retinal angiomatous proliferation (RAP) in real-life practice in 7 Italian centers under the Progetto Luce initiative. METHODS: Clinical data of 95 eyes of 95 patients affected by RAP, regularly followed up and treated with either intravitreal ranibizumab or bevacizumab over 12 months, were examined. After a loading phase of 3 consecutive injections, retreatments were administered following a pro-re-nata regimen on the basis of the persistence or the recurrence of subretinal/intraretinal fluid on optical coherence tomography, or leakage on fluorescein angiography. RESULTS: Overall, the mean best corrected visual acuity changed from 0.66 to 0.53 LogMAR (P: 0.0003); 36.8% of eyes gained at least 3 ETDRS lines, whereas 13.7% lost >3 lines at the end of the follow-up. Mean central retinal thickness improved from 384 µm at baseline to 262 µm at the 12-month examination (P < 0.001). A serous pigment epithelium detachment (PED) was identified in 68.4% of eyes at baseline, and it was still detectable in 30.5% at the end of follow-up. The mean number of injections was 4.4 over the follow-up. A significantly greater proportion of eyes showed PED resolution in the subgroup treated with ranibizumab (P < 0.001). CONCLUSIONS: Intravitreal anti-VEGF treatment in routine clinical practice allows a significant improvement in visual function in patients affected by RAP. A limited number of anti-VEGF injections are generally required in most cases.

Optical Coherence Tomography Angiography in a Normal Iris.

BACKGROUND AND OBJECTIVE: Optical coherence tomography angiography (OCTA) is a new imaging technique for examining the macular region in many retinal diseases. The aim of this study was to assess the applicability of OCTA to detect iris vascularization. PATIENTS AND METHODS: The irises of 28 eyes of 14 patients were examined with AngioVue OCT (Optovue, Fremont, CA). The usual technique was modified using the AngioRetina mode, but with the anterior segment optical adaptor lens, and without autofocus, while making manual adjustments. OCTA scans were captured in both eyes, always by the same operator. The images were acquired in 3 × 3 and 6 × 6 volume cubes. Raw data were then exported and split using an external tool provided by Optovue to obtain three-dimensional (3-D) iris reconstruction. RESULTS: In all eyes, OCTA showed the arterial system more superficially and the venous system more deeply in 3-D reconstruction. CONCLUSION: This is the first report of a study of the vascularization and 3-D reconstruction of the normal iris with OCTA. The method detects iris vascular network and indirectly provides information on the retinal circulation in situations where this is not visible without injecting sodium fluorescein. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:1138-1142.].

Optical Coherence Tomography Angiography of Iris Nevus: A Case Report.

Iris nevus is common: 6% of patients with suspected iris melanoma have lesions other than melanoma, and 36% of them are nevi. Iris nevus turns into melanoma in approximately 8% of cases at a mean of 15 years. This case report provides the first description of an iris tumor examined with iris optical coherence tomography angiography (OCTA) compared to iris fluorescein angiography (IFA). A 60-year-old man with a diagnosis of iris nevus in the left eye was referred to our department for IFA and iris OCTA. The iris vasculature in IFA was visible only in the early phases, but not clearly. OCTA, however, gave visualization of the vascular network and very precisely defined the vessels of the whole lesion, except for the pupillary portion, which was masked by superficial pigment accumulations. IFA and iris OCTA can add information about the vascular architecture compared to slit-lamp biomicroscopy, ultrasound biomicroscopy, and anterior-segment OCT. However, IFA is time-consuming and invasive and can - very occasionally - cause serious adverse reactions. In contrast, OCTA defines the texture of the iris vasculature better. In conclusion, OCTA is a new method, easy to execute, needing no dye injection, and provides useful information on the vascular network of iris lesions. It could therefore be helpful in the diagnosis and follow-up of these lesions.

Intravitreal ranibizumab for choroidal neovascularization in a patient with angioid streaks and multiple evanescent white dots.

BACKGROUND: To report a patient with angioid streaks (ASs) and coincident multiple evanescent white dot syndrome (MEWDS) who developed choroidal neovascularization (CNV). CASE PRESENTATION: A 20-year-old woman presented with reduced vision (20/100) in her left eye (LE). Based on a complete ophthalmologic examination the patient was diagnosed with ASs and coincident MEWDS. Two weeks later best-corrected visual acuity (BCVA) improved up to 20/25 and the MEWDS findings almost disappeared. Two months later BCVA dropped again (20/100) due to the development of CNV which was treated by a single intravitreal injection of ranibizumab (0.5 mg/0.05 mL). One month after this BCVA improved up to 20/40, and there was regression of the CNV. There was no need for retreatment at the last follow-up visit, 1 year after the ranibizumab injection, when the patient showed further recovery of BCVA up to 20/25. CONCLUSIONS: In this case of ASs, MEWDS completely resolved after 2 weeks, but 2 months later CNV developed. A single intravitreal injection of ranibizumab had a long-lasting effect. Larger series are necessary to clarify the pathogenesis of CNV in such cases and the role of intravitreal ranibizumab.

A case of acute exudative polymorphous vitelliform maculopathy: follow-up and wide-field spectral-domain optical coherence tomography.

PURPOSE: To present a case of an HIV-positive patient with acute exudative polymorphous vitelliform maculopathy (AEPVM) and evaluate the presence of specific spectral-domain optical coherence tomography (SD-OCT) findings. METHODS: Case report. RESULTS: We reviewed the AEPVM cases reported in the literature and compared those to our patient to determine if there is a correspondence between the etiology that leads to the onset of AEPVM and clinical and SD-OCT findings. CONCLUSIONS: Acute exudative polymorphous vitelliform maculopathy is a disease that involves the outer retinal layers with lipofuscin deposits and serous detachment of the neuroepithelium with or without intraretinal cysts. Not much is known about the etiology and pathogenesis, and not many cases have been described. A review of the few clinical cases reported in the literature does not show a specific correspondence between etiology and SD-OCT findings.

A randomized trial of intravitreal bevacizumab vs. ranibizumab for myopic CNV.

AIMS: The aim was to compare the efficacy of intravitreal therapy with bevacizumab and ranibizumab for choroidal neovascularization (CNV) in pathologic myopia (PM). METHODS: This was a prospective multicenter randomized nonblinded trial. RESULTS: In seven centers, 78 eyes were randomized 1:1 to treatment with bevacizumab (group B, 40 eyes) or ranibizumab (group R, 38 eyes) given with an "on demand" regimen (PRN). The mean follow-up was 19 months (SD 2, range 12-24). The mean BCVA at baseline was 0.60 logMAR (20/80 Snellen equivalent, Seq) and 50 letter score (ls). Mean final BCVA was 0.51 LogMAR (20/63 Seq) and 57 ls (p = 0.0009 and p = 0.0002, respectively). In group B, mean basal BCVA was 0.52 logMAR (20/63 Seq) and 54 ls, and final BCVA was 0.51 logMar (20/63 Seq) and 57 ls. In group R, mean basal BCVA was 0.62 logMAR (20/80 Seq) and 45 ls, and the final values were 0.50 logMAR (20/63 Seq) and 58 ls. Statistical comparison of the two groups showed no significant difference (logMAR p = 0.90 and letters p = 0.78). Multivariate analysis showed no influence of age or previous photodynamic treatment (PDT) on final visual changes. The mean number of treatments in the first year was 2.7 in group B and 2.3 in group R (p = 0.09). CONCLUSION: Myopic CNV equally benefits from on-demand intravitreal injection of either bevacizumab or ranibizumab; the therapeutic effect is independent of previous PDT and age.

Malignant conjunctival T cell lymphoma diagnosed by punch biopsy as a primary manifestation of systemic cancer.

This report documents a case of T cell lymphoma manifesting only with a conjunctival mass. A 67-year-old man underwent a diagnostic punch biopsy, histopathological examination, and immunohistochemical study for a pink-yellow colored mass infiltrating the bulbar conjunctiva in the lower fornix of the eyelid. A biopsy specimen of the conjunctival mass was found histopathologically to be a malignant T cell lymphoma. Systemic involvement was diagnosed within four weeks after the initial diagnosis by computed tomography, showing evidence of extension at the level of the ethmoidal cells, optic nerve, periorbital tissue, and pancreas. T cell lymphoma of the conjunctiva as a primary manifestation of systemic cancer is an uncommon entity. Punch biopsy may be the first diagnostic pathway useful to initiate a search for systemic involvement of a malignant lymphoid tumor of T cell lineage.

Preferential hyperacuity perimeter in assessing responsiveness to ranibizumab therapy for exudative age-related macular degeneration.

AIM: To investigate the ability of the preferential hyperacuity perimeter test to assess responsiveness to ranibizumab therapy for exudative age-related macular degeneration (AMD). METHODS: Fourteen consecutive patients with newly diagnosed choroidal neovascularisation underwent a preferential hyperacuity perimeter metamorphopsia test (main outcome measures) 1 h before (baseline) and 1 h, 1 day, 1 week and 1 month after one intravitreal injection of ranibizumab (0.05 ml/0.5 mg). Best corrected visual acuity (BCVA) and several spectral domain optical coherence tomography (OCT) parameters (secondary outcome measures) were compared with the metamorphopsia test. RESULTS: Fourteen eyes (14 patients, 78% women, mean age 83 ± 6.2 years) were included in the analysis. The mean preferential hyperacuity perimeter metamorphopsia test score improved significantly from 20.4 ± 35 at baseline to 9.2 ± 23 after the single ranibizumab injection (p < 0.05). The mean reduction in central macular thickness, maximal retinal thickness at the fovea, maximal height of subretinal fluid, maximal diameter of the largest retinal cyst and maximal height of pigment epithelial detachment, as evaluated by spectral domain OCT, closely reflected the functional improvements as evaluated by preferential hyperacuity perimeter, showing a significant correlation with metamorphopsia changes (Spearman correlation 0.9, p < 0.05). Mean BCVA improved significantly from 20/80 to 20/60 (p < 0.05). A significant correlation was also found between the mean BCVA changes and the mean metamorphopsia changes (Spearman correlation 0.97, p < 0.05). The correlation coefficient between OCT measurements and preferential hyperacuity perimeter score within subjects was 0.51 (p < 0.05). CONCLUSION: The improvement in metamorphopsia test score after intravitreal ranibizumab injection, which correlated closely with improvement in several OCT parameters, suggests that the preferential hyperacuity perimeter test may be used to monitor the response to anti-vascular endothelial growth factor (VEGF) treatment in patients with exudative AMD.

Efficacy and safety of anti-vascular endothelial growth factor (VEGF) therapy with intravitreal ranibizumab (Lucentis) for naive retinal vein occlusion: 1-year follow-up.

PURPOSE: To evaluate the efficacy and safety of intravitreal ranibizumab (Lucentis) in patients with treatment-naive retinal vein occlusion. DESIGN: Prospective, consecutive, non-comparative, interventional case series. PARTICIPANTS: Seventeen eyes of 17 consecutive patients with naive retinal vein occlusion. METHODS; Consecutive patients were recruited and received, on demand, intravitreal 0.5 mg of ranibizumab; nine had central retinal vein occlusion (CRVO) and eight had branch retinal vein occlusion (BRVO). Pre- and postoperative clinical evaluation included measurement of best corrected visual acuity (BCVA) for distance, and near vision (MNREAD time, reading fluency), contrast sensitivity, colour fundus photography, fluorescein angiography and optical coherence tomography (OCT). All subjects were followed for a minimum of 12 months. MAIN OUTCOME MEASURES: Change in BCVA, contrast sensitivity, angiographic leakage, OCT central macular thickness (CMT), number of treatments. RESULTS: Patients with CRVO had mean pre-treatment BCVA of 20/240 (1.08 ± 0.25 logarithm of the minimum angle of resolution (logMAR)) and final BCVA of 20/46 (0.36 ± 0.16 logMAR), with significant improvement at 1 year of follow-up (p<0.0001). At 12 months mean BCVA improved to 36.7 letters, with a gain of 6.4 lines, and OCT showed that the mean CMT was 271 µm, with a mean reduction of 360 µm (p<0.0001) from baseline (mean 631 µm). Patients with BRVO had mean pre-treatment BCVA of 20/126 (0.80 ± 0.29 logMAR) and final BCVA of 20/50 (0.41 ± 0.23 logMAR) (p<0.0001). The mean OCT CMT was 278 µm, with a mean reduction of 275 µm (p<0.0001) from baseline (mean 553 µm). Contrast sensitivity, MNREAD time and reading fluency improved significantly in the treated eyes. No ocular or systemic side effects were observed. Eyes with CRVO received an average of 3.0 injections (range 2-4) and those with BRVO 3.6 (range 3-4). CONCLUSIONS: Intravitreal ranibizumab for the management of naive CRVO or BRVO can favourably modify the course of the occlusion, indicating that short- and long-term blockade of vascular endothelial growth factor (VEGF)-A may restore the integrity of the inner blood-retinal barrier, reduce CMT and significantly improve visual function, with a good safety profile. Further prospective long-term studies are warranted to confirm the efficacy, safety and optimal treatment regimen for intravitreal ranibizumab.

Angioid streak-related choroidal neovascularization treated by intravitreal ranibizumab.

PURPOSE: The purpose of this study was to report the visual outcome of intravitreal therapy with ranibizumab of choroidal neovascularization secondary to angioid streaks after 1-year follow-up. METHODS: Nine patients (age, 58 +/- 4 years; range, 53-65 years) were treated with off-label intravitreal injections of 0.3 mg ranibizumab. Primary outcomes were best-corrected visual acuity changes (Early Treatment Diabetic Retinopathy Study logarithm of the minimum angle of resolution and letters) and optical coherence tomography macular thickness changes. RESULTS: Mean follow-up was 14 months (+/-2; range, 12-18 months). Mean visual acuity was 0.52 logarithm of the minimum angle of resolution and 30 letters (range, 0.2-1.2; 0-47 letters) at baseline and 0.37 logarithm of the minimum angle of resolution (P = 0.014) and 37 letters (range, 0-1.2; 2-55 letters) (P = 0.01) at the last examination. Seven of 9 patients (78%) gained vision (mean, 2 lines), 1 patient (11 %) was stable, and 1 patient (11 %) lost 1 line of vision (5 letters). Two patients (22%) gained >or=3 lines of visual acuity, no patient lost >1 line. Mean optical coherence tomography macular thickness was 262.4 microm (+/-34.4 standard deviation) at baseline and 216.4 microm (+/-19 standard deviation) at the last examination (P = 0.05). The mean number of injection was 5 (range, 3-7); 78% of patients needed to be retreated after the loading dose of 3 monthly injections. CONCLUSION: Ranibizumab can be considered as an effective therapy in angioid streak-related neovascularization, even if in an off-label setting.

Verteporfin PDT for non-standard indications--a review of current literature.

BACKGROUND: Verteporfin photodynamic therapy (PDT) is approved for the treatment of predominantly classic subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration (AMD), as well as for subfoveal CNV due to pathologic myopia and ocular histoplasmosis syndrome. Verteporfin PDT addresses the underlying pathology of ocular vascular disorders through its angio-occlusive mechanism of action, which reduces both visual acuity loss and the underlying leakage associated with lesions. Verteporfin PDT has also been associated with encouraging treatment outcomes in case studies involving patients with choroidal vascular disorders such as polypoidal choroidal vasculopathy, central serous chorioretinopathy, choroidal haemangioma, angioid streaks, and inflammatory CNV, i.e. conditions currently considered as non-standard indications of verteporfin PDT. In many studies, outcomes were better than expected based on the natural courses of each of these conditions. Although the anti-vascular endothelial growth factor (VEGF) therapies, ranibizumab and pegaptanib, have been approved for CNV due to AMD, their role in these other choroidal vascular disorders remains to be established. We summarize current literature that has documented the use of verteporfin PDT in these conditions. CONCLUSIONS: The complex pathogenesis of CNV provides a rationale for investigating combination approaches comprising verteporfin PDT and anti-VEGF therapies. Randomized controlled studies are warranted to confirm the preliminary results of verteporfin PDT as a monotherapy or in combination with anti-VEGF therapies in the treatment of a variety of choroidal vascular conditions.

Ranibizumab for exudative age-related macular degeneration: 24-month outcomes from a single-centre institutional setting.

BACKGROUND: To analyse the 24-month outcomes of intravitreal ranibizumab injections for choroidal neovascularisation (CNV) secondary to age-related macular degeneration (AMD). METHODS: The authors reviewed the charts of all consecutive eyes with CNV secondary to AMD, who underwent one intravitreal ranibizumab injection (followed by a pro re nata (1+PRN) decision to retreat or to not retreat) at least 24 months before. Best-corrected visual acuity (BCVA) changes and central macular thickness (CMT) were retrospectively assessed, from baseline (m0) to month 12 (m12), and 24 (m24). RESULTS: Ninety-six eyes of 79 patients (23 male, 56 female, aged 63-90 years) were included for analysis. The number of intravitreal injections administered ranged from 1 to 16. The mean BCVA significantly improved from m0 (0.78+/-0.33) to m12 (0.61+/-0.39, p<0.001), and m24 (0.65+/-0.38, p<0.001). The mean CMT significantly decreased from m0 (323.7+/-118.1) to m12 (254.6+/-92.3, p<0.001), and m24 (259.0+/-89.9, p<0.001). At m24, subretinal fluid, cystoid macular oedema and pigment epithelium detachment were present in fewer eyes (13, 31 and 31 eyes respectively), compared with m0 (33, 61 and 72 eyes, respectively). Overall, at m12 and m24, 91 eyes (94.8%) and 84 eyes (87.5%) lost fewer than 15 letters, and 25 (26%) eyes and 24 eyes (25%) improved by 15 letters or more, respectively; five eyes (5.2%) and 12 eyes (12.5%) lost more than 15 letters, at m12 and m24, respectively. CONCLUSION: In this study, similarly to other studies of variable dosing regimen over 24 months, intravitreal ranibizumab was effective in significantly increasing BCVA and reducing CMT.

Autofluorescence imaging of cystoid macular edema in diabetic retinopathy.

AIM: Our purpose was to assess fundus autofluorescence (FAF) images in patients with diabetic retinopathy and cystoid macular edema (CME) and their correlation with fluorescein angiography (FA) and optical coherence tomography (OCT) findings. METHODS: Sixty-eight eyes of 34 consecutive patients with diabetic retinopathy were examined with autofluorescence imaging using a confocal scanning laser ophthalmoscope, FA and OCT. The eyes were divided into 2 groups, group 1 with CME and group 2 without. RESULTS: In the 44 eyes of group 1 (65% of the series), we identified 3 patterns of FAF: (1) multicystic increased FA (57%), (2) a single cyst of increased FAF (16%), (3) combined single- and multicystic increased FAF (27%). FA and OCT gave a positive correlation between cystic increased FAF and CME (r = 0.95; p = 0.001). Visual acuity loss was not correlated with the size of the cystic area (p = 0.83), but it was related to significant macular thickening (p = 0.007). CONCLUSIONS: Confocal scanning laser ophthalmoscopy can selectively visualize autofluorescent, multilobulated spaces in eyes with diabetic CME. Even if OCT remains preferable for evaluating macular thickening and cysts, FAF might be another useful easy test to rapidly distinguish this entity noninvasively and with no risk.

Intravitreal bevacizumab for CNV-complicated tilted disk syndrome.

BACKGROUND: Tilted disc syndrome is a congenital anomaly characterized by an inferonasal "tilting" of the optic disc. We report three patients affected by macular neovascularisation-complicated tilted disk syndrome treated by intravitreal bevacizumab. METHODS: Three interventional case reports are hereby documented. Ophthalmic evaluations were registered, including monthly visual acuity examination, OCT and fluorescein angiography before and after consecutive intravitreal injection of 1.25 mg bevacizumab (0.05 ml, Avastin). RESULTS: All patients, aged more than 65 years, experienced decreased visual acuity after an observation period of 6 (two patients) and 3 months (one patient). Angiographic leakage with neuroretinal rarefaction and RPE/choriocapillary complex elevation at OCT remained persistent in two patients and reduced in one. CONCLUSIONS: No benefit in terms of visual acuity was noted after intravitreal bevacizumab treatments. Larger studies should be conducted to confirm our small series observation.

Photodynamic therapy with verteporfin of choroidal malignancy from breast cancer.

PURPOSE: To evaluate the effectiveness of photodynamic therapy (PDT) with verteporfin for treating a submacular choroidal metastasis from breast cancer. DESIGN: Interventional case report. METHODS: Multispot PDT irradiation of tumor surface was performed in a 45-year-old woman who had a choroidal metastasis from breast cancer in the right eye. The response of uveal metastasis to photodynamic action was investigated with the use of fluorescein angiography and optical coherence tomography (OCT). RESULTS: Within four months after photosensitization, the exudative detachment of the macula was resolved, with improvement in the visual acuity following decrease in the tumor vascular permeability and absorption of subretinal fluid. CONCLUSIONS: PDT can effectively destroy a malignant tissue and induce an antitumor activity. PDT as an adjunct to chemotherapy is a possible treatment and might be appropriate for patients who require ocular treatment only.