Fluorocarbon Thin Films Fabricated using Carbon Nanotube/Polytetrafluoroethylene Composite Polymer Targets via Mid-Frequency Sputtering.

Carbon nanotube/polytetrafluoroethylene composite polymer targets are proposed for use in the fabrication of fluorocarbon thin films using the mid-frequency sputtering process. Fluorocarbon thin films deposited using carbon nanotube/polytetrafluoroethylene composite targets exhibit an amorphous phase with a smooth surface and show a high water contact angle, optical transmittance, and surface hardness. X-ray photoelectron spectroscopy and Fourier transform infrared spectroscopy studies reveal that as the carbon nanotube concentration increased in the composite target, a carbon cross-linked structure was formed, which enhanced the film hardness and the modulus of the fluorocarbon thin film. Large-area fluorocarbon thin films with a substrate width of 700 mm were successfully fabricated by a pilot-scale roll-to-roll sputtering system using a carbon nanotube/polytetrafluoroethylene composite target.

Natural Short-term Course of Recurrent Macular Edema Following Intravitreal Bevacizumab Therapy in Branch Retinal Vein Occlusion.

PURPOSE: To evaluate the 3-month natural course of recurrent macular edema secondary to branch retinal vein occlusion (BRVO) treated with intravitreal bevacizumab. METHODS: This retrospective, observational study included 36 eyes with macular edema secondary to BRVO. All patients were initially treated with intravitreal bevacizumab for macular edema. Recurrence of macular edema was either not treated (untreated group) or treated with a single intravitreal bevacizumab injection (treated group). Central foveal thickness (CFT) and best-corrected visual acuity (BCVA) were compared at the time of recurrence and 3 months later. RESULTS: At the time of recurrence, the mean CFT and logarithm of the minimum angle of resolution BCVA were 484.9 ± 124.1 µm and 0.58 ± 0.26 in the untreated group (n = 19) and 456.3 ± 126.8 µm and 0.51 ± 0.21 in the treated group (n = 17), respectively. Three months later, the mean CFT and BCVA had changed to 493.7 ± 123.9 µm and 0.62 ± 0.29 in the untreated group and 294.7 ± 104.4 µm and 0.40 ± 0.24 in the treated group, respectively. The differences in CFT and BCVA between the two time points were not significant in the untreated group (p = 0.106 and p = 0.687, respectively), whereas statistically significant differences were noted in the treated group (p = 0.002 and p < 0.001, respectively). CONCLUSIONS: Unlike the first episode of macular edema following BRVO, recurrent macular edema following intravitreal bevacizumab therapy did not spontaneously resolve, suggesting the potential benefit of prompt treatment.

Effect of focal laser photocoagulation in eyes with mild to moderate non-proliferative diabetic retinopathy.

AIM: To report the effect of focal laser photocoagulation on both the severity of hard exudates (HEs) and the rate of disease progression in eyes with mild to moderate non-proliferative diabetic retinopathy (NPDR). METHODS: We retrospectively reviewed the medical records of 33 patients (60 eyes) who had been diagnosed with mild to moderate NPDR between January 2006 and December 2012. The patients were divided into 2 groups: Group A (38 eyes in 20 patients treated using focal laser photocoagulation) and Group B (treated without laser photocoagulation). We also reviewed the best corrected visual acuity measurements, and the fundus photographs taken at both baseline and follow-up visits. RESULTS: In Group A, HE severity grade had decreased significantly from baseline to the final visit (P<0.05), but this was not the case in Group B (P=0.662). The cumulative probabilities of retinopathy progression at 5y were 26% in Group A and 30% in Group B. Kaplan-Meier survival curves showed no significant difference between the groups with regard to retinopathy progression (P=0.805). CONCLUSION: Focal laser photocoagulation reduced the levels of HEs in eyes with mild to moderate NPDR. However, the treatment was not able to decelerate the progression of DR.

The Efficacy of Intravitreal Aflibercept in Submacular Hemorrhage Secondary to Wet Age-related Macular Degeneration.

PURPOSE: To evaluate the efficacy of intravitreal aflibercept monotherapy in submacular hemorrhage (SMH) secondary to wet age-related macular degeneration (AMD). METHODS: This study included 25 eyes in 25 patients with SMH involving the fovea secondary to wet-AMD. All patients were treated with three consecutive monthly intravitreal aflibercept (2.0 mg/0.05 mL) injections, followed by as-needed reinjection. They were followed for at least 6 months. Best-corrected visual acuity (BCVA), central foveal thickness (CFT), and area of SMH were measured at diagnosis, as well as at 3 and 6 months after treatment initiation. RESULTS: The BCVA significantly improved from 0.79 ± 0.41 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.54 ± 0.41 logMAR at 6 months (p < 0.001). BCVA ≥3 lines and stable vision were observed in 96% of the eyes. The CFT significantly decreased from 560.8 ± 215.3 µm at baseline to 299.8 ± 160.2 µm at 6 months (p < 0.001). The area of SMH significantly decreased from 10.5 ± 7.1 mm2 at baseline to 1.8 ± 6.5 mm2 at 6 months (p < 0.001). The BCVA, CFT, and area of SMH at baseline, as well as duration of symptoms, all correlated with BCVA at the 6-month follow-up. CONCLUSIONS: Intravitreal injection of aflibercept is an effective treatment option for patients with SMH secondary to wet-AMD; however, there may be limited efficacy in eyes with large SMH area and cases in which treatment is delayed.

Intravitreal Anti-vascular Endothelial Growth Factor for Treating Polypoidal Choroidal Vasculopathy with Grape-like Polyp Clusters.

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.

Efficacy of Intravitreal Bevacizumab for Recurrent Central Serous Chorioretinopathy in Patients Who Had Previously Responded Well to the Same Therapy.

PURPOSE: To investigate the efficacy of intravitreal bevacizumab therapy in the treatment of recurrent central serous chorioretinopathy (CSC) that had previously resolved after intravitreal bevacizumab administration. METHODS: This retrospective, observational study included 24 eyes from 24 patients with recurrent CSC who had previously responded to intravitreal bevacizumab. Patients were classified into the responder group when resolution of serous retinal detachment was noted within 3 months after intravitreal bevacizumab (1.25 mg/0.05 mL) administration; the remaining patients were classified into the non-responder group. Patient characteristics were compared between the 2 groups. RESULTS: Ten eyes (42%) were included in the responder group, and 14 eyes (58%) were included in the non-responder group. Patients in the responder group were significantly older (mean age, 47.0 ± 4.5 years) than those in the non-responder group (mean age, 40.9 ± 5.5 years; P = 0.023). The visual acuity of the patients in the responder group was significantly worse than that of the patients in the non-responder group at the time of the first (mean 0.25 ± 0.15 vs. 0.13 ± 0.15) and second episodes (0.24 ± 0.14 vs. 0.14 ± 0.18; P = 0.040 and P = 0.021 for the first and second episodes, respectively). CONCLUSIONS: Repeated intravitreal bevacizumab can be considered a useful treatment option for relatively older patients with CSC who previously responded well to the same therapy. The results of the present study also suggest that a vascular endothelial growth factor-dependent pathologic process may be involved in CSC in older subjects.

DIAGNOSIS OF TYPE 3 NEOVASCULARIZATION BASED ON OPTICAL COHERENCE TOMOGRAPHY IMAGES.

PURPOSE: To evaluate the concordance of an optical coherence tomography (OCT)-based diagnosis of Type 3 neovascularization and an indocyanine green angiography (ICGA)-based diagnosis in neovascular age-related macular degeneration (AMD). METHODS: This observational case series includes 263 eyes from 263 patients who were diagnosed with treatment-naive neovascular AMD. Patients exhibiting at least three of the following OCT features were diagnosed with Type 3 neovascularization: subfoveal choroidal thickness <200 µm, presence of intraretinal fluid accumulation, absence of subretinal fluid, gently-sloping dome-shaped retinal pigment epithelial detachment or trapezoid-shaped retinal pigment epithelial detachment without an obvious peak, and intraretinal mass lesion. The incidence of cases exhibiting three or more OCT features was compared among different subtypes of neovascular AMD. Additionally, the concordance of OCT-based diagnosis and ICGA-based diagnosis was evaluated. RESULTS: Three or more OCT features were noted in 8 of 82 (9.8%) eyes with typical neovascular AMD, 4 of 147 (2.7%) eyes with polypoidal choroidal vasculopathy, and 30 of 34 (88.2%) eyes with Type 3 neovascularization, respectively. The incidence was significantly greater in Type 3 neovascularization than in the other subtypes of neovascular AMD (P < 0.001). Of patients diagnosed with Type 3 neovascularization using ICGA-based methods, 88.2% were also diagnosed with Type 3 neovascularization using OCT-based methods. Only 5.2% of patients diagnosed with other subtypes of neovascular AMD using ICGA-based methods were diagnosed with Type 3 neovascularization using OCT-based methods. CONCLUSION: Optical coherence tomography-based diagnosis of Type 3 neovascularization showed relatively high concordance compared with ICGA-based diagnosis. This method may be useful in clinical practice.

Radiating hemorrhage in exudative age-related macular degeneration.

PURPOSE: To investigate the characteristics of radiating hemorrhage secondary to exudative age-related macular degeneration (AMD) and its clinical significance. METHODS: This retrospective, observational case series included 288 eyes of 288 patients who initially presented with submacular hemorrhage secondary to exudative AMD. First, we estimated the incidence of radiating hemorrhage; we then compared the incidence of polypoidal choroidal vasculopathy (PCV) compared with that of the other subtypes of AMD. Optical coherence tomography (OCT) images were analyzed to identify the level of hemorrhage. The extent of submacular hemorrhage was compared between eyes with and without radiating hemorrhage. RESULTS: Radiating hemorrhage was identified in 41 eyes (14.2 %). In 36 of these eyes, the OCT scanning line included the area of radiating hemorrhage. In 31 of these, OCT showed avulsion of the outer retinal layers, including the outer nuclear layer and photoreceptor layer. The outer plexiform layer and inner retinal layer were relatively well preserved. The extent of submacular hemorrhage was significantly smaller in eyes with radiating hemorrhage (mean 4.2 ± 2.9 disc areas) than in eyes without it (mean 8.3 ± 6.2 disc areas) (P < 0.001). In addition, the incidence of radiating hemorrhage was significantly higher in eyes with submacular hemorrhage secondary to PCV (19.4 %) than in those with the other subtypes of AMD (7.5 %; P = 0.025). CONCLUSIONS: Radiating hemorrhage in exudative AMD was found to be a deep retinal hemorrhage generally accompanied with relatively small-sized submacular hemorrhage. The incidence of this type of hemorrhage was higher in PCV than in the other subtypes of AMD.

Optical Coherence Tomography-based Diagnosis of Polypoidal Choroidal Vasculopathy in Korean Patients.

PURPOSE: To evaluate the efficacy of an optical coherence tomography (OCT)-based diagnosis of polypoidal choroidal vasculopathy (PCV) in Korean patients. METHODS: This retrospective, observational case series included 263 eyes of 263 patients (147 eyes with PCV and 116 eyes with typical exudative, age-related macular degeneration [AMD]) who had been diagnosed with treatment naïve exudative AMD. Eyes with three or more of the following OCT findings were diagnosed with PCV: multiple retinal pigment epithelial detachment (RPED), a sharp RPED peak, an RPED notch, a hyporeflective lumen representing polyps, and hyperreflective intraretinal hard exudates. The OCT-based diagnosis was compared with the gold-standard indocyanine green angiography-based method. The sensitivity and specificity of the OCT-based diagnosis was also estimated. An additional analysis was performed using a choroidal thickness criterion. Eyes with a subfoveal choroidal thickness greater than 300 µm were also diagnosed with PCV despite having only two OCT features. RESULTS: In eyes with PCV, three or more OCT features were observed in 126 of 147 eyes (85.7%), and the incidence of typical exudative AMD was 16 of 116 eyes (13.8%). The sensitivity and specificity of an OCT-based diagnosis were 85.7% and 86.2%, respectively. After applying the choroidal thickness criterion, the sensitivity increased from 85.7% to 89.8%, and the specificity decreased from 86.2% to 84.5%. CONCLUSIONS: The OCT-based diagnosis of PCV showed a high sensitivity and specificity in Korean patients. The addition of a choroidal thickness criterion improved the sensitivity of the method with a minimal decrease in its specificity.

RETINAL PIGMENT EPITHELIAL TEAR AFTER INTRAVITREAL RANIBIZUMAB TREATMENT FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

PURPOSE: To evaluate the risk factors for retinal pigment epithelium (RPE) tears after intravitreal ranibizumab injections in neovascular age-related macular degeneration (nAMD) and to determine the efficacy of continued ranibizumab treatment after RPE tears. METHODS: A total of 407 treatment-naïve eyes (377 patients) with nAMD were retrospectively included. All patients were treated with an initial series of 3 monthly loading injections, followed by further injections as required. Baseline characteristics and pigment epithelial detachment (PED) lesion features were evaluated as potential risk factors for RPE tear. The visual and anatomical outcomes after treatment during 12 months were also evaluated. RESULTS: By 12 months, RPE tears developed in 32 eyes (7.9%). Pigment epithelial detachment height was associated with a higher risk of RPE tear (odds ratio [OR], 1.318; 95% confidence interval [CI], 1.217-2.031, P = 0.018). Fibrovascular PED compared with serous PED had a higher risk of developing tears (OR, 9.129; 95% CI, 6.228-32.124, P = 0.039), and typical nAMD (OR, 4.166; 95% CI, 2.030-14.913, P = 0.031) and retinal angiomatous proliferation (OR, 3.778; 95% CI, 2.185-9.277, P = 0.040) had a higher risk of developing tears compared with polypoidal choroidal vasculopathy. Mean best-corrected visual acuity (BCVA) of RPE tear patients showed no significant improvement after treatment at 12 months; however, patients with RPE tears without foveal involvement (19 eyes) showed significant BCVA improvement at 12 months (P = 0.034). CONCLUSION: PED type and nAMD subtype are associated with the development of RPE tears after intravitreal ranibizumab injections. Continued ranibizumab therapy after RPE tear development can maintain visual acuity when the fovea is not involved.

Long-Term Outcomes of Anti-Vascular Endothelial Growth Factor Therapy for Polypoidal Choroidal Vasculopathy.

PURPOSE: To investigate a clinical outcome after more than 4 years for polypoidal choroidal vasculopathy (PCV) treated with anti-vascular endothelial growth factor (VEGF) therapy and to investigate the factors predictive of long-term visual outcomes. METHODS: This retrospective study included 31 eyes, with PCV treated with anti-VEGF therapy (either ranibizumab or bevacizumab, or both), and were followed up for 4 years or longer. The best-corrected visual acuity (BCVA) at baseline was compared with that measured at 3 months and at the final follow-up. Factors associated with final visual acuity were also analyzed. RESULTS: The mean follow-up period was 53.0 ± 4.3 months. During the follow-up period, the patients were treated with an average of 8.8 ± 3.0 intravitreal anti-VEGF injections. BCVA at diagnosis at 12, 24, and 36 months, and at final follow-up was 0.52 ± 0.35, 0.46 ± 0.36, 0.57 ± 0.45, 0.76 ± 0.56, and 0.83 ± 0.60, respectively. When compared to the baseline value, the BCVA was significantly improved at 3 months (P = 0.006), whereas the BCVA at final follow-up was significantly decreased compared to the baseline value (P = 0.018). Among the included eyes, 48.4% experienced deterioration of visual acuity and 51.6% showed stable vision. BCVA at 12 months was most strongly associated with visual acuity at final follow-up. CONCLUSIONS: Although the long-term treatment outcome of PCV is generally unfavorable, stable vision can be achieved in approximately half of the patients. Visual acuity at 12 months after the initial treatment is predictive of long-term visual outcomes.

Short-term choroidal thickness changes in patients treated with either ranibizumab or aflibercept: a comparative study.

PURPOSE: To compare, in neovascular age-related macular degeneration (AMD) patients, short-term choroidal thickness changes in eyes treated using ranibizumab with those in eyes treated using aflibercept. METHODS: This retrospective, observational study included 240 eyes from 240 patients who had been diagnosed with treatment-naive neovascular AMD and treated using three monthly injections of either ranibizumab (ranibizumab group) or aflibercept (aflibercept group). The choroidal thickness change between the time of diagnosis and 3 months later was compared between the two groups. Eyes were then classified into three disease groups: typical neovascular AMD, polypoidal choroidal vasculopathy (PCV) and retinal angiomatous proliferation (RAP). Within each disease group, choroidal thickness change was again compared between the two treatment groups. RESULTS: In the ranibizumab group (n=155), the mean choroidal thicknesses at diagnosis and at 3 months were 255.3±103.9 µm and 242.9±104.8 µm, respectively. In the aflibercept group (n=85), the values were 277.5±119.1 µm and 254.7±114.5 µm, respectively. The decrease was significantly greater in the aflibercept group (p<0.001). In the PCV group, the decrease was greater in the aflibercept group (p=0.001), whereas the difference was not significant in either the typical neovascular AMD group or the RAP group. CONCLUSIONS: A greater decrease in choroidal thickness was noted in eyes treated with aflibercept than in eyes treated with ranibizumab. This difference was more marked in PCV than in other subtypes of neovascular AMD.

Intravitreal Aflibercept and Ranibizumab Injections for Polypoidal Choroidal Vasculopathy.

PURPOSE: To compare the effectiveness of intravitreal injection of aflibercept and ranibizumab for patients with polypoidal choroidal vasculopathy (PCV). DESIGN: Retrospective, interventional case series. METHODS: Ninety-eight treatment-naïve PCV eyes were included. The eyes had received intravitreal aflibercept or ranibizumab injections. All patients were treated using an initial series of 3 monthly loading injections, followed by further injections as required. The visual and anatomic outcomes of treatment were evaluated after 12 months. RESULTS: The mean best-corrected visual acuity (BCVA) in the aflibercept-treated group (38 eyes), expressed as the logarithm of the minimal angle of resolution (logMAR), had decreased from 0.63 ± 0.49 to 0.44 ± 0.37 after 12 months of treatment (P = .012). Similarly, in the ranibizumab-treated group (60 eyes), the BCVA had decreased from 0.66 ± 0.43 to 0.49 ± 0.36 (P = .018). The central foveal thickness had decreased in the aflibercept-treated group from 396 ± 167 µm to 212 ± 144 µm, and in the ranibizumab-treated group from 402 ± 198 µm to 240 ± 183 µm (P < .001 in both cases). However, there was no significant difference between the groups with regard to either BCVA improvement or decrease in central foveal thickness. Polyp regression was significantly more frequent in the aflibercept-treated group, occurring in 39.5% of eyes, than in the ranibizumab-treated group (21.6% of eyes; P = .007). CONCLUSIONS: In PCV patients, the visual acuity improvement achieved after 12 months of intravitreal aflibercept did not differ significantly from that achieved using intravitreal ranibizumab. However, aflibercept treatment more often led to polyp regression than did treatment using ranibizumab.

Polypoidal choroidal vasculopathy in patients aged less than 50 years: characteristics and 6-month treatment outcome.

PURPOSE: To investigate the characteristics and 6-month treatment outcome of polypoidal choroidal vasculopathy (PCV) in patients aged <50 years. METHODS: This retrospective study included 22 eyes from 22 patients who were <50 years old and had been diagnosed with treatment naïve PCV. Analyses of treatment outcome were performed in eyes treated with anti-vascular endothelial growth factor (VEGF) therapy. Eyes that exhibited submacular hemorrhage of ≥1 disc diameter and involving the fovea were included in the hemorrhage group. The remaining eyes were included in the no-hemorrhage group. The baseline best-corrected visual acuity (BCVA) was compared with that at 6 months within each group. RESULTS: The mean age of the 22 patients was 46.5 ± 1.8 (range, 43-49) years. Submacular hemorrhage was noted in ten eyes (45.5 %). The presence of drusen was noted in one eye and pseudodrusen was not noted in any of the eyes included. Treatment outcome was analyzed in 18 eyes. A mean number of 2.9 ± 0.5 intravitreal anti-VEGF injections were administered during the 6-month follow-up period. In the no-hemorrhage group (n = 10), the BCVA at diagnosis and at 6 months was 0.55 ± 0.32 and 0.35 ± 0.22 respectively (P = 0.011). In the hemorrhage group (n = 8), the values were 0.99 ± 0.45 and 0.74 ± 0.63 respectively (P = 0.128). CONCLUSIONS: A relatively high proportion of young PCV patients exhibited submacular hemorrhage at initial presentation. In those without submacular hemorrhage, intravitreal anti-VEGF therapy was found to be beneficial.

Imaging Suprachoroidal Layer in Exudative Age-Related Macular Degeneration.

PURPOSE: To evaluate the prevalence of a visible suprachoroidal layer (SCL) on optical coherence tomography (OCT) in exudative age-related macular degeneration (AMD). MATERIALS AND METHODS: This retrospective study included 252 eyes of 252 patients with treatment-naive typical exudative AMD (n = 80), polypoidal choroidal vasculopathy (PCV) (n = 138) and retinal angiomatous proliferation (RAP) (n = 34). The presence of SCL was identified based on enhanced-depth imaging OCT images, and the prevalence was compared among the three disease groups. In addition, subfoveal choroidal thickness was compared between patients with and without SCL. RESULTS: The SCL was noted in 56 eyes (22.2%). The prevalence was 22.5% in typical exudative AMD (18 of 80 eyes), 18.8% in PCV (26 of 138 eyes) and 35.3% in RAP (12 of 34 eyes) (p = 0.118). Patients with SCL showed significantly thinner choroid (207.5 ± 83.9 µm versus 279.7 ± 116.5 µm, p < 0.001) and were relatively older (72.1 ± 8.1 versus 70.1 ± 8.7 years, p = 0.124) than those without SCL. CONCLUSION: The prevalence of visible SCL was 22.2% in patients with exudative AMD. Age-related changes, including choroidal thinning, may contribute to the development of a visible SCL.

Long-term visual outcome and prognostic factors of Intravitreal anti-vascular endothelial growth factor treatment for retinal angiomatous proliferation.

PURPOSE: To evaluate the long-term visual outcomes and investigate the prognostic factors of anti-vascular endothelial growth factor (VEGF) therapy for retinal angiomatous proliferation (RAP). METHODS: Thirty-eight treatment-naïve RAP eyes (38 patients) that received intravitreal anti-VEGF (ranibizumab and/or bevacizumab) injections were included and analyzed in this retrospective case series. All patients were treated with an initial series of three monthly intravitreal anti-VEGF injections, followed by as-needed injections for a total of 36 months. RESULTS: The mean number of anti-VEGF injections was 9.61 ± 3.1 during the 36-month follow-up. Mean baseline best-corrected visual acuity (BCVA) was 0.79 ± 0.56 logarithm of the minimum angle of resolution (logMAR; 20/123 Snellen equivalent), and 0.75 ± 0.41 logMAR (20/112 Snellen equivalent) at 36 months (P = 0.55). Mean BCVA significantly improved at 3 months (P = 0.001), and the significant improvement persisted until 18 months from baseline (P = 0.02). However, the mean BCVA between 18 and 36 months showed no statistical in comparison with baseline values. Geographic atrophy developed in 14 eyes (36.8 %) during the entire 36-month follow-up period. Among baseline characteristics, baseline BCVA, greatest lesion diameter (GLD), and lesion size were significantly correlated with long-term visual outcome (P = 0.008, 0.02, and 0.002 respectively). CONCLUSIONS: Intravitreal anti-VEGF injections for RAP showed a favorable visual outcome during the first year; however, the visual gains declined after the second year from baseline. Better baseline BCVA, smaller lesion size, and smaller baseline GLD are associated with better long-term visual outcomes in patients with RAP.

Intravitreal Anti-vascular Endothelial Growth Factor for Newly Diagnosed Symptomatic Polypoidal Choroidal Vasculopathy with Extrafoveal Polyps.

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 µm 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 µm, 214.5 ± 108.8 µm, and 229.8 ± 106.1 µm, 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.

Clinical Outcomes of Eyes with Submacular Hemorrhage Secondary to Age-related Macular Degeneration Treated with Anti-vascular Endothelial Growth Factor.

PURPOSE: To evaluate the long-term outcomes of intravitreal anti-vascular endothelial growth factor (VEGF) monotherapy for patients diagnosed with submacular hemorrhage secondary to exudative age-related macular degeneration. METHODS: This retrospective, observational study included 49 patients (49 eyes) who initially presented with submacular hemorrhage associated with exudative age-related macular degeneration and who were followed-up for at least 24 months. Only eyes that were treated with intravitreal anti-VEGF monotherapy were included in the study. Best-corrected visual acuity (BCVA) measurements obtained at diagnosis, six months, and the final visit were compared. The associations of BCVA at the final visit with baseline BCVA, BCVA at six months, symptom duration, hemorrhage extent, and central foveal thickness were also analyzed. RESULTS: Over the course of follow-up (mean, 32.1 ± 8.5 months), an average of 5.1 ± 2.2 anti-VEGF injections were administered. Recurrent hemorrhage was noted in 13 eyes (26.5%). The mean logarithm of the minimal angle of resolution BCVA at diagnosis, six months, and the final visit were 1.40 ± 0.52, 0.87 ± 0.64, and 1.03 ± 0.83, respectively. Both baseline BCVA (p = 0.012) and BCVA at six months (p < 0.001) were significantly associated with BCVA at the final visit. CONCLUSIONS: Improved visual acuity was maintained for more than two years with intravitreal anti-VEGF monotherapy. BCVA at six months is a useful clinical index to predict long-term visual prognosis.

Retinal Pigment Epithelial Tear After Intravitreal Ranibizumab Treatment for Retinal Angiomatous Proliferation.

PURPOSE: To evaluate the incidence and associated risk factors of retinal pigment epithelium (RPE) tears after intravitreal ranibizumab injection treatment for retinal angiomatous proliferation (RAP). DESIGN: Retrospective, observational case series. METHODS: Ninety-eight treatment-naïve RAP eyes (86 patients) that received intravitreal ranibizumab injections were included. All patients were treated with an initial series of 3 monthly loading injections, followed by further injections as required. Baseline characteristics and features were evaluated as potential risk factors for RPE tearing. The visual and anatomic outcomes after treatment were evaluated at 12 months from baseline. RESULTS: RPE tears had developed in 8.2% (8) of the eyes by 12 months. Of these, all had pigment epithelium detachment (PED) at baseline, and the majority (7) had developed an RPE tear within 3 months. Multiple regression analysis showed that higher PED (odds ratio [OR] = 1.411, 95% confidence interval [CI] = 1.199-1.888, P = .011) and thinner choroid (OR = 0.815, 95% CI = 0.719-0.912, P = .023) were associated with a higher risk of RPE tearing. The mean best-corrected visual acuity of the patients with RPE tearing (0.56 ± 0.49 logarithm of the minimal angle of resolution [logMAR]) was significantly worse at 12 months than that of patients without RPE tearing (0.74 ± 0.55 logMAR, P = .009) after treatment. CONCLUSIONS: RPE tears developed in 8.2% of eyes with RAP during the 12 months following ranibizumab injections. Higher PED height and thinner subfoveal choroidal thickness were associated with the development of RPE tears after ranibizumab treatment for RAP.