Short-term results for brolucizumab in treatment-naïve neovascular age-related macular degeneration: a Japanese multicenter study.

PURPOSE: To investigate short-term treatment outcomes of intravitreal brolucizumab (IVBr) for treatment-naïve neovascular age-related macular degeneration (AMD) in a Japanese multicenter study. STUDY DESIGN: Retrospective case control study METHODS: The subjects were 58 eyes of 57 patients with neovascular AMD (43 men and 14 women, mean age 74.6 years) of whom 43 eyes of 42 patients completed initial loading of 3 monthly IVBr injections and were followed for more than 3 months. Best-corrected visual acuity (BCVA) changes, anatomical outcomes, and complications were investigated. RESULTS: Of the 43 eyes that completed loading doses, the AMD subtype was type 1 and type 2 macular neovascularization (MNV) in 51%, polypoidal choroidal vasculopathy (PCV) in 42%, and type 3 MNV in 7%. At 3 months after initiating treatment, BCVA significantly improved (P = 0.002) and central retinal thickness significantly decreased (P < 0.0001). At 3 months, complete retinal and subretinal fluid resolution was achieved in 91% of all eyes and complete regression of polypoidal lesions was achieved in 82% of PCV eyes. Iritis occurred in 8 eyes of 8 patients (14%), but resolved using topical or subtenon corticosteroid injection without visual loss in all cases. CONCLUSIONS: IVBr for treatment-naïve neovascular AMD was effective in the short-term, achieving significantly improved BCVA, good retinal fluid resolution, and a high rate of polypoidal lesion regression. However, iritis was noted in 14% of patients which may limit use of this drug.

PERIPHERAL CHOROIDAL THICKNESS DETERMINED BY WIDE-FIELD OPTICAL COHERENCE TOMOGRAPHY IN EYES WITH CENTRAL SEROUS CHORIORETINOPATHY.

PURPOSE: To determine the central and peripheral choroidal thickness in eyes with central serous chorioretinopathy (CSC) and to compare these thicknesses values with those of control normal eyes. METHODS: Wide-field optical coherence tomographic images of 24 eyes of 19 patients with CSC and 14 normal eyes of 7 individuals were recorded. A 20-mm vertical scan through the fovea was obtained with the Xephilio optical coherence tomographic S1 (Canon, Japan), a wide-field optical coherence tomographic device. The subfoveal choroidal thickness and the thickness at 5 mm superior (S5) and inferior (I5), 7 mm superior (S7) and inferior (I7), 8.5 mm superior (S8) and inferior (I8), and 10 mm superior (S10) and inferior (I10) from the fovea in the CSC eyes and normal eyes were compared. RESULTS: There was no significant difference in the age ( P = 0.8) or the refractive error ( P = 0.7) between the CSC and normal eyes. The choroidal thickness was significantly thicker in the eyes with CSC than that in the normal eyes at subfoveal choroidal thickness ( P < 0.01), S5 ( P = 0.01), and S7 ( P = 0.02). However, there was no significant difference in the choroidal thickness at the more peripheral points (all P > 0.1). CONCLUSION: The thickened choroid in CSC was observed at the fovea and the area just superior to the fovea. The pathogenesis of CSC may be associated with the choroidal thickening confined to the fovea and superior foveal area.

Subfoveal choroidal thickness after brolucizumab therapy for neovascular age-related macular degeneration: a short-term multicenter study.

BACKGROUND/PURPOSE: Observation of choroidal thickness after anti-vascular endothelial growth factor (VEGF) therapy may be important for the ideal management of neovascular age-related macular degeneration (AMD). This study investigated changes in subfoveal choroidal thickness (SCT) during loading doses of intravitreal injections of brolucizumab in eyes with neovascular AMD. METHODS: This study included 73 eyes of 72 patients with neovascular AMD at five university hospitals in Japan. All 73 eyes underwent three monthly 6.0 mg intravitreal injections of brolucizumab at baseline, 1 month, and 2 months. The SCT at 3 months was evaluated using optical coherence tomography. RESULTS: The 73 eyes were classified into the treatment-naïve group (43 eyes) and the switched group (30 eyes) that were switched from other anti-VEGF treatments. After three intravitreal injections of brolucizumab, SCT significantly decreased from 236.5 ± 98.8 µm at baseline to 200.4 ± 98.3 µm at 3 months (percent of baseline 84.7%, P < 0.001) in the treatment-naïve group. In the switched group, SCT also significantly decreased from 229.0 ± 113.2 µm at baseline to 216.9 ± 110.2 µm at 3 months (percent of baseline 94.7%, P = 0.039), although the decrease was not as marked compared to that of the treatment-naïve group. CONCLUSION: Intravitreal injections of brolucizumab for neovascular AMD significantly reduced the SCT in both the treatment-naïve and switched groups. Brolucizumab may cause significant anatomic changes in the choroid, particularly in treatment-naïve AMD eyes, possibly more than that previously reported for other anti-VEGF agents.

Morphological differences of choroid in central serous chorioretinopathy determined by ultra-widefield optical coherence tomography.

PURPOSE: The purpose of this study was to compare the morphology of the central and peripheral choroid of eyes with central serous chorioretinopathy (CSC) to that of normal eyes using ultra-widefield optical coherence tomography (UWF-OCT). METHODS: We reviewed the medical records of 29 eyes of 25 patients (23 men, 2 women; average age 44.4 years) with CSC and 34 eyes of 22 healthy subjects (19 men, 3 women; average age, 49.5 years) with normal eyes. The images obtained by a prototype swept source UWF-OCT (Topcon, Tokyo, Japan) of about 31.5-mm wide and a depth of 10.9 mm were analyzed. The choroidal thickness was measured for each sector of the eye using the conventional automated layer analysis method. The local morphological differences were quantified by the maximum steepness (µm/deg) which was obtained by differentiating the changes in the choroidal thickness from the periphery to the fovea. Only the vertical scans were evaluated to avoid the influence of the optic disc. RESULTS: The choroid was thicker in the macular area than the peripheral area in both normal and CSC eyes. The choroid at the subfovea was significantly thicker in the CSC eyes than that of the normal eyes (P < 0.0001); however, the difference at the periphery was not significant. The mean of the maximum steepness of the choroidal thickness was 20.8 ± 3.8 µm/deg in the CSC eyes which was significantly steeper than the 16.0 ± 4.6 µm/deg in healthy eyes (P < 0.0001). CONCLUSION: The choroid in CSC eyes has a steeper slope around the posterior pole. UWF-OCT can be used to evaluate the abnormalities of the choroidal structures from the posterior pole to the periphery in eyes with CSC.

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS OF CLASSIC CHOROIDAL NEOVASCULARIZATION IN POLYPOIDAL CHOROIDAL VASCULOPATHY.

PURPOSE: To evaluate the flow signals in subretinal hyperreflective material (SHRM) that represents classic choroidal neovascularization (CNV) on fluorescein angiography in eyes with polypoidal choroidal vasculopathy. METHODS: We retrospectively reviewed 20 eyes with polypoidal choroidal vasculopathy that appeared to have classic CNV on fluorescein angiography, accompanied by SHRM on optical coherence tomography (OCT) at the same location. Using OCT angiography (OCTA), we analyzed intrinsic flow signals in the SHRM (cross-sectional B-scans and en face). The possible association between pretreatment OCT angiography findings and fibrotic scar formation after antivascular endothelial growth factor (VEGF) treatment was evaluated. RESULTS: Six of 20 eyes (30%) showed vascular SHRM; the remaining 14 eyes (70%) showed avascular SHRM at the classic CNV site at baseline. The SHRM corresponded with polypoidal lesions seen on indocyanine green angiography in 5 of 6 eyes with vascular SHRM and in all 14 eyes with avascular SHRM. After anti-VEGF treatment, all 6 eyes with vascular SHRM left a fibrotic scar, whereas all 14 eyes with avascular SHRM showed no scar formation (P < 0.001). CONCLUSION: Using OCT angiography, we evaluated the flow signals in SHRM that represented classic CNV in eyes with polypoidal choroidal vasculopathy and successfully differentiated true Type 2 macular neovascularization from pseudo classic CNV.

Comparison of subfoveal choroidal structures in typical neovascular age-related macular degeneration and polypoidal choroidal vasculopathy.

PURPOSE: To evaluate and compare the intrachoroidal structures of eyes with typical neovascular age-related macular degeneration (AMD) with those of eyes with polypoidal choroidal vasculopathy (PCV). STUDY DESIGN: Retrospective and comparative case series. METHODS: Eighty-four treatment-naïve eyes of 84 patients (22 women and 62 men) with typical neovascular AMD or PCV located in the subfoveal region were studied. Cross-sectional images of the retina and choroid were obtained by swept-source optical coherence tomography (SS-OCT). The horizontal SS-OCT images were analyzed by a manual delineation technique and by a binarization method. RESULTS: Thirty-nine eyes with typical neovascular AMD and 45 eyes with PCV were studied. Although the subfoveal choroidal thickness (SCT) did not differ significantly between the 2 subtypes (255.1 ± 86.7 µm in typical neovascular AMD and 289.2 ± 116.5 µm in PCV, P = 0.29), the ratio of the large choroidal vessel layer (LCVL) thickness to the SCT was significantly larger in the eyes with PCV than in the eyes with typical neovascular AMD (0.863 ± 0.084 vs 0.803 ± 0.125, P = 0.023). The binarization method did not find significant differences in the choroidal structure between the 2 subtypes. Multivariate logistic regression analyses found the ratio of the LCVL thickness to the SCT to be the only significantly different factor between typical neovascular AMD and PCV (P = 0.035). CONCLUSION: The intrachoroidal structures of typical neovascular AMD and PCV eyes differ significantly. In eyes with PCV, there seemed to be a greater dilation of the large choroidal vessels.

Structural analyses of choroid after half-dose verteporfin photodynamic therapy for central serous chorioretinopathy.

BACKGROUND/AIMS: To investigate the changes in the intrachoroidal structures after half-dose verteporfin photodynamic therapy (PDT) for central serous chorioretinopathy (CSC). METHODS: Swept-source optical coherence tomography cross-sectional images of 22 eyes of 22 patients with CSC were retrospectively analysed by a manual delineation technique and binarisation method. RESULTS: In the 22 eyes, the mean subfoveal choroidal thickness decreased from 412.9±112.9 µm at baseline to 340.0±111.0 µm at 3 months (p<0.0001). The mean thickness of the large choroidal vessel layer decreased from 368.7±112.7 µm at baseline to 292.2±118.0 µm at 3 months (p<0.0001), but the mean choriocapillaris-medium choroidal vessel layer thickness did not change from 44.2±29.2 µm at baseline to 47.8±25.7 µm at 3 months (p=0.85). Analyses of the binarised choroidal images showed that a 3 mm subfoveal choroidal area decreased from 1.141±0.290 mm2 at baseline to 0.962±0.320 mm2 at 3 months after PDT (p=0.0001). The mean luminal areas decreased from 0.826±0.246 mm2 at baseline to 0.665±0.234 mm2 at 3 months (p=0.0001), however, the mean stromal areas did not change from 0.315±0.066 mm2 at baseline to 0.297±0.095 mm2 at 3 months (p=0.60). CONCLUSIONS: Half-dose PDT reduces subfoveal choroidal thickness and alters the intrachoroidal structures in eyes with CSC.

CHOROIDAL BLOOD FLOW VISUALIZATION IN HIGH MYOPIA USING A PROJECTION ARTIFACT METHOD IN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

PURPOSE: To visualize choroidal blood flow in larger vessels in highly myopic eyes using a phenomenon of the projection artifact to in the sclera using optical coherence tomography angiography. METHODS: The retrospective study included 92 eyes (54 patients) with greater than 8 diopters of myopia. All eyes were examined using optical coherence tomography angiography (RTVue XR Avanti; Optovue Inc, Fremont, CA). The blood flow in choroidal vessels was evaluated by attempting to directly segment the choroid and also by placing the segmentation layer behind the choroid, within the sclera. Subfoveal choroidal thickness was also measured at the same time. The authors also evaluated the 54 normal eyes (54 cases) without high myopia as a control group. RESULTS: Segmentation artifacts occurred in 68 cases (73.9%) and precluded direct visualization of the choroidal blood flow in larger vessels. When the segmentation slab was placed posterior to the choroid within the sclera, the choroidal blood flow was visualized in 41 eyes (44.6%). The mean subfoveal choroidal thickness in eyes with visualization of choroidal blood flow was thinner than without visualization (50.3 ± 42.2 µm vs. 100.3 ± 44.4 µm, P < 0.01). Choroidal blood flow in larger vessels was imaged in no control eye. CONCLUSION: The choroidal vessel anatomy could be imaged by detecting flow using the projection artifact in the sclera with optical coherence tomography angiography. This technique may be useful in estimating the vascularity of the choroid.