Elevated Choroidal Thickness and Central Serous Chorioretinopathy in the Fellow Eyes of Patients with Circumscribed Choroidal Hemangioma.

OBJECTIVE: To determine whether increased choroidal thickness (CT) is associated with circumscribed choroidal hemangioma (CCH) and whether patients with CCH are predisposed to central serous chorioretinopathy (CSCR). METHODS: We performed a retrospective consecutive observational study of 15 fellow eyes of 15 patients who had CCH. A- and B-scan ultrasonography, fluorescein angiography (FA), and optical coherence tomography (OCT) findings were reviewed to confirm the diagnosis of CCH. Fellow eye CT was measured using enhanced depth imaging OCT. FA, indocyanine green angiography, and OCT images of fellow eyes were reviewed for signs of CSCR. RESULTS: Mean subfoveal CT was significantly greater in the fellow eyes of patients with CCH than in age-matched normal eyes (p = 0.004). Three of 15 (20.0%) fellow eyes of CCH patients had retinal pigment epithelium disruptions and/or pigment epithelial detachments indicative of previous asymptomatic CSCR. CONCLUSION: In this pilot study, elevated CT was associated with a risk of developing CCH as well as CSCR in patients of varying ages. Patients diagnosed with CCH should be screened for CSCR in the fellow eye. Further exploration of this association may reveal useful clues about the biology of abnormally elevated choroidal hyperpermeability and its various clinical manifestations.

Predictability of Recurrent Exudation and Subretinal Hemorrhaging in Neovascular Age-Related Macular Degeneration With Indocyanine Green Angiography.

BACKGROUND AND OBJECTIVE: To report the predictability of recurrent exudation and subretinal hemorrhaging after treatment extension in neovascular age-related macular degeneration (AMD) through assessment of interval changes in choroidal neovascularization (CNV) size on indocyanine green (ICG) angiography. PATIENTS AND METHODS: The charts of patients with neovascular AMD who underwent bevacizumab therapy using a treat-and-extend protocol were retrospectively reviewed over a 12-month period. RESULTS: An increase of 33% or more in CNV surface area on ICG angiography from 4 to 6 weeks, 6 to 8 weeks, and 8 to 10 weeks was observed in patients whose treatment interval could not be extended from 6 to 8 weeks, 8 to 10 weeks, and 10 to 12 weeks, respectively, and this was significant compared to patients whose treatment interval was successfully extended during those respective intervals (P < .0001, P = .0002, P = .0004, respectively). CONCLUSION: CNV size change on ICG angiography can predict which patients are likely to experience recurrent exudation and/or subretinal hemorrhaging after treatment extension using treat-and-extend bevacizumab.

Evaluation of choroidal neovascularization with indocyanine green angiography in neovascular age-related macular degeneration subjects undergoing intravitreal bevacizumab therapy.

PURPOSE: To report the clinical implications of interval changes in choroidal neovascularization (CNV) size measured by indocyanine green (ICG) angiography in neovascular age-related macular degeneration (AMD) patients undergoing intravitreal bevacizumab therapy. DESIGN: Retrospective, consecutive chart review. METHODS: The charts of neovascular AMD patients who underwent intravitreal bevacizumab therapy using a treat-and-extend dosing schedule were reviewed. ICG angiographic CNV surface areas were measured at baseline, 2 months, 6 months, and 12 months in each subject. The primary outcome was change in CNV size. Secondary outcomes included the correlation of change in CNV surface area with change in best-corrected visual acuity (BCVA), change in central macular thickness on optical coherence tomography (OCT), and the number of injections delivered over the 12-month study interval. RESULTS: A total of 123 subjects were included in the analysis. The baseline CNV size was 1.9 mm2±2.5 mm2. CNV size was 1.66 mm2±2.11 mm2 at 2 months, 1.60 mm2±2.23 mm2 at 6 months, and 1.50 mm2±2.12 mm2 at 12 months. The change in CNV size from baseline was not statistically significant at any of the follow-up intervals. A decrease in CNV size of 33% or more at 2 months was associated with a significant decrease in CNV size at 12 months (P=.0096), complete resolution of CNV at 12 months (P=.0013), and a decrease in the number of injections delivered over the study interval (P=.0165). Complete resolution of CNV at 12 months occurred in 7.3% of subjects. Subjects that had complete resolution of CNV at 12 months were significantly more likely to gain 3 more lines of BCVA at the end of the study interval (P=.0131). No significant correlation was found between CNV size and change in central macular thickness on OCT. CONCLUSIONS: Our study suggests that change in CNV size on ICG angiography may help the clinician predict the clinical course of neovascular AMD subjects undergoing intravitreal bevacizumab therapy using a treat-and-extend dosing schedule.

Treat-and-extend intravitreal bevacizumab for branch retinal vein occlusion.

BACKGROUND AND OBJECTIVE: To determine the effectiveness and direct medical costs of treat-and-extend (TAE) intravitreal bevacizumab (IVB) for the treatment of branch retinal vein occlusion (BRVO)-associated macular edema (ME). PATIENTS AND METHODS: Retrospective chart review of 52 consecutive patients diagnosed with BRVO-associated ME treated with IVB using a TAE protocol. RESULTS: Mean change in logMAR vision was -0.30 (P < .001), and mean change in central macular thickness was -244.0 µm (P < .001). The mean number of injections was 8.2 (95% CI; 7.8 to 8.6). The yearly average direct cost of the TAE regimen was calculated to be $2,580.26 per patient. CONCLUSION: Treatment of BRVO-associated ME with IVB using a TAE regimen resulted in similar visual outcomes and number of intravitreal injections as did as-needed treatment with 0.5 mg ranibizumab conducted in phase 3 trials but with fewer visits and lower annual medical costs.

Postoperative macular hole formation after vitrectomy with internal limiting membrane peeling for the treatment of epiretinal membrane.

PURPOSE: To evaluate the incidence, clinical features, and outcomes of macular hole formation after pars plana vitrectomy with internal limiting membrane peeling for the management of epiretinal membrane. METHODS: Retrospective consecutive chart review of 423 cases. RESULTS: Eleven subjects developed postoperative macular holes (incidence 2.6%; 95% confidence interval, 1.5-4.6%). Two of the 11 subjects developed central macular holes (incidence 0.5%; 95% confidence interval, 0.1-1.7%) while 9 had eccentric (nonfoveal) macular holes (incidence 2.1%; 95% confidence interval, 1.1-4.0%). Seven of the 9 eccentric macular holes were <115 µm in diameter, 7 were determined to be along the margin of the internal limiting membrane peel, and 8 were either in the superior or temporal macula. The two central macular holes were closed with subsequent pars plana vitrectomy and gas tamponade. There was no association between macular hole formation and age, gender, preoperative visual acuity, axial length, and preoperative central macular thickness. Overall, a 0.2 or more improvement in logMAR was associated with pseudophakia and poorer preoperative acuity on univariate and multivariate analysis, whereas increased preoperative central macular thickness was associated with improved outcomes on univariate but not multivariate analysis. CONCLUSION: Postoperative macular hole formation is an infrequent sequela to pars plana vitrectomy with internal limiting membrane peeling for epiretinal membrane. In our cohort, eccentric macular holes tended to be small, located along the edge of the internal limiting membrane peel, and were not visually significant.

Treat-and-extend bevacizumab for neovascular age-related macular degeneration: the importance of baseline characteristics.

PURPOSE: To evaluate the factors affecting visual and anatomical outcomes and the number of intravitreal bevacizumab injections required in the treatment of neovascular age-related macular degeneration using a treat-and-extend regimen. METHODS: Retrospective consecutive case series. The charts of subjects treated with intravitreal bevacizumab for neovascular age-related macular degeneration using a treat-and-extend regimen over a 12-month period were reviewed. The key variables explored were patient age, phakic status, posterior vitreous detachment status, baseline best-corrected visual acuity (BCVA), baseline central macular thickness (CMT), and type of chorodial neovascularization. The primary outcome measures were improvement in BCVA of 3 logMAR lines or more, maintenance of BCVA within 3 logMAR lines of baseline, number of intravitreal injections delivered over a 12-month period, and final CMT on optical coherence tomography. RESULTS: A total of 230 eyes met the criteria. Mean presenting BCVA was Snellen 20/55 (0.44 logMAR) and mean final BCVA was Snellen 20/44 (0.35 logMAR) (P < 0.001). A total of 23.5% (95% confidence interval [CI], 18.5-29.4%) of the subjects demonstrated an improvement in BCVA of 3 or more logMAR lines, whereas 96.5% (95% CI, 93.3-98.2%) of the subjects lost fewer than 3 logMAR lines. Mean CMT on optical coherence tomography changed from a baseline average of 373.1 µm (95%CI, 360.3-386.1 µm) to a final average of 305.5 µm (95% CI, 290.0-316.0 µm). The average number of injections during the 12-month period was 9.2 (95% CI, 9.0-9.4). Posterior vitreous detachment was associated with fewer injections on univariate and multivariate analysis (8.7 injections in the posterior vitreous detachment group versus 9.8 in the non-posterior vitreous detachment group, P < 0.001). Patients with poorer presenting BCVA and greater baseline CMTs were more likely to demonstrate a 3 or more logMAR line improvement in BCVA. Thinner final CMTs were independently associated with thinner presenting CMTs and fewer injections. CONCLUSION: Favorable visual and anatomical outcomes may be achieved with intravitreal bevacizumab in the treatment of neovascular age-related macular degeneration using a treat-and-extend regimen. Our study suggests that posterior vitreous detachment may play a role in the efficacy of intravitreal bevacizumab during the treatment of neovascular age-related macular degeneration.