Combined cases of polypoidal choroidal vasculopathy and typical age-related macular degeneration.

BACKGROUND: When we classified neovascular exudative age-related macular degeneration (AMD) into three types of polypoidal choroidal vasculopathy (PCV), typical AMD, and retinal angiomatous proliferation (RAP) in our previous study, we reported 5.5% had the combined cases, such as one eye had PCV and the other eye had typical AMD. We examined the clinical characteristics of these combined cases in the current study. METHODS: All cases underwent fluorescein and indocyanine green angiography (FA and ICGA) at the initial examination. All PCV cases were diagnosed definitively based on characteristic aneurysmal lesions seen on ICGA. Follow-up examinations also were conducted to determine whether polypoidal lesions had developed in the eyes with typical AMD. RESULTS: Among 349 patients with neovascular AMD, 20 (5.7%) had one eye with PCV and the other eye with typical AMD. The average age was 73 years. The mean best-corrected visual acuity levels at the initial examination in eyes with PCV and typical AMD were 0.20 and 0.43, respectively (p=0.09). All subgroups of classic and occult CNV were observed in the eyes with typical AMD on FA. During the follow-up period (average, 21.7 months), PCV developed in ten eyes with typical AMD at the initial examination. CONCLUSIONS: Although some cases might include different stages of progression or probable cases of PCV, the combined cases in which one eye has PCV and the other eye has typical AMD suggest that those clinical entities are not independent and possibly overlap.

[Photodynamic therapy with verteporfin for polypoidal choroidal vasculopathy: long-term results].

PURPOSE: To evaluate the long term efficacy of photodynamic therapy (PDT) with verteporfin in Japanese patients with polypoidal choroidal vasculopathy (PCV). METHODS: We retrospectively reviewed 128 eyes of 125 patients with PCV over a 6-month follow-up. The mean age was 75 years. The follow-up period was 6 to 36 (mean, 17.8) months. Results were evaluated studying visual acuity, fundus findings, fluorescein angiography, indocyanine green angiography, and optical coherence tomography. RESULTS: Ninety two eyes were observed for 12 months, and 39 eyes were observed for 24 months after initial PDT. The mean best-corrected visual acuity (BCVA) improved from 0.21 at baseline to 0.28 (p<0.01) at 12 months, and 0.26 (p=0.09) at 24 months, respectively. Nine eyes had decreased BCVA of three or more lines at 24 months. Eyes associated with type 2 CNV needed significantly more repeated treatments (p<0.001) than eyes without it. Nineteen eyes had polypoidal lesions that recurred 6 to 21 months (mean, 14) after the initial PDT application. CONCLUSIONS: The current study showed that PDT is effective for patients with PCV eyes over the long term. Visual complications or recurrence of polypoidal lesions were observed in some patients over the long term. Further studies are needed to determine the efficacy of other treatments besides PDT.

Combined intravitreal bevacizumab and photodynamic therapy for retinal angiomatous proliferation.

PURPOSE: To clarify the efficiency of combined therapy with intravitreal bevacizumab injections and photodynamic therapy (PDT) in patients with retinal angiomatous proliferation (RAP). DESIGN: Retrospective, observational, consecutive case series. METHODS: We retrospectively reviewed 11 consecutive eyes with RAP (10 patients; six men, four women) treated with intravitreal bevacizumab injection and PDT. Patients ranged in age from 63 to 89 years old (average, 79 years). No patients had undergone previous treatment, and patients were followed for at least six months. PDT was applied one or two days after the intravitreal bevacizumab (1.25 mg) injection. RESULTS: The mean best-corrected visual acuity (BCVA) levels at baseline and one, three, and six months after treatment were 0.16, 0.27, 0.31, and 0.29, respectively. A significant improvement in the mean BCVA was observed one, three, and six months after intravitreal bevacizumab injection and PDT (P < .01). The mean improvement in BCVA six months from baseline was 2.64 lines. The BCVA at six months improved in six eyes (54.5%, improved by three lines or more) and was stable in five eyes (45.5%). No patient had a decrease in the BCVA of three or more lines during any six months. The central retinal thickness significantly decreased from 496 +/- 189 microm to 175 +/- 33 microm at six months (P < .001). No patients required retreatment during any six months. No complications such as severe vision loss, endophthalmitis, or systemic events developed. CONCLUSION: Combined intravitreal bevacizumab and PDT for RAP effectively maintained or improved VA and reduced or eliminated edema in the short-term.

Cross-sectional and en face optical coherence tomographic features of polypoidal choroidal vasculopathy.

PURPOSE: To correlate optical coherence tomography (OCT)-ophthalmoscope images with angiographic signs of polypoidal lesions and branching network vessels in eyes with polypoidal choroidal vasculopathy (PCV). METHODS: The authors prospectively examined 50 consecutive eyes with PCV using the OCT-ophthalmoscope and fluorescein and indocyanine green angiography (ICGA). RESULTS: ICGA showed polypoidal lesions in all eyes. In 18 of 22 eyes with a retinal pigment epithelial detachment (PED), OCT-ophthalmoscope cross-sectional B-scan images showed a central dome-shaped PED and a contiguous small PED corresponding to the polypoidal lesions on ICGA. Transverse C-scan images showed an irregularity or protrusion of the highly reflective retinal pigment epithelium (RPE) line of the PED corresponding to the polypoidal lesions on ICGA in all 22 eyes. In 28 eyes without a PED, the B-scan images showed polypoidal lesions as anterior protrusions of a highly reflective RPE line in 26 of 28 eyes; in those 26 eyes, C-scan images showed distinctive rings of a highly reflective RPE line corresponding to the polypoidal lesions on ICGA. ICGA showed an abnormal vascular network in 41 of the 50 eyes that appeared as a highly reflective area on C-scan images in 32 of the 41 eyes. In 20 of the 41 eyes, B-scan images showed two separate highly reflective RPE lines at the area of the abnormal vascular network. CONCLUSIONS: The OCT-ophthalmoscope C-scan images of the irregularity and the protrusion in the PED and the distinctive bright rings in eyes without a PED may be diagnostically important as indicators of polypoidal lesions in eyes with PCV.

Indocyanine green angiography in eyes with substantially increased subretinal fluid 1 week after photodynamic therapy.

PURPOSE: To investigate the characteristics of eyes in which a serous retinal detachment became substantially more extensive and persisted 1 week after photodynamic therapy (PDT) using indocyanine green (ICG) angiography. DESIGN: Retrospective, interventional case series. PATIENTS AND METHODS: The authors reviewed the ICG angiograms of five eyes of five patients with neovascular age-related macular degeneration. RESULTS: In all eyes, the ICG angiograms obtained 1 week after PDT showed a well-demarcated hypofluorescent area corresponding to the treatment spot. Vascular hyperpermeability emanating from the middle and large choroidal vessels was seen within the hypofluorescent area whether the targeted choroidal neovascularization was perfused or not. CONCLUSIONS: Choroidal vascular hyperpermeability on ICG angiography is a common finding in eyes with substantially increased subretinal fluid 1 week after PDT. PDT might even affect the middle and large choroidal vessels within the treatment spots under some conditions, leading to a supply of subretinal fluid and causing a persistent serous retinal detachment.

Choroidal circulatory disturbances associated with retinal angiomatous proliferation on indocyanine green angiography.

PURPOSE: To investigate the association between choroidal perfusion and retinal angiomatous proliferation (RAP). METHODS: We performed indocyanine green angiography (ICGA) on 26 eyes of 13 consecutive patients with RAP, and 17 eyes of 17 age-matched controls without age-related macular degeneration. In eyes with RAP and concurrent pigment epithelial detachments (PEDs), we evaluated ICGA images obtained after the PEDs resolved following treatment. Of the 26 eyes in the study group, five eyes with stage 3 RAP or a disciform scar and two eyes that underwent photodynamic therapy were excluded from further evaluation, leaving 19 eyes (11 eyes with stage 1 or 2 RAP and eight fellow eyes without RAP). RESULTS: Early decreased choroidal filling (EDCF) was observed in nine (81.8%) of 11 eyes with RAP and five (62.5%) of eight fellow eyes without RAP. Late decreased choroidal filling (LDCF) occurred in nine (81.8%) of 11 eyes with RAP and four (50%) of eight fellow eyes without RAP. The incidence of EDCF and LDCF was significantly higher in eyes with RAP than in the control eyes (p < 0.05, p < 0.01, respectively). CONCLUSIONS: Persistent decreased choroidal filling is common in early-stage RAP. Clinicians should be aware of this, especially when considering treatment.

Clinical characteristics of exudative age-related macular degeneration in Japanese patients.

PURPOSE: To clarify the clinical characteristics of exudative age-related macular degeneration (AMD) in Japanese patients. DESIGN: Retrospective, observational, consecutive case series. METHODS: Two hundred and eighty-nine patients with neovascular AMD were examined. RESULTS: The authors classified the patients into three subtypes of neovascular AMD: polypoidal choroidal vasculopathy (PCV), retinal angiomatous proliferation (RAP), and typical AMD. One hundred and fifty-eight patients (54.7%) were diagnosed with PCV and 102 patients (35.3%) with typical AMD. RAP was observed in 13 patients (4.5%). In 16 patients (5.5%), one eye had PCV and the other eye had typical AMD. Most patients with PCV and typical AMD had unilateral disease (81.6% and 94.1%, respectively) with a male preponderance (77.8% and 71.6%, respectively). Nine of 13 patients with RAP were female (69.2%). Patients with RAP were older (mean, 80.3 years for men and 75.3 years for women) than patients with other subtypes. Serous and hemorrhagic pigment epithelial detachment developed in 69 patients (43.7%) with PCV, 22 patients (21.6%) with typical AMD, and nine patients (69.2%) with RAP. In the patients with unilateral disease in each subtype, large drusen in the unaffected eye were seen in 24.0% with PCV, 30.2% with typical AMD, and 77.8% with RAP. CONCLUSIONS: Neovascular AMD in Japanese patients has different demographic features compared with that in White patients. In Japanese patients, there is a preponderance of PCV, male gender, unilaterality, and absence of drusen in the second eye, with the exception of RAP.

Recurrence after surgical ablation for retinal angiomatous proliferation.

PURPOSE: To report the frequency of recurrence of retinal angiomatous proliferation (RAP) lesions after surgical ablation. METHODS: Seven eyes of seven consecutive patients with stage II RAP underwent surgical ablation of retinal feeder and draining vessels of RAP lesions. These eyes were examined with visual acuity testing, biomicroscopic slit-lamp fundus examination, fluorescein and indocyanine green angiographies, and optical coherence tomography before and after surgery. RESULTS: Between 2 months and 13 months after surgical ablation, all 7 eyes (100%) had lesion recurrence with exudative and/or hemorrhagic manifestations such as macular edema, serous detachment of the sensory retina, or pigment epithelial detachment. Retinal feeding and draining vessels were recanalized (six eyes) or newly developed (one eye) in communication with recurrent intraretinal neovascularization. CONCLUSIONS: After surgical ablation for stage II RAP, all seven eyes had recurrence of the RAP lesions. This treatment may be ineffective for RAP. Further study of this surgical technique is necessary before recommending it for the treatment of RAP.