Choroidal vascular alterations evaluated by ultra-widefield indocyanine green angiography in central serous chorioretinopathy.

PURPOSE: This study aims to evaluate choroidal vascular alterations in patients with central serous chorioretinopathy (CSC) using ultra-widefield (UWF) indocyanine green angiography (ICGA). METHODS: This was a retrospective case-control study conducted at a single tertiary eye center. In total, 36 eyes in patients with either unilateral (24 patients) or bilateral (six patients) treatment-naïve CSC and 30 eyes in 24 age-matched controls were evaluated. The number of quadrants with vortex vein engorgement on UWF ICGA was evaluated. Dilated choroidal vessels affecting the macula were regarded as extended vortex vein engorgement. Choroidal vascular hyperpermeability (CVH) area on late-phase ICGA was quantified using stereographic projection. The parameters were compared with clinical and optical coherence tomographic findings. RESULTS: Eyes with CSC had larger CVH area, thicker choroid, and more quadrants with vortex vein engorgement and extended vortex vein engorgement compared with control eyes (all P < 0.001). In patients with unilateral CSC, affected eyes had larger CVH area, thicker choroid, and more extended vortex vein engorgements compared with unaffected fellow eyes (all P < 0.001), but vortex vein engorgement did not significantly differ. CVH was significantly correlated with extended vortex vein engorgement (P < 0.001) and subfoveal choroidal thickness (P = 0.007). CONCLUSIONS: The increased number and binocular symmetry of engorged vortex veins suggest an anatomical predisposition for CSC. CVH area and extended vortex vein engorgement were indicators of choroidal outflow congestion. These parameters may serve as diagnostic clues or predictors of disease development in eyes with CSC.

Real-World Outcomes of Intravitreal Aflibercept for Neovascular Age-Related Macular Degeneration: A Large-Scale Postmarketing Surveillance in Korea.

PURPOSE: To investigate the efficacy and safety of intravitreal aflibercept (IVT-AFL) in Asian patients with neovascular age-related macular degeneration (nAMD) in a real-world clinical setting. PATIENTS AND METHODS: In this analysis of a prospective, regulatory, postmarketing surveillance study for IVT-AFL, 3115 patients with nAMD were included and followed for 8 months. The mean changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were analyzed using last observation carried forward method. A post hoc subgroup analysis and a multivariate logistic regression analysis were also performed to assess factors related to treatment outcomes. RESULTS: Mean BCVA improved from 0.62 to 0.51 logarithm of minimum angle resolution and mean CRT decreased from 383.3 to 289.7 µm, with a mean of 3.4 injections during the 8-month follow-up. In the subgroup analysis, patients who had received 3 initial monthly doses had significantly better anatomical improvements than those treated as needed. Patients with confirmed polypoidal choroidal vasculopathy (PCV) had significantly better anatomical improvements and better visual recovery than those with other types of nAMD. The multivariate regression analysis demonstrated that age, injection number, PCV, and baseline BCVA were significantly associated with higher odds of gaining 3 lines at 8 months, and sex, injection number, PCV, and baseline CRT were associated with CRT ≤250 µm at 8 months. No new safety findings were identified. CONCLUSION: IVT-AFL was effective and well tolerated in a real-world setting with a large number of Asian patients with nAMD. Number of injections and PCV were important determinants for improved treatment outcomes.

Relationship between distribution and severity of non-perfusion and cytokine levels and macular thickness in branch retinal vein occlusion.

We aimed to investigate the relationship between non-perfusion on ultra-widefield angiography (UWF FA) and aqueous cytokine levels and central macular thickness (CMT) in eyes with branch retinal vein occlusion (BRVO). Thirty-five eyes with treatment-naïve BRVO were included. Non-perfusion area (NPA) for partial and complete ischemia was manually segmented and the ischemic index (ISI) for each was calculated using stereographically projected UWF FA for four different retinal zones. Partial and complete ischemia had different regional predominance. Partial ischemia was predominant in the posterior regions, while complete ischemia was predominant in the periphery. And partial ischemic area, located posterior to far periphery, showed significant correlation with central macular thickness and concentrations of angiogenic and inflammatory cytokines, while complete ischemic area showed no correlation with any of the parameters. Taken together, partial but not complete ischemia, particularly in the more posterior retina, was associated with higher cytokine levels and more severe macular edema in eyes with BRVO. These findings would help us to better understand the different clinical significance of ischemia in BRVO depending on the severity and regional distribution.

Optimal fluence rate of photodynamic therapy for chronic central serous chorioretinopathy.

AIMS: To investigate the lowest effective fluence rate of photodynamic therapy (PDT) for treating chronic central serous chorioretinopathy (CSC). METHODS: Fifty-one eyes of 51 patients with chronic CSC were randomly treated with 30% (n=15), 40% (n=16) or 50% (n=17) of the standard-fluence rate of PDT and followed up for 12 months. The success rate, recurrence rate, mean best-corrected visual acuity (BCVA), central foveal thickness (CFT), subfoveal choroidal thickness (SFCT), integrity of the outer retinal layer and complications were evaluated at baseline and at the follow-up periods after PDT. RESULTS: The rate of complete subretinal fluid (SRF) resolution in the 30%-fluence, 40%-fluence and 50%-fluence groups was 60.0%, 81.2% and 100.0%, respectively, at 3 months (p=0.009), and 80.0%, 94.0% and 100.0%, respectively, at 12 months (p=0.06). The recurrence rate in the 50%-fluence group was lower than that in the 30%- and 40%-fluence groups at 12 months (30% vs 50%, 40% vs 50%; p=0.002, p=0.030, respectively (log-rank test)). The mean BCVA improved significantly 12 months after PDT only in the 40%- and 50%-fluence groups (p=0.005, p=0.003, respectively). Mean CFT and SFCT decreased significantly at 12 months in the three groups. The rate of complications did not differ significantly among the three groups. CONCLUSIONS: A 50%-fluence rate of PDT seems to be the most effective for treating chronic CSC, considering the low recurrence rate and high rate of complete SRF resolution, compared with other low-fluence PDT. TRIAL REGISTRATION NUMBER: NCT01630863.

Impact of Early Anatomical and Functional Responses to Bevacizumab in Macular Edema Secondary to Branch Retinal Vein Occlusion.

PURPOSE: To evaluate whether early anatomical and visual acuity (VA) responses to intravitreal bevacizumab (IVB) in macular edema secondary to branch retinal vein occlusion (BRVO) are associated with 1-year follow-up outcomes. METHODS: Ninety-nine treatment-naïve patients (99 eyes) with macular edema after BRVO treated with IVB were analyzed retrospectively. All patients received single injection and were followed up with pro re nata regimen for at least 12 months. The relationship between early (1 month) and late (12 months) anatomical (presence/absence of fluid) and functional response (an improvement of <1, 1 to <3, or ≥3 logMAR lines from baseline in best corrected VA, BCVA) was explored. RESULTS: Fifty-eight eyes (58.6%) had absence of fluid at 1 month after the first injection, but 41 eyes (41.4%) did not. Those with absence of fluid at 1 month were more likely to be fluid-free at 12 months (p = 0.010). Thirty-seven (37.4%), 24 (24.2%), and 38 (38.4%) eyes showed an improvement of <1, 1 to <3, and ≥3 lines, respectively, at 1 month after the first injection. Intercohort differences across three response categories in BCVA change from baseline were statistically significant throughout the follow-up. Each group maintained stable VA changes within 1 line during the follow-up after 1 month. CONCLUSION: The early anatomical and functional response was associated with anatomical and functional improvement at 12 months.