Influencing factors of futile recanalization after endovascular therapy for cerebral infarction with posterior circulation occlusion of large vessels: a retrospective study.

BACKGROUND: The optimal treatment for cerebral infarction caused by posterior circulation occlusion of large vessels has not yet been determined. Intravascular interventional therapy is an important treatment for cerebral infarction with posterior circulation occlusion of large vessels. However, endovascular therapy (EVT) of some posterior circulation cerebrovascular is ineffective and eventually become futile recanalization. Therefore, we performed a retrospective study to explore the factors influencing futile recanalization after EVT in patients with posterior circulation large-vessel occlusion. METHODS: Eighty-six patients with acute cerebral infarction and posterior circulation large vessel occlusion after intravascular intervention were divided into two groups according to their modified Rankin scale (mRS) scores after 3 months: group 1, mRS scores less than or equal to 3 (the effective recanalization group); group 2, mRS scores greater than 3 (the ineffective recanalization group). The basic clinical data, imaging index scores, time from onset to recanalization, and operation time between the two groups were compared and analyzed. Logistic regression was used to analyze the factors influencing indicators of good prognosis, and the ROC curve and Youden index were used to determine the best cutoff value. RESULTS: Between the two groups, there were significant differences in the posterior circulation CT angiography (pc-CTA) scores, GCS scores, pontine midbrain index scores, time from discovery to recanalization, operation time, NIHSS score and incidence of gastrointestinal bleeding. The logistic regression revealed that the NIHSS score and time from discovery to recanalization were associated with good prognoses. CONCLUSION: NIHSS score and recanalization time were independent influencing factors of ineffective recanalization of cerebral infarctions caused by posterior circulation occlusion. EVT is relatively effective for cerebral infarction caused by posterior circulation occlusion when the NIHSS score is less than or equal to 16 and the time from onset to recanalization is less than or equal to 570 min.

Morphological Difference of Choroidal Vasculature Between Polypoidal Choroidal Vasculopathy and Neovascular AMD on OCT: From the Perspective of Pachychoroid.

BACKGROUND AND OBJECTIVE: To investigate the morphological difference of choroidal vasculature between polypoidal choroidal vasculopathy (PCV) and neovascular age-related macular degeneration (nAMD) on optical coherence tomography (OCT). PATIENTS AND METHODS: One hundred eighty-nine patients with macula-involved PCV (n = 107) or nAMD (n = 82) were retrospectively reviewed. The subfoveal choroidal thickness (SFCT) and thickness of the Haller's layer were determined on enhanced depth imaging optical coherence tomography (EDI-OCT). The mean diameters of subfoveal large choroidal vessels were also calculated. RESULTS: Both the SFCT (257.31 µm ± 100.50 µm vs. 209.95 µm ± 97.51 µm) (P < .01) and the thickness of the Haller's layer (213.68 µm ± 82.65 µm vs. 159.67 µm ± 79.86 µm) (P < .01) were greater in PCV patients than nAMD patients. The ratio of thickness of the Haller's layer to the SFCT was higher in the PCV group (0.83 ± 0.07) than the nAMD group (0.7 5± 0.11) (P < .01). The mean diameter of subfoveal large choroidal vessels was greater in PCV patients (163.55 µm ± 62.23 µm vs. 112.81 ± 58.87 µm) (P < .01). CONCLUSION: Choroidal thickening and dilation of large choroidal vessels were commonly seen in PCV patients, supporting that PCV belongs to the pachychoroid spectrum disorders and might be a different entity from nAMD. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e114-e121.].

Comparison of the effects of photodynamic therapy, intravitreal ranibizumab and combination for polypoidal choroidal vasculopathy under 1 + PRN regimen.

BACKGROUND: The optimal treatment for polypoidal choroidal vasculopathy (PCV) is still under debate. Little knowledge is known about the treatment effect of "1+pro re nata(PRN)" treatment regimen for PCV. The aim of this study was to compare the outcomes of photodynamic therapy (PDT), intravitreal ranibizumab injection (IVR) and combination therapy under the "1 + PRN" treatment regimen for PCV. METHODS: Fifty-seven eyes of 57 patients completed the 12 months' follow-up in this prospective study. The patients in the PDT arm(n = 23), ranibizumab arm(n = 18), or combination arm(n = 16) underwent a session of PDT, IVR or combination of both at baseline followed by additional IVR as needed. Mean change of logarithm of the minimal angle of resolution (logMAR) visual acuity (VA), central foveal thickness (CFT) and the regression rate of polyps were evaluated. Cost-benefit analysis was also performed. RESULTS: At Month 12, the mean logMAR VA improved from 0.90 ± 0.52 to 0.75 ± 0.57 in the PDT group (P < 0.05), from 0.96 ± 0.58 to 0.77 ± 0.41 in the IVR group (P < 0.05), and from 0.94 ± 0.55 to 0.72 ± 0.44 in the combination group (P < 0.05), respectively. The CFT decreased from 478.04 ± 156.70 µm, 527.5 ± 195.90 µm, and 522.63 ± 288.40 µm at the baseline to 366.43 ± 148.28 µm, 373.17 ± 134.88 µm and 328.44 ± 103.25 in the PDT group (P < 0.05), IVR group (P < 0.01), and the combination group (P < 0.05), respectively. However, no statistical difference was found between groups (P > 0.05). PDT treatment (60.87%) was superior to the IVR therapy (22.22%) in achieving complete regression of polyps (P < 0.05). Cost-benefit analysis showed that IVR treatment cost the least money for improving per 0.1logMAR units and the combination therapy demanded the least money for reducing per 100 µm of CFT. CONCLUSIONS: PDT, IVR and the combination therapy have similar efficacy in the VA improvement as well as the reduction of CFT under the "1 + PRN" treatment regimen. TRIAL REGISTRATION: Current Controlled Trials NCT03459144 . Registered retrospectively on March 2, 2018.

Long-Term Therapeutic Outcomes of Photodynamic Therapy-Based or Photocoagulation-Based Treatments on Retinal Capillary Hemangioma.

BACKGROUND: Retinal capillary hemangioma (RCH) is a rare and refractory eye tumor. OBJECTIVE: The aim of this study was to investigate the therapeutic efficacy of two laser-based therapies for RCH, photodynamic therapy (PDT), and focal photocoagulation-based treatment. MATERIALS AND METHODS: This was a retrospective study. Eight RCH patients (10 eyes) receiving laser treatment and followed up from November 2011 to December 2016 in our hospital were selected and their medical records reviewed. Clinical results and correlations between various clinicodemographic factors and vision outcome were analyzed. RESULTS: A total of 39 RCH tumor bodies were found and treated. Eleven sessions of PDT and 25 sessions of photocoagulation were administered. Other treatments included five intravitreal injections of antivascular endothelial growth factor or triamcinolone acetonide and one vitreoretinal surgery. After the follow-up period of 54.3 ± 29.8 months, 35 tumor bodies were stable or regressed, and 4 were recurrent. Vision was improved in four eyes, stable in one, and reduced in five relative to baseline. Photocoagulation was more likely to induce tumor bleeding than PDT (4 eyes vs. 1) and to increase subretinal fluid (3 eyes vs. 1). In correlation analysis, subretinal fluid accumulation was predictive of poor vision outcome (r = 0.69, p = 0.03). CONCLUSIONS: Photodynamic- and photocoagulation-based therapies are both reasonably effective against most RCH tumor bodies, but PDT carries lower risks of bleeding and subretinal fluid refraction. Formation of subretinal fluid may predict poor vision outcome in RCH.