David H. Orth

Anti-vascular endothelial growth factor therapy for subfoveal choroidal neovascularization secondary to age-related macular degeneration: Phase II study results

PURPOSEnThere is evidence to suggest that anti-vascular endothelial growth factor (anti-VEGF) therapy may be useful in treating ocular neovascularization. A phase IA single intravitreal injection study of anti-VEGF therapy for patients with subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) revealed a good safety profile. We performed a phase II multiple injection study of anti-VEGF therapy with and without photodynamic therapy for patients with subfoveal CNV secondary to AMD to determine the safety profile of multiple injection therapy.nnnDESIGNnA phase II multiple-dose safety study.nnnPARTICIPANTS/METHODSnTwenty-one patients were treated with intravitreal injection with and without photodynamic therapy.nnnMAIN OUTCOME MEASURESnClinical evidence of toxicity and complications.nnnRESULTSnNo drug-related serious adverse events were revealed. Ophthalmic evaluation revealed that 87.5% of patients who received the anti-VEGF aptamer alone showed stabilized or improved vision 3 months after treatment and that 25% of eyes demonstrated a 3 line or greater improvement in vision on the Early Treatment of Diabetic Retinopathy Study chart during this period. A 60% 3 line gain at 3 months was noted in patients who received both the anti-VEGF aptamer and photodynamic therapy.nnnCONCLUSIONSnAnti-VEGF therapy is a promising treatment for various forms of ocular neovascularization, including AMD. Multiple intravitreal injections of the anti-VEGF aptamer were well tolerated in this phase II study. Further clinical trials are necessary to demonstrate the efficacy and long-term safety of anti-VEGF therapy for AMD.

Pneumatic retinopexy : a two-year follow-up study of the multicenter clinical trial comparing pneumatic retinopexy with scleral buckling

The authors report 2-year follow-up information on 179 of 198 eyes (90%) enrolled in a previously published multicenter, randomized, controlled clinical trial comparing pneumatic retinopexy (PR) with scleral buckling (SB) for the management of selected retinal detachments. Scleral buckling was compared with PR with regard to redetachment after the initial 6-month follow-up period (1% versus 1%), overall attachment (98% versus 99%), subsequent cataract surgery (18% versus 4%; P less than 0.05), preoperative visual acuity (no significant difference), and final visual acuity of 20/50 or better in eyes with macular detachment for a period of 14 days or less (67% versus 89%; P less than or equal to 0.05). Reoperations after a failed PR attempt did not adversely affect visual outcome. After 2 years, PR continues to compare favorably with SB.

Laser treatment in fellow eyes with large drusen: Updated findings from a pilot randomized clinical trial

PURPOSEnTo update the findings from the Choroidal Neovascularization Prevention Trial (CNVPT) with respect to resolution of drusen, incidence of choroidal neovascularization, and visual function.nnnDESIGNnA multicenter, randomized, controlled, pilot clinical trial.nnnPARTICIPANTSnThe 120 patients enrolled in the CNVPT. Patients had signs of choroidal neovascularization or retinal pigment epithelial detachment in 1 eye and had >/=10 large (>63- micro m) drusen in the contralateral, or fellow, eye.nnnINTERVENTIONnThe fellow eye of 59 patients was assigned randomly to argon green laser treatment consisting of multiple 100- micro m spots at least 750 micro m from the center of the fovea. The fellow eye of the remaining 61 patients was assigned randomly to observation.nnnMAIN OUTCOME MEASURESnChange in visual acuity was the primary outcome measure. Incidence of choroidal neovascularization, resolution of drusen, change in contrast threshold, change in critical print size for reading, and incidence of geographic atrophy were secondary outcome measures.nnnRESULTSnThroughout 4 years of follow-up, there were no statistically significant differences in change in visual acuity, contrast threshold, critical print size, or incidence of geographic atrophy. With additional follow-up, the large increase in the incidence of choroidal neovascularization observed within 18 months of treatment was maintained; however, by 30 months, the incidence in the two treatment groups was the same. Most drusen resolution in treated eyes occurred within 24 months of the initial treatment. Treated eyes that received higher-intensity laser burns had an increased risk of choroidal neovascularization. Among eyes developing choroidal neovascularization in each treatment group, most lesions (two thirds or more) were composed of occult neovascularization only.nnnCONCLUSIONSnLaser treatment as applied in the CNVPT caused an excess risk of choroidal neovascularization in the first year or so after treatment. The increased early incidence of choroidal neovascularization was not associated with either a harmful or beneficial effect in this pilot study.

Metastatic fungal chorioretinitis developing during Trichosporon sepsis.

A 70-year-old woman treated for acute myelogenous leukemia developed systemic trichosporosis and presumptive trichosporon chorioretinitis. The elevated choroidal lesion appeared during an episode of trichosporon sepsis and increased in size during immunosuppression. Possible retinal vein occlusion and neovascularization were further complications that may be due to the angioinvasive properties of the organism.

Macular hamartomas of the retinal pigment epithelium and retina.

Four patients with macular hamartomas of the retinal pigment epithelium and retina are described. Associated choroidal neovascularization was noted in one patient.The clinical, fluorescein angiographic, and histopathologic findings of this entity are reviewed.

Management of breakthrough vitreous hemorrhage from presumed extramacular subretinal neovascularization.

Three patients developed vitreous hemorrhage secondary to breakthrough bleeding from presumed extramacular subretinal neovascularization. In one patient, the vitreous hemorrhage cleared spontaneously. In two other patients, trans-pars plana vitrectomy was performed. All patients regained 20/30 vision or better. Residual peripheral retinal pigment epithelial atrophy, organized subretinal hemorrhage, and/or subretinal fibrous membranes were present in all patients. A definite extramacular subretinal neovascular membrane was identified in one patient. Ocular diseases associated with subretinal neovascularization are tabulated. Indications for trans-pars plana vitrectomy in patients with breakthrough vitreous hemorrhage secondary to presumed extramacular subretinal neovascularization are proposed.