Han Joo Cho

Risk Factors for Geographic Atrophy After Intravitreal Ranibizumab Injections for Retinal Angiomatous Proliferation

PURPOSE To describe the risk factors for the development of geographic atrophy (GA) following intravitreal ranibizumab injection treatment for retinal angiomatous proliferation (RAP). DESIGN Retrospective interventional series. METHODS Forty-three eyes (38 South Korean patients) from patients being treated for naïve RAP with intravitreal ranibizumab injection were included in this study. All patients were treated with an initial series of 3 monthly loading injections, followed by further injections as required. Baseline ocular characteristics and lesion features assessed using fluorescein angiography (FA), indocyanine angiography (ICGA), and spectral-domain optical coherence tomography (SD OCT) were evaluated as potential risk factors for GA through 2 years of follow-up. RESULTS At 2 years follow-up, GA had developed in 16 of 43 eyes (37.2%). The mean number of ranibizumab injections was 7.52 ± 2.11. Using multiple logistic regression, thinning of the subfoveal choroid at baseline (odds ratio [OR], 0.955; 95% confidence interval [CI], 0.929-0.982; P = .002), presence of reticular pseudodrusen (OR, 1.092; 95% CI, 1.017-1.485; P = .039), and presence of GA in the fellow eye at baseline (OR, 1.433; 95% CI, 1.061-1.935; P = .025) were identified as significant risk factors for GA development. CONCLUSIONS GA developed in 37.2% of eyes with RAP during the 24 months following intravitreal ranibizumab injections. Subfoveal choroidal thinning at baseline, the presence of reticular pseudodrusen, and the presence of GA in the fellow eye at baseline were associated with increased risk of GA development after treatment.

Short-term Effectiveness of Intravitreal Bevacizumab vs. Ranibizumab Injections for Patients with Polypoidal Choroidal Vasculopathy

Purpose To compare the effectiveness of intravitreal injections of bevacizumab and ranibizumab in patients with treatment-naive polypoidal choroidal vasculopathy (PCV). Methods Records from 106 consecutive patients who received intraviteral bevacizumab (n = 58, 1.25 mg) or ranibizumab (n = 52, 0.5 mg) for treatment of PCV were retrospectively reviewed. After three initial monthly loading injections, injection was performed as needed. The main outcome measures included best-corrected visual acuity (BCVA), foveal central thickness (FCT) as assessed by spectral domain optical coherence tomography, and the changes in polypoidal lesions based on an indocyanine green angiography. Results The average number of injections was 3.31 ± 1.25 in the bevacizumab group and 3.44 ± 0.92 in the ranibizumab group. Mean logarithm of the minimum angle of resolution of BCVA from baseline to 6 months after injection improved by 0.17 in the bevacizumab group (p = 0.03) and by 0.19 in the ranibizumab group (p = 0.01). Average FCT decreased from 322 ± 62.48 µm to 274 ± 40.77 µm in the bevacizumab group (p = 0.02) and from 338 ± 50.79 µm to 286 ± 36.93 µm in the ranibizumab group (p = 0.02). Polyp regression rate was 20.7% (12 of 58 eyes) in the bevacizumab group and 21.2% (11 of 52 eyes) in the ranibizumab group. There was no statistically significant difference between groups in BCVA improvement achieved, FCT improvement achieved, and polyp regression rate between groups. Conclusions Intravitreal injections of bevacizumab and ranibizumab have similar effects in stabilizing of visual acuity, macular edema, and regression of polypoidal complex in PCV eyes over the short term.

Intravitreal bevacizumab for symptomatic retinal arterial macroaneurysm.

PURPOSE To evaluate the therapeutic effect of intravitreal bevacizumab injection for symptomatic retinal arterial macroaneurysm. DESIGN Retrospective interventional case series. METHODS The study included 23 patients (23 eyes) with symptomatic retinal arterial macroaneurysm. They were categorized according to treatment method into 2 groups: an intravitreal bevacizumab-treated group (11 eyes) and an untreated group (12 eyes). Bevacizumab was injected at the initial visit, followed by as-needed monthly reinjection. Best-corrected visual acuity (BCVA) and central macular thickness were documented and analyzed between groups. RESULTS The mean follow-up period for all subjects was 10.83 ± 4.6 months. The mean number of injections for the treated group was 1.42 ± 0.69. The mean logarithm of the minimal angle of resolution (logMAR) of BCVA improved from baseline at the last follow-up by 0.26 in the bevacizumab-treated group (P = .02) and by 0.34 in the untreated group (P = .005). Average central macular thickness decreased from 384.4 ± 150.1 μm to 265 ± 112.5 μm in the bevacizumab-treated group (P = .0002) and from 413.2 ± 155.2 μm to 236.3 ± 103.5 μm in the untreated group (P = .008). The BCVA was significantly improved from baseline after 1 month in the bevacizumab-treated group (P = .02) and after 3 months in the untreated group (P = .01). However, there was no statistically significant difference in BCVA improvement or central macular thickness improvement achieved at the final visit. CONCLUSIONS Intravitreal bevacizumab injection likely hastens resolution of macular edema and hemorrhage secondary to retinal arterial macroaneurysm. Intravitreal bevacizumab injection could be an effective treatment option for symptomatic retinal arterial macroaneurysm.

Anti-vascular endothelial growth factor monotherapy in the treatment of submacular hemorrhage secondary to polypoidal choroidal vasculopathy.

PURPOSE To evaluate the effect of intravitreal anti-vascular endothelial growth factor (VEGF) injections on submacular hemorrhage secondary to polypoidal choroidal vasculopathy. DESIGN Retrospective, interventional case series. METHODS Twenty-seven eyes from 27 polypoidal choroidal vasculopathy patients with submacular hemorrhage involving the fovea were included in the analyses. All patients were treated by anti-VEGF injection with an initial 3 loading injections by month, followed by an as-needed reinjection. Visual acuity, central macular thickness, submacular hemorrhage size, and the occurrence of vitreous hemorrhage were examined during a 12-month follow-up period. RESULTS The mean number of injections administered over the course of 12 months was 3.59 ± 1.04. The size of submacular hemorrhages averaged 18.2 ± 13.8 mm². The mean logarithm of the minimal angle of resolution (logMAR) visual acuity at baseline was 1.02 ± 0.51 (Snellen equivalent, 20/204) and improved significantly to 0.76 ± 0.48 (Snellen equivalent, 20/115) at 12 months (P = .02). Mean central macular thickness decreased from 311.7 ± 124.5 μm at baseline to 246.8 ± 102.8 μm at 12 months (P = .01). At 12 months, visual acuity improved by 0.3 logMAR or more in 10 eyes (37%), stabilized (change between 0 and 0.3 logMAR) in 11 eyes (40.7%), and decreased by 0.3 logMAR or more in 6 eyes (22.2%). Three eyes (11.1%) were subjected to vitrectomy to clear a vitreous hemorrhage that occurred after anti-VEGF therapy. CONCLUSIONS Intravitreal anti-VEGF injection monotherapy may be a valuable therapeutic option in treating eyes with submacular hemorrhage associated with polypoidal choroidal vasculopathy.

Effects of vitreomacular adhesion on anti-vascular endothelial growth factor treatment for polypoidal choroidal vasculopathy.

Purpose: To evaluate the effect of posterior vitreomacular adhesion (VMA), documented by optical coherence tomography, on the outcome of anti–vascular endothelial growth factor treatment of polypoidal choroidal vasculopathy. Methods: Medical records of 102 patients (104 eyes) with polypoidal choroidal vasculopathy were retrospectively reviewed and categorized according to the presence of posterior VMA into 2 subgroups: VMA positive (+) group (23 eyes) and VMA negative (−) group (81 eyes). Best-corrected visual acuity and central macular thickness after antivascular endothelial growth factor treatment were compared between the 2 groups at baseline and at 1 month, 3 months, 6 months, and 12 months. Results: At the last follow-up, average number of injections was 4.82 ± 1.27 in the VMA (+) group and 4.92 ± 1.45 in the VMA (−) group. After injection, the mean logarithm of the minimum angle of resolution of best-corrected visual acuity improved from 0.81 ± 0.53 (Snellen equivalent, 20/129) to 0.67 ± 0.52 (Snellen equivalent, 20/93) in the VMA (+) group (P = 0.01) and from 0.79 ± 0.50 (Snellen equivalent, 20/123) to 0.64 ± 0.58 (Snellen equivalent, 20/91) in the VMA (−) group (P = 0.02). Average central macular thickness decreased from 354.4 ± 124.5 &mgr;m to 249.6 ± 112.5 &mgr;m in the VMA (+) group (P = 0.01) and from 361.2 ± 140.2 &mgr;m to 267.3 ± 103.5 &mgr;m in the VMA (−) group (P = 0.01). Polyp regression rate was 21.7% (5 eyes of 23 eyes) in the VMA (+) group and 22.2% (18 eyes of 81 eyes) in the VMA (−) group. There was no statistically significant difference in the best-corrected visual acuity improvement, central macular thickness improvement, and polyp regression rate between the groups. Conclusion: Unlike typical age-related macular degeneration, posterior VMA was not associated with a visual outcome after intravitreal antivascular endothelial growth factor for polypoidal choroidal vasculopathy.

Hemorrhagic complications after intravitreal ranibizumab injection for polypoidal choroidal vasculopathy

OBJECTIVE To evaluate clinical features and risk factors for hemorrhagic complications in eyes with polypoidal choroidal vasculopathy (PCV) after intravitreal ranibizumab injection. DESIGN Retrospective case series. PARTICIPANTS The charts of 54 patients with PCV who had received intravitreal ranibizumab 0.5 mg. METHODS The study was conducted as a retrospective chart review of 54 patients with PCV who had received intravitreal ranibizumab 0.5 mg. Analysis of 2 groups was based on mean PCV lesion size: < 15mm(2) (n = 24); or ≥ 15mm(2) (n = 32). The occurrence of fresh postoperative subretinal hemorrhage, best corrected visual acuity, systemic disease, and medication history were documented and analyzed. RESULTS The mean injection number was 3.3 ± 0.7 (range, 1 to 6), with a mean follow-up of 7.4 ± 2.8 months (range, 4 to 14 months). During the follow-up period, postoperative subretinal hemorrhage was observed in 5 (8.9%) of 56 eyes. Occurrence of postoperative hemorrhage was significantly increased in the group with large PCV size (p = 0.01). Pars plana vitrectomy was performed for postoperative bleeding that resulted in vitreous hemorrhage in 1 eye (1.8%). Various systemic diseases and medication with an anticoagulant had no correlation with occurrence of hemorrhagic complications. CONCLUSIONS Subretinal hemorrhage after ranibizumab injection can occur in patients with PCV. When considering ranibizumab injection for treatment of a large PCV lesion, the risk for hemorrhagic complications should be considered.

Comparison of spectral-domain and time-domain optical coherence tomography in solar retinopathy.

The purpose of this article is to compare spectral-domain (SD) and time-domain (TD) optical coherence tomography (OCT) findings in patients with solar retinopathy. Complete ocular examinations and OCT were performed in two patients presenting with acute solar retinopathy soon after observation of an eclipse. Both patients were evaluated with SD-OCT and TD-OCT at the same time. SD-OCT demonstrated characteristic defects at the level of the inner and outer segment junction of the photoreceptors in all the affected eyes and decreased reflectiveness of the retinal pigment epithelium layer. TD-OCT images showed unremarkable findings in two eyes with deteriorated visual acuity. SD-OCT improves diagnosis and assessment of the degree and nature of foveal damage in patients with solar retinopathy and may be an important tool for use in identifying foveal damage not detected by TD-OCT. SD-OCT may be preferable to TD-OCT for confirmation or assessment of the degree of foveal damage in patients with solar retinopathy.

Intravitreal ranibizumab injections with and without pneumatic displacement for treating submacular hemorrhage secondary to neovascular age-related macular degeneration.

Purpose: To evaluate the efficacy of intravitreal ranibizumab with and without pneumatic displacement for the treatment of submacular hemorrhage secondary to neovascular age-related macular degeneration. Methods: We retrospectively reviewed the medical records of 93 treatment-naive patients (93 eyes) with submacular hemorrhage secondary to neovascular age-related macular degeneration. All patients were treated with an initial series of 3 monthly intravitreal ranibizumab injections, followed by as-needed injections. For the patients treated with pneumatic displacement, expansive gas was injected at the time of the first ranibizumab injection. Results: Mean submacular hemorrhage area was 8.2 ± 5.8 disk areas, and mean symptom duration was 8.2 ± 5.2 days at baseline. Twelve months into treatment, the mean logarithm of the minimum angle of resolution of best-corrected visual acuity of all subjects significantly improved from 1.19 ± 0.55 (20/309) at baseline to 0.96 ± 0.39 (20/182, P = 0.007) at 12 months. The mean central foveal thickness also significantly improved from 473 ± 223 &mgr;m at baseline to 279 ± 134 &mgr;m (P < 0.001) at 12 months. However, no significant difference in best-corrected visual acuity and mean central foveal thickness between ranibizumab monotherapy (58 eyes) and combination therapy groups (35 eyes) was observed at 12 months. Conclusion: Intravitreal ranibizumab injections with and without pneumatic displacement are viable treatment options for submacular hemorrhage secondary to neovascular age-related macular degeneration.

Intravitreal ranibizumab injection for neovascular age-related macular degeneration in phakic versus pseudophakic eyes.

Purpose: To compare the effect of intravitreal ranibizumab injections for the treatment of neovascular age-related macular degeneration between phakic and pseudophakic eyes. Methods: We retrospectively reviewed the medical records of 110 patients with neovascular age-related macular degeneration receiving intravitreal ranibizumab therapy and categorized them into 2 subgroups: phakic group (75 eyes) and pseudophakic group (45 eyes). For all patients, the initial three loading injections were performed by month, and reinjection was performed as needed. Main outcome measures included best-corrected visual acuity and central macular thickness as assessed by optical coherence tomography. Results: The mean age of the patients was 72 ± 4.2 years, and the patients were followed up for an average of 18 ± 3.6 months. At the last visit, the average number of injections was 3.87 ± 1.18 in the phakic group and 3.62 ± 1.17 in the pseudophakic group. After injection, the mean logarithm of the minimum angle of resolution of best-corrected visual acuity improved from 0.88 ± 0.65 to 0.75 ± 0.66 in the phakic group and from 0.86 ± 0.54 to 0.74 ± 0.09 in the pseudophakic group. Average central macular thickness decreased from 561 ± 289 &mgr;m to 419 ± 216 &mgr;m in the phakic group and from 559 ± 232 &mgr;m to 429 ± 166 &mgr;m in the pseudophakic group. There was no statistically significant difference in the injection number, best-corrected visual acuity improvement was achieved, and central macular thickness improvement was achieved between the phakic group and pseudophakic group. Conclusion: The therapeutic effect of intravitreal ranibizumab injection for neovascular age-related macular degeneration did not show differences between phakic and pseudophakic eyes.

Spectral domain optical coherence tomography findings in acute retinal pigment epitheliitis.

OBJECTIVE To report spectral domain optical coherence tomography (SD-OCT) findings in 3 patients with acute retinal pigment epitheliitis (ARPE). DESIGN Retrospective chart review. METHODS Charts of three young patients with ARPE were reviewed. RESULTS In acute stage, SD-OCT demonstrated abnormal hyperreflectivity involving the photoreceptor outer segment layer and hyporeflectivity involving the associated RPE layer in all cases. In chronic stage, SD-OCT showed decreased abnormal reflectivity. In one case with incomplete recovery of visual acuity, disruption of the photoreceptor inner and outer segment (IS/OS) junction was demonstrated in chronic phase. CONCLUSIONS SD-OCT confirmed that the outer segments of foveal photoreceptors and the associated RPE layer were the primary affected sites with ARPE. Detection of integrity of the foveal IS/OS line in resolved ARPE could be helpful in prediction of visual prognosis.