Hideo Ohtsuka

One-Year Results of Three Monthly Ranibizumab Injections and As-Needed Reinjections for Polypoidal Choroidal Vasculopathy in Japanese Patients

PURPOSE To investigate the 1-year outcomes of monthly intravitreal injections of ranibizumab for 3 months followed by an as-needed reinjection schedule to treat polypoidal choroidal vasculopathy (PCV) in Japanese patients. DESIGN Prospective, consecutive case series. METHODS Eighty-five eyes of 82 consecutive Japanese patients with naïve symptomatic PCV received monthly intravitreal injections of ranibizumab for 3 months followed by an as-needed reinjection schedule. Eighty-one eyes (95%) followed for 1 year were studied. RESULTS A mean of 4.2 ± 1.3 (mean ± standard deviation) injections were administered over 1 year. Twenty-three of 81 eyes (28%) did not require additional injections and 32 eyes (40%) required only 1 injection after the 3 monthly injections. The mean (± standard error) logarithm of minimal angle of resolution (logMAR) visual acuity (VA) at baseline was 0.59 ± 0.37 and improved to 0.37 ± 0.30 (P = .001). Thirty eyes (37%) and 5 eyes (6%), respectively, had improved and decreased VA of 0.3 or more logMAR unit. Indocyanine green angiography showed that the polypoidal lesions resolved in 21 eyes (26%) and 32 eyes (40%) 3 months and 1 year after the first injection, respectively. Abnormal choroidal vessels remained in all eyes. CONCLUSIONS Monthly injections of ranibizumab for 3 months to treat PCV improved the VA, and a reinjection schedule based on need maintained the improved VA. The polypoidal lesions tended to improve over 1 year, whereas abnormal choroidal vessels remained in all eyes. Further long-term follow-up is needed to determine the efficacy of ranibizumab therapy for PCV.

Comparison of one-year outcomes between 23- and 20-gauge vitrectomy for preretinal membrane.

PURPOSE To compare the outcomes of transconjunctival sutureless 23-gauge vitrectomy and conventional 20-gauge vitrectomy 1 year after removal of preretinal membrane. DESIGN Retrospective, consecutive, comparative case series. METHODS One hundred consecutive eyes with a preretinal membrane underwent either 23- and 20-gauge vitrectomy. The rate of improvement of the logarithm minimum angle of resolution visual acuity (VA) was calculated by the formula: (various postoperative values-preoperative values) x 100/ (1 year postoperative values-preoperative values). RESULTS No significant differences were found between the groups in the preoperative and postoperative VAs. The VA improvement was higher and the surgically induced corneal astigmatism was lower 1 week postoperatively in the 23-gauge group compared with the 20-gauge group (P = .006 and P = .001, respectively). The flare values in the anterior chamber measured by laser flare meter preoperatively and 1 week postoperatively did not differ between the groups. The surgical time was significantly (P = .023) shorter in the 23-gauge group than in the 20-gauge group. No apparent complications developed in either group. CONCLUSION Transconjunctival sutureless 23-gauge vitrectomy appears effective for preretinal membrane surgery with an acceptable safety profile. Transconjunctival sutureless 23-gauge vitrectomy may be a treatment option for preretinal membranes.

Improvement of Angiographic Findings of Polypoidal Choroidal Vasculopathy After Intravitreal Injection of Ranibizumab Monthly for 3 Months

PURPOSE To evaluate the efficacy of 1 intravitreal injection of ranibizumab monthly for 3 months in eyes with polypoidal choroidal vasculopathy (PCV), with attention to changes on indocyanine green angiography (ICGA) with confocal scanning laser ophthalmoscopy (cSLO). DESIGN Prospective, consecutive case series. METHODS Fifty consecutive eyes of 50 patients with symptomatic PCV who had not been treated previously received 1 intravitreal injection of 0.5 mg ranibizumab monthly for 3 months. Changes in ICGA findings with cSLO 3 months after the primary injection were evaluated. RESULTS The mean visual acuity (VA) at baseline (0.25; range, 0.1-0.8) improved to 0.38 (P = .001) 3 months after the primary injection. Nineteen eyes (38%) had an improvement in VA of 0.3 or more logMAR unit, and 5 eyes (10%) had a decrease in VA of 0.3 or more logMAR unit. Polypoidal lesions disappeared on ICGA in 13 eyes (26%) and the number of lesions decreased but did not disappear in 26 eyes (52%), with absorption of the accompanying fluid on optical coherence tomography. The remaining 11 eyes (22%) had unchanged or worsened polypoidal lesions. A branching vascular network remained in all 48 eyes in which the network was detected at baseline. Although resolution of the branching vascular networks or decreased diameter of the branching vascular network occurred in 11 eyes (23%), the branching vascular network was unchanged or worse in 37 eyes (77%). CONCLUSION Although a limitation of this study is the short-term follow-up, polypoidal lesions tended to respond to ranibizumab therapy, but the branching vascular network responded poorly.

Results of 2 years of treatment with as-needed ranibizumab reinjection for polypoidal choroidal vasculopathy

Purpose To investigate the 2-year outcomes of three monthly intravitreal ranibizumab injections followed by as-needed reinjections to treat polypoidal choroidal vasculopathy (PCV). Methods Seventy-five consecutive eyes with naïve symptomatic PCV with 2 years of follow-up after treatment were studied prospectively. Results The mean (±SD) numbers of injections were 4.2±1.3 that included three monthly injections in the loading phase and 1.6±1.7 during years 1 and 2, respectively (mean 2-year total, 5.6±1.9). The baseline logarithm of the minimum angle of resolution visual acuity (VA) was 0.59±0.51 that improved significantly (p=0.001 for both comparisons) to 0.37±0.33 and 0.41±0.40 at 1 and 2 years, respectively, after the first injection. Although no significant difference was found between years 1 and 2 after the first injection, the VA tended to decrease slightly during year 2. The improved foveal thickness was maintained during year 2. Thirty (40%) eyes and 19 (25%) eyes, respectively, at years 1 and 2 after the first injection had no polypoidal lesions on indocyanine green angiography. A branching vascular network (BVN) remained in all eyes 2 years after the first injection and tended to increase in size during year 2. Conclusions The 2-year outcomes showed significant VA and foveal thickness improvements in eyes with PCV. During year 2, the magnitude of the improvement was lower compared with year 1. An as-needed reinjection schedule might not prevent polypoidal lesions or BVNs from regrowing. Further investigations should establish a treatment strategy for PCV.

Two-year outcomes of intravitreal bevacizumab therapy for macular oedema secondary to branch retinal vein occlusion

Aim To determine the 2-year outcomes of intravitreal bevacizumab (IVB) injections in eyes with macular oedema (ME) following branch retinal vein occlusion (BRVO). Methods Of 105 consecutive eyes (105 treatment-naïve patients) with ME following BRVO, 89 eyes were followed for 2 years after the first injection. During the 2-year follow-up period, patients were examined at least every 3 months and received an IVB injection (1.25 mg/0.05 mL) if they met prespecified retreatment criteria. Rescue grid laser was permitted based on the findings of the Branch Vein Occlusion Study. Results The baseline logarithm of the minimum angle of resolution visual acuity (VA) was 0.64±0.24 (mean±SD), which significantly (p=0.001) improved 1 month after the first injection to 0.39±0.22. One year after the first injection, VA improved significantly (p=0.001) to 0.33±0.21 and remained 0.34±0.21 until 2 years after the first injection (p=0.001). The changes in foveal thickness were correlated with those of VA during the 2-year follow-up period with a mean of 3.8±1.5 injections (including the first injection). Conclusions This relatively large case series study showed favourable 2-year outcomes using bevacizumab to treat ME following BRVO. Bevacizumab provides substantial long-term benefits in the treatment of ME following BRVO.

Factors predictive of visual acuity outcomes 1 year after photodynamic therapy in Japanese patients with polypoidal choroidal vasculopathy.

Purpose: The purpose of this study was to determine the factors predictive of visual acuity (VA) outcomes 1 year after photodynamic therapy (PDT) for polypoidal choroidal vasculopathy. Methods: We prospectively studied 220 eyes of 210 Japanese patients with polypoidal choroidal vasculopathy treated with primary application of PDT. A stepwise logistic regression model was used to estimate the independent factors predictive of better VA and improvement of VA 1 year after the primary PDT. Results: Visual acuities at the various follow-up evaluations improved significantly compared with baseline (P = 0.001 for all comparisons). The VA improved and decreased more than 0.3 logarithm of minimum angle of resolution unit 1 year after the primary PDT in 55 (25%) and 21 (10%) eyes, respectively. Stepwise logistic regression analysis showed that younger age, smaller greatest linear dimension, better baseline VA, and less baseline hemorrhage were significant and independent factors predictive of better VA 1 year after PDT, and younger age, smaller greatest linear dimension, better baseline VA, less hemorrhaging, and the presence of a serous macular detachment at baseline were significant and independent factors predictive of VA improvement. Conclusion: Photodynamic therapy stabilized eyes anatomically and functionally. Clinical characteristics at baseline were predictors of favorable VA outcomes after PDT. These findings may help establish the strategy of treatment for polypoidal choroidal vasculopathy.

Factors predictive of outcomes 1 year after 3 monthly ranibizumab injections and as-needed reinjections for polypoidal choroidal vasculopathy in Japanese patients.

Purpose: To determine baseline factors predictive of outcomes 1 year after 3 monthly intravitreal ranibizumab injections followed by as-needed injections for polypoidal choroidal vasculopathy. Methods: A nonrandomized prospective 1-year trial collected data from 144 Japanese patients (144 eyes) with symptomatic polypoidal choroidal vasculopathy who received one 0.5-mg intravitreal ranibizumab injection monthly for 3 months followed by as-needed retreatments. Statistical analysis evaluated baseline independent factors predictive of better visual acuity and the need for fewer injections 1 year after the first injection. Results: After the initial 3 monthly injections, a mean ± standard deviation of 1.2 ± 1.1 as-needed injections was administered. The mean visual acuity improved significantly (P < 0.01) from 20/80 to 20/50. Better visual acuity and no history of photodynamic therapy or clusters of grape-like polypoidal lesions were significant independent baseline factors predictive of better visual acuity 1 year after the first injection. No factors were significantly associated with a need for fewer ranibizumab reinjections during follow-up. Conclusion: The baseline clinical characteristics predicted favorable visual acuity outcomes. These findings might be useful to explaining the prognosis of ranibizumab treatment to the patients with polypoidal choroidal vasculopathy.

Incidence of retinal breaks in eyes undergoing 23-gauge or 20-gauge vitrectomy with induction of posterior vitreous detachment.

Purpose: To compare the incidence rates of retinal breaks in eyes in which posterior vitreous detachment was induced during 23-gauge and 20-gauge vitrectomies to treat macular holes or preretinal membranes. Methods: We retrospectively reviewed 122 eyes of 115 patients with a macular hole or preretinal membrane who underwent induction of posterior vitreous detachment during 23-gauge vitrectomy (23-gauge group) and 61 eyes of 58 consecutive patients with the disorders who underwent induction of posterior vitreous detachment during 20-gauge vitrectomy performed by 1 surgeon. Results: No difference was found in the incidence rates of intraoperative retinal breaks between the 23-gauge (16% [20/122]) and 20-gauge (16% [10/61]) groups. A postoperative rhegmatogenous retinal detachment developed in 2 (2%) eyes in the 23-gauge group, whereas no eyes in the 20-gauge group had postoperative retinal breaks or rhegmatogenous retinal detachment. The incidence rates of retinal breaks in eyes with a macular hole and preretinal membrane did not differ significantly. Conclusion: Posterior vitreous detachment induced during vitrectomy frequently results in intraoperative retinal breaks, the incidence of which may be independent of the gauge of the vitreous instruments. Surgeons should be alert to the development of retinal breaks.

23- and 20-Gauge Vitrectomy with Air Tamponade with Combined Phacoemulsification for Idiopathic Macular Hole: A Single-Surgeon Study

PURPOSE To compare the results of 23- and 20-gauge vitrectomies combined with phacoemulsification and aspiration and intraocular lens implantation (phacoemulsification surgery) 1 year after repair of idiopathic macular holes. DESIGN Retrospective, consecutive, comparative case series. METHODS The medical charts of 100 consecutive eyes were reviewed that had undergone either 23- or 20-gauge vitrectomy combined with phacoemulsification surgery to treat an idiopathic macular hole performed by 1 surgeon. The rate of improvement of the logarithm of the minimal angle of resolution visual acuity (VA) was calculated using the formula: (postoperative value - preoperative value) × 100/(1-year postoperative value - preoperative value). RESULTS The macular holes closed successfully after the primary vitrectomy in all eyes in both groups. Although the VAs did not differ significantly before surgery or 1 year after surgery between the 2 groups, the VA improvement was significantly greater 1 and 3 months after surgery (P = .02, for both) in the 23-gauge group compared with the 20-gauge group. The induced corneal astigmatism levels 1 week and 1 and 3 months after surgery were significantly lower (P = .01, P = .01, and P = .03, respectively) and the surgical time was significantly shorter (P = .01) in the 23-gauge group than in the 20-gauge group. No apparent complications developed in either group. CONCLUSIONS Since 23-gauge vitrectomy combined with phacoemulsification surgery is advantageous because the VA improved rapidly after treating the macular holes with an acceptable safety profile, idiopathic macular holes are a good indication for 23-gauge vitrectomy combined with phacoemulsification surgery.

Causes of macular serous retinal detachments in Japanese patients 40 years and older.

Purpose: To investigate the causes of macular serous retinal detachment without hemorrhage at the macula in patients 40 years and older. Methods: Seventy-one eyes of 71 consecutive Japanese patients 40 years and older with the disease were examined using optical coherence tomography, digital simultaneous fluorescein and indocyanine green angiographies with a confocal laser scanning system. Results: Of 71 eyes, 17 eyes (24%) had central serous chorioretinopathy, including three eyes with chronic central serous chorioretinopathy, 40 eyes (56%) had polypoidal choroidal vasculopathy (PCV), 10 eyes (14%) had occult choroidal neovascularization secondary to age-related macular degeneration, one had Harada disease, and another had retinal macroaneurysms. In two eyes, the diagnosis could not be established because of difficulty differentiating among chronic central serous chorioretinopathy, PCV, and occult choroidal neovascularization. Thirty-eight of 59 (64%) eyes of patients in the sixth decade of life and older had PCV. Conclusions: Polypoidal choroidal vasculopathy is a primary cause of macular serous retinal detachment without hemorrhage in Japanese patients over 50 years of age. Since clinical and fluorescein angiographic findings are indistinguishable among central serous chorioretinopathy, PCV, and occult choroidal neovascularization, indocyanine green angiography might help to establish a more definitive diagnosis.