Jae Hui Kim

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.

PREVALENCE OF SUBTYPES OF RETICULAR PSEUDODRUSEN IN NEWLY DIAGNOSED EXUDATIVE AGE-RELATED MACULAR DEGENERATION AND POLYPOIDAL CHOROIDAL VASCULOPATHY IN KOREAN PATIENTS.

Purpose: To evaluate the prevalence and characteristics of subtypes of pseudodrusen in newly diagnosed exudative age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). Methods: This retrospective cross-sectional study included 321 eyes of 321 patients who were newly diagnosed with exudative AMD or PCV. Reticular pseudodrusen was classified into dot pseudodrusen and ribbon pseudodrusen; the prevalence of each subtype was estimated and compared between exudative AMD excluding retinal angiomatous proliferation (RAP), PCV, and RAP. Patient age and choroidal thickness were compared between patients with dot pseudodrusen only and those with ribbon pseudodrusen. Results: The prevalence of reticular pseudodrusen was 13.9% (15 of 108 eyes) in exudative AMD excluding RAP, 3.4% (6 of 175 eyes) in PCV, and 68.4% (27 of 38 eyes) in RAP. Among the eyes with pseudodrusen, dot pseudodrusen and ribbon pseudodrusen were noted in 100% and 40.0%, respectively, in exudative AMD excluding RAP, 100% and 16.7%, respectively, in PCV, and 96.2% and 69.2%, respectively, in RAP. Ribbon pseudodrusen was more frequently observed in RAP (P = 0.032). Patients with ribbon pseudodrusen were significantly older (77.3 ± 6.6 years vs. 72.9 ± 8.1 years, P = 0.042) than those with dot pseudodrusen only. Conclusion: The markedly higher incidence of ribbon pseudodrusen in RAP may suggest possible influence of ribbon pseudodrusen on the development of RAP.

Short-term choroidal thickness changes in patients treated with either ranibizumab or aflibercept: a comparative study

Purpose To compare, in neovascular age-related macular degeneration (AMD) patients, short-term choroidal thickness changes in eyes treated using ranibizumab with those in eyes treated using aflibercept. Methods This retrospective, observational study included 240 eyes from 240 patients who had been diagnosed with treatment-naive neovascular AMD and treated using three monthly injections of either ranibizumab (ranibizumab group) or aflibercept (aflibercept group). The choroidal thickness change between the time of diagnosis and 3 months later was compared between the two groups. Eyes were then classified into three disease groups: typical neovascular AMD, polypoidal choroidal vasculopathy (PCV) and retinal angiomatous proliferation (RAP). Within each disease group, choroidal thickness change was again compared between the two treatment groups. Results In the ranibizumab group (n=155), the mean choroidal thicknesses at diagnosis and at 3 months were 255.3±103.9 μm and 242.9±104.8 μm, respectively. In the aflibercept group (n=85), the values were 277.5±119.1 μm and 254.7±114.5 μm, respectively. The decrease was significantly greater in the aflibercept group (p<0.001). In the PCV group, the decrease was greater in the aflibercept group (p=0.001), whereas the difference was not significant in either the typical neovascular AMD group or the RAP group. Conclusions A greater decrease in choroidal thickness was noted in eyes treated with aflibercept than in eyes treated with ranibizumab. This difference was more marked in PCV than in other subtypes of neovascular AMD.

Fellow-eye neovascularization in unilateral retinal angiomatous proliferation in a Korean population.

To evaluate the incidence of fellow‐eye neovascularization in retinal angiomatous proliferation (RAP) in a Korean population and associated risk factors.

Choroidal Vascular Hyperpermeability and Punctate Hyperfluorescent Spot in Choroidal Neovascularization

PURPOSE To evaluate the prevalence of choroidal vascular hyperpermeability and punctate hyperfluorescent spots in eyes with choroidal neovascularization (CNV). METHODS This retrospective, observational study included 382 eyes with typical exudative AMD (97 eyes), polypoidal choroidal vasculopathy (PCV, 163 eyes), retinal angiomatous proliferation (RAP, 37 eyes), or myopic CNV (86 eyes). The prevalence of choroidal vascular hyperpermeability and punctate hyperfluorescent spots was estimated based on available indocyanine green angiography (ICGA) images. RESULTS Choroidal vascular hyperpermeability was noted in 12.4% (12 eyes) and 26.9% (42 eyes) of eyes with typical exudative AMD and PCV, respectively. Choroidal vascular hyperpermeability was not noted in any eye with RAP or myopic CNV. Punctate hyperfluorescent spots were noted in 43.3% (42 eyes), 72.4% (118 eyes), 10.8% (4 eyes), and 4.7% (4 eyes) of eyes with typical exudative AMD, PCV, RAP, and myopic CNV, respectively. Of the 56 eyes with choroidal vascular hyperpermeability, punctate hyperfluorescent spots were noted in 55 eyes (98.2%). CONCLUSIONS Choroidal vascular hyperpermeability and punctate hyperfluorescent spots may have a common pathophysiology. Although choroidal vascular hyperpermeability and punctate hyperfluorescent spots have been thought to be associated with pathologic conditions, the markedly low prevalence of these findings in eyes with RAP and myopic CNV may not be a normal finding. It is possible that compromised choroidal perfusion, with or without associated with choroidal thinning, may lead the low prevalence of these abnormalities in eyes with these two disorders.

Small retinal haemorrhages accompanied by macular soft drusen: prevalence, and funduscopic and angiographic characteristics

Purpose To investigate the prevalence and clinical significance of small retinal haemorrhages accompanied by macular soft drusen in exudative age-related macular degeneration (AMD). Methods This observational case series included patients who had first been diagnosed with exudative AMD. Small retinal haemorrhages were defined as preretinal or intraretinal haemorrhages, no larger than half the disc diameter in size and located within 3000 μm of the fovea centre. If there was more than one haemorrhage, the entire affected area was less than two-thirds of the disc diameter. Macular soft drusen was defined as the presence of soft drusen (≥125 μm in diameter) within the macular area. The presence of retinal angiomatous proliferation (RAP) was estimated based on the results of indocyanine green angiography (ICGA). The prevalence of reticular pseudodrusen was also estimated. Results Among the 1921 eyes from 1604 patients who were newly diagnosed with exudative AMD during the 40 months prior to the study, 101 eyes (5.3%) from 79 patients presented with the fundus characteristics described above. ICGA images were available for 69 eyes. Among these eyes, 28 eyes (43.1%) and 25 eyes (38.5%) were found to have type 1 and 2 RAP, respectively. A chorioretinal anastomosis (type 3 RAP) was identified in 12 (18.5%) eyes. Reticular pseudodrusen were noted in 78 eyes (77.2%). Conclusions The presence of small retinal haemorrhages accompanied by macular soft drusen was highly predictive of RAP. The high prevalence of both soft drusen and reticular pseudodrusen in these eyes may suggest a profound decrease in choroidal perfusion in these eyes.

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.

Clinical Outcomes of Eyes with Submacular Hemorrhage Secondary to Age-related Macular Degeneration Treated with Anti-vascular Endothelial Growth Factor.

Purpose To evaluate the long-term outcomes of intravitreal anti-vascular endothelial growth factor (VEGF) monotherapy for patients diagnosed with submacular hemorrhage secondary to exudative age-related macular degeneration. Methods This retrospective, observational study included 49 patients (49 eyes) who initially presented with submacular hemorrhage associated with exudative age-related macular degeneration and who were followed-up for at least 24 months. Only eyes that were treated with intravitreal anti-VEGF monotherapy were included in the study. Best-corrected visual acuity (BCVA) measurements obtained at diagnosis, six months, and the final visit were compared. The associations of BCVA at the final visit with baseline BCVA, BCVA at six months, symptom duration, hemorrhage extent, and central foveal thickness were also analyzed. Results Over the course of follow-up (mean, 32.1 ± 8.5 months), an average of 5.1 ± 2.2 anti-VEGF injections were administered. Recurrent hemorrhage was noted in 13 eyes (26.5%). The mean logarithm of the minimal angle of resolution BCVA at diagnosis, six months, and the final visit were 1.40 ± 0.52, 0.87 ± 0.64, and 1.03 ± 0.83, respectively. Both baseline BCVA (p = 0.012) and BCVA at six months (p < 0.001) were significantly associated with BCVA at the final visit. Conclusions Improved visual acuity was maintained for more than two years with intravitreal anti-VEGF monotherapy. BCVA at six months is a useful clinical index to predict long-term visual prognosis.

Long-Term Outcomes in Patients with Neovascular Age-Related Macular Degeneration Who Maintain Dry Macula after Three Monthly Ranibizumab Injections

ABSTRACT Purpose: To evaluate long-term changes in visual acuity and retinal microstructure in patients with neovascular age-related macular degeneration (AMD) who had maintained dry macula after initial treatment. Methods: This retrospective observational study included 55 eyes that were diagnosed with neovascular AMD, were treated with three monthly ranibizumab injections, and maintained dry macula during a two-year follow-up. Best-corrected visual acuity (BCVA) at three months and at the final follow-up were compared, and the degree of visual improvement was compared between eyes with and without improvement of the ellipsoid zone. In addition, the incidence of improvement of the ellipsoid zone was compared between eyes with different extents of disruption. Results: The mean follow-up period was 30.3 ± 4.1 months. BCVA at three months and at the final follow-up was 0.51 ± 0.46 and 0.45 ± 0.49 (P<0.001). Among 35 eyes that exhibited >200 μm of disruption of the ellipsoid zone, 15 (42.9%) showed improvement of the ellipsoid zone, and the improvement in BCVA was greater in these eyes than that in the remaining 20 eyes (P=0.021). A higher incidence of improvement of the ellipsoid zone was noted in eyes with 200 to 800 μm of disruption than in eyes with >800 μm of disruption (P<0.001). Conclusions: Long-term improvement in visual acuity was noted in eyes that had maintained dry macula after three ranibizumab injections. The status of the ellipsoid zone at three months was closely associated with visual improvement.

Short-term efficacy of intravitreal triamcinolone acetonide for bevacizumab-resistant diabetic macular oedema

Kaprio J & Koskenvuo M (2002): Genetic and environmental factors in complex diseases: the older Finnish Twin Cohort. Twin Res 5: 358–365. Neale MC, Boker SM, Xie G & Maes HH (2003). Mx: statistical modeling, 6th Edn. Richmond, VA: Department of Psychiatry. Park SH, Park KH, Kim JM & Choi CY (2010): Relation between axial length and ocular parameters. Ophthalmologica 224: 188–193. Pärssinen O, Jauhonen HM, Kauppinen M, Kaprio J, Koskenvuo M & Rantanen T (2010): Heritability of spherical equivalent: a population-based twin study among 63to 76-year-old female twins. Ophthalmology 117: 1908–1911. Pärssinen O, Kauppinen M, Kaprio J, Koskenvuo M & Rantanen T (2013): Heritability of corneal refraction and corneal astigmatism: a population-based twin study among 66to 79-year-old female twins. Acta Ophthalmol 91: 40–44.