Kaori Sayanagi

Intravitreal Bevacizumab for Choroidal Neovascularization Attributable to Pathological Myopia: One-Year Results

PURPOSE To assess the potential effect of intravitreal bevacizumab (IVB) (Avastin) on retinal function and anatomic recovery in eyes with choroidal neovascularization attributable to pathological myopia (mCNV). DESIGN Retrospective case series. METHODS setting: Institutional. patient population: Sixty-three eyes of 63 patients were treated with IVB for mCNV. intervention procedure: 1 mg of bevacizumab was injected into the vitreous via the pars plana. IVB was repeated after two to three months if there was fluorescein leakage in fluorescein angiogram (FA), apparent subretinal fluid in optical coherence tomography (OCT) persisted, or both. main outcome measurement: Best-corrected visual acuity (BCVA) and CNV size measured on FA. RESULTS IVB was performed one to six times during the first 12 months (mean, 2.4 +/- 1.4 times). The size of the mCNV decreased and the BCVA improved significantly (P < .01 for both comparisons). The BCVA improved more than three lines in 25 eyes (40%), worsened more than three lines in three eyes (5%), and was unchanged in 35 (56%) eyes 12 months after. Fluorescein leakage from the mCNV ceased in 30 eyes (48%), diminished in 28 (44%), and was unchanged in five (8%) eyes. Stepwise analysis showed that the number of IVB (P < .01), macular atrophy associated with mCNV (P < .05), and myopic atrophy (P < .05) were significant predictive factors for BCVA at 12 months. CONCLUSIONS Although the current study lacked a control group, IVB seems to be an effective treatment for mCNV after a long-term. The absence of chorioretinal atrophy and that of recurrence and persistency of mCNV are positive predictive factors.

Optical coherence tomographic findings of Macular holes and retinal detachment after vitrectomy in highly myopic eyes

PURPOSE Macular holes cause retinal detachments in highly myopic eyes. Because degenerative macular changes often coexist, biomicroscopic evaluation of macular hole status after retinal reattachment is sometimes difficult. We studied macular holes with retinal detachment after vitrectomy using optical coherence tomography and evaluated the anatomic status of the hole and factors associated with anatomic success. DESIGN Retrospective, nonrandomized, comparative study. PATIENTS Sixteen eyes that underwent vitrectomy for retinal detachment associated with a macular hole were included. Internal limiting membrane peeling with indocyanine green was performed in 14 eyes; the epiretinal membrane was peeled with a diamond-dusted membrane scraper alone in two eyes. All retinas reattached postoperatively. The follow-up period at the optical coherence tomography examination was at least 6 months. METHODS Optical coherence tomography was performed vertically and horizontally, and the presence of a persistent macular hole was determined. Other information was obtained from patient records. RESULTS The macular holes closed in seven of 16 eyes (44%). Age, sex, axial length, preoperative best-corrected visual acuity, duration of symptoms, preoperative refractive error, and the preoperative area of the retinal detachment were not significantly correlated with hole closure. Improved postoperative best-corrected visual acuity (P <.05) was significantly associated with macular hole closure, and more frequent visual improvement (P =.06) was of borderline significance. CONCLUSIONS The success rate was lower than those obtained in eyes without myopia or in myopic macular holes without retinal detachments. Macular hole closure may predict improved visual outcome for patients with retinal detachment and macular holes. Optical coherence tomography detects persistent macular holes in highly myopic eyes with retinal detachment.

Lacquer crack formation and choroidal neovascularization in pathologic myopia.

Purpose: To clarify the characteristics of choroidal neovascularization (CNV) due to myopic CNV (mCNV) and the relation to lacquer crack (LC) formation. Patients and Methods: Thirty-seven eyes with mCNV underwent fluorescein angiography (FA) and indocyanine green angiography (ICGA) using Heidelberg Retina Angiograph 2 (HRA2; Heidelberg, Germany). mCNV was detected by FA and ICGA; LCs were detected by late-phase ICGA. Results: Thirty-five eyes (95%) had classic mCNV, and 2 (5%) had occult CNV. LCs developed in 35 (95%) of 37 eyes. In 33 eyes (94%), classic mCNV originated from LCs; the 2 other eyes had small horizontal dotlike LCs, but mCNV originated from the adjacent area of LC. No occult CNV was associated with LCs. Two morphologic types of LCs were observed, linear (21 eyes [62%]) and stellate (12 eyes [32%]) from which mCNV originated, with no significant differences in parameters between the two types. Classic mCNV demonstrated well-delineated hyperfluorescence by late-phase ICGA in 10 eyes (29%), which was significantly correlated with absence of a dark rim (P = 0.022). Conclusions: ICGA using HRA2 provides more detailed information on mCNV and LCs. LC formation is essential for classic mCNV to develop. Morphologic variations of LCs were not different clinically. Late-phase hyperfluorescence, probably due to the absence of pigment epithelium around the mCNV, may represent its activity.

Foveal anatomical status and surgical results in vitrectomy for myopic foveoschisis

PurposeMyopic foveoschisis (MF), a major cause of visual loss in highly myopic patients, shows varied foveal anatomic characteristics. We determined how the foveal status is related to surgical results in MF.MethodsForty-four eyes underwent vitrectomy for MF, including internal limiting membrane (ILM) peeling and gas tamponade. The eyes were divided into three groups depending on the preoperative foveal anatomy: foveal detachment (FD, n = 17), retinoschisis (RS, n = 16), and macular hole (MH, n = 11). Best-corrected visual acuity (BCVA) and optical coherence tomographic findings preoperatively and 3, 6, and 12 months postoperatively were obtained and compared.ResultsBCVA improved two lines or more in 81% of the FD group, 50% of the RS group, and 45% of the MH group 12 months postoperatively. The FD group had significantly improved vision (P < 0.01). Visual improvement was borderline in the RS group (P = 0.057) and not significant in the MH group. Visual improvement was significantly better in FD eyes than in RS (P < 0.05) or MH (P < 0.01) eyes. In FD and RS eyes, the postoperative BCVA was significantly correlated with age (P < 0.05) and preoperative BCVA (P < 0.01), whereas visual improvement was correlated with symptom duration (P < 0.05) and preoperative BCVA (P < 0.01).ConclusionsVitrectomy including ILM peeling and gas tamponade is safe and effective for MF. Patients with FD showed the most visual improvement postoperatively and therefore can obtain the most benefit from the surgery. Surgery also benefits RS and MH patients by preserving vision. The foveal status, age, duration of symptoms, and preoperative BCVA are key factors determining postoperative visual outcome in MF.

Photoreceptor Inner and Outer Segment Defects in Myopic Foveoschisis

PURPOSE To evaluate pathologic features of the photoreceptors in myopic foveoschisis with the Fourier-domain optical coherence tomography (FD-OCT). DESIGN Observational case series. METHODS Seventeen eyes of 15 patients with myopic foveoschisis (foveal detachment type, six eyes; foveoschisis type, 11 eyes) were included. We observed the photoreceptor inner and outer segments (IS/OS) and evaluated the morphologic status using FD-OCT. Fundus photographs and time-domain OCT (TD-OCT) images also were obtained. RESULTS IS/OS defects, which are uncommon in retinal detachments in eyes with myopia, were seen clearly in five eyes (three eyes [50%] with the foveal detachment type; two eyes [18%] with the foveal schisis type). Fundus photographs showed myopic chorioretinal atrophy in eight study eyes (47%), including diffuse atrophy in four eyes (24%) and patchy atrophy in four eyes (24%). The IS/OS defects on FD-OCT were accompanied by myopic chorioretinal atrophy in three (60%) of five eyes. CONCLUSIONS FD-OCT enables observation of more detailed retinal structures in these myopic eyes. The IS/OS defects may be specific to, but are not rare, in myopic foveoschisis and may predict the postoperative visual recovery.

En-face high-penetration optical coherence tomography imaging in polypoidal choroidal vasculopathy.

Aim To observe the choroidal microstructure in polypoidal choroidal vasculopathy (PCV) using high-penetration optical coherence tomography (HP-OCT) with a long-wavelength light source that visualises tissue beneath the retinal pigment epithelium (RPE) and deep choroid, and to compare the findings with those of indocyanine green angiography (ICGA). Methods In this retrospective, non-invasive, observational case series, 19 eyes (18 patients) with PCV were observed using HP-OCT (swept source, 100 000 A-scans/s, 1060 nm wavelength) and ICGA. The HP-OCT scan protocol was a 3×3-mm or 6×6-mm square containing 256×256 or 512×128 A-scans. The choroidal thickness (CT) was measured using HP-OCT. Results ICGA showed 43 polypoidal lesions in 14 eyes and a vascular network in 17 eyes. HP-OCT showed 41 of the 43 polypoidal lesions visualised by ICGA as RPE rings with inner reflectivity and 15 eyes with a vascular network. Six eyes with RPE rings with inner reflectivity on HP-OCT were not visualised on ICGA images. The choroidal vascular network was dilated in 14 (33%) of 43 polypoidal lesions and 22 (47%) of 47 polypoidal lesions on ICGA and HP-OCT images, respectively. The mean CT at the fovea was 250 μm. The CT at the dilated choroidal vessels beneath the polypoidal lesions was significantly (p = 0.0095) thicker than that of the undilated choroidal vessels beneath the polypoidal lesions. Conclusions HP-OCT can visualise choroidal vascular abnormalities in eyes with PCV and should be useful for understanding the pathogenesis of these abnormalities.

Marginal crack after intravitreal bevacizumab for myopic choroidal neovascularization

Purpose:  To report new indocyanine green angiographic (ICGA) findings after intravitreal bevacizumab (IVB) for myopic choroidal neovascularization (mCNV).

Residual Indocyanine Green Fluorescence Pattern after Vitrectomy for Idiopathic Macular Hole with Internal Limiting Membrane Peeling

Background: Internal limiting membrane (ILM) peeling with indocyanine green (ICG) staining is a commonly used procedure to treat idiopathic macular holes (MH). Aim: To report changes in the patterns of residual ICG fluorescence over time after vitrectomy using the Heidelberg Retina Angiograph 2 (HRA2, Heidelberg Engineering, Heidelberg, Germany). Methods: 10 patients (10 eyes) who had undergone vitrectomy for MH with ILM peeling were included. 9 (90%) patients underwent ILM peeling with ICG, and 1 (10%) patient had it with triamcinolone acetonide (TA). We observed residual ICG using HRA2, postoperatively. Autofluorescence, optical coherence tomography images and best-corrected visual acuity (BCVA) measurements were also obtained. The minimal follow-up was 3 months. Results: The MHs were closed postoperatively in all patients (100%). In eyes that underwent ILM peeling with ICG, the BCVA improved significantly (p<0.001) in 8 (89%) eyes and was unchanged in 1 (11%) eye. HRA2 showed the ICG fluorescence patterns but not TA postoperatively. The ICG hyperfluorescent signal was typically diffuse at the posterior retina and was hypofluorescent around the fovea. The hyperfluorescence then migrated towards the optic nerve disc presumably along the nerve fibre, and the area of ILM peeling was clearly identified. A large number of hyperfluorescent dots were observed instead of diffuse hyperfluorescence that was observed just after surgery. Conclusions: Patterns of residual ICG fluorescence were sequentially observed with HRA2 after vitrectomy for MH with ICG-assisted ILM peeling.

Transient Choroidal Thinning after Intravitreal Bevacizumab Injection for Myopic Choroidal Neovascularization

Purpose: To evaluate the choroidal thickness changes in the eyes with myopic choroidal neovascularization (mCNV) after intravitreal injection of bevacizumab (IVB). Methods: Ten highly myopic eyes with mCNV treated with IVB were included. All patients underwent a single, horizontal B-scan image centered on the fovea, before, and 1 month and 3 month after IVB using Heidelberg optical coherence tomography (OCT). Choroidal thickness (CT) defined as the distance from the retinal pigment epithelium to the chorio-scleral interface in OCT image at the fovea, 2mm nasally and 2mm temporally was measured. Results: Foveal mean CT was 52.8 microns before IVB, and it significantly decreased to 37.5 microns 1 month after (P<0.05). Similarly, the 2mm temporal mean CT was 80.5 microns before IVB, and it significantly decreased to 69.5 microns 1 month after (P<0.05). On 3 months after IVB, mean CT at the fovea improved to 48.9 microns (P=0.67); however, the mean temporal CT remained thin as 67.0 microns (P=0.07 vs. baseline). The mean nasal CT remained at the similar throughout the follow-up (P=0.90 and 0.56) The change in CT on 1 month after IVB was significantly correlated with age and preoperative CT (P=0.01 and 0.04, respectively). Conclusions: Subfoveal and temporal choroidal thinning is transiently observed. IVB may affect the choroidal circulation in such myopic eyes as with thin choroid.

Chediak-Higashi syndrome with progressive visual loss.

BACKGROUND The change of visual function in Chediak-Higashi syndrome has not been well described. CASES The visual function of a 12-year-old Japanese girl with ocular albinism due to Chediak-Higashi syndrome was followed by periodic ophthalmological examinations. OBSERVATIONS A lack of pigmentation in the iris and ocular fundus, and pigmentary degeneration of the peripheral retina were observed. The visual loss and the constriction of visual field progressed with increasing age. The electroretinogram was extinguished at 12 years of age. CONCLUSIONS The constriction of the visual field may be due to the pigmentary degeneration of the ocular fundus. Ophthalmologists should be aware that progressive visual loss and the constriction of visual field can occur in patients with Chediak-Higashi syndrome as they grow older.