Kaori Soga

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.

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.

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.

Fundus autofluorescence related to retinal morphological and functional changes in idiopathic macular holes

Purpose:  To investigate fundus autofluorescence (FAF) characteristics in relation to morphological and functional features of idiopathic macular hole (IMH).

Choroidal vascular hypofluorescence in indocyanine green angiography of high myopia

The choroidal circulation in high myopia decreases in conjunction with ocular enlargement experimentally and clinically.1 2 Using indocyanine green angiography (ICGA), investigators have reported narrowing and loss of the large choroidal vessels during the follow-up period.3 4 ICGA is a useful diagnostic tool with which to observe the choroidal circulation, and Heidelberg retina angiography 2 (HRA2; Heidelberg Engineering, Heidelberg, Germany) is a confocal laser scanning system that provides a higher resolution of ICGA compared with the conventional fundus camera. In the current study, we report a new finding of choroidal vasculature seen on HRA2-ICGA. ### Case 1 A 78-year-old woman had myopic choroidal neovascularization (mCNV) in her right eye. The best-corrected visual acuity (BCVA) was 20/40. The axial length was 27.93 mm. Fluorescein angiography (FA) and fundus photography showed subfoveal choroidal neovascularization (CNV) and several patchy atrophies. Early-phase HRA2-ICGA showed a filling delay, and late-phase HRA2-ICGA showed several linear hypofluorescences that corresponded exactly with the choroidal vessels that were perfused in the early. Conventional ICGA did not detect linear hypofluorescence (figs 1A–D, 2). Figure 1 HRA2-indocyanine green angiography (ICGA), conventional ICGA, fluorescein angiography (FA) and fundus photography from case 1. (A) Early-phase HRA2-ICGA showing normal choroidal circulation (arrows) except for a localized filling delay at the macula. An area of …

Wavefront analysis and ultrastructural findings in an eye with posterior lentiglobus

An 8-year-old girl with unilateral posterior lenticoglobus underwent lens aspiration and intraocular lens implantation. Wavefront analysis performed before surgery to assess the surgical indication showed a higher-order aberration of 0.502 μm root mean square. After surgery, the value decreased to 0.132 μm root mean square. Preoperative best-corrected visual acuity of 0.1 improved to 0.3 postoperatively. Electron-microscopic examinations of the posterior capsule revealed unusual nodular structures and variations in capsular density.

Outer retinal folds in highly myopic macular hole and retinal detachment.

PURPOSE To report the intraretinal microstructure in macular hole and retinal detachment in a highly myopic eye using spectral-domain optical coherence tomography. METHODS Two eyes of two patients with macular holes and retinal detachment were examined with spectral-domain optical coherence tomography. Fundus photographs and time-domain optical coherence tomography images also were obtained. RESULTS Spectral-domain optical coherence tomography disclosed outer retinal fold formation toward the subretinal space at the level of the photoreceptor inner and outer segment layer, the cystoid spaces expanding outside of the macular hole and epiretinal membrane in all eyes. CONCLUSION The outer retinal fold may indicate the tension of the inner retina and the redundancy of the outer retina, which may be responsible for the occurrence of macular holes and retinal detachment in these eyes.