Konstantinos T. Tsaousis

Intravitreal aflibercept treatment of retinal angiomatous proliferation: a pilot study and short-term efficacy

Retinal angiomatous proliferation (RAP) is a type of neovascular age-related macular degeneration (AMD) with a reportedly poor prognosis and limited response to several therapies including direct laser photocoagulation, transpupillary thermotherapy, surgical removal, and photodynamic therapy (PDT) [1]. However, the introduction of intravitreal anti-vascular endothelial growth factor (anti-VEGF) medications has offered a novel alternative for RAP treatment. Multiple studies have shown that ranibizumab may be effective in these cases especially those in stages 1 and 2 [2, 3]. Following the approval of aflibercept for use in the British national health system, we have designed a pilot study to investigate the short-term results of intravitreal aflibercept administered to RAP patients with no previous treatments. Notably, previous studies confirmed the efficacy of aflibercept in wet age-related macular degeneration and macular edema due to retinal vein occlusions [4, 5]. Twelve patients (12 eyes; mean age, 80±7.08 years) with RAP lesions at stage 1 and 2 without any previous treatments were recruited from the outpatient medical retina service of the University Hospital of Leicester, in the UK, between November 2013 and January 2014 and were enrolled in a prospective, consecutive, and nonrandomized manner. The study conformed to the tenets of the Declaration of Helsinki. All participants provided written informed consent after verbal explanation. Before therapy, all patients were examined thoroughly with visual acuity (LogMAR) measurement, optical coherence tomography (3D OCT-1000, Topcon Corporation, Tokyo, Japan), and fluorescein angiography performed to confirm the diagnosis. Patients were administered 2 mg of aflibercept (Eylea, 40 mg/ml, Bayer, Germany) intravitreously every 30 days for a total three injections. One month after the third treatment, the patients were reexamined and numerical data were collected. The primary study outcomes were the change in central subfield (1 mm as indicated in the ETDRS grid) retinal thickness (CRT), and the bestcorrected distance visual acuity (BCDVA, LogMAR). Secondary indices for statistical analysis were retrieved from the optical coherence tomography report: (1) average macular thickness (μm) (nine subfields of 6 mm area in an ETDRS grid); (2) central foveal point thickness (μm); and (3) total volume (mm) in a 6 mm macular area. Difference between the pretreatment and posttreatment values were determined using one-way analysis of variance (ANOVA) with a 5 % significance level. Data were collected prospectively, and analyzed using Microsoft Excel 2007 for Windows (Microsoft Corporation, Redmond, WA, USA) and SPSS version 16.0 for Windows (SPSS Inc., Chicago, IL, USA). All subjects showed a decrease in the central retinal thickness (mean 128±62.94 μm). In 10/12 eyes visual acuity improved following treatment (mean 0.14±0.16 LogMAR). Posttreatment visual acuity significantly correlated with the pretreatment visual acuity (p<0.001) (Fig. 1). The gain in BCDVA improvement was not correlated with the decrease in the 1 mm central subfield thickness (p=0.252) but was significantly correlated with the decrease in the central foveal point thickness (p=0.034) (Fig. 2). The results show that aflibercept is efficacious in cases of retinal angiomatous proliferation; after three treatments, the central retinal thickness decreased, and the retinal architecture K. T. Tsaousis :V. E. Konidaris : S. Banerjee : T. Empeslidis Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK

The concept of virtual clinics in monitoring patients with age-related macular degeneration

To present clinical results regarding the treatment of patients with age‐related macular degeneration (neovascular form) after the implementation of a ‘virtual’ type of follow‐up in a single retina service centre.

Incidence of Retinal Pigment Epithelial Tears and Associated Risk Factors After Treatment of Age-Related Macular Degeneration with Intravitreal Anti-VEGF Injections §

Purpose : To study the incidence and risk factors for retinal pigment epithelium tears following intravitreal anti-vascular endothelial growth factor (VEGF) injections. Methods : Retrospective longitudinal study. 4027 intravitreal anti-VEGF injections in 628 patients (676 eyes) for choroidal neovascularisation associated with age related macular degeneration in a period of 18 months were studied. Results : Seventeen patients (mean age 83.95±5.84) developed retinal pigment epithelium tears. The incidence rate was 0.4%. Fibrovascular pigment epithelium detachment (PED) was previously observed in all cases. In 88 % (15/17) of AMD patients that had a RPE tear, PED height was found to be less than 400 microns at presentation. In 5 of 7 patients with RPE tear grade <4, continuing of anti-VEGF treatment resulted to improvement of visual acuity. Conclusion : Critical risk factors for RPE tears are presence of PED as well as advanced age. Visual improvement appears to depend more on the extent and location of the RPE tear and less on the PED height.

Multifocal chorioretinitis caused by Bartonella henselae: imaging findings of spectral domain optical coherence tomography during treatment with trimethoprim-sulfamethoxazole

Multifocal chorioretinitis caused by Bartonella henselae : imaging findings of spectral domain optical coherence tomography during treatment with trimethoprim-sulfamethoxazole

Clinical real-world results of switching treatment from ranibizumab to aflibercept in patients with diabetic macular oedema

Clinical real-world results of switching treatment from ranibizumab to aflibercept in patients with diabetic macular oedema

Diagnosis and Monitoring of Choroidal Osteoma through Multimodal Imaging

A 16-year-old Caucasian female with a 6-month history of decreased visual acuity and metamorphopsia in the left eye is reported. The fundus of the left eye revealed a well defined lesion in the macula region. Diagnosis of choroidal osteoma was established using spectral domain optical coherence tomography (OCT), fundus fluorescein angiography (FFA), indocyanine green angiography (ICG), and B-scan ultrasonography. Subretinal fluid (SRF) and retinal pigment epithelium (RPE) detachment were noted in the absence of obvious classic choroidal neovascularisation (CNV). The patient was followed up for over 13 months without any treatment in the interim and the lesion was noted to have enlarged but visual acuity and SRF had remained stable. We report an interesting case where subretinal fluid was noted in the absence of evident choroidal neovascularisation and provide an example of the imaging modalities application in the era of “optical biopsy.”

Bilateral sensorineural hearing loss secondary to sympathetic ophthalmia in a human leukocyte antigen-A2 positive patient

We report a case of sympathetic ophthalmia 1 month following trauma in a 71-year-old immunocompetent female patient of Indian origin. The patient was hospitalized with signs and symptoms of meningism, ataxia, and neurosensory deafness. We explore and provide further clinical evidence in supporting the hypothesis of antigen cross-reactivity derived from tissues with common neural crest embryological background such as the uvea and cells of the labyrinth. The patient was human leukocyte antigen-A2 positive and treatment with oral steroids and cyclosporine has managed to have favorable results and control the inflammation.

SHORT-TERM FLUCTUATION OF MACULAR EDEMA IN A PATIENT DIAGNOSED EARLY WITH IDIOPATHIC MACULAR TELANGIECTASIA TYPE 1: FOLLOW-UP WITH SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY.

PURPOSE To present a case of idiopathic macular telangiectasia Type 1, diagnosed at early stages and its close monitoring through spectral domain optical coherence tomography. METHODS Case report. RESULTS A case is presented of a 43-year-old man with blurred vision in his right eye and no further symptoms. The patient did not have any history of ophthalmic disease. Imaging test with fluorescein angiography confirmed a diagnosis of idiopathic macular telangiectasia Type 1. CONCLUSION During a close follow-up period of 6 months, spectral domain optical coherence tomography demonstrated considerable fluctuations regarding his central retinal thickness (macular edema), presence of lipid exudates, and associated visual acuity loss.

Retinal Pigment Epithelial Tear Developing in a Patient with Outer Retinal Tubulations: Pathogenic Association or Coincidence?

Outer Retinal Tubulations (ORTs) first described by Zweifel and colleagues [1], can be detected by Spectral Domain Optical Coherence Tomography (SD-OCT). They consist of round or ovoid structures with hyper-reflective borders and cavities which, in comparison, are hyporeflective. They were initially described in Age-related Macular Degeneration (AMD) but have since been reported in other conditions, including Bietti crystalline dystrophy and chronic central serous chorioretinopathy [2,3].

Valacyclovir as a Therapeutic Agent in Acute Retinal Necrosis: Two Case Reports

Introduction: Acute retinal necrosis (ARN) is a rare, rapidly progressive viral retinitis. The current standard of care for ARN consists of intravenous acyclovir for 5-10 days, followed by oral acyclovir for an additional 6-12 weeks. Valacyclovir has superior plasma bioavailability to acyclovir as an oral preparation. The aim of this study is to add to the evidence of treating ARN with valacyclovir with 2 additional cases.