Kyoko Fujita

Role of Photodynamic Therapy in Polypoidal Choroidal Vasculopathy

PurposeTo determine the efficacy of photodynamic therapy (PDT) with verteporfin for polypoidal choroidal vasculopathy (PCV).MethodsPDT was performed in 35 patients (35 eyes) with PCV. We evaluated the number of treatments and compared visual acuity (VA), ophthalmological findings, and changes in polypoidal lesions and branching vascular networks by measuring lesion diameters using Heidelberg retina angiography before PDT, and then every 3 months for 1 year after PDT.ResultsThe mean annual number of treatment sessions was 2.2. VA was improved or maintained in 80% of the patients. Retinal pigment epithelium detachment, retinal detachment, hemorrhage, and/or exudates disappeared in 69%, and leakage resolved in 74% of the patients. Polypoidal lesions disappeared completely on indocyanine green angiography in 83% of the patients. All branching vascular networks persisted. Polypoidal lesions had recurred at the termini of the remaining branching vascular networks at 9 months after the first PDT in two eyes and at 12 months in one eye.ConclusionsPDT with verteporfin for PCV appears to improve or maintain VA for the first posttreatment year. Approximately 70% of PCV cases showed improved ophthalmoscopic findings. However, as polypoidal lesions recur after PDT in some cases, further study is needed to confirm the long-term efficacy of PDT for PCV. Jpn J Ophthalmol 2007;51:270–277 @ Japanese Ophthalmological Society 2007

Correlation of Integrity of Cone Outer Segment Tips Line With Retinal Sensitivity After Half-dose Photodynamic Therapy for Chronic Central Serous Chorioretinopathy

PURPOSE To investigate the relationship between the integrity of the photoreceptor microstructures and retinal sensitivity after half-dose photodynamic therapy (PDT) in eyes with chronic central serous chorioretinopathy (CSC). DESIGN Prospective, noncomparative, interventional case series. METHODS Thirteen eyes of 13 patients with chronic CSC who had received half-dose verteporfin PDT were studied. The best-corrected visual acuity (BCVA), macular retinal sensitivity in the central 12 degrees, and optical coherence tomographic (OCT) findings were evaluated at baseline and at 1, 3, 6, and 12 months after the half-dose PDT. The integrities of the external limiting membrane (ELM), the inner segment/outer segment junction (IS/OS) line, and the cone outer segment tips (COST) line were determined. The retinal sensitivity was determined by MP-1 microperimetry. RESULTS The serous retinal detachment (SRD) was completely resolved in 11 eyes at 1 month and in 1 eye at 3 months. The remaining eye had a persistent SRD throughout the follow-up period. The mean retinal sensitivity was significantly better at 1, 3, 6, and 12 months after the half-dose PDT than at baseline. Before the PDT, 12 eyes had a continuous ELM and 1 eye had a fragmented ELM. The number of eyes with an intact IS/OS line and COST line increased with increasing post-PDT time. At 12 months after PDT, the IS/OS line was detected in 11 eyes and the COST line in 6 eyes. At 6 and 12 months, the retinal sensitivity was significantly higher in eyes with an intact COST line and IS/OS lines than in eyes with an intact IS/OS line only. However, no difference was found in the visual acuity of these 2 groups. The 1 eye with a persistent SRD and another eye with fragmented ELM and absent IS/OS and COST lines through the follow-up periods were associated with poor retinal sensitivity of 8.5 dB and 10.9 dB respectively. CONCLUSIONS Our findings show that there is a significant improvement in the macular sensitivity after half-dose PDT in eyes with chronic CSC. The improvement was correlated with the recovery of the IS/OS and COST lines at 6 and 12 months.

Retinal sensitivity after photodynamic therapy with half-dose verteporfin for chronic central serous chorioretinopathy: short-term results.

Background: To assess retinal sensitivity after photodynamic therapy (PDT) with half-dose verteporfin in patients with chronic central serous chorioretinopathy. Methods: Sixteen eyes with chronic chorioretinopathy treated using PDT with half-dose verteporfin were enrolled. Microperimetry covering the central area 12 degrees in diameter was performed before and at 1 month and 3 months after PDT. Retinal sensitivities within the retinal serous detachment before PDT, the PDT spot area, and the central area 2 degrees in diameter were evaluated. Results: Fourteen of 16 eyes showed complete resolution of retinal detachment at 3 months after PDT. Mean retinal sensitivities within the retinal serous detachment before and at 1 month and 3 months after PDT were 8.9 dB, 12.1 dB, and 14.7 dB, respectively. Mean retinal sensitivities within the PDT spot area were 11.0 dB, 14.2 dB, and 15.7 dB, respectively. Mean retinal sensitivities in the central area 2 degrees in diameter were 6.0 dB, 9.9 dB, and 12.5 dB, respectively. Mean retinal sensitivities at both 1 month and 3 months after PDT showed statistically significant improvements as compared with before PDT (both, P < 0.05). Conclusion: Photodynamic therapy with half-dose verteporfin appears to be an effective and safe treatment for patients with chronic chorioretinopathy, improving retinal sensitivity for at least 3 months.

One-Year Outcomes with Half-Dose Verteporfin Photodynamic Therapy for Chronic Central Serous Chorioretinopathy

PURPOSE To assess the 1-year outcome of half-dose verteporfin photodynamic therapy (PDT) for patients with chronic central serous chorioretinopathy (CSC). DESIGN Retrospective, interventional case series with no controls. PARTICIPANTS A total of 204 eyes of 204 patients with chronic CSC were studied. METHODS Fluorescein angiography (FA) and indocyanine green angiography (ICGA) were performed before PDT. The best-corrected visual acuities (BCVAs) were measured and optical coherence tomography was performed before and 1, 3, 6, 9, and 12 months after PDT. MAIN OUTCOME MEASURES The main outcome measures were the resolution of the serous retinal detachment (SRD), changes in BCVA, and ocular and systemic complications at 12 months. RESULTS A total of 182 of 204 eyes (89.2%) had complete resolution of the SRD at 12 months after the PDT. Eleven eyes (5.4%) had a persistent SRD throughout the follow-up period, and 12 eyes (5.9%) had a recurrence of the SRD after an earlier resolution. One of the 12 eyes had a spontaneous resolution of the SRD 6 months after PDT. The mean±standard deviation BCVA in logarithm of the minimum angle of resolution (logMAR) units significantly improved from 0.11±0.25 before to 0.07±0.23 at 1 month, 0.02±0.23 at 3 months, 0.01±0.23 at 6 months, 0.00±0.24 at 9 months, and -0.01±0.22 at 12 months (P<0.0001). The eyes with an SRD at 12 months were more likely to have an intermediate hyperfluorescence on ICGA (chi-square test, P<0.001) and poorer BCVA before the half-dose PDT (Student t test, P=0.04) than those without SRD at 12 months. None of the patients developed any systemic complications or experienced any severe visual reduction after the half-dose PDT. However, polypoidal lesion appeared in 1 eye 8 months after the PDT. CONCLUSIONS Half-dose PDT is an effective and safe method to treat eyes with chronic CSC with an SRD. The CSC resolved and the BCVA improved significantly after PDT. Half-dose PDT was less effective for cases without intense hyperpermeability on ICGA and those with lower BCVA before the PDT.

Assessing quality of life in the treatment of patients with age-related macular degeneration: clinical research findings and recommendations for clinical practice.

Background The importance of incorporating quality-of-life (QoL) assessments into medical practice is growing as health care practice shifts from a “disease-based” to a “patient-centered” model. The prevalence of age-related macular degeneration (AMD) is increasing in today’s aging population. The purpose of this paper is: (1) to discuss, by reviewing the current literature, the impact of AMD on patients’ QoL and the utility of QoL assessments in evaluating the impact of AMD and its treatment; and (2) to make a recommendation for incorporating QoL into clinical practice. Methods We conducted a PubMed and an open Internet search to identify publications on the measurement of QoL in AMD, as well as the impact of AMD and the effect of treatment on QoL. A total of 28 articles were selected. Results AMD has been found to cause a severity-dependent decrement in QoL that is comparable to systemic diseases such as cancer, ischemic heart disease, and stroke. QoL impairment manifests as greater social dependence, difficulty with daily living, higher rates of clinical depression, increased risk of falls, premature admission to nursing homes, and suicide. The National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) is the most widely used eye disease-specific QoL instrument in AMD. It has been shown to correlate significantly with visual acuity (VA). QoL reflects aspects of AMD including psychological well-being, functional capacity, and the ability to perform patients’ valued activities, which are not captured by a single, numerical VA score. Conclusion The literature shows that the adverse impact of AMD on QoL is comparable to serious systemic disease. Eye disease-specific instruments for measuring QoL, such as the NEI VFQ-25, have shown a significant correlation of QoL decrement with measures of disease severity, as well as significant QoL improvement with treatment. The NEI VFQ-25 and other validated instruments provide a wide-ranging assessment of vision-related functioning that is important to patients and complementary to VA measurement. We strongly recommend the incorporation of QoL assessment into routine clinical practice.

Detection of morphologic alterations by spectral-domain optical coherence tomography before and after half-dose verteporfin photodynamic therapy in chronic central serous chorioretinopathy.

Purpose: To study the morphologic features of serous retinal detachment, the photoreceptor inner and outer segment junction line, retinal pigment epithelium irregularities, pigment epithelial detachment, and the subfoveal choroid before and after treatment of chronic central serous chorioretinopathy, using spectral-domain optical coherence tomography. Methods: We studied 17 eyes of 17 consecutive patients (all men) with chronic central serous chorioretinopathy. We performed photodynamic therapy (PDT) with half-dose (3 mg/m2) verteporfin. We studied morphologic features using spectral-domain optical coherence tomography before and at 1, 3, 6, and 12 months after PDT. Results: Retinal detachment showed reattachment in 16 of the 17 eyes by 3 months after PDT. The inner and outer segment junction line could be visualized in 13 eyes at 6 months after PDT. Retinal pigment epithelium irregularities were confirmed in all 17 eyes before and during the year after PDT. Pigment epithelial detachment initially disappeared but then recurred in 5 eyes after PDT. Subfoveal highly reflective substances first lessened in intensity but then again became prominent in 2 eyes. Conclusion: The authors identified recurrent pigment epithelial detachment and/or retinal detachment during the 1-year period after PDT. Even if retinal detachment initially disappears, retinal pigment epithelium or choroidal morphologic changes can still develop. The effect of half-dose PDT for chronic central serous chorioretinopathy may thus be temporary.

Improvement in Vision-Related Function with Intravitreal Aflibercept: Data from Phase 3 Studies in Wet Age-Related Macular Degeneration

PURPOSE To evaluate the effect of intravitreal aflibercept injection on visual function in wet age-related macular degeneration (AMD). DESIGN Prospective, multicenter, double-masked, active-controlled, parallel-group, randomized phase 3 clinical studies (VEGF Trap-Eye: Investigation of Efficacy and Safety in Wet AMD [VIEW] 1 and 2 [clinicaltrials.gov identifiers, NCT00509795 and NCT00637377, respectively]). PARTICIPANTS Patients (n=2419) with active, treatment-naïve, exudative AMD. This analysis included patients who received intravitreal aflibercept 2.0 mg every 8 weeks (2q8; n=607) or ranibizumab 0.5 mg every 4 weeks (0.5q4; n=595). INTERVENTION Patients were randomized 1:1:1:1 to receive intravitreal aflibercept 2q8 (after 3 initial monthly doses), intravitreal aflibercept 2q4, intravitreal aflibercept 0.5q4, or ranibizumab 0.5q4 in the study eye. Patients in the intravitreal aflibercept 2q8 group received a sham injection alternating with active treatment. MAIN OUTCOME MEASURES The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was administered at baseline and at weeks 12, 24, 36, and 52. The NEI VFQ-25 subscale scores were compared between intravitreal aflibercept 2q8 and ranibizumab 0.5q4 treatment arms, the approved dosing for each agent worldwide. Change in composite NEI VFQ-25 score was evaluated based on categorical change in visual acuity (worsened, unchanged, improved). RESULTS Baseline NEI VFQ-25 scores were similar for both treatments in both studies. Mean change from baseline to 52 weeks was similar for ranibizumab 0.5q4 and intravitreal aflibercept 2q8 across all 12 subscales, with the greatest improvements noted for mental health and general vision (9.0-11.6 points, both treatments, both studies). Improvement of 4 points or more (both treatments, both studies) also was observed for subscales near vision, distance vision, role difficulties, and dependency. Mean change from baseline to 52 weeks in NEI VFQ-25 composite score (pooled data) stratified by clinical response showed meaningful improvement only in patients who gained 5 Early Treatment Diabetic Retinopathy letters or more (7.3 and 7.8 points for intravitreal aflibercept 2q8 and ranibizumab 0.5q4, respectively). CONCLUSIONS Visual function outcomes were similar across all NEI VFQ-25 subscales over 52 weeks for intravitreal aflibercept 2q8 and ranibizumab 0.5q4, with clinically meaningful improvement recorded in 6 of 12 subscales.

Screening and follow-up of diabetic retinopathy using a new mosaic 9-field fundus photography system

AIM To evaluate the clinical usefulness of a newly developed fundus photographing system and assess its applicability to telemedicine. METHODS Nine overlapping 45 degrees fundus photographs were taken by a new camera equipped with nine internal fixation targets to provide standardized 9-field photographs. The digitally stored images were either edited in 3x3 form or reconstructed as collage (9F) and compared to the ophthalmological examination (OP) and single-field non-mydriatic photography (SC). In telemedicine, 9-field images derived from 61 adolescent diabetics were sent to ophthalmologists over an analog phone line. RESULTS The sensitivities of the examinations by 9F without and with mydriasis (78 and 82%) were equivalent to OP (84%) and superior to SC (64%). The diagnosis of severity by 9F was also comparable to those by OP, whereas SC tended to underestimate the severity. An average of 1 min 19 s was required to send one edited 9-field photography (average size 259+/-30 KB) over the Internet. Twelve of these eyes were diagnosed as diabetic retinopathy on a desktop monitor whereas SC gave only seven. CONCLUSION This new 9-field fundus photography system can be appropriate for the screening and follow-up of diabetic retinopathy in adult and adolescent diabetic subjects, especially when applied to telemedicine over the Internet.

Findings of Optical Coherence Tomographic Angiography at the Choriocapillaris Level in Central Serous Chorioretinopathy.

Purpose: To reveal vascular signals at the choriocapillaris level in central serous chorioretinopathy (CSC) using optical coherence tomographic angiography (OCTA). Procedures: We analyzed vascular signals at the choriocapillaris level in 58 CSC and 51 contralateral eyes by OCTA (RTVue XR Avanti with AngioVue; Optovue Inc., Fremont, Calif., USA). Data analysis included age, best corrected visual acuity (BCVA), disease duration and serous retinal detachment (SRD) height. Results: Morphologically, abnormal signals at the choriocapillaris level were detected in all CSC eyes (100%), and then classified into three patterns. Age, BCVA, disease duration and SRD height showed no significant correlation with signal patterns. Thirty-one contralateral eyes (61%) showed abnormal signals at the choriocapillaris level on OCTA, while 20 (39%) had a normal pattern. Conclusions: OCTA revealed three types of abnormal signals not only in CSC eyes but also in fellow eyes without SRD. OCTA may provide information for elucidating the underlying pathogenesis of CSC.

Quantification of metamorphopsia in chronic central serous chorioretinopathy after half-dose verteporfin photodynamic therapy.

Purpose: To determine the degree of metamorphopsia before and 1 year after half-dose verteporfin photodynamic therapy in eyes with chronic central serous chorioretinopathy. Methods: This was a retrospective, noncomparative, interventional case series. Forty-five eyes of 45 consecutive patients with chronic central serous chorioretinopathy were evaluated. The degree of metamorphopsia was measured with M-CHARTS before and at 1, 3, 6, 9, and 12 months after half-dose verteporfin photodynamic therapy. The best-corrected visual acuity was also measured. Results: Forty of the 45 eyes had a complete resolution of the serous retinal detachment at 1 month, 1 eye at 3 months, and 3 eyes at 6 months. The serous retinal detachment in one eye persisted throughout the follow-up period. The mean horizontal metamorphopsia score improved significantly from 0.61 ± 0.52° at baseline to 0.49 ± 0.56° at 12 months (P = 0.04). The vertical metamorphopsia score improved significantly from 0.52 ± 0.53° at baseline to 0.33 ± 0.46° at 12 months (P = 0.005). Conclusion: Half-dose verteporfin photodynamic therapy for chronic central serous chorioretinopathy results in significant improvements of metamorphopsia at 1 year, especially in eyes with good best-corrected visual acuity at the baseline. Half-dose verteporfin photodynamic therapy can be a therapeutic option for patients with good visual acuity who complain of metamorphopsia.