Mamoru Uenishi

Comparison of the Effect of Ranibizumab and Verteporfin for Polypoidal Choroidal Vasculopathy: 12-Month LAPTOP Study Results

PURPOSE To compare the effect of photodynamic therapy (PDT) and intravitreal ranibizumab in patients with polypoidal choroidal vasculopathy (PCV). DESIGN Randomized clinical trial. METHODS SETTING Multicenter. STUDY POPULATION Total of 93 patients with treatment-naïve PCV. INTERVENTION Patients were randomized to 2 arms. Patients in the PDT arm underwent a single session of PDT with verteporfin, and patients in the ranibizumab arm received 3 monthly ranibizumab injections at baseline. Additional treatment was performed as needed in each arm. MAIN OUTCOME MEASURES Primary outcome measurement was the proportion of patients gaining or losing more than 0.2 logarithm of minimal angle of resolution (logMAR) units from baseline. Mean change of logMAR and central retinal thickness (CRT) were also evaluated. RESULTS In the PDT arm (n = 47), 17.0% achieved visual acuity gain, 55.3% had no change, and 27.7% experienced visual acuity loss. The results were 30.4%, 60.9%, and 8.7%, respectively, in the ranibizumab arm (n = 46), significantly better than the PDT arm (P = .039). In the PDT arm, mean CRT improved (366.8 ± 113.6 μm to 289.1 ± 202.3 μm, P < .001), but logMAR was unchanged (0.57 ± 0.31 to 0.62 ± 0.40). The ranibizumab arm demonstrated improvement in both CRT (418.9 ± 168.6 μm to 311.2 ± 146.9 μm, P < .001) and logMAR (0.48 ± 0.27 to 0.39 ± 0.26, P = .003). Mean change of logMAR was also greater in the ranibizumab arm (P = .011). CONCLUSION Intravitreal injection of ranibizumab is more effective than PDT for treatment-naïve PCV.

Comparative Assessment of Photodynamic Therapy for Typical Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy: A Multicenter Study in Hyogo Prefecture, Japan

Purpose: We aimed to evaluate the effects of photodynamic therapy (PDT) on different phenotypes of age-related macular degenerations (AMD): typical AMD (tAMD) and polypoidal choroidal vasculopathy (PCV). Procedures: 246 eyes from 242 patients (tAMD: 139, PCV: 107 eyes) were recruited. Gender, age, best-corrected visual acuity (BCVA) before treatment, greatest linear dimension before treatment, lesion phenotype and PDT frequency were evaluated for predicting the BCVA at 12 months after PDT using stepwise multiple regression analyses. Additionally, 125 eyes with tAMD and 97 eyes with PCV followed up for more than 12 months after the final PDT were compared for the recurrence period. Results: In the stepwise analysis, a younger age, better pretreatment BCVA, lower PDT frequency, lesions with PCV and a smaller pretreatment greatest linear dimension were all significantly beneficial for a better BCVA at 12 months after PDT. PCV showed a significantly lower PDT frequency and greater improvement in the BCVA than tAMD. The recurrence period of PCV was significantly later than that of tAMD. Conclusions: The phenotype of AMD is significantly correlated with its prognosis after PDT. PCV showed a significantly better response to PDT in terms of BCVA improvement and effect durability.

Ocular surface changes after excimer laser phototherapeutic keratectomy.

PURPOSE To study the ocular surface disorder in patients with Avellino, granular, and lattice dystrophy, band keratopathy, and corneal leukoma before and after excimer laser phototherapeutic keratectomy. DESIGN A prospective case-controlled study. PARTICIPANTS A total of 45 eyes of 33 patients with superficial corneal opacities seen at Kobe Kaisei Hospital, Department of Ophthalmology, and 40 eyes of 20 normal control subjects were studied. INTERVENTION The subjects underwent routine ophthalmic examinations, corneal sensitivity measurements, tear film break up time (BUT), Schirmer test, tear film lipid layer interferometry, and conjunctival impression cytology. MAIN OUTCOME MEASURES The patients and the control subjects were compared for prephototherapeutic keratectomy (PTK) tear function parameters, tear film lipid layer interferometry grade, goblet cell density, and conjunctival squamous metaplasia grade. Alterations of these parameters within 3 months after PTK were also looked for. RESULTS The average pre-PTK corneal sensitivity and tear film break up time were lower in patients compared with control subjects before PTK. Tear film lipid layer interferometry grade and conjunctival squamous metaplasia grades were higher in the patients than the controls before PTK. All these parameters improved gradually and significantly after PTK. Goblet cell density was significantly lower in the patients compared with controls before PTK. Schirmer test results and goblet cell density did not show any significant alterations after PTK. CONCLUSIONS Concurrent improvements in corneal sensitivity, tear film break up time, lipid layer interference grades, and conjunctival squamous metaplasia grades all point to the favorable effects of PTK on the ocular surface by improving the stability of the tear film and ocular surface health through attainment of a regular corneal surface and probably inducing qualitatively/quantitatively better mucin production by a healthier epithelium after PTK.

Photodynamic therapy for typical age-related macular degeneration and polypoidal choroidal vasculopathy: A 30-month multicenter study in Hyogo, Japan

PurposeTo evaluate the long-term effects of photodynamic therapy (PDT) on different phenotypes of age-related macular degeneration (AMD): typical AMD (tAMD) and polypoidal choroidal vasculopathy (PCV).MethodsA multicenter prospective study of 207 eyes of 201 patients (tAMD, 123 eyes; PCV, 84 eyes) treated with PDT. Sex, age, best-corrected visual acuity (BCVA), greatest linear dimension, and lesion type were evaluated for pretreatment factors. PDT frequency, BCVA at 30 months post-PDT, frequency of recurrence, and mean recurrence period were compared as posttreatment outcomes.ResultsThe 30 months post-PDT mean BCVA was significantly lower than the pre-PDT value in the tAMD group, but it remained unchanged in the PCV group. There was no difference in PDT frequency between the two groups. Multivariate analysis revealed that lesion type was the only predicting factor significantly associated with BCVA at 30 months post-PDT. The incidence of recurrence before 30 months post-PDT was not significantly different between the tAMD and PCV groups, whereas the mean duration of the PDT effect was significantly longer in the PCV group than in the tAMD group.ConclusionsPDT may have some advantages for PCV patients, but not for tAMD patients. However, as PCV often recurred 12 months post-PDT, long-term observation after the treatment is crucial.

Visual and tear function improvement after superficial phototherapeutic keratectomy (PTK) for mid-stromal corneal scarring.

Purpose To study the changes in visual and tear film function following superficial excimer laser phototherapeutic keratectomy in patients with mid-stromal corneal scars.Methods Fourteen eyes of 14 patients with mid-stromal corneal scars seen at the Department of Ophthalmology at Kobe Kaisei Hospital underwent superficial phototherapeutic keratectomy (PTK). The subjects underwent routine ophthalmic examinations, corneal sensitivity measurements, tear film break-up time (BUT), Schirmer test and tear film lipid layer interferometry. Thirty eyes of 15 normal control subjects were also studied. The patients and the control subjects were compared for pre-PTK tear function parameters and tear film lipid layer interferometry grade. The alterations in these parameters within 6 months following PTK were also determined.Results Visual improvement was achieved in 12 eyes (86%). A hyperopic shift was observed in all eyes. The average pre-PTK corneal sensitivity and tear film BUT were lower in patients compared with control subjects before PTK. Tear film lipid layer interferometry grades were also higher in the patients than the controls before PTK. All these parameters improved gradually and significantly after PTK. Schirmer test results did not show any significant alterations after PTK.Conclusion We conclude that PTK is an effective means of treating corneal scars and attaining visual improvement, even in cases with deeper corneal involvement, and may obviate the need for corneal transplantation. Simultaneous improvements in corneal sensitivity and tear film stability suggest favourable effects of PTK on the ocular surface.

Comparison of the effect between pegaptanib and ranibizumab on exudative age-related macular degeneration with small lesion size

Purpose To compare the effect of pegaptanib versus ranibizumab on exudative age-related macular degeneration (AMD) with small lesion size. Methods This is a retrospective study of 81 eyes from 78 patients with exudative AMD treated and followed up over 12 months. Patients with baseline best corrected visual acuity (BCVA) under 20/400 and with a greatest linear dimension of lesion over 4500 μm were excluded from the study. Twenty-six eyes from 25 patients were treated with three consecutive intravitreal injections of pegaptanib (IVP group) and 55 eyes from 54 patients were treated with three consecutive ranibizumab injections (IVR group). Each therapy was repeated as needed. The alteration in BCVA was evaluated in the IVP and IVR groups. Results No differences were detected in baseline parameters between the IVP and IVR groups. The mean BCVA (logMAR) at month 1, 3, 6 and 12 after the initial treatment was improved from baseline in the IVP group (−0.095, −0.17, −0.18 and −0.18, respectively) and in the IVR group (−0.077, −0.15, −0.17 and −0.11, respectively), which was statistically significant. There was no difference in the change in mean BCVA between IVP and IVR groups at the same time periods. Conclusions The visual outcome of IVP was equivalent with IVR in exudative AMD with small lesion size.

Long-term results of photodynamic therapy or ranibizumab for polypoidal choroidal vasculopathy in LAPTOP study

Background/aim We previously reported that ranibizumab performed better on visual prognosis than photodynamic therapy (PDT) in a Ranibizumab (Lucentis) And Photodynamic Therapy On Polypoidal choroidal vasculopathy (LAPTOP) study. To determine if the first-choice treatment, either PDT or intravitreal ranibizumab, has a long-term effect in patients with polypoidal choroidal vasculopathy (PCV). Methods We reviewed medical records of patientsrandomised to either PDT (29 eyes) or ranibizumab (27 eyes) from July 2009 to June 2011 in LAPTOP study. Retreatment or switching to other treatments were at the investigator’s discretion after release from the 2-year LAPTOP study up to 5years. We evaluated visual acuity (VA), continuity of initial treatment, percentage of dry macula achievement and macular atrophy at 5 years. Results The logarithm of minimal angle of resolution VA was 0.56 in the PDT and 0.44 in the ranibizumab groups at baseline (p=0.101) and was 0.55 and 0.28 at 5years, respectively (p<0.05). More than 70% of the patients converted to aflibercept in following years. Achievement percentages of dry macula were 74% (PDT) and 63% (ranibizumab) at 5years, and macular atrophy was detected in 78% (PDT) and 60% (ranibizumab) with a mean area of 7.7 and 3.5 mm2, respectively (p=0.155). Conclusions The better VA in the initial ranibizumab group compared with the PDT group at 2 years was retained at the 5-year follow-up.

The Comparison of the Surgical Outcome for the Full-Thickness Macular Hole with/without Lamellar Hole-Associated Epiretinal Proliferation

Aims To compare the surgical outcome of pars plana vitrectomy (PPV) for full-thickness macular hole (FTMH) with and without lamellar hole-associated epiretinal proliferation (LHEP). Methods This retrospective study included 158 eyes of 158 patients with FTMH treated with PPV. The following variables were analyzed: sex, age, preoperative best corrected visual acuity (pre-BCVA), BCVA 6 months after the surgery (6M-BCVA), the axial length of eye, the minimum diameter of FTMH, the diameter of basal side of FTMH, postoperative continuity of subfoveal ellipsoid zone (EZ) and external limiting membrane (ELM), and the preoperative presence of LHEP. Results Twenty-eight eyes had FTMH with LHEP and 130 without LHEP. The mean ± SD age (years) was 72.6 ± 7.9 and 68.6 ± 8.7, respectively (p = 0.02). 6M-BCVA was 0.38 ± 0.30 and 0.26 ± 0.25, respectively (p = 0.03). The diameter of basal side of FTMH (μm) was 901.5 ± 404.9 and 658.9 ± 288.1, respectively (p = 0.00027). EZ was disrupted in 24 eyes and 63 eyes, respectively (p = 0.00071). ELM was disrupted in 15 eyes and 23 eyes, respectively (p = 0.00015). The FTMH diameters and the presence of LHEP were inversely correlated with the continuity of EZ and ELM. Conclusion The preoperative appearance of LHEP could be one of the prognostic factor for the treatment of FTMH.