Miho Haruyama

A Study of Laser Photocoagulation for Polypoidal Choroidal Vasculopathy

PURPOSE To evaluate the efficacy of laser photocoagulation for polypoidal choroidal vasculopathy (PCV) involving the macula. METHODS The records of 38 patients (47 eyes) undergoing laser photocoagulation for PCV causing serosanguineous detachment involving the fovea were reviewed and the results were evaluated. Ten eyes underwent photocoagulation to induce a fusion scar covering whole lesions consisting of both abnormal vessels and polypoidal lesions. Thirty-seven eyes underwent photocoagulation for only polypoidal lesions. When serosanguineous detachment recurred, additional photocoagulation was performed, targeting the causative lesions. Photocoagulation was performed with an argon dye laser or multicolor krypton laser. Final visual acuity, macular changes at the final visit, and the number of photocoagulations were evaluated. Follow-up period after the first photocoagulation was at least 1 year. RESULTS Of the 10 eyes undergoing photocoagulation of whole lesions, 9 showed absorption of exudate and/or blood after one photocoagulation, and maintained or improved visual acuity. Of the 37 eyes undergoing laser photocoagulation of only polypoidal lesions, 20 (54%) showed decreased visual acuity because of recurrent or persistent exudation and/or classic choroidal neovascularization or, alternatively, because of atrophy at the fovea; 32 of the 37 eyes had undergone photocoagulation at least twice or more. CONCLUSION Photocoagulation is recommended only for whole lesions.

Indocyanine green angiographic and optical coherence tomographic findings support classification of polypoidal choroidal vasculopathy into two types

Purpose:  We assessed the characteristic indocyanine green angiographic (ICGA) and spectral domain optical coherence tomographic (SD‐OCT) findings of two types of polypoidal choroidal vasculopathy (PCV), distinguishable by different filling patterns on ICGA.

Indocyanine green angiographic findings of chorioretinal folds.

PURPOSE To analyze indocyanine green (ICG) angiographic findings of chorioretinal folds. METHODS Eight patients (9 eyes) in whom chorioretinal folds had been diagnosed were enrolled in this study. Color photography, fluorescein angiography (FA) and ICG angiography (IA) were performed. RESULTS Indocyanine green angiography demonstrated choroidal venous congestion and a filling delay of the choroidal vessels in one case with an orbital tumor. In one posterior scleritis case, IA showed a filling delay of choroidal vessels in the early phase and multiple patchy hypofluorescent lesions scattered in the posterior pole during the late phase. Idiopathic cases showed choroidal venous dilatation. No abnormalities of the choroidal vasculature in the form of radial folds, were revealed in two cases of AMD. Linear hyperfluorescent areas suggestive of chorioretinal folds seen on IA were less numerous and wider than those observed on FA in some eyes. On the other hand, they were equally numerous and wider on IA than those on FA in other eyes. CONCLUSION Indocyanine green angiography is useful for evaluating both pathological conditions of the choroidal vasculature and the width of chorioretinal folds at the level of the choroidal vasculature.

Indocyanine green video-angiographic findings in choroidal osteoma

Indocyanine green video-angiography (ICG) was done twice on three patients with choroidal osteoma. Choroidal osteoma consisted of two portions, a yellow-white area and a surrounding orange area. The early phase of ICG angiography showed hypofluorescence due to blockage, corresponding to the osteoma. However, the hypofluorescence was greater in areas corresponding to the orange portions of the lesions than in the yellow-white parts. In the late phase, tumor staining was present, corresponding to the orange area. Although long-standing yellow-white lesions blocked fluorescence in the late phase, some of these showed hyperfluorescence. ICG video-angiography showed areas of blocked fluorescence in the early phase as well as hyperfluorescent areas accompanied by several small hypofluorescent foci in the late phase, corresponding to very slight ophthalmoscopically observed changes in the vicinity of the osteoma. During follow-up observation, fluorescein angiography confirmed the extension of the osteoma into this area. These results confirm that the characteristic findings of choroidal osteoma can be observed with ICG video-angiography. This imaging technique showed the lesions were larger than they appeared with ophthalmoscopy and fluorescein angiography.

Surgical removal of choroidal neovascularization in angioid streaks

PurposeAll the studies so far on surgical removal of choroidal neovascularization (CNV) in angioid streaks (AS) were conducted on a small number of cases. Therefore, a definitive evaluation of the surgical method was not available. The present study aimed to evaluate this surgical modality.Subjects and MethodWe performed surgical removal of foveal CNV accompanied by AS. Eighteen eyes of seventeen patients were available for follow-up of over 12 months. Surgical indications included foveal CNV, fluorescence leakage from the CNV in late-phase fluorescein angiography, and visual acuity of 0.3 or lower.ResultsThe best visual acuity was improved in 44% and unchanged in 44%. The final visual acuity was improved in 33% and unchanged in 39%. 22% had a preoperative visual acuity of 0.2 or above; and 44% and 17% achieved best and final visual acuity, respectively, of 0.2 or above. Since all cases developed atrophy of the choriocapillaris in the fovea, none of the cases were capable of fixation within atrophy. The fixation point was localized outside atrophy in 56% and fixation was poor in 44%. The diameter of postoperative atrophy of choriocapillaris was significantly greater (p ≪ 0.05) than the preoperative CNV diameter. CNV recurred in 8 eyes (44%), 88% of which occurred within one year.ConclusionsSurgical removal of CNV in AS is an effective method to maintain preoperative visual acuity. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:440–444, 2003)

Hyperfluorescent Areas Observed in Late-phase Indocyanine Green Angiography (IA) of IA Findings in Fellow Eyes of Unilateral Age-related Macular Degeneration

PURPOSE To evaluate abnormal findings of indocyanine green angiography (IA), predisposing to exudative age-related macular degeneration (AMD) in fellow eyes of unilateral exudative AMD. METHODS We categorized 83 fellow eyes of unilateral exudative AMD into two groups, i.e. 55 eyes with early age-related maculopathy, and 28 eyes with normal aging. We performed IA. RESULTS The late phase of IA demonstrated hyperfluorescent areas in 27 of the 83 fellow eyes, which included 22 of the 55 eyes with early age-related maculopathy and five eyes of 28 eyes with normal aging. The prevalence of the late-phase hyperfluorescence was statistically significant in early age-related maculopathy. Eight of the 22 eyes with early age-related maculopathy and one of the five eyes with normal aging progressed to exudative AMD. CONCLUSIONS Hyperfluorescent areas observed in late-phase IA before the manifestation of exudative AMD suggested the possible presence of choroidal neovascular membrane in the subretinal pigment epithelial space.

Comparison of pro re nata versus Bimonthly Injection of Intravitreal Aflibercept for Typical Neovascular Age-Related Macular Degeneration.

Purpose: The aim of this study was to clarify the 1-year outcomes of pro re nata (PRN) and bimonthly intravitreal injections of aflibercept (IVA) for typical neovascular age-related macular degeneration (tAMD) after the initial 3 monthly IVA. Methods: We conducted a prospective, interventional study. Fifty-eight treatment-naïve patients with tAMD were randomly assigned to the PRN (30 patients) or the bimonthly (28 patients) treatment group. Both groups initially received 3 monthly IVA. Visual acuity, central macular retinal thickness (CRT), and central choroidal thickness (CCT) were evaluated at 12 months. Subanalysis was performed to identify factors associated with the best-corrected visual acuity (BCVA). Results: BCVA was significantly improved only in the bimonthly group at 12 months. CRT and CCT were significantly decreased in both groups. Subanalysis showed that the only factor associated with BCVA improvement at 12 months was the existence of pigment epithelial detachment at baseline. Conclusions: BCVA showed significant improvement only in the bimonthly group but not in the PRN group at 12 months.

Characteristics of Hyperautofluorescent Choroidal Vessels within the Macular Atrophic Area Using Spectral-Domain Optical Coherence Tomography.

Purpose: The aim of this study was to clarify the characteristic findings in patients with geographic atrophy with or without hyperautofluorescent choroidal vessels within macular atrophic areas on short-wavelength fundus autofluorescence imaging. Procedures: Sixty-seven eyes of 43 consecutive patients with macular atrophic areas were divided into groups with (group 1) and without (group 2) hyperautofluorescent choroidal vessels on fundus autofluorescence imaging and then retrospectively studied using spectral-domain optical coherence tomography. Results: In group 1 (n = 21), the average subfoveal choroidal thickness was 61.5 ± 20.1 μm, and the average foveal retinal thickness was 93.0 ± 51.3 μm. On the other hand, in group 2 (n = 46), the average subfoveal choroidal thickness was 200.7 ± 83.1 μm, and the average foveal retinal thickness was 109.2 ± 58.5 μm. Although retinal thickness did not differ significantly between the two groups (p = 0.28), the difference in choroidal thickness was statistically significant (p < 0.001). Conclusions: Choroidal thinning might contribute to the hyperautofluorescence of choroidal vessels.

Response to 'photodynamic therapy for polypoidal choroidal vasculopathy'

Dear Editor, In our study, maximum GLD was 6000 μm including the fovea in eyes with PCV. There are several disadvantages associated with PDT, as you mentioned. In addition, transformation from PCV into polypoidal CNVor secondary CNV development under the retina after PDT during the follow-up study may have been related to PDT. Furthermore, eyes with good visual acuity cannot undergo PDT. Anti-VEGF drugs are useful for absorbing exudation in eyes with PCV, whether or not polypoidal lesions regress [in our recent study, causative polypoidal lesions disappeared on ICGA in 15% of 26 eyes with visual acuity of 0.6 or more after three treatments with ranibizumab, and mean visual acuity improved from log MAR 0.11 to 0.03 (P< 0.001)]. Therefore, PCV patients with good visual acuity are thought to have a good indication for ranibizumab monotherapy. However, the Everest study showed that the disappearance rate of polypoidal lesions on ICGA was significantly better with PDT alone and PDT plus ranibizumab than with ranibizumab monotherapy (personal communication). Persistent polypoidal lesions may result in recurrent exudation and/or hemorrhage, such that several re-treatments will be needed for recurrent exudation over an extended period. Therefore, PDT is needed in cases with visual acuity of 0.5 or less. These cases, especially, respond well to PDT, as we have shown in this study. PCV manifests in various ways, e.g., as a small network with one polypoidal lesion or a large network with multiple polypoidal lesions. In the near future, we plan to choose the best modality based on clinical manifestation.