Min Kyu Shin

Perfluoro-n-octane–assisted Single-layered Inverted Internal Limiting Membrane Flap Technique for Macular Hole Surgery

Vitrectomy became the standard treatment of macular hole after its introduction by Kelly and Wendel.1 Although progression of surgical techniques and diagnostic tools have improved the anatomical outcomes of macular hole surgery, postoperative visual recovery is usually limited.2–4 Furthermore, surg

Reduced-Fluence Photodynamic Therapy in Polypoidal Choroidal Vasculopathy Nonresponsive to Ranibizumab

BACKGROUND AND OBJECTIVE To evaluate the effect of reduced-fluence photodynamic therapy (PDT) on polypoidal choroidal vasculopathy (PCV) unresponsive to intravitreal ranibizumab. PATIENTS AND METHODS Patients with PCV unresponsive to ranibizumab administered 3 months consecutively who then received reduced-fluence PDT were retrospectively surveyed. Nonresponders were defined as patients having no reduction in intraretinal and/or subretinal fluid after 3 consecutive treatments. RESULTS In total, 22 of 104 eyes (21.2%) were non-responders, and 16 of 22 nonresponders received reduced-fluence PDT. Nine eyes achieved complete fluid resolution, and six had reduced but persistent fluid. In one eye, fluid persisted at 6 months despite an additional anti-vascular endothelial growth factor (anti-VEGF) injection after reduced-fluence PDT. Mean macular thickness decreased significantly at 3 and 6 months after PDT, but the mean visual acuity was worse than baseline. CONCLUSION Reduced-fluence PDT in nonresponders gradually decreased intraretinal and/or subretinal fluid over several months but did not maintain visual acuity.

Choroidal Watershed Zone and Growth of Polypoidal Choroidal Vasculopathy

ABSTRACT Purpose: To investigate the topographic relationship between polypoidal choroidal vasculopathy (PCV) growth and choroidal watershed zones (CWZ) by using indocyanine green angiography (ICGA). Materials and Methods: We evaluated PCV lesions smaller than the CWZ at baseline and followed up more than 6 months. The CWZ was traced in the early phase ICGA at baseline. The vascular lesion of PCV was traced in baseline and follow-up ICGA. These traces were overlapped and topographic relationships between CWZs and PCV growth were evaluated. Results: Among 31 eyes of 31 patients, enlargement of a PCV lesion was observed in 20 patients (64.5%) at mean follow-up of 30.4 months (6–68 months). A topographical relationship between the CWZ and PCV growth was demonstrated in 14 eyes (70.0%), as the shape of the PCV lesion conformed to the boundary of the CWZ, and/or the growth of the branching vascular network was aligned to the direction of the CWZ extension to the periphery. Growth beyond the boundary of the CWZ was noted in 9 eyes (45.0%), however growth area was greater inside the CWZ than outside in all eyes. Of 15 eyes of extrafoveal lesion at baseline, 8 eyes in which the vascular lesion progressed to the fovea had the CWZ involving the fovea, whereas PCV in three eyes with an extrafoveal CWZ remained as a non-subfoveal disease after mean follow-up of 17.0 months (p = 0.019). Conclusions: A subfoveal CWZ was related to PCV growth to the fovea. Topographical relationships between PCV growth and the CWZ suggest that choroidal circulation is a predisposition for PCV growth.

Topographical relationship between the choroidal watershed zone and submacular idiopathic choroidal neovascularisation

Aims To investigate the relationship between idiopathic choroidal neovascularisation (CNV) and choroidal watershed zones (CWZs) using indocyanine green angiography (ICGA). Design Multicentre, retrospective, interventional case series. Methods The medical records and ICGA findings of 44 patients (44 eyes) diagnosed with idiopathic CNV were reviewed. CWZs, defined as hypofluorescence that disappeared during the early phase of ICGA, were classified, and the findings were compared with those of a control group of 30 eyes. The topographical relationship between CWZs and CNV was evaluated. Visual acuity and recurrence were analysed according to the CWZ classification. Results The CNV lesion was subfoveal in 16 eyes, juxtafoveal in 12 eyes and extrafoveal in 16 eyes. The most common types of CWZs were stellate (23 eyes, 52.3%) and vertical (19 eyes, 43.2%). CWZs involving the fovea were seen in more patients with idiopathic CNV (37 eyes, 84.1%) than in the control group (11 eyes, 36.7%, p<0.001). The topographical relationship between CWZs and CNV was determined in 42 eyes (95.5%), with the CNV located within the CWZ in 39 eyes and at the margin in 3 eyes. Extrafoveal CNV was within the CWZ in all 16 affected eyes. At 6 months, visual acuity was significantly worse in patients with subfoveal CNV (p=0.028) or stellate CWZs (p=0.039). Conclusions The findings of a CWZ were related to the location and functional outcome of idiopathic CNV. Our results suggest that choroidal circulation is a predisposing factor for the development of CNV in young patients.

Serous retinal detachment accompanied by MEWDS in a myopic patient with dome-shaped macula.

Macular serous retinal detachment (MSRD) is a rare complication in highly myopic patients with an inferior staphyloma, tilted disc, or dome-shaped macula. Multiple evanescent white dot syndrome (MEWDS) presents with sudden visual loss and multiple yellowish dots that resolve spontaneously within several weeks. The authors report the development and spontaneous resolution of subretinal fluid accompanied by MEWDS in a myopic patient with a dome-shaped macula. Dysfunction of the retinal pigment epithelium due to MEWDS likely induced temporary MSRD in this patient.

Growth of Polypoidal Choroidal Vasculopathy Aligned to Choroidal Watershed Zone.

Polypoidal choroidal vasculopathy (PCV) is a subtype of exudative age-related macula\r degeneration, and its natural history is quite variable. We reported that growth of PCV was related to a choroidal watershed zone (CWZ) in the article entitled “Choroidal Watershed Zone and Growth of Polypoidal Choroidal Vasculopathy.” In detail, PCV growth had a topographic correlation with a CWZ as the boundary of a PCV lesion conformed to the CWZ, or the growth direction was aligned to a peripheral extension of the CWZ. However, the study had some limitations owing to its retrospective nature, and selection bias might be implicated. Herein, we report follow-up findings in one of the cases included in the study. After the submission of the manuscript for publication, a patient visited our outpatient clinic complaining of metamorphopsia and decreased vision. He was the case in Figure 1 of the literature, showing growth of a PCV lesion within a CWZ during 3 years of follow-up (Figure 1A–C). Fundus examination revealed the development of a large pigment epithelial detachment at the temporal side of the macula. Indocyanine green angiography (ICGA) demonstrated that the vascular lesion enlarged beyond the CWZ boundary, compared to the lesion examined with ICGA 40 months before (Figure 1D). The most prominent growth was noted in the superotemporal direction, which was along the CWZ extension to the periphery that had been observed in ICGA at baseline (Figure 1A and E). With two consecutive intravitreal bevacizumab injections and photodynamic therapy, the macula became dry and his vision remained 20/20. The findings above are important to support the conclusions in the previous retrospective study. The growth of PCV was in the direction of the CWZ extension, was more prominent within the CWZ, and finally progressed beyond the

Evaluation of Macular Function Using Pattern Electroretinogram in Idiopathic Epiretinal Membrane.

Purpose Pattern electroretinogram (PERG) in idiopathic epiretinal membrane (ERM) was investigated to find the correlation of the ganglion cell function with postoperative visual acuity. Design This was a retrospective consecutive chart review. Methods Medical records of 24 eyes that underwent vitrectomy and membrane peeling for idiopathic ERM were reviewed retrospectively. The amplitude and implicit time of P50 and N95 in preoperative PERG were analyzed to find correlation with visual acuity and foveal thickness. The ratio of the parameters in involved eyes to those in healthy fellow eyes was calculated for analysis. Results Visual acuity (logarithm of the minimum angle of resolution) improved from 0.53 at baseline to 0.34 at 6 months (P = 0.003). Foveal thickness decreased significantly from 488.3 &mgr;m at baseline to 374.7 &mgr;m (P = 0.001). The preoperative N95 amplitude ratio was significantly correlated with visual acuity at 6 months after ERM removal (r = −0.423, P = 0.040), whereas the amplitude of P50 and implicit time of both waves showed no significant correlation with postoperative visual acuity. The implicit time ratio of P50 (r = 0.530, P = 0.008) and N95 (r = 0.436, P = 0.033) showed significant correlation with preoperative foveal thickness on optical coherence tomography. Conclusions N95 amplitude in PERG was a predictor of visual outcomes after ERM surgery. These results suggest the correlation of postoperative visual acuity with the function of the ganglion cell layer, which is the closest cell layer to be affected by ERM.