Tetsuya Yamagishi

Subfoveal Choroidal Thickness after Ranibizumab Therapy for Neovascular Age-related Macular Degeneration: 12-Month Results

PURPOSE To investigate the changes in subfoveal choroidal thickness after intravitreal injections of ranibizumab (IVRs) for neovascular age-related macular degeneration (AMD). DESIGN Prospective, consecutive, interventional case series. PARTICIPANTS Eighty eyes (40 affected eyes with neovascular AMD and 40 unaffected fellow eyes) of 40 patients. METHODS Forty eyes with neovascular AMD were treated with 0.5-mg IVRs monthly for 3 months and received additional IVRs as needed over the following 9-month period. Subfoveal choroidal thickness in all 80 eyes was measured by use of enhanced depth imaging optical coherence tomography images before and after starting the IVRs. MAIN OUTCOME MEASURES Changes in subfoveal choroidal thickness after treatment by IVRs over a 12-month period. RESULTS Twenty-three eyes (57.5%) were diagnosed with typical neovascular AMD, 16 eyes (40%) were diagnosed with polypoidal choroidal vasculopathy, and 1 eye (2.5%) was diagnosed with retinal angiomatous proliferation. Fifteen eyes (38%) had received some previous treatments for the neovascular lesion before undergoing the IVRs. The mean best-corrected visual acuity of the affected eyes was improved from 0.54 logarithm of the minimum angle of resolution units at baseline to 0.42 at 12 months (P = 0.020). The mean subfoveal choroidal thickness in the affected eyes decreased from 244±62 μm at baseline to 234±66 μm at 1 month (P = 0.013), 226±68 μm at 3 months (P<0.001), 229±67 μm at 6 months (P = 0.002), and 226±66 μm at 12 months (P = 0.002; the change ratio, 93%), whereas that in the unaffected eyes changed from 237±80 μm at baseline to 238±83 μm at 12 months (P = 0.78). In the affected eyes, the change ratio of subfoveal choroidal thickness at 12 months was not correlated with the number of IVRs (mean, 5.8±2.9). Subfoveal choroidal thickness demonstrated a similar trend toward decreasing during the following period independent of the subtypes of neovascular AMD or the treatment histories. CONCLUSIONS Subfoveal choroidal thickness decreased after IVRs in eyes with neovascular AMD. Intravitreal injections of ranibizumab may provide a pharmacologic effect not only on the neovascular lesion but also on the underlying choroid.

Subfoveal choroidal thickness in retinal angiomatous proliferation.

Purpose: To investigate the subfoveal choroidal thickness in patients with retinal angiomatous proliferation (RAP). Methods: In consecutive patients with RAP, subfoveal choroidal thickness was retrospectively measured by the use of enhanced depth imaging spectral domain optical coherence tomography in comparison with age-matched control subjects. Results: Nineteen eyes of 19 patients with RAP and 32 eyes of 32 control subjects were included in this study. No significant differences were found between the eyes with RAP and the control eyes regarding age, gender, spherical equivalent, and axial length. Mean subfoveal choroidal thickness in 19 eyes with RAP was significantly less than that in the control eyes (129.5 ± 35.8 &mgr;m vs. 201.3 ± 55.0 &mgr;m, P < 0.0001). The difference in mean subfoveal choroidal thickness between eyes with Stage 2 RAP (132.8 ± 38.2 &mgr;m) and eyes with Stage 3 RAP (126.4 ± 36.6 &mgr;m) was not significant, though each measurement was significantly less than that in the control eyes (P < 0.001 and P = 0.002, respectively). Conclusion: Eyes with RAP had a significantly thinner subfoveal choroid compared with normal eyes. Such morphologic features may be related to the pathologic mechanism of RAP.

Predictive factors of resolved retinal fluid after intravitreal ranibizumab for polypoidal choroidal vasculopathy

Background/aims To investigate the predictive factors for the resolution of retinal fluid after intravitreal injections of ranibizumab (IVRs) for polypoidal choroidal vasculopathy (PCV). Methods Forty-seven eyes of 45 patients with symptomatic PCV received 0.5 mg of IVR monthly for 3 months. One month after the third IVR, the presence of dry macula, defined as absence of retinal fluid as detected by the use of optical coherence tomography, was retrospectively evaluated and correlated with clinical characteristics at baseline. Most of the eyes were followed for over 6 months. Results Of the 47 eyes, 31 eyes (66%) achieved the dry macula along with increased best-corrected visual acuity (BCVA) (0.64 to 0.46 logarithm of the minimum angle of resolution units, p<0.0001), while the other 16 eyes without dry macula showed no significant change of BCVA. Univariate analyses of the baseline characteristics identified the smaller size of the largest polyp (p=0.0008) and the absence of serous or haemorrhagic pigment epithelial detachment (p=0.045) as predictive factors for the dry macula. Multivariate logistic regression found the independent predictor for the dry macula to be the smaller size of the largest polyp (p=0.001). No severe systemic or ocular adverse events were observed. Conclusions IVR may be helpful for resolution of retinal fluid and increased BCVA in the short term, but larger polyps and pigment epithelial detachments at baseline may be negative prognostic factors for a therapeutic response. Further studies are needed to clarify the long-term efficacy of IVR for PCV.

Choroidal thickness in inferior staphyloma associated with posterior serous retinal detachment.

Purpose: The purpose of the study was to describe the choroidal findings in eyes with posterior serous retinal detachment associated with inferior staphyloma by enhanced depth imaging optical coherence tomography. Methods: The study involved five eyes of five patients with the inferior staphyloma accompanied by posterior serous retinal detachment. In each case, the upper border of the staphyloma was lying across the macula. Enhanced depth imaging spectral domain optical coherence tomography was performed in a vertical–sectional manner through the fovea, and the choroidal thicknesses at the thinnest point, at the fovea, and at 0.5 mm and 1.0 mm superior and inferior to the thinnest point were measured. Fluorescein angiography and indocyanine green angiography were also performed. Results: In all 5 eyes, the choroid was thinnest at the upper border of the staphyloma (mean, 37.4 &mgr;m; SD, 13.5 &mgr;m; range, 23–53 &mgr;m). Fluorescein angiography showed a band of window defects along the upper border of the staphyloma, where indocyanine green angiography demonstrated persistent hypoperfusion in all 5 eyes. Conclusion: The choroid was markedly thin at the upper border of the inferior staphyloma accompanied by posterior serous retinal detachment. Such choroidal abnormality seemed to play an important role in the development of serous retinal detachment.

Changes in fundus autofluorescence after treatments for polypoidal choroidal vasculopathy

Background/aims To evaluate changes in fundus autofluorescence (FAF) after treatments for polypoidal choroidal vasculopathy (PCV). Methods Thirty-six eyes of 35 patients with treatment-naive PCV underwent intravitreal injection of ranibizumab, photodynamic therapy, or a combination of both treatments. FAF and indocyanine green angiography (ICGA) at baseline were compared with those obtained 12 months later about the changes at the affected lesion. Results In the 36 eyes, 88 polyps were detected on ICGA at baseline, and 65 (73.9%) of those showed centred hypoautofluorescence and a circumferential hyperautofluorescent ring on FAF. Twelve months later, ICGA revealed resolution of 42 of those 65 polyps. Of those 42 resolved polyps, 30 hyperautofluorescent rings (71.4%) were eliminated concurrently with the resolution of polyp. Statistical analysis revealed that an elimination of the hyperautofluorescent ring was more frequently observed in association with the resolved polyps than with the persistent polyps (p<0.0001). All the hypoautofluorescent findings corresponding to branching vascular networks at baseline were unchanged during the follow-up period. Conclusions Elimination of the hyperautofluorescent ring is highly associated with the resolution of the polyp on ICGA. We propose that FAF has a potential as a non-invasive method of evaluating the therapeutic efficacy of treatments for PCV.

Distinct Aqueous Humour Cytokine Profiles of Patients with Pachychoroid Neovasculopathy and Neovascular Age-related Macular Degeneration

This study investigated the pathophysiological features of pachychoroid neovasculopathy (PNV) and neovascular age-related macular degeneration (nAMD) by analysing and comparing cytokine profiles in aqueous humour (AH) collected from 18 PNV, 18 nAMD and 11 control patients. Responses to intravitreal injection of aflibercept were also analysed in the PNV and nAMD groups. In the PNV group, vascular endothelial growth factor (VEGF)-A was significantly lower than in the nAMD group (p = 0.03) but was almost identical to that in the control group (p = 0.86). The nAMD group showed positive correlations between interleukin (IL)-6 and IL-8 (r = 0.78, p < 0.001), IL-6 and monocyte chemoattractant protein (MCP)-1 (r = 0.68, p = 0.002) and IL-8 and MCP-1 (r = 0.68, p = 0.002). In the nAMD group, eyes with dry maculae one month after the first aflibercept injection showed significantly lower VEGF-A and placental growth factor (PlGF) at baseline than those with wet maculae (p = 0.02 for both). However, there was no significant difference between dry and wet maculae in the PNV group. The results suggest that angiogenic factors and proinflammatory cytokines may play the distinct roles in the pathogenesis of PNV and nAMD.