scholarly journals Focal choroidal excavation complicated with choroidal neovascularization in young and middle aged patients

2018 ◽  
Author(s):  
Wenyi Tang ◽  
Ting Zhang ◽  
Qinmeng Shu ◽  
Chunhui Jiang ◽  
Qing Chang ◽  
...  
Keyword(s):  
Choroidal Neovascularization ◽  
Retinal Thickness ◽  
Young Patients ◽  
Central Retinal Thickness ◽  
Middle Aged ◽  
Aged Patients ◽  
Focal Choroidal Excavation ◽  
Anti Vegf ◽  
Mean Width ◽  
The Mean

Abstract Background To investigate the clinical and optical coherence tomography (OCT) features of focal choroidal excavation (FCE) complicated with choroidal neovascularization (CNV) in young and middle aged patients. Methods We performed a retrospective review of 26 patients with FCE accompanied by CNV. All patients underwent a complete ophthalmic examination. We analyzed the clinical characteristics of patients, focusing on the spectral-domain OCT features. All patients received intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents. And we assessed the changes of central retinal thickness and best-corrected visual acuity (BCVA) after anti-VEGF therapy. Results The mean age of 26 patients was 35.5 ± 7.3 years (range, 21 - 48 years). Of the 26 FCE lesions, 11 were located subfoveally, 6 were parafoveal, and 9 were extrafoveal. The mean FCE depth was 129.8 ± 50.3 μm, and the mean width was 901.3 ± 306.0 μm. The FCE depth was correlated positively with the width, but not correlated with age or refractive error. CNV was located within the excavation (19 eyes) or adjacent to the excavation (7 eyes). After anti-VEGF therapy, the central retinal thickness was significantly reduced and the BCVA was significantly improved. In the absorption process of subretinal fluid, we found that the fluid in the excavations needed to be absorbed at the last. A small amount of residual fluid could still be seen in a few deep excavations even after a long-term follow-up. Conclusions FCE may be an important reason to cause CNV. Especially in young patients with idiopathic CNV, we should pay attention to the use of OCT to check the presence of FCE. Anti-VEGF therapy is generally effective for CNV associated with FCE.

Anti-VEGF-Therapie bei myopischer choroidaler Neovaskularisation: Langzeitergebnisse

2015 ◽  
Vol 1 (1) ◽  
pp. 38-39
Keyword(s):  
Visual Acuity ◽  
Choroidal Neovascularization ◽  
Retinal Thickness ◽  
Central Retinal Thickness ◽  
Myopic Choroidal Neovascularization ◽  
Retrospektive Analyse ◽  
Corrected Visual Acuity ◽  
Anti Vegf ◽  
Best Corrected Visual Acuity

Ziel: Beurteilung der mittel- und langfristigen Wirksamkeit von Anti-VEGF-Wirkstoffen in der Behandlung der choroidalen Neovaskularisation infolge einer pathologischen Myopie (myopic choroidal neovascularization; mCNV).Methoden: Retrospektive Analyse von mCNV-Patienten, die 2 Jahre oder länger mit einer intravitrealen Anti-VEGF-Therapie behandelt worden waren. Wir verglichen die Sehschärfe mit bester Korrektur (best-corrected visual acuity; BCVA) sowie die zentrale Netzhaut-Dicke (central retinal thickness; CRT) vor und nach der Behandlung. Die Anzahl der Injektionen pro Jahr wurde ebenfalls erfasst.Ergebnisse: Auswertungen der Ergebnisse erfolgten nach 2 Jahren für 67 Augen, nach 3 Jahren für 52 Augen, nach 4 Jahren für 28 Augen und nach 5 Jahren für 13 Augen. Die mittlere Veränderung der BCVA gegenüber dem Ausgangswert war nach 2 Jahren signifikant (+8,6 Buchstaben; p < 0,001); diese Verbesserung blieb über einen Zeitraum von 5 Jahren signifikant stabil bestehen. Die mittlere CRT nahm im Verlauf signifikant ab; der Tiefstwert war nach 2 Jahren erreicht (-104,0 μm; p < 0,001). Die mittlere Anzahl der Injektionen betrug im 1. Jahr 5,2 und ging in den nachfolgenden Jahren zurück (p < 0,001).Schlussfolgerung: In der hier beschriebenen Untergruppe von mCNV-Patienten war die intravitreale Anti-VEGF-Therapie über einen Zeitraum von 5 Jahren wirksam, wobei sich der BCVA-Wert fortwährend erhöhte.Übersetzung aus Ophthalmologica 2014;232:57-63 (DOI: 10.1159/000360307)

scholarly journals Switch to Aflibercept in Diabetic Macular Edema Patients Unresponsive to Previous Anti-VEGF Therapy

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Filipe Mira ◽  
Manuel Paulo ◽  
Filipe Henriques ◽  
João Figueira
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Retrospective Review ◽  
Retinal Thickness ◽  
Central Retinal Thickness ◽  
Functional Improvement ◽  
Anti Vegf ◽  
The Mean

Purpose. The aim was to evaluate the efficacy of aflibercept in patients with diabetic macular edema (DME) unresponsive to prior anti-VEGF therapy. Methods. Retrospective review of DME unresponsive to previous anti-VEGF switched to aflibercept with 3 months of follow-up. Changes in best correct visual acuity (BCVA), central retinal thickness (CRT), and frequency of injections were analyzed. The percentage of subjects who had ≥20/40 (logMAR equivalent 0.3) and ≤20/200 (logMAR equivalent 1) was evaluated. Results. A total of 32 eyes from 26 patients were included. Mean age was 65 ± 10 years old. The mean number of previous anti-VEGF injections was 5.34 ± 2.38, and the mean number of aflibercept injections at the end of the study was 2.00 ± 0.00. The CRT at baseline was 501.47 ± 150.51 μm and 367.97 ± 124.61 μm at 3 months of follow-up (P<0.001). The logMAR BCVA at baseline was 0.71 ± 0.36 and 0.65 ± 0.33 at the end of the follow-up (P=0.037). At baseline, 12.5% of patients had ≥20/40 compared with 25% at the end of follow-up. At baseline, 28.13% of patients had 20/200 or inferior vision compared with 15.63% at the end of the follow-up. Conclusions. DME patients unresponsive to previous multiple ranibizumab injections demonstrate a significant anatomical and functional improvement with the switch to aflibercept.

scholarly journals Our experience in visual functions' improvement in patiens with “wet” age-related macular degeneration at switching from one anti-VEGF agent to another

2017 ◽  
Vol 10 (3) ◽  
pp. 67-73
Author(s):  
Sergey A Korotkikh ◽  
Evgeniy V Bobykin
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Choroidal Neovascularization ◽  
Retinal Thickness ◽  
Age Related Macular Degeneration ◽  
Central Retinal Thickness ◽  
Macular Volume ◽  
Anti Vegf ◽  
Age Related ◽  
Previously Treated

Purpose. To assess mean changes in visual acuity, central retinal thickness and macular volume as well as to determine the duration of clinical choroidal neovascularization inactivity after single aflibercept injection in neovascular age-related macular degeneration (nAMD) patients switched from ranibizumab (preliminary date). Methods. Open-label prospective study. The study enrolled 23 patients with nAMD previously treated with ranibizumab. Results. Mean age of patients was 70.5 years, 16 were women. Mean number of ranibizumab injections given prior to switching to aflibercept was 8.7. After single aflibercept inravitreal injection mean visual acuity has significantly improved from 0.40 to 0.47 Snellen chart. Mean central retinal thickness has significantly reduced from 323.1 to 246.9 μm and mean macular volume has significantly reduced from 7.71 to 6.74 mm3. Duration of choroidal neovascularization (CNV) inactivity was 2.91 months. Conclusion. Single aflibercept intravitreal injection has resulted in significant visual gain as well as in significant central retinal thickness (CRT) and macular volume reduction. This provides evidence of aflibecept efficacy in nAMD patients previously treated with anti-VEGF. Duration of CNV inactivity provides clinical data supporting aflibercept injection every 8 weeks in nAMD patients. (For citation: Korotkikh SA, Bobykin EV. Our experience in visual functions' improvement in patiens with “wet” age-related ­macular degeneration at switching from one anti-VEGF agent to another. Ophthalmology Journal. 2017;10(3):67-73. doi: 10.17816/OV10367-73).

Central retinal thickness fluctuations in patients treated with anti-VEGF for neovascular age related macular degeneration

2021 ◽  
pp. 112067212110378
Author(s):  
Francesco Ciucci ◽  
Giuseppina Ioele ◽  
Antonio Bardocci ◽  
Giorgio Lofoco ◽  
Barbara Antonelli ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Retinal Thickness ◽  
Treatment Algorithm ◽  
Real Life ◽  
Principal Component ◽  
Age Related Macular Degeneration ◽  
Central Retinal Thickness ◽  
First Year ◽  
Anti Vegf ◽  
Age Related

Purpose: This is a retrospective, single-center, non randomized interventional real life study, investigating the correlation between variability of central retinal thickness (CRT) and functional outcomes during 2 years of anti-VEGF therapy in patients treated for neovascular age related macular degeneration (nAMD). Background: CRT fluctuations can depend on various factors such as the correct timing of injections, the therapeutic algorithm, and the number of injections (NI) performed; it is important to understand if CRT fluctuations are responsible for worse visual outcomes and consequently to identify the correct ways to avoid or reduce them. Methods: Forty-one patients were treated for nAMD with aflibercept: 0.5 mg intravitreal aflibercept was administered every 4 weeks during the first 3 months, then bimonthly over the first year, and after the first year adopting a PRN regimen. Standard deviation of CRT (CRT/SD), BCVA, and NI were recorded. Correlation studies were performed by Pearson’s test, Ancova, and Principal Component Analysis. Results: A negative correlation was found between CRT/SD and final BCVA. In patients who lost more than 15 letters, CRT/SD mean was significantly higher in comparison with patients who lost less than 15 letters. Patients with final BCVA >65 letters showed lower CRT/SD values compared to patients with final BCVA ⩽65 letters. Multivariate analysis confirmed that in patients with higher baseline BCVA, improvement of BCVA was correlated to NI, and lower values of CRT fluctuations were observed. Conclusions: CRT fluctuations, even after an appropriate NI given per year, significantly influence BCVA; a proactive treatment algorithm appears crucial when treating patients with nAMD.

scholarly journals Macular density alterations in myopic choroidal neovascularization and the effect of anti-VEGF on it

2021 ◽  
Vol 14 (8) ◽  
pp. 1205-1212
Author(s):  
Jian-Bo Mao ◽  
◽  
Jia-Feng Yu ◽  
Xin-Yi Deng ◽  
Chen-Yi Liu ◽  
...  
Keyword(s):  
Choroidal Neovascularization ◽  
Capillary Density ◽  
Normal Group ◽  
Reduction Ratio ◽  
Vessel Density ◽  
Lesion Area ◽  
Flow Area ◽  
Myopic Choroidal Neovascularization ◽  
Anti Vegf ◽  
The Mean

AIM: To analyse macular microvascular alterations in myopic choroidal neovascularization (mCNV) and the efficiency of anti-vascular endothelial growth factor (anti-VEGF) therapy for mCNV by optical coherence tomography angiography (OCTA). METHODS: A total of 123 patients were included in this retrospective study, divided into mCNV group, high myopia (HM) group, and normal group at the Affiliated Eye Hospital of Wenzhou Medical University from January 2017 to January 2019. Superficial vessel density, deep capillary density, foveal avascular zone (FAZ) area, A-circularity index (AI) and vessel density around the 300 μm width of the FAZ region density (FD) and the area of choroidal neovascularization (CNV) lesion (only for mCNV group) were measured on 3×3 mm2 OCTA images. FAZ area was corrected for axial length. Central macular thickness (CMT) was measured on OCT in mCNV group. Compared the parameters on OCTA of 3 groups and pre-anti-VEGF and post-anti-VEGF at 1, 2, 3, and 6mo follow-up in mCNV group. RESULTS: There were significant differences among 3 groups in superficial vessel density, deep capillary density and FD (P<0.05). FAZ area in HM group was smaller than normal group (P<0.05), but there was no significant difference between mCNV group and the other two group. AI increased in mCNV group (P<0.05). The mean CMT, area and flow area of CNV lesion decreased after treatment (P<0.05), while vessel density and FAZ didn’t change. The mean CMT, area and flow area of CNV lesion statistically decreased after anti-VEGF treatment in mCNV group (P<0.05), while superficial vessel density, deep capillary density and FAZ area, AI and FD didn’t change. The mean reduction ratio of lesions was 50.32% (7.07% to 100%). Lesion regression 100% was observed in 2 cases (4.88%). There was a negative correlation between the CNV lesion area and reduction ratio (r=-0.380, P=0.042) and the flow lesion area and reduction ratio (r=-0.402, P=0.030). CONCLUSION: Macular vessel density decreases, FAZ turns smaller and more irregular in mCNV eyes. Anti-VEGF therapy is efficient for mCNV without affecting vessel density and FAZ, but it is unable to completely eliminate CNV lesions in most cases. The bigger mCNV lesions have lower reduction ratio.

scholarly journals Association between Retinal Thickness Variability and Visual Acuity Outcome during Maintenance Therapy Using Intravitreal Anti-Vascular Endothelial Growth Factor Agents for Neovascular Age-Related Macular Degeneration

2021 ◽  
Vol 11 (10) ◽  
pp. 1024
Author(s):  
Timothy Y. Y. Lai ◽  
Ricky Y. K. Lai
Keyword(s):  
Visual Acuity ◽  
Retinal Thickness ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Age Related ◽  
Thickness Variability ◽  
The Mean ◽  
Endothelial Growth Factor

Previous studies based on clinical trial data have demonstrated that greater fluctuations in retinal thickness during the course of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD) is associated with poorer visual acuity outcomes. However, it was unclear whether similar findings would be observed in real-world clinical settings. This study aimed to evaluate the association between retinal thickness variability and visual outcomes in eyes receiving anti-VEGF therapy for nAMD using pro re nata treatment regimen. A total of 64 eyes which received intravitreal anti-VEGF therapy (bevacizumab, ranibizumab or aflibercept) for the treatment of nAMD were evaluated. Variability in spectral-domain optical coherence tomography (OCT) central subfield thickness (CST) was calculated from the standard deviation (SD) values of all follow-up visits after three loading doses from month 3 to month 24. Eyes were divided into quartiles based on the OCT CST variability values and the mean best-corrected visual acuity values at 2 years were compared. At baseline, the mean ± SD logMAR visual acuity and CST were 0.59 ± 0.39 and 364 ± 113 µm, respectively. A significant correlation was found between CST variability and visual acuity at 2 years (Spearman’s ρ = 0.54, p < 0.0001), indicating that eyes with lower CST variability had better visual acuity at 2 years. Eyes with the least CST variability were associated with the highest mean visual acuity improvement at 2 years (quartile 1: +9.7 letters, quartile 2: +1.1 letters, quartile 3: −2.5 letters, quartile 4: −9.5 letters; p = 0.018). No significant difference in the number of anti-VEGF injections was found between the four CST variability quartile groups (p = 0.21). These findings showed that eyes undergoing anti-VEGF therapy for nAMD with more stable OCT CST variability during the follow-up period were associated with better visual outcomes. Clinicians should consider adopting treatment strategies to reduce CST variability during the treatment course for nAMD.

scholarly journals Type 1 Choroidal Neovascularization Evolution by Optical Coherence Tomography Angiography: Long-Term Follow-Up

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Marco Rispoli ◽  
Maria Cristina Savastano ◽  
Bruno Lumbroso ◽  
Lisa Toto ◽  
Luca Di Antonio
Keyword(s):  
Optical Coherence Tomography ◽  
Choroidal Neovascularization ◽  
Structural Changes ◽  
Imaging Techniques ◽  
Optical Coherence ◽  
Anti Vegf ◽  
The Mean

Purpose. To evaluate structural changes in response to antivascular endothelial growth factor (anti-VEGF) treatment in patients with long-term type 1 choroidal neovascularization (CNV) by optical coherence tomography (OCT) and OCT angiography (OCTA). Method. This is a longitudinal study that involved a total of 51 eyes with type 1 CNV (35 female and 16 male eyes). Structural OCT and OCTA were performed on all the subjects. AngioVue OCTA (XR Avanti, Optovue, Inc., Fremont, CA) was used to obtain qualitative and quantitative information. All eyes were treated with an anti-VEGF ProReNata (PRN) approach and were followed for a mean of 38.9 months (SD±7.22). Best-corrected visual acuity (BCVA) was assessed at each follow-up timepoint. Results. We observed two kinds of possible evolution of type 1 CNV: “positive evolution,” including stabilization in 20% of patients and chronicity in 35%, and “negative evolution,” in which fibrosis was shown in 18% of patients, chorioretinal atrophy in 25%, and hemorrhage or RPE tears in 2%. The mean BCVA at baseline was 33.67±15.85 ETDRS letters; after 1 and 2 years, it was 31.61±18.04 and 31.18±18.58 ETDRS letters, respectively. The mean BCVA at the end of follow-up was 25.27±20 ETDRS letters. The difference between the values at baseline and at the end of follow-up was not statistically significant (P=0.06, r2=0.10). Conclusions. This study describes an in vivo structural long-term evolution of type 1 CNV by OCT and OCTA. Different possible CNV outcomes were observed. This study suggests that new retinal imaging techniques could be useful tools for assessing the potential retinal changes in the evolution of type 1 CNV to develop personalized medicine. Further studies using OCTA in the long term are needed to better understand why similarly treated type 1 CNV cases evolve differently and produce different results.

Success of Intravitreal Ranibizumab for Myopic Choroidal Neovascularization After 2 Years of Treatment

2017 ◽  
Vol 1 (2) ◽  
pp. 122-125 ◽  
Author(s):  
Beatriz Abadia ◽  
Pilar Calvo ◽  
Antonio Ferreras ◽  
Gloria Lopez ◽  
Jesús Leciñena ◽  
...  
Keyword(s):  
Choroidal Neovascularization ◽  
Medical Records ◽  
Functional Outcomes ◽  
Retinal Thickness ◽  
Pathological Myopia ◽  
Intravitreal Ranibizumab ◽  
Corrected Visual Acuity ◽  
The Mean ◽  
Pro Re Nata

Purpose: To analyze the anatomical and functional outcomes in patients with choroidal neovascularization (CNV) secondary to pathological myopia (PM). Methods: Retrospective review of the medical records of 40 patients with CNV secondary to PM treated exclusively with intravitreal ranibizumab 0.5 mg and at least 24 months of follow-up. The initial dose comprised 1 or 3 monthly injections followed by a pro re nata regimen. Best-corrected visual acuity (BCVA), central retinal thickness (CRT) measured with spectral domain optical coherence tomography (OCT), and ocular and systemic adverse event were recorded. Results: Mean patient age was 62.5 ± 12.5 years. The mean spherical equivalent refractive error was −12.3 ± 6.9 diopters, and a single intravitreal injection was initially performed in 72.5% of cases. Mean baseline BCVA was 0.33 ± 0.20 logMAR (Snellen equivalent, 20/60), and mean CRT by OCT was 340.65 ± 80 µm. Both BCVA and OCT revealed significant improvement compared to baseline at all established cutoff points ( P < .001). Final BCVA was 0.50 ± 0.3 logMAR (Snellen, 20/40), and final CRT was 255.69 ± 47.7 µm ( P < .001). The mean number of ranibizumab injections was 2.75 ± 1.97. No cases of endophthalmitis or retinal detachments were reported, and no serious adverse systemic events were identified. Conclusion: Excellent anatomical and functional outcomes were obtained after treatment with intravitreal ranibizumab for CNV secondary to PM.

Cerebral Leptomeningeal Angiomatosis CT and MRI evaluation

1998 ◽  
Vol 11 (4) ◽  
pp. 463-470
Author(s):  
J. Tsitouridis ◽  
S. Stamos ◽  
J. Demertzis ◽  
P. Nikolopoulos
Keyword(s):  
Cerebral Cortex ◽  
Young Patients ◽  
Middle Aged ◽  
Vascular Calcifications ◽  
Aged Patients ◽  
Weber Syndrome ◽  
Sturge Weber Syndrome ◽  
Mri Evaluation ◽  
Ct And Mri

Leptomeningeal angiomatosis is an uncommon benign hamartomatous lesion usually involving the leptomeninges with or without cerebral cortex involvement. Three middle-aged patients with seizures from adulthood had undergone CT and MRI examinations and craniotomies which revealed leptomeningeal angiomatosis. Another two young patients with Sturge-Weber syndrome and leptomeningeal angiomatosis were also evaluated. MRI is clearly helpful in establishing the topography and vascular malformative nature of the lesion, while CT is more accurate in detecting vascular calcifications.

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