Baseline Subfoveal Choroidal Thickness Research Articles

Factors Predictive of Visual Outcome 1 Year After Intravitreal Aflibercept Injection for Typical Neovascular Age-Related Macular Degeneration.

Several factors have been reported to be associated with visual outcomes after intravitreal ranibizumab treatment for neovascular age-related macular degeneration (AMD). In the present study, we investigated the factors associated with visual outcomes after intravitreal aflibercept injection (IAI) for typical neovascular AMD. We retrospectively studied the visual changes in 47 eyes of 51 patients with typical neovascular AMD, who had been initially treated with 3 monthly IAI followed by as-needed IAI. Mean best-corrected visual acuity (BCVA) improved during the 12-month follow-up period in 40 eyes of 37 patients without reticular pseudodrusen (RPD) in both eyes, whereas it deteriorated in 11 eyes of 10 patients with RPD in either eye. Multiple regression analysis revealed that visual gain at 12 months after the first IAI positively correlated with worse baseline BCVA and thicker baseline subfoveal choroidal thickness (P = 0.018, P = 0.004, respectively), but not with absence of RPD (P = 0.13). Subfoveal choroidal thickness was significantly thinner in eyes with RPD compared with that in eyes without RPD (P = 0.003). Visual gain after IAI in eyes with typical neovascular AMD appears to be limited in patients with RPD, which may reflect the poor visual outcome after IAI in eyes with a thinner subfoveal choroid that is seen predominately in patients with RPD.

Choroidal Thickness Changes in Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy: A 12-Month Prospective Study

To describe 12-month changes in choroidal thickness after anti-vascular endothelial growth factor (anti-VEGF) therapy for typical age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). Prospective, consecutive, noninterventional, longitudinal case series. This study included patients with typical AMD and PCV who received anti-VEGF therapy over a 12-month period. We used spectral-domain optical coherence tomography with enhanced depth imaging mode to measure choroidal thickness. Of the 163 patients, 77 had typical AMD and 86 had PCV. Patients with PCV were younger (67.6 vs 72.5 years, P < .01) and received fewer anti-VEGF injections (3.9 vs 5.6, P= .02) than patients with typical AMD. Baseline subfoveal choroidal thickness was not significantly different between PCV and typical AMD eyes, and was thicker in the study eye compared to fellow eye in the typical AMD group (223.1 vs 208.8μm, P < .01). Subfoveal choroidal thickness decreased significantly in both typical AMD (213.7μm to 190.3μm, P < .001) and PCV (240.8μm to 213.4μm, P < .01) eyes, but no significant change was noted in fellow unaffected eyes. Reduction in choroidal thickness was associated with elevated C-reactive protein (odds ratio [OR]: 1.4, P= .04) and smoking (OR: 7.6, P= .03) at baseline, but not with age, refractive error, diagnosis of typical AMD or PCV, number or type of anti-VEGF injections, PDT therapy, or baseline choroidal thickness. A significant reduction in subfoveal choroidal thickness was noted after anti-VEGF therapy in typical AMD and PCV. Choroidal thickness changes were similar despite differences in number of anti-VEGF treatment.

Changes in choroidal thickness after intravitreal dexamethasone implant injection in retinal vein occlusion

AimsTo investigate the choroidal thickness changes in eyes with retinal vein occlusion (RVO) and to determine the effect of an intravitreal dexamethasone implant (Ozurdex) on choroidal thickness.MethodsThis study comprised 47...

Choroidal Thickness Changes After Photodynamic Therapy and Recurrence of Chronic Central Serous Chorioretinopathy

To investigate long-term changes in subfoveal choroidal thickness (SCT) after photodynamic therapy (PDT) and their relationship with chronic central serous chorioretinopathy (CSC) recurrence. Retrospective, observational, comparative case series. Fifty-seven eyes with chronic CSC (52 patients, ≥2 years follow-up) treated with half-fluence or half-dose PDT were divided into 2 groups: those with incomplete CSC resolution or subretinal fluid (SRF) recurrence (SRF+) and those with complete SRF absorption without disease recurrence (SRF-). The SCT was measured using spectral-domain optical coherence tomography and relative SCT ratios (follow-up SCT: baseline SCT ratio) were compared between the 2 groups. Mean follow-up period was 33.9 ± 9.9 months (range: 24-62 months). Four of 57 eyes (7%) had persistent SRF after PDT and 12 of 53 eyes (22.6%) had initial SRF resolution with SRF recurrence. The SRF+ group had a slower reduction in SCT during the first month (P < .001) and a higher relative SCT ratio than the SRF- group throughout follow-up (P < .001). The relative SCT ratio at 1 month was highly predictive of CSC recurrence (area under the curve = 0.902, 95% confidence interval: 0.823-0.982). Using a relative SCT ratio cutoff of 93.1%, sensitivity of this measure was 93.8% and specificity was 78.1%. Those with incomplete SRF absorption or SRF recurrence had a slower SCT decline at 1 month and a higher SCT ratio throughout follow-up compared to those without CSC recurrence. The SCT changes may reflect PDT efficacy and help predict long-term recurrence and early treatment outcomes.

Retinal and Choroidal Changes With Severe Hypertension and Their Association With Visual Outcome

To investigate retinal and choroidal changes using spectral-domain optical coherence tomography (SD-OCT) and to evaluate visual outcome in patients with severe hypertension. In 42 eyes with hypertensive retinopathy from 21 patients with severe hypertension (systolic blood pressure [SBP] ≥ 180 mm Hg or diastolic blood pressure [DBP] ≥ 110 mm Hg), SD-OCT was performed on the day blood pressure (BP) was measured. Best-corrected visual acuity (BCVA), fundus features, and SD-OCT morphologic findings were evaluated and OCT features were compared between baseline and final visits. Associations between clinical findings, OCT image features, and Keith-Wagener-Barker (KWB) hypertensive retinopathy grades and baseline and final BCVA were examined. Optical coherence tomography findings included macular edema (central macular thickness > 300 μm), irregularly reflective regions, retinal nerve fiber layer thickening, subretinal fluid (SRF), intraretinal fluid, and intraretinal hyperreflective dots. All abnormalities rapidly resolved with BP control except for the hyperreflective dots. Central macular thickness, subfoveal choroidal thickness (SCT), and SRF height significantly decreased following BP control. Subretinal fluid height was significantly correlated with baseline BCVA, final BCVA, and SCT. Based on fundoscopic and OCT features, eyes were classified as showing mild to moderate retinopathy, malignant retinopathy without SRF, and malignant retinopathy with SRF. Unlike KWB grades (P = 0.077), the OCT-based retinopathy grades were significantly correlated to final BCVA, as shown by linear regression analyses (P = 0.025). Severe hypertension resulted in exudative retinal and choroidal changes, characterized by SRF accumulation and increased SCT. Our grading system may represent retinopathy severity and predict visual outcome better than the KWB grading system in patients with severe hypertension.

Baseline Choroidal Thickness as a Predictor for Response to Anti–Vascular Endothelial Growth Factor Therapy in Diabetic Macular Edema

To determine the association between baseline subfoveal choroidal thickness and short-term response to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in diabetic macular edema (DME). Retrospective, consecutive case series. Fifty-three eyes from 42 patients diagnosed with treatment-naïve DME were treated with 3 monthly intravitreal injections of ranibizumab or bevacizumab. Serial enhanced depth imaging optical coherence tomography scans were used to measure subfoveal choroidal thickness and central macular thickness (CMT). Anatomic response (CMT decrease ≥ 50 μm) and functional response (best-corrected visual acuity gain ≥ 1 line) were assessed at 3 months follow-up using univariate and multivariate analyses. After 3 monthly anti-VEGF treatments, subfoveal choroidal thickness decreased significantly (225 μm at baseline, 201 μm at 3 months, P < .0001). The anatomic responder group (32 eyes) had a greater baseline choroidal thickness (243 ± 15 μm) than the nonresponder group (21 eyes, 198 ± 13 μm, P = .03). Similarly, the functional responder group (28 eyes) tended to have a greater baseline subfoveal choroidal thickness (239 ± 12 μm) than the nonresponder group (25 eyes, 211 ± 16 μm, P = .08). Multivariate analyses revealed that a greater baseline subfoveal choroidal thickness was associated with a better anatomic (odds ratio = 1.12 for every 10 μm increase, P = .03) and functional response (odds ratio = 8.45 for >200 μm vs ≤ 200 μm, P = .008). Baseline subfoveal choroidal thickness may help predict which patients with DME will respond more favorably in the short term to intravitreal anti-VEGF pharmacotherapy. In this study, eyes with a thicker baseline subfoveal choroidal thickness had better short-term anatomic and functional responses.

Measurement of subfoveal choroidal thickness after cataract surgery in enhanced depth imaging optical coherence tomography.

To compare subfoveal choroidal thickness (SFCT) before and after uneventful cataract surgery using enhanced depth imaging optical coherence tomography (EDI-OCT). A prospective study was conducted on 115 eyes of 95 patients who had phacoemulsification. Measurements of SFCT were performed preoperatively, 1 day (D1), 7 days (D7), 1 month (M1), and 3 months (M3) after surgery using the EDI-OCT technique. Central retinal thickness (CRT) was measured before surgery and at M1 and M3. The 95 patients had a mean age of 76 ± 8.3 years. The mean SFCT at baseline was 224 ± 75 μm. It showed a negative correlation with age and axial length (P = 0.03). The SFCT significantly increased after surgery with a mean value of 232 ± 76 μm at D1 (P < 0.001), 237 ± 78 μm at M1 (P < 0.001), and 232 ± 76 μm at M3 (P < 0.001). The mean CRT increased from 234 ± 48 μm at baseline to 248 ± 48 μm at M1 (P = 0.005), and 252 ± 81 μm at M3 (P = 0.001). Three (2.6%) patients developed a pseudophakic cystoid macular edema (PCME). The greatest progression of SFCT after phacoemulsification was observed for these patients. It preceded the occurrence of pseudophakic cystoid macular edema (PCME) by 1 month. Mean SFCT increased after cataract surgery. The changes in baseline SFCT were greater in PCME patients and preceded the increase in CRT.

Retention of good visual acuity in eyes with neovascular age-related macular degeneration and chronic refractory subfoveal subretinal fluid

PurposeTo describe the clinical characteristics of a subset of eyes with neovascular age-related macular degeneration (NVAMD) receiving intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy which retain good visual acuity despite chronic, persistent subfoveal subretinal fluid (SRF). DesignRetrospective, observational case series. MethodsStudy eyes were identified from a consecutive series of 186 patients treated with anti-VEGF therapy seen for regular follow-up over a 3-month period. The clinical histories of 10 eyes of 9 patients with NVAMD, chronic subfoveal SRF despite continuous anti-VEGF therapy, and good long-term visual acuity of 20/40 or greater were reviewed. Demographic factors, baseline and final visual acuity, neovascular lesion type, duration of persistent fluid, baseline and final subfoveal choroidal thickness, presence of geographic atrophy, and number of anti-VEGF injections were analyzed. ResultsThe mean age of patients was 78years (range 55–91). The mean duration of persistent fluid was 5.2years (range 1.3–11.0). Long-term visual acuities remained stable at 20/40 or better in all eyes. All eyes had type 1 (sub-retinal pigment epithelial) neovascularization. Average baseline subfoveal choroidal thickness was 285.3μm and the average follow-up subfoveal choroidal thickness was 239.7μm. No eyes had the presence of geographic atrophy. The mean number of injections was 36.5 (range 17–66). ConclusionSome eyes with type 1 neovascularization associated with chronic persistent subfoveal subretinal fluid despite continuous intravitreal anti-VEGF therapy may maintain good long-term visual outcomes. We hypothesize that type 1 neovascularization and greater subfoveal choroidal thickness may exert a protective effect on photoreceptor integrity. Further studies are necessary to assess long-term visual prognosis and predictive factors in patients with type 1 neovascularization leading to persistent subretinal fluid that is recalcitrant to anti-VEGF treatment.

Early Visual and Morphologic Changes After Half-Fluence Photodynamic Therapy in Chronic Central Serous Chorioretinopathy

To evaluate the early functional and morphologic changes in patients with chronic central serous chorioretinopathy (CSC) after half-fluence photodynamic therapy (PDT) and to compare with fellow eyes. This prospective study included 32 symptomatic and 28 fellow eyes of 32 patients with chronic CSC. Indocyanine green angiography-guided half-fluence PDT (25 J/cm(2)) was performed. Best-corrected visual acuity (BCVA), central foveal thickness (CFT), and subfoveal choroidal thickness (SFCT) were evaluated at baseline and at days 1, 3, 7, 30, and 60 after PDT. The mean age was 48.1±7.9 years. Baseline BCVA [logarithm of the minimum angle of resolution (logMAR)] improved from 0.56±0.23 to 0.54±0.24, 0.45±0.25, 0.38±0.23, 0.36±0.23, and 0.35±0.21 at days 1, 3, 7, 30, and 60. (P=0.91, P=0.004, P=0.002, P=0.001, and P<0.001, respectively). Baseline CFT decreased from 315±131 to 312±136, 305±136, 235±106, 174±44, and 165±36 μm at days 1, 3, 7, 30, and 60 (P=0.41, P=0.33, P=0.004, P<0.001, and P<0.001, respectively). Baseline SFCT in the symptomatic eyes was significantly greater compared with the fellow eyes (P=0.002) and changed from 517±98 to 546±109, 528±110, 495±119, 462±124, and 457±123 μm at days 1, 3, 7, 30, and 60 (P=0.02, P=0.42, P=0.07, P=0.004, P=0.003, respectively). The SFCT in the symptomatic eyes was greater in the fellow eyes at baseline. Functional and morphological chorioretinal changes started in very early period of treatment. Half-fluence PDT for chronic CSC resulted in thinner CFT and SFCT, and also showed a significant improvement in visual acuity.