Idiopathic Choroidal Neovascularization Research Articles

Efficacy and safety of intravitreal injections of conbercept for the treatment of idiopathic choroidal neovascularization.

To determine the efficacy and safety of intravitreally injected conbercept, a vascular endothelial growth factor receptor fusion protein, for the treatment of idiopathic choroidal neovascularization (ICNV). This retrospective study analyzed outcomes in 40 patients (40 eyes) with ICNV who received intravitreal injections of conbercept 0.5 mg (0.05 ml) and were followed up for at least 12 months. All patients underwent full ophthalmic examinations, including best-corrected vision acuity (BCVA), intraocular pressure (IOP), slit-lamp examination, color fundus photography, optical coherence tomography angiography, multifocal electroretinogram, and fundus fluorescence angiography, if necessary, at baseline and after 1, 3, 6, and 12 months. BCVA, macular central retinal thickness (CRT), IOP, CNV blood flow area, thickness of the CNV-pigment epithelial detachment complex, thickness of the retinal nerve fiber layer (RNFL), and the first positive peak (P1) amplitude density in ring 1 before and after treatment were compared. Mean baseline BCVA (logMAR), CRT, CNV blood flow area, and CNV-pigment epithelial detachment complex thickness were significantly lower 1, 3, 6, and 12 months after than before conbercept treatment (P < 0.05 each). IOP and baseline RNFL thickness were unaffected by conbercept treatment. P1 amplitude density was significantly higher 1, 3, 6, and 12 months after than before conbercept treatment (P < 0.05 each). None of the 40 eyes showed obvious ocular adverse reactions, such as endophthalmitis, glaucoma, cataract progression, and retinal detachment, and none of the patients experienced systemic adverse events, such as cardiovascular and cerebrovascular accidents. Intravitreal injection of conbercept is beneficial to eyes with ICNV, inducing the recovery of macular structure and function and improving BCVA, while not damaging the neuroretina. Intravitreal conbercept is safe and effective for the treatment of ICNV.

Differential diagnosis of myopic choroidal neovascularization (mCNV): insights from multimodal imaging and treatment implications.

The aim of this article is to conduct a comprehensive systematic review about the current understandings and differential diagnosis of myopic choroidal neovascularization (mCNV) and other several similar diseases, describing their multimodal imaging analysis, prognostic implications, and current types of management. This systematic review was performed based on a search on the PubMed database of relevant papers regarding mCNV and other entities discussed in the paper, according to our current knowledge. Through the integration of a multimodal imaging approach, especially optical coherence tomography (OCT), along with accurate demographic and clinical assessment, it becomes possible to effectively differentiate mCNV from similar yet heterogeneous entities. These conditions include macular hemorrhage due to new lacquer crack (LC) formation, inflammatory diseases such as punctate inner choroidopathy (PIC)/multifocal choroidits (MFC) and epiphenomenon multiple evanescent white dot syndrome (Epi-MEWDS), neovascular age-related macular degeneration (nAMD), idiopathic CNV (ICNV), dome-shaped macula (DSM) with subretinal fluid, retinal pigment epithelium (RPE) humps, angioid streaks (AS), choroidal rupture (CR), and choroidal osteoma (CO). Each one of these entities will be described and discussed in this article. Myopic choroidal neovascularization is a common retinal condition, especially among young individuals. Accurate diagnosis and differentiation from similar conditions are crucial for effective treatment. Multimodal imaging, particularly OCT, plays a crucial role in precise assessment. Future research should focus on defining biomarkers and distinguishing features to facilitate prompt treatment.

Recurrent Idiopathic Choroidal Neovascularization in an Adolescent

Purpose: To report recurrent idiopathic choroidal neovascularization (CNV) in an adolescent.Case summary: A 14-year-old male presented with reduced vision in the right eye, 3 weeks in duration. His best-corrected visual acuity (BCVA) was 0.2. He lacked any medical or ocular history, any family history of retinal disease, and any trauma history. Autorefraction yielded a spherical equivalent of -4.75 diopters. Neither posterior staphyloma nor myopic macular degeneration was apparent in a fundus photograph. However, the photograph revealed a greyish foveal lesion with a subretinal hemorrhage, but was otherwise unremarkable. Optical coherence tomography and fluorescein angiography revealed foveal CNV with a subretinal hemorrhage and fluid. As no feature known to cause CNV was apparent, we diagnosed idiopathic CNV and prescribed right-eye intravitreal ranibizumab injections. After treatment, the BCVA became 1.0, but the CNV continued to recur; he has received 26 intravitreal ranibizumab injections over the last 47 months.Conclusions: Most idiopathic CNVs in adolescents are well-treated with fewer injections. However, CNV can continue to recur; multiple intravitreal injections and careful monitoring may be required.

Long-Term Outcomes of High-Dose Conbercept Treatment for Myopic Choroidal Neovascularization and Idiopathic Choroidal Neovascularization

Introduction: The aim of the study was to report 2-year outcomes of intravitreal injection of high-dose conbercept (1 mg 2 + PRN scheme) for subjects with myopic choroidal neovascularization (mCNV) and idiopathic choroidal neovascularization (iCNV) by optical coherence tomography angiography follow-up. Methods: A total of 38 subjects (38 eyes) were enrolled in this retrospective study, which were divided into group A (mCNV, 20 subjects, 20 eyes) and group B (iCNV, 18 subjects, 18 eyes). All subjects received 1.0 mg of conbercept intravitreally at diagnosis and again 35 days later. Additional conbercept injection was administered upon findings of decreased best-corrected visual acuity (BCVA); metamorphosis aggravation, macular hemorrhage, or edema; increased central retinal thickness (CRT); or leakage observed by fluorescein angiography. The BCVA, CRT, and CNV areas of the two groups were evaluated at baseline and at 1, 2, 4, 6, 12, and 24 months after surgery. Results: The BCVA of group A improved from 0.31 ± 0.16 logMAR at baseline to 0.12 ± 0.03 logMAR at the final follow-up (p p p p > 0.05). Conclusion: Intravitreal injection of conbercept (1 mg 2 + PRN scheme) is effective for treating patients with mCNV or iCNV, which can improve and stabilize vision as well as dramatically alleviate metamorphopsia.

Choroidal neovascularization (CNV) due to non‐age‐related macular degeneration (AMD) causes: Multimodal imaging and treatment outcome in a retrospective case series

AbstractPurpose: To present the management (clinical evaluation, fundus imaging and treatment outcome) of patients with non‐AMD related CNV.Methods: We retrospectively reviewed the medical records of a case series with non‐AMD related CNV patients that were referred to our clinic since January 2021 and treated with intravitreal injections of anti‐VEGF (ranibizumab or aflibercept). The following data were retrieved: demographic data, best‐corrected visual acuity (BCVA) at the initial and final visit, number of injections and side‐effects, fundus fluorescein angiography (FFA), optical coherence tomography (OCT) and OCT‐angiography imaging results.Results: We included nine eyes of nine patients (seven females and two males, median age: 59 years, range 19–72): five myopic, three with idiopathic CNV, one with angioid streaks (AS). Median BCVA at presentation was 0.7 (range 0.1–0.8). FFA revealed a classic CNV in all cases (subfoveal: eight cases, extrafoveal: one case). OCT‐angiography confirmed the presence of an active CNV in six out of nine cases. In OCT, there was minimal fluid (five out of nine cases), subretinal fluid (two cases) or both subretinal and intraretinal fluid (two cases). The median number of injections was three (range 1–14) with no reported adverse events. An improvement in BCVA was documented in all cases after treatment. On the final recorded visit, OCT showed minimal/no fluid in all patients while in OCT‐angiography the CNV showed signs of inactivity in the majority cases.Conclusions: Multimodal imaging is useful in the diagnosis, follow‐up and management of cases with non‐AMD related CNV. Most of them demonstrated minimal signs of exudative disease and required less number of anti‐VEGF injections compared to neovascular AMD cases.

A retrospective analysis on comparison of optical coherence tomography manifestations among AMD, CEC, PM and ICN and its relationship with vision.

Both macular choroidal neovascularization (MCN) and visual changes can occur in age-related macular degeneration (AMD), central exudative chorioretinopathy (CEC), pathological myopia (PM) and idiopathic choroidal neovascularization (ICN), but whether the optical coherence tomography (OCT) manifestations of the four diseases are different and their relationships with vision are not clear. This study clarifies this problem and can guide clinicians to prevent vision changes of patients according to OCT performance. 76 patients with MCN, included 25 AMD, 21 CEC, 18 PM and 12 ICN [refer to Chinese Ophthalmology (3rd Edition)], detected by OCT instrument, were enrolled in this study from June 2020 to June 2022. The OCT manifestations and indexes were observed. A comprehensive refractometer was used for detection of best corrected visual acuity (BCVA) and axial length (AL). Pearson chi squared and 1 way analysis of variance were used for enumeration data and continuous data test, and Pearson correlation coefficient was used for relationship analysis. (I) Macular edema proportions in the MCN eyes among AMD, CEC, PM and ICN groups were 96.00% and 94.12%, 14.29% and 14.29%, 44.44% and 32.00%, 33.33% and 28.57%, with statistical differences (both P<0.001). (II) Patients with macular edema had a significantly higher loose and thickened tissue reflex of the neuroepithelial layer (100.00% vs. 4.26%) and limited non-reflective dark area (100.00% vs. 4.26%) (both P<0.001). (III) PM had the lowest width, height and central fovea thickness (CFT) [(1,403.43±114.41), (210.74±21.22) and (250.70±41.36) μm], and the highest distance to the fovea, BCVA and AL [(234.44±288.69) μm, (0.30±0.08) Log minimal angle of resolution (MAR), (28.48±5.72) mm] (all P<0.001). (IV) The width and height of patients with macular edema were lower than those of patients without macular edema [(1,738.43±348.71) vs. (2,493.95±771.53) μm, P<0.001; (305.71±81.22) vs. (367.29±107.91) μm, P=0.002] (P<0.05). (V) The width and height, CFT were negatively correlated to BCVA (r=-0.635, -0.712, -0.724, all P<0.001), and height, CFT were negatively correlated to AL (r=-0.244, -0.275, P=0.018, 0.007). The distance to the fovea was positively correlated to BCVA and AL (r=0.241, P=0.019; r=0.267, P=0.007). Most of the OCT indexes were related to the BCVA and AL in MCN patients, and MCN patients with OCT changes should be reminded to protect their vision.

Choroidal Neovascularization in Pediatric Patients: Analysis of Etiologic Factors, Clinical Characteristics and Treatment Outcomes.

Background and Objectives: Choroidal neovascularization (CNV) is a common pathologic lesion that occurs in various chorioretinopathy, but very limited published data have reported in pediatric patients. This study aimed to investigate the etiologic factors, clinical features, and treatment outcomes of choroidal neovascularization (CNV) in children.Methods: In this study, 33 eyes in 30 patients aged 18 years or younger with CNV were included. Comprehensive ophthalmic examination was performed in all the patients. The demographic profiles, laterality, visual acuity, optical coherence tomographic findings, fundus fluorescein angiographic findings, and the underlying pathology were analyzed. The types, locations, treatment outcomes, and recurrences of CNV were noted.Results: The average age was 11.2 ± 4.6 (range, 1–18) years. Most CNVs affecting children were classic and type 2. The most common etiologic factors of CNV in pediatric patients were congenital/developing abnormalities (9/30, 30.0%) and inflammatory retinochoroidopathy (9/30, 30.0%), followed by idiopathic CNV (8/30, 26.7%). Subtype analysis showed that the etiologic factor was inflammatory retinochoroidopathy in children 12 years or older, whereas congenital/developing abnormalities were present in children younger than 12 years. Eyes with active CNVs required a mean of 1.40 ± 0.58 injections. No recurrence was observed during follow-up.Conclusions: The etiologic factors of CNV in young Chinese patients were diverse, with congenital/developing abnormalities, inflammatory retinochoroidopathy and idiopathic CNV being the 3 most common ones. Eyes with active CNVs had good responses to antivascular endothelial growth factor treatment with low recurrence.

ASSESSMENT OF INTRAOCULAR PRESSURE FOLLOWING THE INTRAVITREAL INJECTION OF ANTI-VEGF

Objective: The objective of the study is to assess the frequency of raised IOP after intravitreal injection of Anti VEGF by using an applanation tonometer.&#x0D; Methods: Each patients who fulfil the presence criteria were nominated by the researcher through ‘the outpatient department (OPD) of ophthalmology, Jinnah Post Graduate Medical Center. Performa was filled. Aim and process of study was explained to all patients. Conversant consent was reserved. Model ocular inspection, including IOP was done.&#x0D; By using either a 30-or 32-gauge needle, 1.25 ml bevacizumab (Avastin) were administered by the researcher under the direct supervision of consultant. Patients were consistently sterilely prepped, that was comprised incerted of topical antibiotic and anesthetic drops, supplement of a lid speculum. Later pointing the injection place on the sclera with a caliper calculating 3.0 to 3.5 mm after limbus, conjunctiva was expatriate somewhat through a sterile cotton-tipped applicator immediately earlier ingoing the eye by a needle. Later injection, place was occluded provisionally it was amended through a sterile cotton-tipped applicator while the needle remained inhibited from the eye. Since the needle was inhibited, a drop of anesthetic was employed on the cornea and IOP was measured. Then next IOP interpretation was measured later 1day of intravitreal Avastin.&#x0D; All pressures were measured using the applantation tonometry. IOPs were measured earlier intravitreal Avastin "baseline IOP" and instantly following injection "T0" and 1day next injection.&#x0D; Results: 235 Patients exactly nominated for the research study. Intravitreal Injection, Bevacizumab was applied in 235 Eyes of overstated 235 patients. Elsewhere of the 235 patients, 133 males and 102 females, Their ages ranged from 30-70 y (mean 52.02 y. The most shared sign intravitreal with bevacizumab, diabetic retinopathy observed in 114 (48.5%) patients, indicated by exudative ARMD in 70 (29.7%) patients, BRVO in 12 (5%) patients, Myopic CNV23(9.7) with CRVO observed in 11 (4.6%) patients, Eale’s sickness in 2(0.85%) patients even as Idiopathic CNV was observed in only 3 (1%) patient. Of the 235 patients, 118 (50.2%) patients with right eye suffered, 117(49.7%) patients with left eye suffered. After 24 h of intravitreal Bevacizumab Raised IOP was observed in only 3 (1.28) patient and 232(98.2) patient IOP was in the normal range. According to our study, the result of stratification with respect to age, side of the eye and gender is not significant as p-value for age (0.838), gender (0.723) and side of the eye (0.556), respectively.&#x0D; Conclusion: In our study, frequency of raised IOP after anti VEGF were found 3(1.28) patient out of 232 (98.2). Anti-VEGF treatment is the foundation for the management of numerous retinal illnesses. Notwithstanding its capable effectiveness in uncertain the sickness and refining, vision for the patients, intravitreal injection of anti-VEGF products may be related with overwhelming problems. To diminish the risk cautious care to the injection method and suitable post-injection observing are essential.

SENSITIVITY AND SPECIFICITY OF MULTISPECTRAL IMAGING FOR POLYPOIDAL CHOROIDAL VASCULOPATHY.

To evaluate the sensitivity and specificity of multispectral imaging (MSI), a noninvasive imaging technique composed of a series of monochromatic scanning light, for polypoidal choroidal vasculopathy (PCV). This was a prospective observational study. Polypoidal lesions on MSI are defined by oval or lobular hyperreflective oval lesion with dark hyporeflective center. Branching vascular networks on MSI is featured by hyperreflective interlacing signal. Detection sensitivity and specificity of polypoidal lesions was compared with indocyanine green angiography, whereas sensitivity and specificity of branching vascular networks, subretinal fluid, and pigment epithelium detachment were compared with optical coherence tomography. Among 67 eyes, 38 eyes (56.7%) were diagnosed with PCV, 7 eyes (10.4%) with neovascular age-related macular degeneration, 13 eyes (19.4%) with central serous chorioretinopathy, 6 eyes (9.0%) with pathological myopia, and 3 eyes (4.5%) with idiopathic choroidal neovascularization. Compared with indocyanine green angiography, the sensitivity and specificity for diagnosing PCV by MSI alone was 84.21% and 93.10%, respectively, and the positive predictive value and the negative predictive value for PCV by MSI was 94.12% and 81.82%, respectively. The sensitivity and specificity for detecting polypoidal lesions were 84.21% and 93.10% compared with indocyanine green angiography. Compared with optical coherence tomography, the sensitivity and specificity for detecting branching vascular networks were 95.83% and 88.37%, for the subretinal fluid were 76.92% and 86.67%, and for the pigment epithelium detachment were 91.11% and 90.91%, respectively. Multispectral imaging allowed noninvasive visualization of polypoidal lesions and branching vascular networks and may serve as a new diagnostic option for PCV.

Intravitreal Conbercept for Idiopathic Choroidal Neovascularization in Nursing Women.

Purpose: To report the clinical course and vascular endothelial growth factor (VEGF) levels in breast milk among three nursing women diagnosed with idiopathic choroidal neovascularization (CNV) before and after intravitreal injection of conbercept. Methods: This was an observational case series. The main outcomes and measures included best-corrected visual acuity (BCVA), anatomical features using optical coherence tomography, and breast milk concentrations of VEGF before and after the intravitreal injection of conbercept. Results: BCVA was increased, and no ocular or systemic safety problems were observed in any of the three patients during the follow-up period. An enzyme-linked immunosorbent assay was used to measure VEGF concentrations in the breast milk samples. Samples were collected 1 day before and 1, 7, and 30 days after the first intravitreal injection of conbercept. After conbercept injection, VEGF levels in breast milk were slightly decreased and did not change significantly in the following week; levels recovered fully by 30 days post-treatment. Conclusions: Intravitreal injection of conbercept shows favorable effectiveness and safety in the treatment of idiopathic CNV in nursing women and does not result in a significant reduction in VEGF in human breast milk.

Idiopathic choroidal neovascularization in a young boy

Idiopathic choroidal neovascularization in a young boy

Spectral domain-optical coherence tomography retinal biomarkers in choroidal neovascularization of multifocal choroiditis, myopic choroidal neovascularization, and idiopathic choroidal neovascularization

Objective To use optical coherence tomography (OCT) to compare retinal biomarkers of choroidal neovascularization (CNV) secondary to multifocal choroiditis (MFC), myopic choroidal neovascularization (mCNV), and idiopathic choroidal neovascularization (ICNV) and to provide a basis for its clinical diagnosis and treatment. Methods In this retrospective case study, patients admitted to the Second Hospital of Hebei Medical University between January 2018 and January 2021 who were initially diagnosed with CNV secondary to MFC, mCNV, and ICNV were categorized into groups, by disease, for analysis. Spectral domain-OCT (SD-OCT) was used to describe and measure the morphological characteristics of CNV lesions in each group. The retinal biomarkers of CNV in MFC, mCNV, and ICNV were compared. Results Sixty-eight patients (71 eyes) were included and all eyes were diagnosed with active type 2 CNV. The MFC group had higher refraction than the ICNV group (P2 < 0.05). The choroidal thickness (CT) and CNV diameter of the MFC group were significantly greater than those of the mCNV group (P1 < 0.05). The number of eyes with sub-retinal fluids (SRF) and a “pitchfork sign” was significantly greater in the MFC group than in the mCNV group (P1 < 0.05). There was a significant difference only in CT) values between the MFC and ICNV groups (P2 < 0.001), but not in the other observation indicators (P2 > 0.05). Conclusions OCT biomarkers, such as the diameter of the CNV, SRF, the “pitchfork sign,” and CT under CNV are useful in distinguishing CNV secondary to MFC from mCNV, which can allow the timely selection of treatment in some difficult cases. There were no differences between the MFC group and ICNV group except in refractive error, which indicates that some ICNV cases may be an early stage of a type of occult chorioretinitis. Long-term follow-up is needed for ICNV patients to confirm whether there is any potential inflammation. Key messages Sometimes, it is difficult to separate MFC with CNV from myopic CNV and ICNV in clinical. OCT biomarkers, such as the diameter of the CNV, SRF, the “pitchfork sign,” and CT under CNV are useful in distinguishing CNV secondary to MFC from mCNV. There were no differences between the MFC group and ICNV group except in refractive error.

Retrobulbar triamcinolone for inflammatory choroidal neovascularization in pregnancy

BackgroundChoroidal neovascularization (CNV) in pregnancy has rarely been described. A differential diagnosis between inflammatory, idiopathic, and myopic CNV may be challenging. Moreover, there is no consensus on management, and therapeutic options may be further limited by patient and physician concerns about potential risk to the fetus. Herein, we report a case of inflammatory CNV during pregnancy and describe a previously unreported management approach with retrobulbar triamcinolone injections.Case presentationA 36-year-old woman presented with vision loss and metamorphopsia in her right eye while 21 weeks pregnant. She was diagnosed with an inflammatory CNV based on the following multimodal imaging findings: a type 2 lesion with the “pitchfork sign” on OCT, along with the absence of tomographic signs of myopic CNV, and the presence on autofluorescence of multiple hyper-autofluorescent spots, interpreted as focal areas of inflammation at the level of the outer retina and inner choroid. The patient refused oral corticosteroids and any intravitreal injection therapies. Therefore, she was treated with two trans-Tenon’s retrobulbar injections of triamcinolone acetonide after explaining the procedure and acquiring consent. The treatment resulted in a regression of inflammatory signs and a reduction of neovascular activity. No adverse events occurred for the mother or the baby, neither during the pregnancy nor after delivery.ConclusionInflammatory CNV may be rarely associated with pregnancy. The correct diagnosis is crucial to allow the consideration of all possible management options. To the best of our knowledge, this is the first reported case of treatment with retrobulbar triamcinolone injections. This may represent a suitable therapeutic option in the absence of any other therapeutic approaches.

Evaluation of efficacy and recurrence for anti-vascular endothelial growth factor therapy in idiopathic choroidal neovascularization

BackgroundThis study aimed to evaluate the visual and morphological outcomes of intravitreal anti-VEGF therapy and the recurrence for idiopathic choroidal neovascularization (ICNV).MethodsThis retrospective study included 35 patients (35 eyes) with ICNV from July 2012 to October 2017. All patients received 1 intravitreal anti-VEGF injection followed by pro re nata injections until there was no sign of ICNV activity. This was defined as the first follow-up period. To evaluate ICNV recurrence, we continued to follow-up 27 of the 35 patients for at least 2 years after the initial diagnosis, and the longest follow-up period was 5 years. Additional injection was performed when ICNV recurred. Best corrected visual acuity (BCVA) and central retinal thickness (CRT) were recorded and morphological improvement in optical coherence tomography (OCT) was assessed. Parameters that affect prognosis and recurrence were analysed.ResultsThe mean follow-up period was 168.0 ± 34.82 weeks. Mean BCVA improved from 56.20 ± 14.13 letters at baseline to 73.31 ± 12.57 letters (P<0.01); Mean CRT decreased from 353.6 ± 98.70 μm at baseline to 273.1 ± 53.56 μm (P < 0.001) at the end of the first follow-up period. Better baseline BCVA indicated a better morphological improvement (P = 0.026) in OCT: the lesion had completely subsided with recovery of the foveal contour. Those with high baseline BCVA (more than 60 letters) showed significant resolution of CNV lesions (P = 0.036). ICNV recurred in six patients (22.2%), 1 of whom experienced 2 recurrences. The mean timing of recurrence was 90.83 ± 49.02 weeks after diagnosis. There was no significant correlation between ICNV recurrence and the morphological improvement (P = 0.633). The final BCVA in patients with recurrence did not differ from that in patients without recurrence (P = 0.065).ConclusionsIntravitreal anti-VEGF therapy on a pro re nata basis was effective for treating ICNV. High baseline BCVA indicated a better prognosis. Re-treatment with anti-VEGF could effectively lead to resolution of recurrent ICNV. Disease recurrence had no significant effect on final visual prognosis and had no correlation with the morphological improvement during treatment, suggesting that follow-up for subsequent monitoring should be performed in all ICNV patients.

Long-Term Efficacy of Intravitreal Conbercept Injection in the Treatment of Idiopathic Choroidal Neovascularization.

Purpose: To investigate the long-term efficacy of intravitreal conbercept injection in treating idiopathic choroidal neovascularization (CNV). Methods: In this longitudinal retrospective cohort study, 27 eyes (27 patients) with idiopathic CNV receiving conbercept intravitreously (0.5 mg/0.05 mL) with 1+PRN regimen were included. Best corrected visual acuity (BCVA) and central retinal thickness (CRT) at the baseline and the end of follow-up were compared, respectively. The number of injections and recurrence time were evaluated. Results: Of the 27 patients, 7 were men and 20 were women. Their mean age at diagnosis was 31.37 ± 7.35 (16-46) years. The follow-up period was 44.59 ± 8.60 (27-58) months. The mean initial injection number was 1.22 ± 0.42, and 1.67 ± 1.04 injections were administered throughout the follow-up. Seven patients experienced CNV relapse, with 1 episode in 4 patients, 2 episodes in 2 patients, and 5 episodes in 1 patient. LogMAR BCVA changed from 0.77 ± 0.19 at baseline to 0.09 ± 0.10 at the final visit, and CRT decreased from 343 ± 73.5 μm to 172.41 ± 30.82 μm. Both BCVA improvement and CRT reduction were statistically significant (P < 0.001). No ocular or systemic complications occurred. Conclusions: Intravitreal injection of conbercept shows favorable effectiveness in the treatment of idiopathic CNV during a long-term period of follow-up.

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

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. 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. The mean age of 26 patients was 35.5±7.3y (range, 21-48y). Of the 26 FCE lesions, 11 were located subfoveal, 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. 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.

INTRAOCULAR PRESSURE;

Objectives: To determine mean changes in intraocular pressure after intra-vitreal bevacizumab (anti vascular endothelial growth factor) in non-glaucomatous patients suffering from retinal vascular disorders. Study Design: Quasi experimental study. Setting: Outdoor patient Department of Layton Rahmatullah Benevolent Trust Free Eye Hospital, Lahore. Period: 06 months from Jan-2017 to June-2017. Patients and Methods: A total number of 100 patients having age 18-65 years who presented with retinal vascular disorders. Pre injection intraocular pressure was measured with Goldman Applanation Tonometer five minutes before injection. After that intravitreal bevacizumab was injected using standardized technique. Post-injection, intraocular pressure was measured after 1 month of injection. Data was analyzed with the help of SPSS v19. Paired sample t-test was applied to determine any significant difference in pre-injection and post-injection IOP at p-value of &lt;0.05. Mean change in IOP was also calculated. Results: Mean age of patients was 51.76+9.22 Years. There were 50% male patients and 50% female patients. Diabetic retinopathy was diagnosed in 41% patients, central serous chorio-retinopathy in 17%, age related macular degeneration in 16%, branch retinal venous occlusion in 15% and idiopathic choroidal neovascularization in 11% patients. Right sided eye was affected in 53% patients. Mean pre-injection IOP was 14.07+3.15 and mean post-injection IOP was 14.54+2.31 mmHg (p-value 0.12). Mean difference in pre-injection and post-injection IOP (after 1 month of injection) was -0.523+2.98 mmHg. Conclusion: Bevacizumab can be safely administered for the treatment of non-glaucomatous retinal vascular disorders without significantly disturbing the IOP for a longer period of time.

Cytokine profiling reveals increased serum inflammatory cytokines in idiopathic choroidal neovascularization

BackgroundThe exact pathogenesis of idiopathic choroidal neovascularization (ICNV) remains unclear. Cytokine-mediated inflammation has been thought to be involved in the pathophysiology of ICNV. The purpose of this study was to investigate serum cytokine profiles in patients with ICNV and to explore the relationship between serum cytokine levels and ICNV severity.MethodsThis case-control study was conducted in 32 ICNV patients and 30 healthy volunteers. Clinical and demographic information was obtained from the medical data platform and the serum was analysed with a multiplex assay to determine the levels of seven cytokines: interleukin (IL)-2, IL-10, IL-15, IL-17, basic fibroblast growth factor (basic FGF), granulocyte-macrophage colony-stimulating factor (GM-CSF), and vascular endothelial growth factor (VEGF).ResultsSerum levels of IL-2, IL-10, IL-17, basic FGF, and VEGF were elevated in ICNV patients compared to controls. Serum GM-CSF levels were positively related to central retinal thickness, and serum IL-17 levels were positively related to CNV lesion area.ConclusionSerum inflammatory cytokines were significantly elevated in ICNV patients compared to controls. This suggests that systemic inflammation may play a critical role in the physiopathology of ICNV.

Идиопатическая субретинальная неоваскулярная мембрана. Анализ клинического случая

Идиопатическая субретинальная неоваскулярная мембрана. Анализ клинического случая

Research progress of nucleotide-binding oligomerzation domain like receptors 3 inflammasome in age-related macular degeneration

Polypoidal choroidal vasculopathy (PCV) is a kind of fundus disease characterized by choroidal anomalous branch vascular network and terminal polypoidal dilatation.The pathological basis of idiopathic choroidal neovascularization is similar to age-related macular degeneration (AMD). It is controversial that whether PCV and AMD is the same disease.Optical coherence tomography angiography (OCTA) is a new, noninvasive imaging technique that plays an important role in clinical practice.OCTA not only provides B-scans of the retina, but also offers rapid, high-resolution, repeated and accurate visualization of blood flow, which provides representation of the vascular morphology of the retina and choroid.OCTA is a noninvasive imaging modality capable of evaluating and assessing the morphology of PCV and their associated vascular patterns.The vascular endothelial growth factor (VEGF) participates in the pathophysiology of PCV, so anti-VEGF therapy has become the first-line treatment for PCV.Intravitreal injection of bevacizumab, ranibizumab, and aflibercept improves and stabilizes the vision of patients with PCV.In this article, we summarized the new progress of diagnosis and treatment associated with PCV. Key words: Polypoidal choroidal vasculopathy; Optical coherence tomography angiography imaging; Clinical feature; Diagnose; Therapy