Mean Greatest Linear Dimension Research Articles

Focal choroidal excavation-morphological features and clinical correlation.

PurposeTo describe and correlate the morphological and clinical features of focal choroidal excavation (FCE).MethodsThis is a consecutive case series from the review of the 4436 optical coherence tomography scans performed by Kowloon East Cluster Ophthalmic Service from 1 August 2014-31 January 2016. Statistical analysis was performed on SPSS 18.0 (SPSS, Chicago, IL, USA). A significance level of P<0.05 was taken.ResultsAll 16 patients with FCE had unilateral involvement. The mean age of diagnosis was 52.56±14.00. The mean greatest linear dimension (GLD) of FCE was 636.25±265.11 μm. The mean choroidal thickness was 183.63±52.39 μm. Fourteen FCEs (87.5%) were conforming and two were non-conforming (12.5%). In the eyes with FCE, concurrent macular pathology was present in four cases (25.0%). Tractional pathologies of macular pucker and macular scar corresponded to the two non-conforming FCEs in the series. Polypoidal choroidal vasculopathy (PCV) and lacquer crack had a close topographic relationship with the FCE. The mean GLD was significantly larger in eyes with concurrent macular pathology than those without (878.00 vs 555.67 μm, P=0.029). In the fellow eyes, concurrent macular pathology was present in 5 cases (31.3%): PCV in 3 cases and chronic central serous chorioretinopathy in 2 cases.ConclusionAs a significant proportion of FCE is associated with concurrent macular pathology in the involved or fellow eye, angiography for both eyes is recommended even for asymptomatic cases. The GLD of FCE may have clinical value in risk stratification.

The natural history of polypoidal choroidal vasculopathy: a multi-center series of untreated Asian patients

We aimed to evaluate the long-term natural history of polypoidal choroidal vasculopathy (PCV) in untreated patients. This is a retrospective observational case series. Patients with symptomatic PCV who did not receive any treatment for at least 12months were included from the records of three ophthalmic clinics in Asia. The medical records and imaging data were reviewed. Visual outcomes at month 12 and at last follow-up were analyzed. The influence of demographics and presenting features on visual outcome was analyzed. A total of 32 eyes (32 patients) were included in this analysis. The mean follow-up was 59.9months (range, 18-119months), the mean age was 65.7years and 21 (65.6%) patients were male. The mean presenting logMAR visual acuity was 0.79 (Standard deviation [SD] 0.49). The center of the fovea was involved by the PCV complex in 25 eyes (78.1%). The mean greatest linear dimension (GLD) of the PCV complex was 2584μm (SD 880). Twenty-three eyes (71.9%) had a cluster-of-grapes configuration on indocyanine green angiography. Leakage of fluorescein angiography was present in 29 eyes (90.6%). The mean logMAR vision deteriorated from 0.79 at baseline to 0.88 at month 12 (p = 0.11), and further to 1.14 (p = 0.003) at the last follow-up. The proportion of eyes that improved, remained unchanged and worsened was 21.9%, 31.3% and 46.9%, respectively, at month 12; and 28.1%, 9.4% and 62.5%, respectively, at last follow-up. The proportion of eyes with logMAR vision worse than 1.0 was 28.1% at presentation, and increased to 31.3% at month 12 and further to 53.1% at last follow-up. Reasons for poor vision were due to retinal, subretinal or vitreous hemorrhage, and retinal pigment epithelium (RPE) atrophy and scarring. None of the presenting features were found to significantly influence visual outcome. Half of eyes presenting with symptomatic PCV had a relatively benign course without treatment and some even had vision improvement. However, in the remaining eyes, vision deteriorated significantly, mainly due to hemorrhage and scarring. There may be subtypes of PCV with divergent natural history.

Choroidal neovascularization in 36 eyes of children and adolescents

To describe the clinical features and outcomes among eyes with choroidal neovascularization (CNV) in children and adolescents. A total of 36 eyes of 27 patients <18 years of age diagnosed with CNV between January 1978 and December 2008 were retrospectively reviewed. CNV was clinically diagnosed in all patients and its presence was confirmed by fundus fluorescein angiography (FFA). A total of 19 eyes underwent treatment. Anatomical outcome was evaluated as regressed/persistent/recurrent CNV. Snellen's values for best corrected visual acuity (BCVA) were converted to logMAR for statistical calculations. Of the 27 patients, 17 (63%) were male. Nine (33.3%) of the 27 patients had bilateral CNV. At presentation, CNV was active in 22 (61.1%) eyes and regressed in 14 (28.9%) eyes. All active CNV cases were 'classic' type, with the majority (80.5%) being subfoveal. The mean greatest linear dimension (GLD) was 3.16 ± 1.94 mm (range, 0.9-10.15). The most common cause (41.7%) was post-inflammatory. The mean duration to regression in treated eyes was 103.53 days (15 eyes). Recurrence was noted in three (8.3%) eyes. The mean duration to first recurrence was 260 days (range, 90-390), and the mean follow-up duration was 779.53 ± 988.00 days. CNV remains a cause of significant visual decline in children and adolescents. Male predominance, post-inflammatory etiology, bilateral affection, and subfoveal location are noteworthy, with a high regression rate in response to treatment. Re-treatment is required in a limited number of cases.

Initial non-responders to ranibizumab in the treatment of age-related macular degeneration (AMD)

BackgroundPatients with exudative age-related macular degeneration (AMD) who did not respond to ranibizumab at the induction phase were assessed and referred to as initial non-responders.MethodsWe retrospectively reviewed the medical records of 215 patients (218 eyes) with exudative AMD. For the initial treatments, patients received three intravitreal injections of ranibizumab (IVR) every 4 weeks. Minimum follow-up period was 12 months. We defined patients with no improvement of best corrected logMAR visual acuity (BCVA), and with no decrease of central retinal thickness (CRT) at the end of the initial treatment, as initial non-responders. Patients who had previous treatment history prior to this investigation were included, but patients who had photodynamic therapy (PDT) with IVR were excluded.ResultsTwenty-two eyes (10.1%) were identified as initial non-responders. The mean BCVA of initial non-responders before IVR and after induction phase were 0.39 and 0.36, respectively. There was no significant difference between these values, however the mean BCVA decreased significantly to 0.55 at 12 months after the beginning of the induction phase (P = 0.021). The mean greatest linear dimension (GLD) of the lesion before IVR of initial non-responders was 4,121 μm. We found 16 eyes with typical AMD, and six eyes with polypoidal choroidal vasculopathy. One eye had predominantly classic choroidal neovascularization (CNV), and others had occult CNV of typical AMD. As additional treatments, twelve eyes received PDT, and in three of the eyes exudation remained after PDT.ConclusionInitial non-responders were more prevalent in patients with occult CNV than in patients with other CNV types. Some of the initial non-responders did not respond to PDT. This study suggested possible involvement of other factors, in addition to vascular endothelial growth factor, in the occurrence of CNV in initial non-responder patients.

Low-fluence-rate photodynamic therapy to treat subfoveal choroidal neovascularization in pathological myopia. A study of efficacy and safety

To evaluate the efficacy and safety of low-fluence-rate photodynamic therapy (LFPDT) to treat choroidal neovascularisation (CNV) secondary to pathological myopia (PM). Twenty-five eyes with CNV in PM underwent LFPDT, with a standard dose of verteporfin and timing but adopting fluence and irradiance rates reduced to 25 mJ/cm2 and 300 mW/cm2, respectively. Best corrected visual acuity (BCVA) was measured and biomicroscopy and fluorescein angiography (FA) were evaluated. Particular attention was paid to choroidal hypoperfusion, and to changes (depigmentation/atrophy) at the RPE level in areas exposed to laser light. After a mean follow-up of 13.4+/-2.46 months (range: 12-21), and 1.37+/-0.66 treatments (range: 1-3), BCVA was stable in 29 (91%) eyes. Two (6%) patients gained more than three lines and one (3%) eye lost more than three lines. Mean greatest linear dimension did not change significantly (p=0.08) at the end of follow-up. RPE depigmentation was present in six eyes (18%) and no patient showed RPE atrophy. LFPDT is effective and safe for CNV secondary to PM treatment, stabilizing visual acuity and lesion size and determining only mild RPE changes. Further controlled studies are needed to demonstrate the long-term efficacy and safety of this treatment option.

Photodynamic Therapy With and Without Adjunctive Intravitreal Triamcinolone Acetonide: A Retrospective Comparative Study

To compare photodynamic therapy (PDT) with and without adjunctive intravitreal triamcinolone acetonide (IVTA) in the treatment of choroidal neovascularization secondary to age-related macular degeneration. Sixty-six eyes received PDT with IVTA and 73 eyes received PDT only. Outcome measures included changes in visual acuity and greatest linear dimension (GLD), the presence of angiographic leakage, the re-treatment rate, and adverse events. Patients treated with PDT with IVTA had reduced mean GLD compared to patients treated with PDT only at all study time points (3 [P = .0049], 6 [P = .003], and 12 [P = .05] months). Forty-four percent of patients in the PDT with IVTA group and 22% of patients in the PDT only group achieved angiographic closure at 3 months (P = .027). There were no significant differences in the final visual acuity outcome or the re-treatment rate between the two groups. PDT with IVTA therapy has a favorable outcome on GLD. There is a modest improvement in visual acuity with PDT with IVTA therapy, which diminishes over time.

The effect of the first application of verteporfin photodynamic therapy on lesion growth in choroidal neovascularisation and its potential impact on combination therapy

Purpose: To evaluate the impact of lesion size on the observed growth of the choroidal neovascularisation (CNV) following the first application of photodynamic therapy (PDT).Methods: A retrospective study of consecutive patients with subfoveal classic CNV or predominantly classic CNV undergoing first verteporfin photodynamic therapy (VPDT) according to treatment of age‐related macular degeneration with photodynamic therapy (TAP) protocol between June 2005 and September 2005. Patients were classified into two groups according to baseline greatest linear dimension (GLD) at the time of VPDT monotherapy. Group 1 comprised patients with lesion GLD less then 2000 µm and Group 2, patients with lesion GLD 2000 µm or larger. Difference between the mean GLD at baseline and at three months post‐treatment were investigated for clinical significance using the paired t‐test.Results: Group 1 (n = 16) showed a mean change in GLD from 1380.25 µm to 2031.25 µm, while Group 2 (n = 26) showed a mean change of 2909.26 µm to 3023.07 µm. Data of mean percentage change in GLD for Group 1 showed a 51.97 per cent increase in the lesion size [95% CI, 22.93 ‐ 81.01%] in comparison to Group 2, which showed only 5.8 per cent increase in the lesion [95% CI, −9.65 ‐ 21.61%]. Comparison of the mean percentage change in GLD between the two groups showed a statistically significant difference (p = 0.003).Conclusions: Our study demonstrates that following the first application of VPDT, smaller lesions enlarge disproportionately more than larger lesions. As we have entered into the era of using angiostatic agents in combination with VPDT, it may be important to evaluate this effect with regards to the timing of VPDT commencement.

Intravitreal Bevacizumab Therapy for Choroidal Neovascularization Secondary to Age-Related Macular Degeneration: 6-Month Results of an Open-Label Uncontrolled Clinical Study

To investigate the 6-month safety and clinical outcomes of intravitreal injections of bevacizumab administered to treat choroidal neovascularization secondary to age-related macular degeneration. Twenty-seven patients underwent 1.25 mg intravitreal injections of bevacizumab at baseline. A similar intravitreal injection was administered to all eyes at 1 and 2 month follow-up visits. At baseline and at each follow-up visit (1, 2, 3, and 6 months), patients underwent best-corrected visual acuity (BCVA) measurement, fluorescein angiography, indocyanine green angiography, and optical coherence tomography. Laboratory testing, visual field analyses, and endothelial cell counts were performed at baseline and third and sixth months. At 3 months, the mean BCVA remained substantially stable at 20/100. Mean central retinal thickness (CRT) decreased from 373 to 279 microm (p<0.01). Mean lesion greatest linear dimension (GLD) decreased from 4087 to 3782 microns (p<0.01). At 6 months, mean BCVA slightly decreased from 20/100(-1) to 20/125(-3) (not significant, p=0.40). Mean CRT was still inferior to baseline (305 microm, p<0.01). Mean lesion GLD was 4186 microm, not different from baseline values (p=0.59), but superior to 3-month mean GLD (p<0.01). Significant visual field defects or endothelial cell losses were not detected at 3 and 6 months. Laboratory testing did not reveal any clinically significant deviations compared to baseline values. Intravitreal therapy using bevacizumab over 6 months showed stabilization of visual acuity and choroidal neovascularization activity; the safety data were convincing.

Photodynamic Therapy With Verteporfin for Choroidal Neovascularization in Patients with Angioid Streaks

PurposeTo evaluate the functional and anatomic outcomes of photodynamic therapy (PDT) for choroidal neovascularization (CNV) in patients with angioid streaks.MethodsThe authors retrospectively evaluated 6 consecutive patients (6 eyes) with CNV secondary to angioid streaks. All patients were treated with standard PDT with verteporfin protocol. Standardized protocol refraction, visual acuity testing, ophthalmologic examination, color photographs, fluorescein angiograms and indocyanin angiograms were used to evaluate the results of PDT with verteporfin. Main outcome measures were visual acuity and CNV size.ResultsTheir mean age was 61.3±5.50 years (range, 53-68 years). Follow-up time ranged from 12 to 38 months with mean of 20.5±10.91 months. The mean visual acuity at baseline was 20/100 (range 20/25-20/500), and the mean visual acuity at the last examination was 20/320(range 20/125-counting finger). The mean greatest linear dimension (GLD) at baseline was 2400±766.81 µm, and the mean GLD at the last examination was 3483±444.59 µm.ConclusionsPDT for CNV associated with angioid streaks seemed to slow down but not prevent the progression of the disease and associated visual loss.

Long-term results of photodynamic therapy for the treatment of choroidal neovascularization secondary to angioid streaks

To evaluate the anatomic-functional results and complications associated with the use of photodynamic therapy (PDT) with verteporfin in the treatment of choroidal neovascularization (CNV) secondary to angioid streaks (AS). The authors retrospectively evaluated 10 consecutive patients (10 eyes) with CNV secondary to AS. All patients were treated with standard PDT with verteporfin protocol. The primary outcome to evaluate was the proportion of cases that lost < 3 lines of visual acuity (VA) measured on ETDRS charts. Secondary outcomes were changes in the greatest linear dimension (GLD) and in the area of the lesion. Seven previously examined patients were used as a control group. The mean duration of follow-up was 18 months (SD 9.2, range 6-36 months). In nine cases CNV was subfoveal and in one case, juxtafoveal. Mean VA was 20/126 at baseline (range 20/40-20/320) and 20/500 at the final examination (range 20/64-20/800). Three patients (30%) lost< 3 lines of VA. Four patients (40%) lost > or =6 lines of VA. The mean line change was -4.9 lines. The mean GLD went from 2861 microm at baseline (SD 1086.6, range 1350-4300 microm) to 4452 microm at last visit (SD 2564.2, range 1260-9450 microm). The mean area of the lesion was 3.78 mm(2) at baseline (SD 1.9, range 1.0-5.7 mm(2)) and 12.1 mm(2) at the final examination (SD 15.1, range 0.8-50.6 mm(2)). One patient developed a subfoveal rip of the retinal pigment epithelium. In the control group, the mean duration of follow-up was 15 months (SD 2.4, range 12-18 months). At baseline, the mean VA was 20/160 (range 20/100-20/320) and the mean GLD was 2685 microm (SD 676.8, range 1800-3500 microm). At the last examination, mean VA was 20/640 (range: 20/400-20/800) and mean GLD was 5528 microm (SD 2106.90, range 3500-8000 microm). PDT with verteporfin does not seem to be a good treatment for stabilization of VA and lesion size in CNV secondary to AS, although the overall results seem to be slightly better in the group of patients treated with PDT than in the control group.