Mean Initial Visual Acuity Research Articles

Comparison of intravitreal ranibizumab and bevacizumab for the treatment of macular edema secondary to retinal vein occlusion.

To compare the efficacy of ranibizumab and bevacizumab for macular edema due to retinal vein occlusion (RVO). A retrospective study was conducted at a single academic institution. Eighty-one patients naïve to anti-VEGF therapy with RVO and macular edema were identified. Twenty-six eyes were treated with ranibizumab, 33 eyes with bevacizumab, and 22 eyes with bevacizumab then switched to ranibizumab (crossover). The main outcome was change in visual acuity at 3 months, 6 months, and final visit. The mean visual acuity improved from 20/80 to 20/40 in the ranibizumab (R) group and from 20/125 to 20/60 in the bevacizumab (B) group (P=0.66). The mean change in central subfield thickness (CST) was -186 and -212µm, respectively (P=0.69). Mean time between injections was 94±21.1d in the R group and 103.8±10.5d in the B group (P=0.78). In the crossover group, mean initial visual acuity was 20/125, reached 20/60 at crossover, and remained 20/60 at conclusion (P=0.91). Both ranibizumab and bevacizumab are effective for the treatment of RVO and appear to have similar visual and anatomic outcomes. Changing treatments from bevacizumab to ranibizumab did not result in further gains in visual acuity.

Visual Loss Associated with Rickettsial Disease

Purpose: To characterize and analyze ocular involvement associated with visual loss in a cohort of patients with rickettsial disease.Methods: Retrospective study of 16 eyes of 14 patients.Results: Mean initial visual acuity (VA) was 20/63 (range, 20/800–20/25). White retinal lesions infiltrating inner retina was the most common finding occurring in 14 eyes (87.5%). It was associated with a serous retinal detachment (SRD), accurately detectable by optical coherence tomography, in 11 eyes (78.6%). Other findings included optic neuropathy in 7 eyes (43.75%), cystoid macular edema in 1 eye (6.25%), branch retinal artery occlusion in 1 eye (6.25%), and choroidal neovascularization in 1 eye (6.25%). Thirteen patients were treated with a 2-week course of oral doxycycline 200 mg/day. Mean final VA was 20/40.Conclusions: Inner retinitis, associated with mild vitritis and SRD, and optic neuropathy are the most common vision-threatening ocular manifestations of rickettsial disease.

LONG-TERM RESULTS OF REPEATED ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY IN EYES WITH RETINAL PIGMENT EPITHELIAL TEARS

To evaluate the long-term results of retinal pigment epithelium tears in eyes treated with repeated anti-vascular endothelial growth factor (VEGF) therapy. Five patients with retinal pigment epithelial tears (without foveal center involvement) after anti-VEGF injection were studied retrospectively. Mean follow-up time was 52 months, with measurements of visual acuity and evaluation of macular findings by angiography and optical coherence tomography during this period. All eyes had a persistent submacular neovascular membrane 30 days after the tear. An anti-VEGF drug was reinjected until the membranes stopped leaking. The mean initial visual acuity immediately after the tear was 20/160, and the mean final visual acuity was 20/60. The number of anti-VEGF reinjections varied from two to eight during the follow-up period. Long-term optical coherence tomography analysis showed reduced fluid and remodeling of the torn retinal pigment epithelium. Long-term visual results with repeated anti-VEGF therapy are not as devastating as suggested previously. Visual acuity and metamorphopsia improve with time as long as the neovascular membrane is inactive. Optical coherence tomography changes in the macular area reflect the visual acuity improvement.

Branch retinal artery occlusion associated with posterior uveitis

BackgroundThe purpose of this study is to report the clinical features and visual outcome of branch retinal artery occlusion (BRAO) associated with posterior uveitis. This is a retrospective study including the 18 eyes of 18 patients. All patients underwent a complete ophthalmic evaluation. Fundus photography, fluorescein angiography, and visual field testing were performed in all cases.ResultsDiseases associated with BRAO included active ocular toxoplasmosis in 7 patients, rickettsiosis in 4, Behçet’s uveitis in 2, West Nile virus infection in 1, idiopathic retinal vasculitis in 1, Crohn’s disease in 1, ocular tuberculosis in 1, and idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome in 1 patient. The mean initial visual acuity was 20/50. BRAO involved the first order retinal artery in 33.3% of the eyes, the second order retinal artery in 33.3%, an arteriole in 27.8%, and a cilioretinal artery in 5.5%. The macula was involved in 44.4% of the eyes and an acute focus of retinitis or retinochoroiditis was associated to BRAO in 55.5%. Repermeabilization of the occluded artery occurred in all patients with permanent scotomas in the corresponding visual field. The mean visual acuity at last visit was 20/32.ConclusionsBRAO, with subsequent visual impairment, may occur in the eyes with posterior uveitis. Physicians should be aware of such vision-threatening complication of infectious and inflammatory eye diseases.

TIMING OF ACUTE MACULA-ON RHEGMATOGENOUS RETINAL DETACHMENT REPAIR

To determine if same-day or next available surgery changed the outcome of patients presenting with acute macula-on rhegmatogenous retinal detachments. A retrospective review of patients presenting with acute macula-on rhegmatogenous retinal detachments treated with small-gauge vitrectomy was performed. Data collection included subjects' demographics, duration of symptoms, location and extent of the retinal detachment, and timing of surgery. The primary outcome was anatomical and functional success rate for patients having same-day surgery compared with those for whom surgery was delayed. One hundred and fourteen patients were included in this study. Sixty-two patients operated on day of presentation, 46 patients operated the day after presentation, and in 6 patients, surgery was delayed from 2 to 5 days. Time to surgery in hours ranged between 1 and 120 hours (mean 14.5 ± 15.05 hours). Retinal reattachment was achieved in 95.6% of patients, with 80% requiring only one procedure. Mean initial visual acuity was logarithm of the minimum angle of resolution 0.42 (SD 0.6), and mean final visual acuity was logarithm of the minimum angle of resolution 0.39 (SD 0.67) (P = 0.53). Time to surgery was not found to effect final anatomical outcome (P = 0.56). No statistically significant association was observed between change in visual acuity and time to surgery (P = 0.99). Modest delay in timing of surgery for macula-on rhegmatogenous retinal detachment did not adversely impact on patients' outcome.

A clinical study of Leber hereditary optic neuropathy

To investigate the clinical characteristics of Leber hereditary optic neurology (LHON) patients with different primary site mutation. Four hundred and fourteen patients with optic neuropathy were divided into three groups: clinically diagnosed LHON group (group A), probable LHON group (group B), optic neuropathy of unknown reason group (group C). Visual acuity (VA), colour vision, Intraocular pressure (IOP), virtual field and visual evoked potential (VEP) were tested for all the patients. Some (64 cases) had optical coherence tomography (OCT) measurement. Mutations of mtDNA were detected for all the groups, and clinical analysis were carried out emphatically in the patients with the 11778 mutation confirmed by gene assessment. T paired test was used to evaluate two group patients of different Mitochondrial DNA mutation. Gene mutations were found in 215 of the 414 patients (52%). Approximately 93% (199/255) of the patients were caused by the common primary mutations (11778, 14484, 3460 mutation), in which 100% mutation (106/106) in group A, 65% (91/139) in group B, and 11% (18/169) in group C. No cases were diagnosed with confirmed LHON in the patients with unilateral optic neuropathy. Fundus examination in 334 eyes of 167 cases showed pseudo papilledema (54 eyes), normal (67 eyes), pale disc or pale on the temporal side of the optic disc (213 eyes). On the basis data of OCT from 64 patients and 84 normal person, RNFL was found thickening at the early stage and thinning gradually at the later stage in the LHON patients. But, the RNFL thickness of patients with 1-2 years history was not significantly different from the patients with over 2 years history(P = 0.051), and there was no difference among the patients with different mitochondrial DNA mutations. The initial mean VA of patients with the 14484 mutation and 11778 mutation were 3.6 ± 0.65, 3.75 ± 0.54 (t = 0.536, P > 0.05), but the follow-up VA were 4.29 ± 0.55 (t = 4.034, P < 0.001) and 3.93 ± 0.49 respectively (t = 1.857, P > 0.05). The symptoms and fundus manifestation were similar in the LHOH patients with different primary site mutation. Gene mutation analysis is helpful to assess the prognosis of visual acuity.

Long-term visual acuity in patients with age-related macular degeneration and persistence of subretinal fluid after treatment with ranibizumab

ObjectiveTo analyse the long-term visual acuity (VA) in patients with age-related macular degeneration (ARMD) treated with ranibizumab, and who had persistent subretinal fluid after the induction therapy and/or in the successive controls. Materials and methodsWe reviewed the medical records, optical coherence tomography (OCT) and fluorescein angiograms of 216 patients treated with ranibizumab between January 2008 and April 2010, selecting those who had persistent subretinal fluid or recurrent fluid for at least one year of follow-up. ResultsA total of 36 eyes from 34 patients were included, with 19 eyes (52.7%) having persistent, and 17 (47.2%) recurrent subretinal fluid throughout the follow-up (mean 29.06±9.28 months). The average number of injections was 7.89±3.2. The central macular thickness (CMT) at the start of follow-up was 330±84μm, at 3 months 265.2±62μm, and 294.5±37μm at the end of the follow-up. The initial mean VA was 0.3±0.2, at 3 months 0.43±0.2 (p<0.05) and at the final review, 0.41±0.22 (p<0.05). Hemorrhages in recurrences were associated with a worse final VA (p=0.004). At the end of follow-up, 18 eyes (50%) continued with ranibizumab treatment, 16 eyes (44%) were kept under observation, and 2 patients died. There were no differences between VA and CMT between the groups. ConclusionsThe persistence or recurrence of macular subretinal fluid in patients treated with ranibizumab does not significantly reduce the visual gain obtained after induction therapy, despite discontinuation of treatment during follow-up. Haemorrhages in the recurrences were associated with a worse final VA.

Agudeza visual a largo plazo en pacientes con degeneración macular asociada a la edad tratados con ranibizumab y persistencia de fluido subretiniano

ObjectiveTo analyse the long-term visual acuity (VA) in patients with age-related macular degeneration (ARMD) treated with ranibizumab, and who had persistent subretinal fluid after the induction therapy and/or in the successive controls. Materials and methodsWe reviewed the medical records, optical coherence tomography (OCT) and fluorescein angiograms of 216 patients treated with ranibizumab between January 2008 and April 2010, selecting those who had persistent subretinal fluid or recurrent fluid for at least one year of follow-up. ResultsA total of 36 eyes from 34 patients were included, with 19 eyes (52.7%) having persistent, and 17 (47.2%) recurrent subretinal fluid throughout the follow- up (mean 29.06±9.28 months). The average number of injections was 7.89±3.2. The central macular thickness (CMT) at the start of follow-up was 330±84μm, at 3 months 265.2±62μm, and 294.5±37μm at the end of the follow-up. The initial mean VA was 0.3±0.2, at 3 months 0.43±0.2 (P<.05) and at the final review, 0.41±0.22 (P<.05). Haemorrhages in recurrences were associated with a worse final VA (P=.004). At the end of follow-up, 18 eyes (50%) continued with ranibizumab treatment, 16 eyes (44%) were kept under observation, and 2 patients died. There were no differences between VA and CMT between the groups. ConclusionsThe persistence or recurrence of macular subretinal fluid in patients treated with ranibizumab does not significantly reduce the visual gain obtained after induction therapy, despite discontinuation of treatment during follow-up. Haemorrhages in the recurrences were associated with a worse final VA.

RANIBIZUMAB (LUCENTIS®) INJECTION BY ANTERIOR CHAMBER IN APHAKIC EYES WITH MYOPIC CHOROIDAL NEOVASCULARIZATION

Purpose. macular choroidal neovascularization (CNV) is one of the most vision-threatening complications of myopia, which can lead to severe vision loss. Our purpose was to evaluate the safety and efficacy of trans-corneal injection of ranibizumab in the treatment of myopic CNV in aphakic patients. Materials and Methods. ten eyes of 10 aphakic patients with CNV secondary to pathologic myopia treated with three trans- corneal injection of ranibizumab were evaluated. A complete ophthalmologic examination including best-corrected visual acuity (BCVA) and fundus biomicroscopy, specular microscopy, fundus optical coherence tomography (OCT), fluorescein an- giography (FA) were performed at baseline and monthly for all patients. Mean time of follow-up was 6 months. results. The mean axial length was 27,6 mm (range, 25.7-31.3 mm). The mean initial visual acuity (VA) was 0.19 (decimal equivalent). A statistically significant improvement to a mean VA of 0.33 decimal equivalent (log-MAR:0.48) was demon- strated at the final follow-up. VA improved by a mean of 2.86 lines. Mean central macular thickness (CMT) measured with OCT was 340 μm (range, 179-663 μm) at the baseline, and was reduced significantly at the final follow-up to 212μm (range, 125-455 μm). No injection complications or drug-related side effects were noted during the follow-up period. Conclusions. in this small series of aphakic eyes with limited follow-up, ranibizumab by anterior chamber administration seems to be a safe and effective treatment for CNV secondary to pathologic myopia (PM), without any complications. Further studies to evaluate the safety and efficacy are justified.

PHOTODYNAMIC THERAPY FOR SYMPTOMATIC SUBRETINAL FLUID RELATED TO CHOROIDAL NEVUS

The purpose of this article is to evaluate the role of photodynamic therapy (PDT) for symptomatic choroidal nevus with subretinal fluid (SRF) extending to the fovea. Retrospective review of the medical records of all patients who underwent PDT for a symptomatic choroidal nevus with SRF. Seventeen patients were included in the study. The mean initial visual acuity was 20/80 (range, counting fingers to 20/20). The mean initial tumor thickness was 1.23 mm (range, 0.66-1.93 mm). All tumors presented at least 2 risk factors for growing (including orange pigment, symptoms, peripapillary location, SRF, and thickness >2 mm). The mean number of PDT sessions was 1.41 (range, 1-3). The mean final visual acuity improved to 20/60 (range, counting fingers to 20/20). Subretinal fluid was reduced in all eyes (100%) and had completely disappeared in 9 eyes (53%) after PDT. Of 9 cases with complete resolution of the SRF, 2 patients (22%) presented recurrence. The mean final tumor thickness increased to 1.24 mm (range, 0.66-2.01 mm) at a mean follow-up of 22.47 months (range, 6-60 months). Tumor thickness increased in 3 eyes (18%) and remained unchanged in 13 eyes (76%), and 1 lesion (6%) shrank down to a flat chorioretinal scar. Photodynamic therapy is a good treatment option to reduce SRF in symptomatic choroidal nevus with serous macular detachment. Further growth into melanoma was observed in 18% of cases. Thus, PDT may not allow a good local tumor control. Longer follow-up is required to determine its value in these patients.

INTRAVITREAL BEVACIZUMAB FOR MACULAR EDEMA SECONDARY TO BRANCH RETINAL VEIN OCCLUSION

To evaluate the effect of intravitreal bevacizumab on the visual and anatomical outcome in eyes with macular edema secondary to branch retinal vein occlusion. A retrospective, consecutive case series identified 53 consecutive patients with a branch retinal vein occlusion treated with intravitreal bevacizumab. Clinical variables were analyzed, including best-corrected visual acuity, angiographic characteristics, central foveal thickness, and complications. Fifty-three eyes were identified with a mean initial best-corrected visual acuity of 20/137 and final best-corrected visual acuity of 20/96 (P = 0.05). The mean final line change was +1.6 lines (95% confidence interval, +0.7 to +2.3; +8 letters [95% confidence interval, +3.5 to 11.5]). At final follow-up, 28% gained ≥ 3 lines, whereas a loss of >3 lines was seen in 6% of eyes. The mean initial central foveal thickness of 425 μm decreased to 289 μm (P < 0.001). Mean number of injections was 2.5, and mean follow-up was 9 months. Eyes treated for ≤ 6 months after the onset of branch retinal vein occlusion showed improved functional outcomes (e.g., final best-corrected visual acuity, mean line change) as compared with those treated with >6 months of symptoms (P < 0.01). Intravitreal bevacizumab appears to be an effective treatment for macular edema secondary to branch retinal vein occlusion in many subjects. Eyes treated with intravitreal bevacizumab showed a significant reduction in central foveal thickness and improvement in visual acuity. Early treatment with intravitreal bevacizumab resulted in a greater improvement in visual acuity compared with delayed treatment.

Photodynamic therapy for symptomatic high risk choroidal melanocytic lesions

AbstractPurpose To evaluate the role of photodynamic therapy (PDT) for symptomatic high risk choroidal melanocytic (HRCM) lesions with subretinal fluid extending to the fovea.Methods Retrospective review of the medical records of all patients who underwent PDT for a HRCM lesion.Results Seventeen patients were included in the study. The mean initial visual acuity was 20/80 (range CF‐20/20). The mean initial tumor thickness was 1.23 mm (range 0.66‐1.93). All tumors presented at least 2 risk factors for growing. The mean number of PDT sessions was 1.41 (range 1‐3). The mean final visual acuity improved to 20/60 (range CF‐ 20/20). Subretinal fluid was reduced in all (100%) eyes and had completely disappeared in 9 (53%) eyes after PDT. The mean final tumor thickness increased to 1.24 mm (range 0.66 to 2.01) at a mean follow‐up of 22.47 months (range 6‐60). Tumor thickness increased in 3 (18%) eyes, remained unchanged in 13 (76%) eyes, and 1 (6%) lesion shrank down to a flat chorioretinal scar.Conclusion PDT prevents vision loss with improvement of choroidal leakage in HRCM lesions with serous macular detachment, but doesn´t allow a good local tumor control. Longer follow‐up is required to determine its value in these patients.

Long‐term visual acuity in patients with age‐related macular degeneration treated with ranibizumab and persistence of subretinal fluid

AbstractPurpose To analyze the visual acuity (VA) in the long term in patients with age‐related macular degeneration (ARMD) treated with ranibizumab with persistent subretinal fluid after induction therapy and / or in the follow‐up.Methods A retrospective study of all patients with ARMD treated with ranibizumab between January 2008 and April 2010 with persistent subretinal fluid for at least one year of follow‐up after the induction therapy with ranibizumab. We reviewed the medical records, optical coherence tomography and fluorescein angiography in all patients included in the study.Results 36 eyes of 34 patients were included in the study of a total of 216 patients analyzed. 19 eyes (52.7%) had persistent and 17 (47.2%) recurrent sub‐retinal fluid during the follow‐up (mean 29.06 ± 9.28 months). The initial mean VA was 0.3 ± 0.2, at 3 months 0.43 ± 0.2 and at the end of the follow‐up 0.41 ± 0.22 (p&gt; 0.05). The appearance of bleeding in the relapse was associated with poorer final VA (p = 0.004). There was no significant difference in final VA in the membrane type, lesion size, presence of pigment epithelial detachment or blood before treatment. 18 eyes (50%) remain on treatment with ranibizumab,16 eyes (44%) are observed and 2 patients died. We did not find differences in VA and central macular thickness between both groups.Conclusion The persistence or recurrence of macular subretinal fluid in patients treated with ranibizumab did not significantly lower visual gain obtained after the induction therapy, despite the discontinuation of treatment during the follow‐up.

Anterior Segment Tumor Biopsy Using an Aspiration Cutter Technique: Clinical Experience

To report the results and complications of an aspiration cutter-assisted anterior segment tumor biopsy performed under viscoelastic. Retrospective, consecutive, interventional case series. Fifty-five patients with anterior segment tumors underwent aspiration cutter-assisted biopsy at a single center. Fifty-six biopsies were performed, because 1 eye underwent biopsy twice. Indications for biopsy included: suspected anterior segment malignancy, patient's desire for pathologic confirmation before treatment, atypical tumor, and genetic tumor analysis. The main evaluated outcomes were the perioperative visual acuity, the biopsy technique, and related complications. The initial sample comprised 55 consecutively biopsied patients, from which a minimum 1-month follow-up existed for 52 biopsy samples. The median total follow-up was 30.4 months (range, 1 to 190 months). The mean initial visual acuity was 20/50 before and 20/50 1 month after biopsy. No patient lost vision. Most cases were suspected iris melanoma (n = 39/56; 69.6%), followed by suspicious iris nevi (n = 4/56; 7.1%) and melanocytoma (n = 4/56; 7.1%). Seven (n = 7/52; 13.4%) wounds required a single 10-0 nylon suture to achieve negative Seidel test results at the corneal entry site. Postoperative surgical findings included transiently increased intraocular pressure (n = 6/52; 11.5%), 1 hyphema, 1 flare, and 1 persistent pupillary defect. All but the pupillary defect resolved within 4 weeks of the biopsy procedure. There were no secondary infections or cataracts. This study suggests that small-incision, aspiration cutter-assisted anterior segment biopsy seems to be a safe and effective procedure. No short- or long-term complications that would prevent its use were noted.

Intravitreal Ranibizumab for Choroidal Neovascularization Secondary to Pathological Myopia: 12-Month Follow-Up

Purpose: To evaluate the efficacy and safety of intravitreal ranibizumab in the treatment of choroidal neovascularization (CNV) due to pathological myopia (PM). Methods: This retrospective case series studied outcomes in patients with CNV secondary to PM who were treated with intravitreal ranibizumab. Patients underwent complete ophthalmic evaluation, which included best-corrected visual acuity testing measured with Early Treatment Diabetic Retinopathy Study charts, optical coherence tomography (OCT) and baseline fluorescein angiography (FA). Indications for retreatment included the persistence of subretinal fluid on OCT as well as hemorrhages and new CNV on FA. Patients were followed for a minimum of 12 months. Results: We treated 29 eyes in 29 patients; the mean age was 56.8 years. Thirteen eyes were naïve, while 16 had been previously treated with photodynamic therapy or intravitreal bevacizumab. The mean initial visual acuity was 44.8 letters; at the 12-month follow-up, it was 53.7 letters. The mean OCT foveal thickness decreased by 35.3 µm. Patients received an average of 1.38 injections. Statistically significant differences were observed both in visual acuity and in central foveal thickness. All subgroups had favorable outcomes. None of the patients developed injection-induced complications or drug-related side effects. Conclusion: Intravitreal injection of ranibizumab appears to be safe and efficacious in patients with CNV secondary to PM followed over a 12-month period.

PHACOEMULSIFICATION WITH INTRAVITREAL BEVACIZUMAB AND TRIAMCINOLONE ACETONIDE INJECTION IN DIABETIC PATIENTS WITH CLINICALLY SIGNIFICANT MACULAR EDEMA AND CATARACT

The purpose of this study was to evaluate the results of phacoemulsification with intravitreal bevacizumab and triamcinolone acetonide injection in patients with diabetic clinically significant macular edema and cataract. The records of 22 diabetic patients, with clinically significant macular edema and cataract who have undergone phacoemulsification with intravitreal injection of 1.25 mg bevacizumab and 2 mg triamcinolone acetonide, were retrospectively evaluated. All patients have undergone focal or modified grid argon laser photocoagulation 1 month after the surgery. All patients were evaluated by spectral OCT/OCT SLO before, 1 month, and 3 months after the surgery. The main parameters were the best-corrected visual acuity (BCVA) and central macular thickness (CMT). Paired samples t-test was used for statistical analysis. The mean initial best-corrected visual acuity was 0.15 ± 0.09 (0.05-0.3), whereas it was 0.6 ± 0.28 (SD) (0.3-0.7), 0.6 ± 0.22 (SD) (0.4-0.7) at 1 month and 3 months after the surgery, respectively. The BCVA levels recorded at 1 month and 3 months after the surgery were significantly higher than the initial BCVA (P = 0.002). The mean initial CMT was 392.2 ± 109.5 μm, whereas it was 295 ± 57.2 μm and 265.5 ± 30.3 μm at 1 month and 3 months after the surgery, respectively. The CMT values recorded at 1 month and 3 months after the surgery were significantly lower than the initial CMT (P < 0.001, P < 0.001). Phacoemulsification with intravitreal injection of bevacizumab and triamcinolone acetonide provides a decrease in CMT with a gain in BCVA in diabetic patients with clinically significant macular edema and cataract.

Photodynamic therapy of symptomatic choroidal nevi

Purpose:To evaluate the role of photodynamic therapy (PDT) for patients with symptomatic choroidal nevi involving the fovea or located near the fovea with subretinal fluid extending to the fovea.Materials and Methods:Retrospective review of five patients who underwent PDT for choroidal nevi at two separate centers in Ankara and Barcelona.Results:The mean initial logMAR visual acuity was 0.5 (range: 0 to 1.5). The mean largest tumor base diameter was 3.2 mm (range: 2.1–4.5 mm) and the mean tumor thickness was 1.1 mm (range: 0.7–1.6 mm). The mean number of PDT sessions was 1.6 (range:1–3). The mean final tumor thickness was 1.0 mm (range: 0–1.6 mm) at a mean follow-up of 19 months (range: 12–32 months). The mean final logMAR visual acuity was 0.4 (range: 0–1.5). Subfoveal fluid disappeared or decreased significantly in 4 of 5 eyes (80%) after PDT.Conclusions:PDT led to resolution of subretinal fluid with preservation of visual acuity in many symptomatic choroidal nevi in this study. Careful case selection is important as PDT of indeterminate pigmented tumors may delay the diagnosis and treatment of an early choroidal melanoma and thereby increase the risk for metastasis.

COMBINED RANIBIZUMAB AND PHOTODYNAMIC THERAPY TO TREAT EXUDATIVE AGE-RELATED MACULAR DEGENERATION

The purposes of this study were to determine whether the association of photodynamic therapy (PDT) and intravitreal ranibizumab could improve vision in a group of patients with choroidal neovascularization secondary to age-related macular degeneration and whether it could reduce the number and frequency of intravitreal injections, thus minimizing adverse effects. A nonrandomized, prospective, interventional study was conducted of a case series of 53 patients with sub- and juxtafoveal choroidal neovascularization secondary to age-related macular degeneration treated with a single initial dose of PDT and intravitreal ranibizumab. Retreatments were performed as required with monthly ranibizumab and PDT every 3 months if there were relapses. The retreatment criteria were based on visual acuity, optical coherence tomography, and fluorescein angiography. Follow-up lasted 12 months in all cases. The mean initial visual acuity was 40.6 letters versus 47.8 letters at the end of follow-up with a gain of 7.2 letters (P < 0.001). Moreover, 78.8% maintained or improved their initial vision, and 92.3% avoided moderate vision loss (>15 letters). A total of 65 PDT treatments (mean, 1.22 per patient) was performed and 126 doses of ranibizumab were injected (mean, 2.37 per patient). Only a single initial dose (PDT + ranibizumab) was required in 21 cases (39.6%). The central retinal thickness and choroidal neovascularization size decreased to 118 microm and 0.26 disk areas, respectively, from baseline to 12 months. Combined customized PDT + ranibizumab treatment can achieve visual results similar to those obtained with intravitreal monotherapy with the advantage of fewer intravitreous injections and reduced potential for adverse effects.

Cinical Manifestations and Prognosis of Cytomegalovirus Retinitis

Purpose: Cytomegalovirus (CMV) retinitis is common in patients with immunodeficient conditions caused by acquired immunodeficiency syndrome (AIDS), cytotoxic chemotherapy and immunosuppresive treatment. The purpose of this study was to assess the clinical manifestations and prognosis of CMV retinitis cases. Methords: Thirty-one eyes of 21 patients who were diagnosed with CMV retinitis were retrospectively reviewed. The clinical manifestations and prognosis of all patients were analyzed. Results: The average age of patients was 24.419.8 years. Eight patients were female and 13 patients were male. The predisposing conditions of patients were leukemia (nine patients), immunosuppressed conditions due to organ transplantation (three patients), AIDS (two patients) and other (seven patients). Eleven patients exhibited bilateral disease. The mean follow-up period was 31.3 months, and there were no differences between mean initial visual acuity (0.700.31) and mean visual acuity (0.770.20) at final visit. The major causes of visual loss were retinitis and atrophic changes involving the macula. Although retinitis was successfully treated with anti-viral agents in all cases, cataract (10 eyes, 31.3%), cystoid macular edema (four eyes, 12.5%), retinal detachment (two eyes, 6.3%), epiretinal membrane (two eyes, 6.3%) and immune recovery uveitis (two eyes, 6.3%) developed after the initial treatment. Conclusions: Although the visual prognosis of CMV retinitis was relatively good after administration of appropriate antiviral therapy, clinicians should remain alert for the development of late complications, including retinal detachment, cystoid macular edema and immune recovery uveitis.

Focal photodynamic therapy for idiopathic polypoidal choroidal vasculopathy

Abstract Purpose To evaluate the focal treatment with photodynamic therapy (PDT) to treat idiopathic polypoidal choroidal vasculopathy (IPCV). Methods Retrospective study of 8 eyes of 6 patients with visual loss and diagnosed of IPCV. Diagnosis was confirmed with indocyanine green (ICG) angiography. We treated with PDT only the “hot spots” or the maximum hyperfluorescence focal area. In the first month, funduscopic and visual acuity examination using ETDRS optotype were performed. In the third month all the examinations including a fluorescein and ICG angiography were repeated. Afterwards, controls had taken place every 6 months. Results Five women and one men were included in the study. Its age was between 64 and 85 years. Mean follow‐up was 18.1 months (range: 6‐35 months). Mean initial and final visual acuity were 20/100 and 20/80 respectively. We observed a visual acuity improvement in 6 eyes and a visual stability in 2 eyes. Five eyes needed only one treatment, 2 eyes two PDT sessions and only one eye required 5 PDT sessions. Conclusion In our study, focal photodynamic therapy of “hot spots” has shown to be an effective, non invasive and secure treatment for idiopathic polypoidal choroidal vasculopathy.