Retinal Pigment Epithelial Detachment Research Articles

RANIBIZUMAB AND AFLIBERCEPT FOR THE TREATMENT OF PIGMENT EPITHELIAL DETACHMENT IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: Data from an Observational Study.

To assess the effect of intravitreal ranibizumab and aflibercept on retinal pigment epithelial detachment (RPED) in patients with neovascular age-related macular degeneration. This was a retrospective analysis of data from a prospectively designed and implemented clinical audit. Analysis included change in RPED dimensions and visual acuity in 92/233 treatment-naive eyes with neovascular age-related macular degeneration and RPED 6 months after treatment with either aflibercept or ranibizumab. There was no significant between-group difference in the adjusted mean change for maximum RPED height (P = 0.195), diameter (P = 0.522) or visual acuity (P = 0.836) at 6 months. Injection frequency was the only clinical variable that affected RPED height (P = 0.050) and visual acuity change for both treatment groups (P = 0.004). Around 30% of eyes in each group had complete resolution of RPED at 6 months. Eyes with neovascular age-related macular degeneration and RPED showed significant functional and anatomical responses after 6 months of intravitreal anti-vascular endothelial growth factor injections. However, we found no significant difference in anatomical response or change in visual acuity between eyes treated with ranibizumab compared with aflibercept. Larger, prospectively designed, randomized studies with longer term follow-up may identify a difference between the two drugs that we did not detect.

Age-related macular degeneration in China: a population-based and clinical study

BackgroundAge-related macular degeneration (AMD) is one of the most common causes of irreversible blindness worldwide. We assessed its epidemiology and related factors in China. MethodsThrough population-based studies and clinical investigations, we assessed prevalence, incidence, and associated factors of AMD. The population-based investigations included several epidemiological surveys of ophthalmological and systemic diseases in China. The clinical studies consisted of biochemical examinations of aqueous humour samples obtained from patients undergoing intraocular surgery. FindingsIn the Beijing Eye Public Health Care Study, by use of a telemedicine approach, macular degeneration was identified to have caused visual impairment in 2700 (0·48%) of 562 788 elderly study participants (aged 55–85 years). In the Beijing Eye Study study, including 4439 participants and surveys done three times in 5-year intervals over a total period of 10 years, the prevalence of early AMD was 1·4%, late AMD was 0·20%, and exudative AMD was 0·10% per individual. Factors linearly association with AMD prevalence were older age (OR 1·06, 95% CI 1·04–1·08; p<0·0001), hyperopic refractive error (OR 1·16, 1·04–1·28; p=0·008), residence in a rural region (OR 0·33, 0·17–0·49; p<0·0001), and a lower level of education (OR 1·36, 1·07–1·65; p=0·01). The 5-year incidence of early AMD was 4·2% (SD 0·4, 95% CI 3·5–5·0), late AMD was 0·1% (SD 0·1, 0·0–0·2), and neovascular AMD was 0·1% (SD 0·1, 0·0–0·2). 5-year incidence was correlated with older age (odds ratio [OR] 1·03, 95% CI 1·01–1·06; p=0·01) and hyperopic refractive error (OR 1·15, 1·03–1·33; p=0·03). In participants with exudative AMD, as compared with control participants, intraocular concentrations of intercellular adhesion molecule-1 (844 pg/mL [SD 2073] vs 246 pg/mL [SD 206]; p=0·001) and soluble vascular cell adhesion molecule-1 (7978 pg/mL [SD 7120] vs 2999 pg/mL [SD 1426]; p=0·001) were significantly elevated. The concentration of MCP-1 decreased (p=0·009) with the type of subfoveal neovascular membrane (classic membrane type, occult membrane, retinal pigment epithelium detachment; p=0·009). In control participants, as compared with patients with neovascular AMD, the concentration of vascular endothelial growth factor (VEGF) was correlated with significantly shorter axial length (r −0·58; p=0·008). InterpretationBesides older age, hyperopic refractive error was the most important risk factor for prevalence and incidence of AMD in Chinese adults. The intraocular concentration of VEGF as a major AMD-associated growth factor decreased with increased axial length. The marked increase in myopia in the generation now aged younger than 30 years in China might be assumed to have a protective effect against AMD in the future. FundingNational Natural Science Foundation of China.

The efficacy of intravitreal injection of tissue plasminogen activator, ranibizumab and C3F8 in the treatment of early submacular hemorrhage induce to polypoid choroid vasculopathy

Objective To observe the clinical effect of intravitreal injection of tissue plasminogen activator (t-PA), ranibizumab and C3F8 in the treatment of early submacular hemorrhage (SMH) induce to polypoid choroidal vasculopathy (PCV). Methods The clinical data of 20 eyes of 20 patients with early SMH induce to PCV were enrolled in this study. The duration of bleeding in the eye was 7 to 28 days, and the mean duration of bleeding was 14.8±5.6 days. All eyes are measured using the Snellen chart best corrected visual acuity (BCVA), logarithm of the minimum angle of resolution (logMAR) was used to calculate visual acuity. Measure central retinal thickness (CRT) and central retinal pigment epithelial detachment (PED) thickness using frequency-domain optical coherence tomography. The average logMAR BCVA of eyes was 1.73±0.91; the mean CRT was 620.0±275.8 μm; the average central PED thickness was 720.3±261.9 μm. All eyes receive intravitreal injection of t-PA, ranibizumab and C3F8. The intravitreal injection of ranibizumab was administered once a month for 3 consecutive months, followed by an on-demand treatment plan. Mean follow-up time was 9.9±3.6 months. The changes in BCVA, CRT, central PED thickness and clearance degree of SMH at 6 months after treatment were observed. Results On the 6 months after treatment, the average logMAR BCVA, CRT and central PED thickness of the eyes were respectively 0.42±0.37, 290.2±97.4 μm and 41.6±78.1 μm. Compared with baseline, the after treatment BCVA was significantly increased (F=38.14, P=0.000), but the CRT and central PED were significantly decreased (F=7.48, 75.94; P=0.000, 0.000). Among the 20 eyes, 16 eyes of SMH was completely cleared, accounting for 80%;4 eyes was partially cleared, accounting for 20%. No recurrence and systemic or local complications occurred during follow-up of all eyes. Conclusion Intravitreal injection of t- PA, ranibizumab, and C3F8 in the treatment of early SMH induce to PCV can effectively remove SMH, improve vision, reduce CRT and central thickness of PED. Key words: Choroid diseases/therapy; Submacular hemorrhage; Tissue plasminogen activator/therapeutic use; Angiogenesis inhibitors/therapeutic use; Noble gases/therapeutic use

Isolated pigment epithelium detachment: evidence for relation to central serous chorioretinopathy and effect of photodynamic therapy.

To describe clinical characteristics and response to verteporfin therapy (PDT) in eyes with retinal pigment epithelium detachment (PED) in the absence of primary disease other than characteristics compatible with central serous chorioretinopathy (CSC). Retrospective review of 634 consecutive patients diagnosed with isolated PED or CSC in one or both eyes in the period from 2007 to 2014 at a single institution. Pigment epithelium detachment (PED) in the absence of primary pathology other than angiographic choroidal hyperpermeability in the incident or fellow eye or manifest CSC in the fellow eye was found in 22 eyes in 19 patients. Follow-up ranged from 4 to 61months. Five of 19 patients (26%) had classic CSC in the fellow eye. Transition from isolated PED to manifest CSC in the eye with PED was observed in seven eyes (33%) over a median untreated period of observation of 11months (range, 1-32months). A single session of PDT followed up 1-6months later showed full resolution of the PED in seven (78%) of nine eyes. Of the 13 untreated eyes, five eyes (38%) underwent spontaneous resolution of the PED. Fellow-eye findings, conversion to CSC, resolution of PED after PDT or, less commonly, spontaneously support that isolated PED is a manifestation of CSC that represents an intermediate stage between pachychoroid and classic CSC. The chance of experiencing resolution of the PED was roughly twice as high with PDT as with untreated observation.

Retinal pigment epithelium hyperplasia overlying pigment epithelial detachment in age-related macular degeneration can masquerade as neovascularization on optical coherence tomography angiography

PurposeTo report the image artifacts due to retinal pigment epithelium (RPE) hyperplasia overlying retinal pigment epithelial detachment (PED) in age-related macular degeneration (AMD), which can masquerade as neovascularization on optical coherence tomography angiography (OCTA).MethodsA hospital-based, retrospective, and cross-sectional study. Twenty-two eyes from 16 patients with non-vascularized PED related to AMD were included in this study. All patients were examined by OCTA, spectral-domain optical coherence tomography, fluorescence angiography, and indocyanine green angiography. Vascular flow signals (VFS) on both the outer retinal slab of en face OCTA and cross-sectional OCTA and their correspondence with RPE hyperplasia were evaluated.ResultsFifteen eyes (68.2%) showed VFS on both the outer retina slab of en face OCTA and cross-sectional OCTA, all corresponding to the RPE hyperplasia overlying PED. Among them, 12 eyes with lump RPE hyperplasia outside foveal avascular zone (FAZ) all showed obvious VFS on the outer retina slab of OCTA, and 3 eyes with scattered RPE hyperplasia outside FAZ showed VFS fragments. Of note, 4 eyes had accompanied RPE hyperplasia inside FAZ, and 7 eyes without RPE hyperplasia overlying PED showed no corresponding VFS on the outer retina slab of OCTA. Additionally, a round-like dark band at the edge of PED was observed in the outer retina slab on en face OCTA in 17 eyes (77.3%).ConclusionsRPE hyperplasia overlying PED in AMD can masquerade as neovascularization on OCTA. To avoid misdiagnosis and unnecessary treatment, this RPE hyperplasia-related image artifact should be considered when interpreting OCTA images.

Clinicopathologic Correlation of Aneurysmal Type 1 Neovascularization in Age-Related Macular Degeneration

To correlate multimodal retinal imaging with high-resolution epoxy resin histologic analysis aligned to invivo tomograms in a patient with exudative aneurysmal type 1 (AT1) neovascularization and hemorrhage secondary to age-related macular degeneration (AMD). Case study and clinicopathologic correlation. An 84-year-old man of European descent with AT1 neovascularization secondary to AMD with a 6-year follow-up with combined antiangiogenic and photodynamic therapy. Multimodal imaging from each clinic visit, including fluorescein angiography, indocyanine green angiography, and OCT, was correlated with exvivo OCT and high-resolution histologic images of the donor eye, aligned to the en face images showing hemorrhage and exudation. Location of the branching vascular network and the aneurysmal vascular dilations in angiography, correlated with histologic findings. Clinically, a hemorrhagic detachment of the retinal pigment epithelium (RPE) in the macular area was associated with an AT1 neovascularization extending near the optic nerve head, where the choroid, which was thin overall, was extremely thin. Resolution of the hemorrhage accompanied by progressive macular atrophy and internal changes in the reflectivity of the RPE detachment were observed. Histologic analysis suggested aphysical continuity from a hyalinized choroidal artery to a capillary bed (branching vascular network) in the sub-RPE-basal lamina (BL) space without visualization of aneurysmal dilations. Clinicopathologic correlation of AT1 neovascularization from an intact treated eye with dye-based angiographic and OCT scans supports the proposed nomenclature of AT1 neovascularization over polypoidal choroidal vasculopathy. We described continuity of the sub-RPE-BL branching vascular network with choroidal arteries and histologic correlates of common OCT signatures of neovascular AMD. The thinness of choroid in this patient of European descent contrasts with that reported for Asian populations, in which AT1 neovascularization is associated commonly with pachychoroid disease characteristics. This case reinforces the different manifestations of AT1 neovascularization across and within diverse ethnicities and diseases.

Peripheral Exudative Haemorrhagic Chorioretinopathy: Course of Disease and Diagnosis - Including Wide-field Imaging of Associated Diseases Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy, Therapy

PEHCR (peripheral exudative haemorrhagic chorioretinopathy) is a disease manifested clinically, particularly by subretinal bleeding, retinal exudates, retinal pigment epithelium detachments (RPE detachments), exudative retinal detachment and sub-RPE bleeding. The PEHCR lesion is often characterized by its polypoidal pattern, which is very similar to PCV (polypoidal choroidal vasculopathy) polyps. Diagnosis is best made with a wide-field ICGA (indocyanine green angiography). In approximately half of patients, macular changes in the form of drusen, up to exudative AMD (age-related macular degeneration), are detected in the affected eye or partner eye. Since there is very little literature directly available on PEHCR, this work also discusses the peripheral changes described in the context of AMD that were investigated with wide-field imaging.

Manifestaciones retinianas en pacientes con glomerulonefritis membranoproliferativa mediada por complemento

Complement-mediated membranoproliferative glomerulonephritis is a rare progressive glomerular disease. In some patients it can be associated with retinal lesions. Therefore, the purpose of this study was to assess a case series with this diagnosis in our hospital. A cross-sectional study was conducted on 8 patients diagnosed with complement-mediated membranoproliferative glomerulonephritis. Funduscopy, optical coherence tomography (OCT) and Swept Source domain OCT angiography were performed. Only 1 of the 8 patients showed drusen-like deposits that were located under the retinal pigment epithelium in the OCT, with the presence of associated choroidal neovascularization being ruled out in OCT angiography. Therefore, membranoproliferative glomerulonephritis may produce retinal alterations with drusen or retinal pigment epithelium detachment, and requires an appropriate differential diagnosis to be made with age-related macular degeneration. The follow-up of these patients is important in order to detect vision-threatening complications.

Detachment of retinal pigment epithelium in retinopathy due to malaria

Abstract Case report A 45-year-old man was diagnosed with malaria with neurological involvement. Two months later he referred metamorphopsia in the left eye. Malarial retinopathy was observed in the fundus examination. The Optic Coherence Tomography (OCT) of the macula showed parafoveal pigment epithelium detachment (DEP). Specific anti-malarial treatment was initiated, with the disappearance of the retinopathy being observed. Discussion Plasmodium falciparum is responsible for the retinopathy in neurological malaria. A funduscopic examination and macular OCT should be performed in these patients, as neurological malaria is associated with a higher mortality when there is a retinal involvement.

Clinical analysis of 426 emmetropia patients with unilateral rhegmatogenous retinal detachment and retinal lesions in the contralateral eyes

Objective To summarize the clinical features and visual outcome of posterior scleritis presented with symptoms involving affected optic nerve. Methods Retrospective case series study. Twelve eyes of 12 female patients with posterior scleritis were included in this study. The average age was 35.2±14.31 years old. The patients got diagnosed with an average of 24.75±22.91 days. Ocular pain was complained in all patients, and blurred vision in 11 patients. The best corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp microscope examination, B-scan ultrasound, optical coherence tomography (OCT), fundus photography, fundus fluorescein angiography (FFA) and ocular wall thickness measurement were performed in all patients. Nine eyes received visual field examination. All patients received systemic corticosteroid and steroidal eye drops for 3 months. Clinical features and outcome were retrospectively studied. Results Before treatment, the BCVA was from 0.8. There were 3 eyes with scleral hyperemia, 3 eyes with anterior chamber flares, 12 eyes with papilledema and different degrees of retinal vein dilatation, 3 eyes with star-shaped macular exudates and 2 eyes with macular retinal pigment epithelium detachment. B-scan ultrasound demonstrated that the ocular walls were thickening in all eyes with typical T-sign, and the average thickness was 2.76±0.68 mm. OCT demonstrated optic disc swelling, and the macular retinal detachment in 2 eyes. In the FFA examination, the fluorescein leakage of the disc was enhanced with time. In the Humphrey test, the value of mean deviation (MD) was 12.56±5.73 dB and pattern standard deviation (PSD) was 8.15±4.23 dB in 9 eyes before the treatment. After treatment for 3 months, the symptoms were attenuated and the visual acuity was obviously improved with BCVA>0.1 in all eyes. Scleral hyperemia and anterior chamber flares were only found in 1 eye. The optic disc edema gradually faded away. The ocular wall thickness in the poster part of the eyeball decreased, and the T-sign disappeared in all eyes, the average thickness was 1.53±0.41 mm. Compared with parameters before the treatment, the difference was statistically significant (t=0.003 5, P<0.05). OCT demonstrated the recovery of the macular retinal detachment. There was no abnormal leakage evidenced in FFA in the optic disc and macular. After treatment, the value of MD and PSD was 5.19±4.82 dB and (4.33±3.76) dB, respectively. The difference of MD value between before and after the treatment was significant (t=0.026, P<0.05). Conclusions Posterior scleritis with an initial symptom of optic nerve was tend to affect middle-aged patients, with clinical manifestations of anterior segment signs in some patients and optic disc swelling with retinal vein dilatation in all patients. B ultrasound examination showed typical T sign. Systemic corticosteroid treatment always obtained remission of the ocular inflammatory activity, and could achieve favorable visual outcome. Key words: Scleritis/diagnosis; Scleritis/therapy; Optic neuritis; Disease attributes

The effects of lutein on cisplatin-induced retinal injury: an experimental study

Aim: Lutein is one of the most common carotenoids defined in human plasma as having potent anti-oxidant effects. We aimed to determine the biochemical and histopathological effects of lutein on cisplatin-induced oxidative retinal injury in rats.Materials and methods: Twenty-four rats were equally divided into four groups as healthy controls (HC group), only cisplatin (5 mg/kg) administered group (CIS group), Lutein (0.5 mg/kg) + cisplatin (5 mg/kg) administered group (LC group), and only Lutein (0.5 mg/kg) (LUT group) administered group. From the blood samples obtained, serum malondialdehyde (MDA), total glutathione (tGSH), interleukin 1 beta (IL-1β), and tumor necrosis factor alpha (TNF-α) levels were investigated. In histopathological analyses, the total retinal thickness, retinal pigment epithelium (RPE), photoreceptor layer (PL), outer nuclear layer (ONL), outer plexiform layer (OPL), inner nuclear layer (INL), inner plexiform layer (IPL), and ganglion cell layer (GCL) were evaluated.Results: MDA, IL-1β, and TNF-a levels were statistically significantly higher (p < 0.001) in CIS group compared with other three groups while tGSH levels were statistically significantly lower (p < 0.001). In subgroup analyses, there was no any statistically significant difference regarding all four parameters analyzed between HC, LC, and LUT groups. In histopathological analyses, cisplatin-induced retinal damage included atrophy and disorganization on outer segment, degeneration and detachment of RPE and PL from choroid, degeneration and edema of INL and IPL, total degeneration of GCL; while cisplatin-induced retinal damage was determined to be significantly prevented with 0.5 mg lutein treatment on histopathological evaluations.Conclusions: Lutein co-administration was highly effective in prevention of cisplatin-induced retinal damage due to the anti-oxidant and anti-inflammatory effects of lutein.

Clinical outcomes in Caucasian patients with polypoidal choroidal vasculopathy.

To describe treatment outcomes in a cohort of Caucasian patients with polypoidal choroidal vasculopathy (PCV). Clinical charts from 48 eyes of 45 Caucasian patients with PCV were retrospectively reviewed. All cases were diagnosed with indocyanine green angiography. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) imaging were analyzed at baseline and final follow-up. Eyes were treated with a combination of verteporfin photodynamic therapy (PDT) and anti-vascular endothelial growth factor (VEGF) (n = 24), or PDT monotherapy (n = 9), or anti-VEGF monotherapy (n = 8), or no treatment (n = 7). Aflibercept was the anti-VEGF agent in 30 out of 32 eyes. Sixteen out of 24 eyes in the combination treatment group received initial PDT at diagnosis. All treatments led to stabilization of BCVA at final visit with a trend for better visual acuity in the anti-VEGF monotherapy group. There was a substantial reduction in central retinal thickness associated with resolution of subfoveal fluid and improvement in retinal pigment epithelial detachment in all treatment groups. BCVA and OCT findings remained stable in eyes which received no treatment. The use of PDT was associated with 0.5 fewer intravitreal injections per annum, which was not statistically significant. In the largest series of Caucasian patients with PCV presented to date, anti-VEGF monotherapy, PDT, or their combination preserved visual acuity and improved subfoveal exudative changes. Combination treatment was not superior to anti-VEGF monotherapy.

Gender variation in central serous chorioretinopathy.

Comparison of presentation and outcomes of central serous chorioretinopathy (CSC) between male and female subjects in different ethnic populations. Retrospective comparison between male and female subjects with CSC was completed. Demographic details, clinical presentations, imaging features and treatment outcomes were compared at baseline and at last follow-up. This study included 155 male and 155 female subjects with a mean (CSD) age of 43.8 ± 10.3 and 57.0 ± 12.1 years, respectively, and a mean duration of follow-up of 8.49 ± 12.6 months. At presentation, there was no difference in visual acuity; however, visual acuity was significantly higher for female subjects at last follow-up (p = 0.02). Optical coherence tomography (OCT) analysis showed that subretinal deposits (p < 0.001), hyperreflective foci (p = 0.001), retinal pigment epithelial detachment (p = 0.01) and retinal pigment epithelium (RPE) irregularities (p = 0.03) were higher in male subjects at presentation. Angiographic analysis showed that diffuse leakage and RPE tracts were common in males (p = 0.01 and p = 0.02). No significant differences in choroidal dilatation or diffuse choroidal leakages were noted. Female subjects with CSC appear to have better outcomes, with less chances of diffuse RPE damage and other OCT features compared to males.

Corrigendum to “Two-Year Outcome of Aflibercept in Patients with Pigment Epithelial Detachment due to Neovascular Age-Related Macular Degeneration (nAMD) Refractory to Ranibizumab”

[This corrects the article DOI: 10.1155/2017/8984313.].

Unusual ocular clinical manifestation of leptospirosis

Abstract Clinical case An uncommon case is presented of a 15-year-old girl with bilateral, multiple serous detachments of retina and retinal pigment epithelium. With clinical and laboratory (IgG 1/160 and IgM 1/160, using an indirect immunofluorescence assay) diagnoses of leptospirosis, a complete ophthalmic examination, fluorescein angiography, autofluorescence and optical coherence tomography were performed, and the patient was followed for two years. Discussion Bilateral, multiple serous detachments of retina and retinal pigment epithelium can be a complication of systemic leptospirosis, a zoonotic disease caused by Leptospira. Without a detailed medical history it may be underdiagnosed, mainly because it can mimic other more common diseases. It may be prudent to ask patients regarding contact with pets.

PROGRESSION OF MACULAR ATROPHY IN EYES WITH TYPE 1 NEOVASCULARIZATION AND AGE-RELATED MACULAR DEGENERATION RECEIVING LONG-TERM INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY: An Optical Coherence Tomographic Angiography Analysis.

To evaluate the size and location of macular atrophy in eyes with Type-1 neovascularization (NV) and age-related macular degeneration receiving chronic intravitreal anti-vascular endothelial growth factor therapy. A retrospective review of a case series of 27 eyes with Type-1 NV and retinal pigment epithelial detachment (PED) having a minimum of 12 months follow-up was performed. Demographic information and visual acuity at baseline and the final follow-up were collected. Spectral-domain optical coherence tomography (OCT) and near-infrared reflectance were analyzed at 6-month intervals to detect and measure macular atrophy. Location and area (in square millimeter) of macular atrophy were measured using Heidelberg software tools. Also, OCT angiography was used to colocalize the area of Type-1 NV flow versus the location of atrophy. Twenty-seven eyes of 27 patients were included in this analysis. The median visual acuity was 20/50, mean age was 82.7 years, and mean number of injections was 29.5. A larger percentage of eyes (59.3%) developed atrophy predominantly eccentric to the PED versus predominantly overlying the PED (11.1%) when measured with spectral-domain OCT and near-infrared imaging. At the final follow-up, there was a larger area of atrophy surrounding the fibrovascular PED (mean, 3.326 mm) than overlying it (mean, 0.542 mm), and this was statistically significant (P = 0.0118). En-face OCT images were overlaid with OCT angiography in 11 eyes, and a predominantly eccentric pattern of atrophy was identified in 9 of 11 eyes. Using this method, the mean area of atrophy predominantly overlying the Type-1 NV was 1.652 mm (range of 0-10.464 mm), whereas the area of atrophy predominantly eccentric to the neovascular complex was 4.345 mm (range of 0.705-13.758 mm), and this was statistically significant (P = 0.0465). The average rate of atrophy progression was 1.04 mm/year (SD 0.938). With long-term anti-vascular endothelial growth factor therapy for eyes with Type-1 NV secondary to age-related macular degeneration, macular atrophy tends to develop predominantly eccentric to the PED and the neovascular flow imaged on OCT angiography. With chronic vascular endothelial growth factor suppression, Type-1 NV may evolve into a multilayered PED that may confer a protective effect to the overlying retinal pigment epithelium and outer retina.

Can the route of Toxoplasma gondii infection affect the ophthalmic outcomes?

Ocular toxoplasmosis is the most common cause of retinochoroiditis worldwide in humans. Some studies highlighted the idea that ocular lesions differ according to the route of infection but none of them mimicked the natural route. The current study aimed to investigate the ophthalmic outcomes in congenital and oral routes of infection with Toxoplasma in experimental animals. Mice were divided into three groups; group I: congenital infection, group II: acquired oral infection and group III: non-infected. We used Me49 chronic low-virulence T. gondii strain. We found that retina is the most affected part in both modes of infections. However, the retinal changes are different and more pronounced in case of congenital infection. The congenitally infected mice showed retinal lesions e.g. total detachment of retinal pigment epithelium from the photoreceptor layer and irregular arrangement of retinal layers. More severe damage was observed in mice infected early in pregnancy. While the postnatal orally infected mice showed fewer changes. In conclusion, the routes of Toxoplasma infection affect the ophthalmic outcomes and this may be the case in human disease. Although both are vision threatening, it seems that the prognosis of postnatal acquired ocular toxoplasmosis is better than that of congenital disease.

Factors predicting 2-year treatment results of ranibizumab therapy for polypoidal choroidal vasculopathy in eyes with good baseline visual acuity.

This study aimed to explore predictors of long-term stabilization of polypoidal choroidal vasculopathy (PCV) lesions and vision in response to injection of intravitreal ranibizumab (IVR). The treated eyes had a baseline best corrected visual acuity (BCVA) of at least 0.6 (logarithm of the minimal angle of resolution (logMAR) 0.22).We treated 45 eyes showing BCVA between 0.6 (logMAR 0.22) and 1.0 (logMAR 0), with IVR for 3 consecutive months. All eyes were confirmed to have subfoveal PCV prior to starting this treatment regimen. Additional IVR was administered at the subsequent monthly visits, if necessitated by evidence of persistent PCV, for up to 23 months after the first ranibizumab injection. The subjects were then carefully followed-up for 24 months, allowing detailed retrospective evaluation of changes in mean BCVA, central retinal thickness (CRT), serous retinal detachment (SRD), hemorrhage, and polypoidal lesion numbers. The relationships between retreatment and each of the baseline characteristics and SRD development during follow-up were analyzed.The mean logMAR BCVAs were 0.111 ± 0.076, 0.068 ± 0.206 (P = .0033) and 0.115 ± 0.265 (P = .27) at baseline and at 12 and 24 months, respectively. At 24 months, 87% of eyes had BCVA of 20/40 or better. Not requiring retreatment between 12 and 23 months was found to be significantly associated with the absence of retinal pigment epithelial detachment (RPED) at baseline (odds ratio: 0.262 (95% confidence interval (CI): 0.073–0.946). The rates of retreatment from 12 to 23 months were significantly higher in eyes with SRD at 6 and 12 months than in those without SRD (P = .004 and P < .001).In conclusion, during 24 months of antivascular endothelial growth factor (VEGF) therapy using ranibizumab for PCV, BCVA was maintained in those with good visual acuity at baseline. Comprehensive analyses revealed RPED at baseline and SRD development during follow-up to correlate significantly with the need for retreatment between 12 and 23 months. Our observations might facilitate tailoring treatments to individual PCV patients.

Regression patterns of choroidal melanoma: After palladium-103 (103Pd) plaque brachytherapy.

Purpose:To describe the patterns of regression of choroidal melanoma after treatment with plaque brachytherapy.Methods:Retrospective interventional case series including 170 consecutive patients treated with 103Pd eye plaque radiation for choroidal melanoma. Outcome measures were changes in tumor thickness, surface characteristics, tumor vascularity, ultrasonography, fluorescein angiography, optical coherence tomography, and histopathology.Results:The mean initial tumor thickness was 3.9 mm (median 2.8 mm; range 2–11.3 mm) that decreased to 1.7 mm (median 1.2 mm; range 0–7.1 mm) after plaque brachytherapy. On imaging, tumors were pigmented in 51% (n = 86/170), amelanotic in 10% (n = 17/170), and variably pigmented in 39% (n = 67/170). Tumor pigmentation increased in 64% (n = 106/166), decreased in 18% (n = 30/166), and was unchanged in 18% (n = 30/166). Of the 120 that demonstrated intrinsic vascularity, 10% (n = 12/120) had decreased tumor-related vascularity and 90% (n = 108/120) showed complete resolution. Subretinal fluid was present in 34% (n = 58/170) of eyes at presentation. Of them, 15% (9; n = 9/58) had persistent SRF at last follow-up. On ultrasound imaging, 88% (n = 149/170) tumors presented with low to moderate internal reflectivity of which 61% (n = 91/149) showed increased reflectivity on regression. We noted a crescendo–decrescendo fluctuation in the presence of orange pigment lipofuscin along with complete resolution of drusenoid retinal pigment epithelial detachments. In the entire series of 170 patients, there was 0.5% (1) failure of local control, 2% (4) secondary enucleations, and 6% (10) patients developing metastasis.Conclusion:Findings related to choroidal melanoma regression after 103Pd plaque brachytherapy included decreased intrinsic tumor vascularity, decreased tumor-related subretinal fluid, increased pigmentation, specific changes in orange pigment lipofuscin and resolution of drusenoid retinal pigment epithelial detachments, as well as decreased tumor thickness with an increase in internal reflectivity on ultrasound.

OPTIMAL MANAGEMENT OF PIGMENT EPITHELIAL DETACHMENTS IN EYES WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

This review aimed to determine the optimal management of retinal pigment epithelial detachments (PEDs) in neovascular age-related macular degeneration (nAMD) based on review of available evidence in the literature. A comprehensive literature review evaluates previous retrospective and prospective studies that assessed the treatment of PEDs in nAMD. Studies illustrated that anti-vascular endothelial growth factor (VEGF) therapy can be effective in eyes with PED secondary to nAMD. Similar visual outcomes are associated with different anti-VEGF treatments. Higher anti-VEGF doses may improve anatomical response, without correlation with vision improvement. Fibrovascular PEDs may be difficult to treat, but even these eyes can gain vision with anti-VEGF therapy. A retinal pigment epithelial tear may develop in 15% to 20% of eyes with PEDs after anti-VEGF therapy, especially in PEDs greater than 500 µm to 600 µm in height; however, vision may stabilize with continued therapy. Atrophy may complicate eyes with PED and nAMD after anti-VEGF therapy, especially in association with complete PED resolution. Available literature suggests that anti-VEGF therapy is safe and efficacious for PED and nAMD. Treatment should focus on vision gains rather than PED resolution because there is no apparent correlation between anatomical and functional improvement in most eyes with PED and nAMD.