Subretinal Neovascular Membrane Research Articles

CLINICAL-OPHTHALMOLOGICAL INDICATORS WHICH DETERMINE THE SEVERITY OF AGE-MACULAR DEGENERATION

Background. The search for biomarkers and simple mathematical systems for predicting the severity of age-related macular degeneration (AMD) is necessary and relevant.
 Aim: to determine prognostic clinical and ophthalmological indicators that determine the severity of AMD.
 Material and methods. The study included observational data of 302 eyes (152 patients), in which the stage of AMD was determined according to the recommendations of the AREDS study. The age of the patients was 71.18 years, 59.9% were women, 40.1% were men. Visual acuity, maximum corrected visual acuity (MCVA), the number of drusen of various calibers, the presence of changes in the retinal pigment epithelium, subretinal neovascular membrane (SNM) and geographic atrophy were determined.
 Results. By age, patients with a mild course of AMD were younger than those with a severe course by 6.9 years (p<0.001). Smokers accounted for 31.5% of patients, the course of AMD in such patients was more often severe – 37.2% versus 21.9% in non-smokers (p=0.006). Visual acuity and MCVA were significantly worse in patients with severe AMD (p<0.001). There was no significant difference in the number of small and medium-sized drusen (p>0.5). Large drusen, pigmentary changes and SNM were found almost only in patients with severe AMD. Moreover, pigmentary changes were present in almost all patients with severe AMD (92.6%), and SNM and geographic atrophy – in 23.9% and 21.8%, respectively. According to the data of the discriminant analysis, almost all indicators had a clear relationship with the course of AMD, but the F coefficient was the largest for pigmentary changes, MCVA, the number of large drusen and age. These indicators were included in the system of discriminant equations for determining the AMD severity.
 Conclusion. With the help of discriminant analysis, the indicators determining the severity of the course of AMD were found.

Макулярная неоваскуляризация при вителлиформной дистрофии: анализ эффективности антиангиогенной терапии на примере клинических случаев

Best vitelliform macular dystrophy (BVMD) is caused by BEST1 mutation and leads to the accumulation of vitelliform material in the subretinal space. The formation of subretinal neovascular membrane can be one of BVMD complications. Herein, we discuss the criteria for initiating anti-VEGF therapy and efficacy assessment in two patients (3 eyes) with vitelliform macular dystrophy. Keyword: macular neovascularization, vitelliform macular dystrophy, optical coherence tomography, anti-VEGF therapy

Diagnosis of choroidal nevus following multiple intravitreal anti-VEGF injections (case study)

This article describes a clinical case of a female patient with choroidal nevus, who was previously diagnosed in another clinic with "subretinal neovascular membrane as a result of central serous chorioretinopathy" and subsequently underwent multiple intravitreal anti-VEGF injections. Based on the analysis of OCT angiography images, the macular changes in this case were interpreted as a polypoidal form of neovascularization in a patient with subfoveolar choroidal nevus.

Combined effect of carrying both CFH (rs1061170) and TGFβ1 (rs1800469) gene variants on the risks of various forms of age-related macular degeneration

Background: Age-related macular degeneration (AMD) is one of the most common disorders that can lead to total central vision loss after choroidal neovascularization or geographic atrophy (GA). Because the genetic component of the disease plays an important role in the pathogenesis, has an impact on the clinical presentation, and determines the response to treatment, studies on the genetic component of AMD are relevant for better understanding the molecular mechanisms underlying the pathogenesis. Purpose: To investigate associations among TGFβ1 C509T (rs1800469) and CFH T1277С (rs1061170) polymorphisms, their gene-to-gene interactions and the risks of various forms of AMD. Material and Methods: This was a case-control study. The case group included 61 patients with AMD. Of these, 31 were diagnosed with late dry AMD (GA), and 30, with wet AMD (neovascular AMD or nAMD). Patients with nAMD were divided into two subgroups of 14 patients with type 1 or occult subretinal neovascular membrane (SNM), the SNM1 subgroup and 16 patients with type 2 or classical SNM, the SNM2 subgroup. The control group was composed of 50 individuals with no eye disease and of an age distribution similar to that of the case group. Polymerase chain reaction (PCR) and restriction analysis of gene amplification products were performed to determine TGFβ1 rs1800469 and CFH rs1061170. Results: We found a significant effect of TGFβ1 C509T (rs1800469) and CFH T1277C (rs1061170) gene variants on the risks of various forms of AMD. CFH 1277TT genotype was associated with decreased AMD risk, whereas 1277CC genotype, with increased AMD risk (first and foremost, increased GA risk) (р less 0.05). TGFβ1 509CC genotype was associated with increased risk, whereas TGFβ1 509TT genotype, with decreased risk of both GA and SNM2. Conclusion: For the first time, a combined effect of gene variants of interest on the susceptibility to the development of AMD has been investigated, and synergism between these variants in increasing the risk of certain forms of the disease (e.g., GA) established. The results obtained create prerequisites for developing individualized prediction of risk and novel treatment strategies for the disease.

Baseline demographic, clinical and multimodal imaging features of young patients with type 2 macular telangiectasia

PurposeMacular telangiectasia (MacTel) type 2 is observed in patients in their 5th–8th decades of life. The clinical and imaging findings in younger patients is unknown in larger cohorts. The study purpose is to report prevalence, baseline clinical and spectral domain optical coherence tomography (SDOCT) findings in young MacTel patients below 40 years.MethodsThis hospital-based, multicentre, retrospective, cross-sectional study included patients between 2011 and 2023. Retinal photographs from multiple imaging techniques were evaluated to diagnose and stage type 2 MacTel and describe their SDOCT findings. Imaging characteristics were correlated with clinical stages and visual acuity.ResultsAmong all MacTel patients seen in hospital, prevalence of young MacTel cases less than age 40 was 1.77% (32/1806; 62 eyes). Youngest participant was 34 years, while mean age was 38.44 ± 1.795 years. Sixteen patients (50%) were diabetics. Perifoveal greying (n = 56, 90%) and perifoveal hyperreflective middle retinal layers (n = 47, 76%) were the most prevalent clinical and SDOCT imaging finding respectively. Less than 10% (n = 6) eyes had proliferative disease. Presence of retinal pigment clumps (RPC) (7% vs. 67%; p = 0.002) coincided with proliferative MacTel. Poor vision was associated with presence of outer retinal layer SDOCT findings like outward bending of inner retinal layers (p = 0.047), RPC (p = 0.007), subfoveal neurosensory detachment (p = 0.048) and subretinal neovascular membrane (p = 0.001).ConclusionType 2 MacTel before age 40 is rare, common in women and diabetics, and affects vision in advanced stage. Disease symmetry, comparison with older cases, and longitudinal SDOCT changes in such patients require further study.

A practical clinical approach to traumatic choroidal rupture

Background: Traumatic choroidal rupture is a posterior segment manifestation of trauma and is more common in closed-globe injuries. It is defined as a tear of the choroid and Bruch’s membrane following blunt trauma. This narrative review summarizes the current literature and provides a practical clinical approach to the diagnosis and management of traumatic choroidal rupture and its complications. Methods: In this narrative review, we searched the PubMed/MEDLINE database using the search term choroidal rupture to provide a practical and updated approach to traumatic choroidal rupture, focusing on its definition, etiology, diagnosis, imaging, management of complications, and prognosis as mentioned in the literature over the last two decades. Results: Traumatic choroidal rupture occurs due to increased tensile stress on the eye wall and is three-fold more common in closed-globe injuries than in open injuries. Subretinal or sub-retinal pigment epithelial hemorrhage and macular edema are early signs. Macular involvement is associated with poor visual prognosis. Damage to Bruch’s membrane increases the risk of subretinal choroidal neovascular membrane (CNVM). Traumatic epiretinal membrane is another complication. Imaging modalities such as spectral-domain optical coherence tomography, indocyanine green angiography, conventional fundus fluorescein angiography, and optical coherence tomography angiography (OCT-A) can be used in diagnosis or monitoring for complications. OCT-A offers unique opportunities for the diagnosis, treatment, and follow-up of both the initial presentation and possible complications. Frequent follow-up has been suggested in the first year after trauma. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection is effective and less invasive in managing CNVM. The visual outcome depends on the location of the rupture, baseline visual acuity, and presence of optic atrophy or macular holes. Risk factors for developing CNVM include rupture involving the macula, longer rupture length or rupture closer to the foveal center, and older age. Conclusions: Choroidal rupture is a posterior segment entity that usually occurs after trauma, compromises choroidal vessels and Bruch’s membrane, and can lead to CNVM. The use of novel noninvasive imaging modalities and efficient anti-VEGF therapy to manage this entity or its subsequent complications produces better visual outcomes. Early diagnosis and frequent follow-up of these patients allow treatment of possible complications, thereby improving the visual prognosis.

Оценка объемов выполнения интраокулярных инъекций пациентам с неоваскулярной формой возрастной макулярной дегенерацией в офтальмохирургической клинике

Purpose. Evaluation of the volume of intravitreal injections in the treatment of neovascular form of age-related macular degeneration (nAMD) in an ophthalmological clinic. Material and methods. An analysis was made for 2021–2022. Aflibercept was used in all cases. The course began with 3 monthly loading injections with a further transition to the T&E treatment regimen. Results. A total of 467 nAMD patients received treatment in 2021. In their structure, 87 patients were primary, 380 people were repeated. The average number of injections was 6 during the first year in primary patients and 3 injections in repeat patients. Treatment was denied to 8 primary and 32 repeat patients for various reasons. In total, 522 injections were performed for primary patients and 1140 for repeated ones in 2021. The duration of therapy in all 380 repeat patients ranged from 2 to 9 years. 584 patients received nAMD treatment in 2022. One eye was treated in 492 people, both eyes were treated in 92 people. In their structure, 102 patients were primary, 482 people were repeated. The average number of injections was 6 during the first year in primary patients and 3 injections in repeat patients. Further treatment was denied to 4 primary and 42 repeat patients for various reasons in 2022. In total, 612 injections were performed in primary patients and 1,446 injections in repeat patients in 2022. In total, during the study period (two years), 1134 injections were performed in primary patients and 2586 injections in repeat patients. The number of «discharged» repeat patients was only 8.4 % in 2021 and 8.7 % in 2022. These figures objectively characterize the progressive increase in the total number of patients requiring anti-VEGF therapy for nAMD. It should also be noted that this analysis did not include patients with other pathologies requiring anti-VEGF therapy (diabetic macular edema, post-thrombotic retinopathy with macular edema, subretinal neovascular membrane). Conclusion. The obtained facts point to the need of search for more effective methods of treatment, what will probably allow to develop criteria for increasing the interval or stopping this type of therapy. Keywords: anti-VEGF therapy, intravitreal injections, aflibercept, age-related macular degeneration, volume of therapy

Successful management of rubella retinopathy–related subretinal neovascular membrane with intravitreal ranibizumab

A seven-year-old boy with a known case of bilateral rubella retinopathy presented to us as part of his annual follow-up. Best-corrected visual acuity (BCVA) at presentation was 20/80 in the right eye and 20/600 in the left eye. On dilated fundoscopy, the right eye showed the presence of subretinal neovascular membrane (SRNVM), subretinal fluid, and classical salt-and-pepper retinopathy, all of which was documented by imaging. The left eye was poorly dilating and showed a pale disc. The right eye was treated with two doses of intravitreal ranibizumab at an interval of two months. Post-treatment examination showed resolution of SRNVM accompanied by scarring and significant improvement in BCVA.

Оценка отдаленных результатов хирургии субмакулярных кровоизлияний на фоне влажной формы возрастной макулярной дегенерации

Purpose. To evaluate the long-term outcomes of surgery of submacular hemorrhage (SMH) in patients with exudative age-related macular degeneration. Material and methods. A dynamic follow-up of 32 patients with SMH (32 eyes) was carried out, who underwent 25G endovitreal intervention with subretinal injection of 1000 to 3000 IU of the Gemaza drug. The area of the SMH in all cases was extensive with the capture of the fovea. The follow-up period ranged from 24 to 30 months. Results. There was displacement of almost the entire volume of SMH from the macular area to the low periphery in all operated eyes by the next day after the operation. There were complete elimination of SMH and the formation of a normal configuration of the macular profile in 7 days after surgery in all eyes. All patients were satisfied with the results of the surgery according to significant increase of visual acuity and disappearance of a spot in the central visual field. Postoperative complications appeared in four eyes at different times of follow up period, but they were eliminated after reoperation. Conclusion. Subretinal administration of the drug Gemaza and pneumodislocation of the blood clot is an effective method for the treatment of SMH with a limitation period of up to 2 weeks. In the vast majority of cases (88%), it was possible to achieve complete elimination of the SMH and a significant improvement in central vision. Key words: submacular hemorrhage, Gemaza, recombinant prourokinase, age-related macular degeneration, subretinal neovascular membrane

Дифференциальная диагностика клинических форм серпигинозного хориоидита как ключ к выбору тактики лечения

Purpose. To present a case report of serpiginous chorioiditis to perform the differential diagnosis for treatment. Material and methods. The patient, 33 year old, with a decrease of visual acuity. The comprehensive ophthalmologic examinations ware carried out, including the examination of best corrected visual acuity (BCVA), slit lamp indirect ophthalmoscopy, microperimetry, optical coherence tomography (OCT), OCT – angiography, fundus autofluorescence (AF). Results. During the examination the diagnosis was «OU Classical serpiginous chorioiditis with activity on the left eye. Subretinal neovascular membranes type 2 on the left eye». Conclusions. A non-infectious cause of serpiginous choroiditis was diagnosed. It was recommended the glucocorticosteroids' treatment. In this case, the process was complicated by the development of macular neovascularization, which required the administration of the angiogenesis inhibitors. Keywords: serpiginous choroiditis, tuberculosis, choroid, multifocal serpiginoid choroiditis

RARE CASE OF SPONTANEOUS SUB-RETINAL HAEMORRHAGE ASSOCIATED WITH IDOPATHIC INTRACRANIAL HYPERTENSION

Introduction: Idiopathic Intracranial Hypertension (IIH)is defined as increase in intracranial pressure due to unspecified causes leading to headache, papilledema, and transient vision loss. Usually the patients present with mild visual loss but about 25% may develop permanent visual loss due to irreversible optic disc damage. One rare cause of severe visual loss is subretinal hemorrhage (SRH) due to underlying Subretinal Neovascular membrane.
 Case Report: We report a case of a 36-year-old man diagnosed with IIH and papilloedema with sudden onset profound visual loss in his right eye. On examination, there was a large peripapillary SRH superior to the disc and involving the macula.We stress the importance of recognizing this uncommon complication of papilledema and discuss the possible causes for developing SRH, its most common outcome and the diagnostic as well as treatment modalities available.
 Discussion: We stress the importance of recognizing this uncommon complication of papilledema and discuss the possible causes for developing SRH, its most common outcome and the diagnostic as well as current treatment modalities available.
 Conclusion: This report highlights a rare case of spontaneous sub retinal haemorrhage in a patient with IIH. Measurement of optic nerve sheath diameter can be a vital tool for the diagnosis of raised intracranial pressure in this setting.

Spectral domain OCT features in type 2 macular telangiectasia (type 2 MacTel): its relevance with clinical staging and visual acuity

BackgroundTo report spectral domain optical coherence tomography (SDOCT) imaging findings in type 2 macular telangiectasia (MacTel) and correlate them with clinical stages and visual acuity.MethodsThis retrospective, cross-sectional study included type 2 MacTel cases who underwent SDOCT imaging with Spectralis machine. Macular SDOCT images were analysed. Imaging features were tested for correlation with different clinicals stages and visual acuity.Results212 eyes of 108 type 2 MacTel patients were included. Hyperreflective middle retinal layer (87%) was the most frequently detected abnormality. This was followed by inner retinal cavities (49%), outward bending of inner retinal layers (35%), retinal pigment clumps (35%) and foveal contour irregularity (31%). Hyperreflective middle retinal layers (p < 0.001), inner (p = 0.032) and outer retinal (p = 0.002) cavities and internal limiting membrane drape (p = 0.031) were associated with poor vision in non-proliferative group and presence of retinal pigment clumps (p = 0.002), subretinal fluid (p = 0.037) and foveal contour irregularity (p < 0.001) were associated with poor vision in proliferative group.ConclusionThe described SDOCT features are practical for the diagnosis and staging in type 2 MacTel. Presence of hyperreflective middle retinal layers, hyporeflective inner and outer retinal cavities and internal limiting membrane drape were associated with poor vision in the non-proliferative group while retinal pigment clumps and subretinal neovascular membrane were associated with proliferative group and poor vision. Further long-term studies are required to describe the progressive and sequential changes on SDOCT.

Хирургическое лечение обширной субмакулярной геморрагии у пациента с экссудативной формой возрастной макулярной дегенерации (клинический случай)

Purpose. To evaluate the result of surgical treatment of submacular hemorrhage in patient with exudative age-related macular degeneration (AMD) by subretinal injection Gemase® and pneumatic retinopexy of blood clot. Material and methods. The article presents a clinical case of surgical treatment of submacular hemorrhage in patient with exudative AMD. The patient underwent three-port 25G vitrectomy, subretinal injection Gemase® 2000 ME by 38G needle, after which pneumatic retinopexy was performed. Results. Next day after the operation, there was displacement of subretinal blood clot from macula beyond out the lower vascular arcade. When observed after 6 months, the subretinal hemorrhage completely resolved, there was a regression of activity of subretinal neovascular membrane and macular edema, the retina was adherent in all cases. Visual acuity has improved. There was no recurrence of hemorrhage. Conclusion. This method of treatment allows you to increase and maintain the central visual acuity, as well as significantly reduce size of absolute central scotoma. Key words: submacular hemorrhage, recombinant prourokinase, Gemase®, exudative age-related macular degeneration, choroidal neovascularization, subretinal neovascular membrane.

Использование аутологичной кондиционированной плазмы (аср) в хирургии тяжелой патологии заднего отрезка глаза. Трехлетний опыт использования технологии

Purpose. To evaluate the effectiveness and long-term results of the use of autologous conditioned plasma in the surgery of open eye injury, including perforating eye injuries, surgery of the cicatricial stage of the subretinal neovascular membrane, rhematogenous retinal detachment, including retinal detachment with macular hole in people with high myopia with expressed scleral staphyloma, without the use of an additional laser coagulation of the retina and the almost complete exclusion of silicone tamponade. Material and methods. Since 2018, more than 250 patients with various vitreous pathologies of the posterior eye segment have been operated on perforating eye injuries, cicatricial stage of the subretinal neovascular membrane, idiopathic macular rupture, rhegmatogenous retinal detachment, including those with macular holes, including cases with high myopia and expressed scleral staphyloma. The developed technology of surgical closure of defects of the retina, choroid, sclera of various lengths using autologous conditioned plasma, made it possible to completely eliminate the need for laser coagulation of the retina, which in most cases would be difficult and unsafe, and to practically exclude silicone tamponade. A method of seamless sealing of sclero and conjunctivotomies with the variant of air tamponade using autologous conditioned plasma has been developed and successfully applied. Results. In the early postoperative period the patients in all clinical groups had no complications. Complete adhesion of the retina and sealing of defects in the structures of the eye after using autologous conditioned plasma without additional laser coagulation of the retina on the background of the applied air and silicone tamponade was observed in all patients. In the long-term follow-up period up to 28 months, there were isolated recurrences of retinal detachment after surgery of complex open eye injury, rhematogenous retinal detachment on the background of progression of proliferative vitreoretinopathy. More than 89% of patients had no complications in the long-term period. Complete closure of the sclero and conjunctivotomies without the use of additional suture fixation had been achieved. In all cases, the vascular pattern of the conjunctiva was preserved, in no case was a reactive process detected at the site of application of autologous conditioned plasma. Conclusion. The use of autologous conditioned plasma is an effective and safe method of sealing defects of the retina, choroid, sclera of various lengths in complex open eye injury, of surgery of rhematogenous retinal detachment, including high myopia and the presence of a macular hole, of surgery of the cicatricial stage of the subretinal neovascular membrane, allowing to completely eliminate the need for laser coagulation of the retina, minimize the need for silicone tamponade.

Quantitative analysis of optical coherence tomography in age related macular degeneration

Age related macular degeneration (ARMD) is a common degenerative disorder of macula in people above 50 years. The dry and wet/neovascular forms can lead to loss of vision. Optical coherence tomography is a popular tool in the diagnosis of AMRD. Aim of the study is to assess the Optical Coherence Tomography to diagnose the Age Related Macular Degeneration in a tertiary care centre. This prospective hospital based study was conducted on 50 patients presenting with age related macular degeneration clinically (100 eyes). Inclusion criteria was patients newly diagnosed clinically as ARMD and on no treatment. Exclusion criteria was Patients already diagnosed ARMD and on treatment, Patients with other retinal and macular diseases, and previous laser treatment. There were 42(84%) of patients are of 50-70 years age. Males were 21, and females were 29 without significant difference (p=0.7). Out of 100 eyes, 32% diagnosed as wet ARMD and 60% eyes had dry ARMD Dry ARMD is common in females (34%) and wet ARMD common in males (26%). In dry ARMD cases, 77.04% eyes had drusen by OCT, and 72.72% eyes had classic Choroidal neovascular membranes (CNVM). OCT showed sub-foveal CNVM as the common type of classic CNVM. 16 men were smokers, and 36 patients have hypertension. Smoking was significantly associated with ARMD (P &amp;#60; 0.05). Increased prevalence of wet ARMD in males due to smoking, which leads to risk for CNVM. Smoking was significantly associated with ARMD (P &amp;#60; 0.01) in our study. The prevalence was increased with increasing age. Dry ARMD was much more common than Wet ARMD, and both types increased in frequency with increasing age. ARMD is more common in females. OCT is highly specific in detecting the early sub-retinal neo vascular membrane and to assess the activity of neovascular membranes in early wet ARMD.

Real-world outcomes of intravitreal anti-vascular endothelial growth factor monotherapy in proliferative type 2 macular telangiectasia.

To study the effect of anti-VEGFs in proliferative MacTel 2 METHODS: Sixty-four eyes of 51 patients of MacTel 2 with subretinal neovascular membrane (SRNVM) undergoing intravitreal anti-VEGF monotherapy at our institution between January 2015 and December 2018 were evaluated for visual acuity, central macular thickness (CMT) and total macular volume (TMV) using optical coherence tomography (OCT). Repeat investigations were performed at the final follow-up. Location of SRNVM was foveal (F) in 65.6% eyes and extrafoveal (EF) in 34.4% eyes. Both CMT and TMV were lower significantly at baseline in EF-SRNVM. Fifty-six eyes received intravitreal bevacizumab and 8 eyes received ranibizumab. Average 2.14 ± 1.21 injections (range, 1-6) were administered. After a mean follow-up duration of 16.01 ± 12.96months, the final visual acuity (VA) improved in 35.9% eyes, reduced in 28.1% and remained unchanged in 35.9% eyes. Significant improvement of VA was seen in F-SRNVM; however, overall, there was no significant improvement in visual acuity. Significant reduction in CMT was seen in F-SRNVM from 391.73 ± 152.45μm to 293.33 ± 114.77μm (p < 0.05) while EF-SRNVM did not show significant reduction. Total macular volume overall changed significantly from 8.79 ± 1.69 to 8.05 ± 1.27 (p < 0.05) and individually in F- and EF-SRNVM (p < 0.05). Intravitreal bevacizumab and ranibizumab monotherapy both had similar efficacy. Anti-VEGF agents can be successfully used to treat proliferative MacTels. Macular volume measurement on OCT may be a useful parameter for evaluating EF-SRNVM and as a prognostic marker of management outcomes.

Relevance of Multicolor Imaging in Type 2 Macular Telangiectasia.

Purpose:To report the imaging characteristics of various clinical features in idiopathic macular telangiectasia (MacTel 2) on multicolor imaging (MCI) and compare its accuracy vis-à-vis color fundus photograph (CFP) and fluorescein angiography (FA).Methods:In this retrospective observational study, 54 eyes of 27 patients with MacTel 2 were included after institutional review board approval. Multimodal imaging with CFP, optical coherence tomography (OCT), MCI, and FA was done. Images were analyzed to identify and describe the clinical findings in MacTel 2. Sensitivity, specificity, and positive and negative predictive values were computed for the various imaging modalities in MacTel 2.Results:In this study, the MCI identified all the different clinical features of MacTel 2 in 100% of cases. The confocal blue reflectance (BR) image was more sensitive than CFP (100% vs. 96.3%) in identifying the loss of retinal transparency in MacTel 2. For other clinical features such as right-angled vessels, superficial retinal crystals, and retinal pigment epithelial hyperplasia/plaques, the sensitivity of BR, and green reflectance (GR) image, was comparable to that of CFP. Confocal infrared reflectance (IR) images showed poor sensitivity in identifying the non-proliferative features in MacTel 2 (P < 0.001). Loss of retinal transparency was not picked up on IR image. Other features such as right-angled vessels, superficial retinal crystals, and pigment plaques were seen in 20%, 4.6%, and 26.3% of cases, respectively. However, confocal IR images were superior to FA (100% vs. 47%) and CFP (100% vs. 15%) in identifying the extent and location of subretinal neovascular membrane. The confocal BR and GR images were unable to identify the choroidal neovascular membrane (P < 0.001).Conclusion:MCI is a useful and non-invasive imaging modality to identify the clinical features in MacTel 2. MCI can be used as a complementary imaging tool to CFP, FA, and OCT.

Multicolor imaging in macular telangiectasia-a comparison with fundus autofluorescence.

To describe various clinical features of idiopathic juxtafoveal retinal telangiectasis group 2A or idiopathic macular telangiectasia type 2 (MacTel) on multicolor imaging (MCI) and compare imaging findings of MacTel on MCI with fundus autofluorescence (FAF). Patients with a clinical diagnosis of MacTel based on Gass and Blodi's classification were included. FAF and MCI images were graded qualitatively for stage of disease, margins of involvement, hyperautofluorescence on FAF (corresponding retinal atrophy on MCI), and detection of crystals. FAF and MCI were graded quantitatively for the area and number of quadrants involved, hypoautofluorescene on FAF (corresponding intraretinal pigment hyperplasia or retinal pigment epithelium [RPE] atrophy on MCI), and foci of right-angled venules. Seventy-eight eyes of forty five patients were included with both imaging modalities showing no difference with respect tostaging of non-proliferative MacTel. Retinal crystals were recognized on MCI but not on FAF. Neurosensory retinal atrophy and subretinal neovascular membranes were detected using MCI with 92.3 and 83.3% sensitivity, respectively. Intraretinal pigmented hyperplasia was more accurately detected (70.1 vs 58.4%) compared with RPE atrophy on MCI. MCI showed larger area of involvement, higher number of quadrants involved (p < 0.001), and better delineation of margins (p = 0.002) compared with FAF. A higher mean number of vessel dipping foci was noted on MCI in comparison with FAF (3.34 vs 3.1). Various parameters were more easily defined using MCI compared with FAF which qualifies MCI as an enface depth-resolved imaging adjunct to conventional multimodal imaging in MacTel. The ability to detect enface as well as cross-sectional imaging features makes MCI a valuable tool in MacTel.

Optical coherence tomography angiography findings of fellow eye of proliferative macular telangiectasia type 2: Long term study.

To report the characteristics of non-proliferative fellow eyes in patients with unilateral proliferative macular telangiectasia type 2 (MacTel). This was a multicenter, retrospective study and included fellow eyes of eyes with subretinal neovascular membrane (SRNVM). Multimodal imaging including fundus photography, optical coherence tomography (OCT), and OCT angiography (OCTA) was performed. OCT and OCTA measurements included central macular thickness (CMT), subfoveal choroidal thickness (SFCT), foveal avascular zone (FAZ) area and qualitative parameters such as distortion or enlargement of FAZ, increased inter-vascular spacing, dilated, tortuous vessel at margin of FAZ, crowding of vessel, and loss of choriocapillaris (CC). Thirteen fellow eyes of 13 patients with mean age of 63.6 ± 12.0 years were included. Fellow eyes had various stages of the diseases - stage 2 (four eyes), 3 (six eyes), and 4 (three eyes). OCTA showed increased intervascular spacing (8; 61.5%), dilated (11; 84.6%), and elongated vessels (8; 61.5%) at the margin of the FAZ, crowding of vessels (6; 46.2%), capillary non-perfusion areas outside the FAZ (4; 30.8%), and areas of CC loss (4; 30.8%). Mean follow-up was 9.1 ± 12.9 months. Out of six eyes with follow-up of ⩾12 months, two developed SRNVM at 18 and 33 months with OCTA showing crowding and entanglement of dilated retinal vessels in deep capillary plexus at baseline which corresponded to the area affected by SRNVM. Fellow eyes of proliferative MacTel showed established disease stages on OCTA with progressive capillary crowding and entanglement of vessels likely corresponding to the future site of SRNVM.

Bevacizumab in Wet AMD treatment: A tribute to the thirteen years of experience from the beginning of the anti-VEGF era in Romania.

This study aimed to identify and describe anatomical and functional changes on short (1–3 months) and medium (6–12 months) term after intravitreal injections of bevacizumab (Avastin, Genentech) in patients with choroidal neovascularization (CNV) in the context of exudative form of age-related macular degeneration (AMD). We performed a retrospective, analytical, interventional study, based on a series of cases with exudative form of AMD, which also comprised a prospective component related to the inclusion and treatment of the patients with a very new interventional method for that time (2006) and the follow-up of the effects of intravitreal injection of bevacizumab (1.25 mg) therapy in three monthly doses for short (1–3 months) and medium (6–18 months) periods of time. The follow-up of these patients was made by determining visual acuity (VA) as best corrected visual acuity (BCVA) at baseline and at every visit, slit lamp examination with contact or noncontact lenses each time, and optical coherence tomography and/or angiofluorography, applied only for certain patients, at various times of the study. In total, 376 intravitreal injections were administered to 117 eyes of 96 patients. The VA improved in the assessment of 3 months in 77 eyes (66%), either subjective (by the patient) or objectively quantified (by the physician). In 40 eyes (34%), there was no change in VA. In patients for whom optical coherence tomography could be performed, a significant reduction of the macula's thickness was found. The use of bevacizumab in subretinal neovascular membrane treatment is effective and safe on short and medium term, with the improvement of BCVA and reduction of macular edema in a significant number of cases.