Photodynamic therapy of choroidal neovascularization with enlargement of the spot size to include the feeding complex

This is a case report of a 83-year-old man with choroidal neovascularization (CNV), due to age-related macular degeneration (AMD) in his right eye. Digital fluorescein (FA) and indocyanine green angiography (ICG) were performed, which disclosed predominantly classic subfoveal CNV and a dilated and tortuous feeding complex. The visual acuity was 20/800. Anti-vascular endothelial growth factor (anti-VEGF) treatment was suggested, however, the patient was not keen to receive an intraocular injection. Modified photodynamic therapy (PDT) with spot size enlarged, to include not only the CNV lesion but the feeding complex as well, was performed. Ten days after one session of PDT, ICG showed absence of leakage from the CNV and complete occlusion of the feeding complex. The visual acuity gradually improved to 20/100 and remained stable during the following 23 months. No evidence of CNV leakage was seen in the FA and ICG during the follow up period. Adjustment of the PDT spot size to include the detectable by ICG feeding complex might be an additional option in order to close the subfoveal CNV and might be considered as an alternative to intravitreal injection of anti-VEGF in selected cases where anti-VEGF treatment is not available

Skin rash associated with intravitreal bevacizumab in a patient with macular choroidal neovascularization

Ioannis D Ladas, Marilita M Moschos, Thanos D Papakostas, Athanasios I Kotsolis, Ilias Georgalas, Michail ApostolopoulosDepartment of Ophthalmology, “G. Gennimatas” Hospital of Athens, University of Athens, Athens, GreecePurpose: The purpose of this observational case report is to describe a case of skin rash after intravitreal use of bevacizumab.Methods: A 50-year-old man with choroidal neovascularization in the right eye due to age-related macular degeneration was treated with three intravitreal injections of bevacizumab.Results: Twelve days after the first injection, the patient developed a maculopapular rash on his forehead and on both temporal regions around his eyes. The rash disappeared eight days after treatment with topical corticosteroids. A skin rash with the same distribution reappeared 14 days after the second and 10 days after the third injection. Similarly, it disappeared five and seven days after the use of the same treatment. The follow-up period was 15 months after the third injection. During the follow-up period the rash did not reappear.Conclusion: This case report may initiate further investigation of similar cases to support this observation, as there are a lack of reports of skin rash after intravitreal administration of bevacizumab.Keywords: skin rash, bevacizumab, age-related macular degeneratio

Fluorescein angiography and optical coherence tomography concordance for choroidal neovascularisation in multifocal choroidtis

Purpose To compare the utility of fluorescein angiography (FA) and optical coherence tomography (OCT) as diagnostic adjuncts in evaluating symptomatic patients with choroidal neovascularisation (CNV) due to multifocal choroiditis (MFC). Methods Patients with CNV due to MFC were retrospectively evaluated in a consecutive fashion. Fundus photography, FA, OCT and biomicroscopy were used to establish the diagnosis. Primary outcome measures included CNV classification (type 1 or occult and type 2 or classic) location and the associated FA and OCT findings. Results Twenty eyes from 17 patients were included in the study. In 19 eyes (95%) the FA revealed CNV type 2; in one eye (5%) the type of CNV was indeterminate due to a subretinal haemorrhage that covered the lesion. Thirteen eyes had OCT imaging and all revealed hyper-reflectance beneath the neurosensory retina. However, only 53.8% revealed subretinal fluid (SRF) or intraretinal cystic abnormalities. Conclusions The CNV in MFC is virtually always type 2, or so-called classic CNV, with vessels beneath the neurosensory retina. Except when blocked by subretinal blood, the neovascularisation is clearly demonstrated by FA. In contrast, only 53.8% of these eyes showed clear evidence of actively proliferating neovascularisation on OCT. Therefore, eyes suspected of having CNV in MFC should be evaluated with FA

RANIBIZUMAB FOR THE TREATMENT OF EXUDATIVE AGE-RELATED MACULAR DEGENERATION ASSOCIATED WITH RETINAL PIGMENT EPITHELIAL TEAR

Purpose: To evaluate the efficacy of intravitreal ranibizumab in eyes with exudative age-related macular degeneration associated with retinal pigment epithelial tear. Methods: In this retrospective case series, patients with active exudative age-related macular degeneration associated with retinal pigment epithelial tear were treated by repeated injections of intravitreal ranibizumab. The outcome measures were best-corrected visual acuity and the signs of lesion activity, as evaluated by optical coherence tomography, fluorescein angiography, and indocyanine green angiography. Results: Twenty-one eyes of 20 patients were followed-up for a median of 12 months (range, 6-28 months). The median number of injections was 7 (range, 3-15). The best-corrected visual acuity improved in 6 eyes (28.57%), remained stable in 12 (57.14%), and decreased in 3 (14.28%). At the end of the follow-up time, 19 eyes (90.47%) had an inactive neovascular lesion in angiography, while 18 eyes (85.71%) had no signs of intraretinal or subretinal fluid. Conclusion: Intravitreal ranibizumab was effective in improving or stabilizing vision and resulting in a quiescent lesion in the majority of patients with exudative age-related macular degeneration associated with retinal pigment epithelial tear. The functional results were apparently better in eyes without foveal involvement by the retinal pigment epithelial tear. RETINA 31:1083-1088, 201

Efficacy of photodynamic therapy in the management of occult choroidal Neovascularization associated with serous pigment epithelium detachment

Aims: To evaluate the efficacy of photodynamic therapy (PDT) in the treatment of subfoveal occult choroidal neovascularization (CNV) associated with serous pigment epithelium detachment (PED) in eyes with age-related macular degeneration. Methods: Hundred and fifty-three patients ( 161 eyes) with subfoveal occult CNV due to age-related macular degeneration, were divided into two groups. The first group (70 patients, 75 eyes) included eyes with occult CNV associated with serous PED of at least 1 disc diameter in size and the second (83 patients, 86 eyes) eyes with late leakage of undetermined source. All the patients were treated with PDT. The follow-up time ranged from 12 to 48 months. Results: At the last examination, in the first group, the visual acuity (VA) improved or remained stable in 17 (22.7%) and decreased in 58 (77.3%). In the second group, the VA improved or remained stable in 37 (43%) and decreased in 49 (57%). The difference in the change (decrease) in the VA between the two groups was statistically very significant (p = 0.0075). Retinal pigment epithelium tear occurred in 15 eyes (20%) of the first group. Conclusion: Our study showed that the visual prognosis of eyes treated with PDT due to subfoveal occult CNV associated with serous PED is not favorable. We believe that the distinction between the two forms of occult CNV is essential, as they carry a different prognosis. Copyright (c) 2007 S. Karger AG, Basel

SAFETY OF REPEAT INTRAVITREAL INJECTIONS OF BEVACIZUMAB VERSUS RANIBIZUMAB Our Experience After 2,000 Injections

Purpose: To compare the safety of repeat intravitreal injections of bevacizumab versus ranibizumab performed on a large series of patients during the past 2 years period of time. Methods: Four hundred fifty patients receiving 2,000 injections (1,275 bevacizumab and 725 ranibizumab) were studied retrospectively. Injections performed in a usual examination room under the standard sterile conditions. Follow-up varied from 3 to 24 months. Results: Serious ocular adverse events were uncommon. Only one patient developed retinal detachment (0.05%). Most common procedure-related ocular adverse event was injection-site redness (64.75%). Postoperative subconjuctival hemorrhage occurred after 200 (10%) injections. Patients receiving aspirin treatment were more prone to have subconjuctival hemorrhage (P = 0.0002). Most common drug-related ocular adverse event was uveitis (1.90%), which was treated successfully and lasted no > 12 days. There was no statistically significant difference between the patients treated with bevacizumab or ranibizumab regarding the noted adverse events (P > 0.5%). Conclusion: Multiple intravitreal injections of bevacizumab or ranibizumab were both well tolerated and safe. Performing injections on a usual examination room proved safe. Injection-site redness, subconjuctival hemorrhage, and uveitis were the most common ocular adverse events. Aspirin treatment was a risk factor for the development of subconjuctival hemorrhage

Intravitreal bevacizumab combined with photodynamic therapy for the treatment of occult choroidal neovascularization associated with serous pigment epithelium detachment in age-related macular degeneration

Purpose: To evaluate the efficacy of intravitreal injection of bevacizurnab combined with photodynamic therapy (PDT) for the treatment of occult choroidal neovascularization (CNV) associated with serous pigment epithelium detachment (s-PED) due to age-related macular degeneration (AMD). Methods: In this retrospective study, six patients (six eyes) with subfoveal occult CNV associated with s-PED due to AMD were treated with intravitreal bevacizurnab combined with PDT. All patients were treated at baseline with PDT followed by intravitreal bevacizumab 1.25 mg 1 hour later. Afterwards, according to the findings of optical coherence tomography and fluorescein angiography, repeat bevacizurnab injections were given, if necessary, monthly for three doses followed by further doses every 3 months. PDT was repeated every 3 months according to the same criteria. Follow-up time was 9 months. Results: All patients completed their treatment during the first 3 months from baseline. Best-corrected visual acuity (BCVA) improved or remained stable related to the baseline values in all patients at the end of the follow-up time. Mean BCVA improved from 20/67 to 20/42. S-PED and subretinal fluid decreased or disappeared. The mean central 1-mm retinal thickness was reduced from baseline value for the 9-month follow-up period by 128 mu m. Conclusion: Intravitreal bevacizumab combined with PDT seems to be a promising treatment with good functional and anatomical results for occult CNV associated with s-PED due to AMD