Polypoidal choroidal vasculopathy (PCV): the 4-year review of the real-life treatment experiences

Mansing Ratanasukon, Patama Bhurayanontachai, Pichai Jirarattanasopa Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla Province 90110, ThailandPurpose: The purpose of this article was to study the real-life treatment results of polypoidal choroidal vasculopathy (PCV).Design: This was a retrospective study.Methods: Patients with presumed age-related macular degeneration were reviewed, and PCV diagnosis was made using the EVEREST study criteria. Outcomes were changes in visual acuity (VA) and central retinal thickness, time between treatments, follow-up time, and number of treatments.Results: The prevalence of PCV was 30.8%. At the beginning, 195 eyes received monotherapy of anti-vascular endothelial growth factor (anti-VEGF) injections, either bevacizumab or ranibizumab, and only six eyes received the combination of anti-VEGF injection and photodynamic therapy (PDT) at the time of the first treatment. During the follow-up, some patients received “rescue or add-on” PDT when they had a poor response after anti-VEGF injections. After 4 years, the average number of injections was 8.25 and 9.15 for the anti-VEGF monotherapy and the combination groups, respectively. The average time between the first anti-VEGF injections and the first PDT was 21.4 months. The average VA in the anti-VEGF monotherapy group increased by 1.5 letters, whereas it decreased by 0.95 letters in the combination group (P=0.48).Conclusion: The review demonstrated the same visual outcomes between the combination therapy of anti-VEGF injections and rescue or add-on PDT vs monotherapy anti-VEGF injections in PCV treatment. When compared with EVEREST II and Planet studies, the “initial” or “rescue or add-on PDT” might have different effects on the final visual outcomes.Keywords: polypoidal choroidal vasculopathy, anti-vascular endothelial growth factor, photodynamic therap

High-dose antioxidants for central serous chorioretinopathy; The randomized placebo-controlled study

<p>Abstract</p> <p>Background</p> <p>To determine the efficacy of high-dose antioxidants in the acute stage of central serous chorioretinopathy (CSC).</p> <p>Methods</p> <p>This was a randomized placebo-controlled study. The patients with acute CSC (onset within 6 weeks) were randomized to receive either high-dose antioxidant tablets (study group A) or placebo tablets (control group B) for 3 months or until the complete resolution of subretinal fluid. After 3 months, additional treatment with laser or photodynamic therapy (PDT) was considered if any fluorescein leakage persisted. The outcomes measured were the changes in visual acuity (VA) and central macular thickness (CMT), the number of patients with subretinal fluid at each follow-up time, the number of patients with fluorescein leakage at the end of the 3^rd month and patients who received additional treatments.</p> <p>Results</p> <p>Fifty-one of 58 patients (88%) completed the follow-up criteria. The baseline demographic data were comparable in both groups. At the end of the 3^rd month, the VA and CMT showed no statistical difference between the groups but the patients in group A has less fluorescein leakage and additional treatments than in group B (p = 0.027 and 0.03).</p> <p>Conclusion</p> <p>The high-dose antioxidants for acute CSC did not show any benefits in VA and CMT. However, the drugs might decrease the chance for fluorescein leakage and additional treatments at the end of the 3^rd month.</p

Response of central serous chorioretinopathy evaluated by multimodal retinal imaging

PurposeTo identify predictive biomarkers of treatment outcomes by multimodal retinal imaging in patients affected by central serous chorioretinopathy (CSC).Patients and methodsIn this interventional non-randomized clinical study, 27 treatment-naive CSC patients were prospectively enrolled and treated with oral eplerenone for 5-13 weeks. Primary outcomes included presence of pathological findings on indocyaine green angiography (ICGA), structural optical coherence tomography (OCT) and OCT-angiography (OCT-A) at baseline associated with different response to the treatment.ResultsA total of 29 eyes of 27 patients (2 females, 25 males) met the inclusion criteria and were included in the study (mean age was 45\ub17 years). Mean CSC duration at baseline was 13.5\ub14.4 weeks. After a mean of 10.5 weeks of treatment, mean central macular thickness significantly reduced (P<0.001), and mean best-corrected visual acuity improved (P<0.001). Seventeen eyes (61%) demonstrated total reabsorption of subretinal fluid on structural OCT, five eyes (18%) presented a partial response to eplerenone therapy and six eyes (21%) showed no response. The complete response to the treatment was associated with absence of CNV at OCT-A and the presence of hotspot at ICGA (P<0.001 and P=0.002, respectively). None of eight eyes with CNV in OCT-A imaging had a complete response to eplerenone and none of three eyes without hotspot at ICGA showed a complete response to the treatment.ConclusionsMultimodal retinal imaging allowed us to propose predictive biomarkers (ie, absence of CNV on OCT-A and presence of hotspot on ICGA) for treatment outcomes.Eye advance online publication, 5 January 2018; doi:10.1038/eye.2017.295

Diagnosed a Patient with Central Serous Chorioretinopathy? Now What?: Management of Central Serous Chorioretinopathy

The goal of this paper is to provide a comprehensive review of the management options for central serous chorioretinopathy (CSCR). The majority of cases of acute CSCR may be managed with observation and cessation of corticosteroids, if possible, as well as life-style modifications including stress reduction and control of hypertension. The management of chronic disease is more challenging and may include either medication or laser-based treatment. Management of CSCR necessitates an individualized and selective treatment approach. There is overall poor evidence for the use of systemic and intravitreal medications. From this class of treatments, mineralocorticoid receptor antagonists appear to have the greatest potential. Although conventional thermal photocoagulation may be used in select cases, the most promising treatment options at this time for chronic CSCR are photodynamic therapy, either half-dose or half-fluence, and non-damaging (subthreshold) retinal laser therapy