Intravitreal aflibercept for myopic choroidal neovascularization

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Bevacizumab for Macular Serous Neuroretinal Detachment in Tilted Disk Syndrome

Background. Tilted disc syndrome (TDS) is a congenital anomaly characterized by “tilting” of the optic disc tipycally associated with myopic astigmatism, visual field defect, inferior staphyloma, and retinal pigment epithelium atrophy. Associated complications such as macular serous neuroretinal detachment are well described; however, ideal therapy for such complication is unknown. Methods. One interventional case report is hereby described. A patient affected by macular serous neuroretinal detachment-complicated tilted disk syndrome underwent a complete ophthalmic examination. Optical coherence tomography and fluorescein angiography were taken at baseline and at scheduled visits. Two intravitreal treatments of bevacizumab (avastin, 1.25 mg/0.05 mL) were performed at monthly interval. Results. At scheduled visit, one month after the second injection, OCT depicted persistence of neuroretinal detachment. Best-corrected visual acuity remain stable as well as metamorphopsia and functional discomfort. Conclusion. Clinical evidence of this brief interventional case report indicates that one patient affected by recent serous macular detachment-complicated TDS did not benefit from 2 consecutive monthly intravitreal Avastin treatments. Best-corrected visual acuity remained stable over a total observation period of 6 months

Features of the normal choriocapillaris with OCT-angiography: Density estimation and textural properties

The main objective of our work is to perform an in depth analysis of the structural features of normal choriocapillaris imaged with OCT Angiography. Specifically, we provide an optimal radius for a circular Region of Interest (ROI) to obtain a stable estimate of the subfoveal choriocapillaris density and characterize its textural properties using Markov Random Fields. On each binarized image of the choriocapillaris OCT Angiography we performed simulated measurements of the subfoveal choriocapillaris densities with circular Regions of Interest (ROIs) of different radii and with small random displacements from the center of the Foveal Avascular Zone (FAZ). We then calculated the variability of the density measure with different ROI radii. We then characterized the textural features of choriocapillaris binary images by estimating the parameters of an Ising model. For each image we calculated the Optimal Radius (OR) as the minimum ROI radius required to obtain a standard deviation in the simulation below 0.01. The density measured with the individual OR was 0.52 ± 0.07 (mean ± STD). Similar density values (0.51 ± 0.07) were obtained using a fixed ROI radius of 450 μm. The Ising model yielded two parameter estimates (β = 0.34 ± 0.03; γ = 0.003 ± 0.012; mean ± STD), characterizing pixel clustering and white pixel density respectively. Using the estimated parameters to synthetize new random textures via simulation we obtained a good reproduction of the original choriocapillaris structural features and density. In conclusion, we developed an extensive characterization of the normal subfoveal choriocapillaris that might be used for flow analysis and applied to the investigation pathological alterations

Verteporfin photodynamic therapy combined with intravitreal triamcinolone for choroidal neovascularization due to angioid streaks

Alfredo Pece1, Gaetano Russo2, Federico Ricci3, Vincenzo Isola1, Ugo Introini4, Giuseppe Querques51Department of Ophthalmology, Melegnano Hospital, Milan, Italy; 2Fondazione Evangelica Betania, Napoli, Italy; 3University of Tor Vergata, Rome, Italy; 5University, Paris XII, France; 4San Raffaele University Hospital, Milan, ItalyPurpose: To report the visual outcome of photodynamic therapy (PDT) combined with intravitreal triamcinolone acetonide (IVTA) for choroidal neovascularization (CNV) secondary to angioid streaks (AS).Methods: Five eyes of five consecutive patients (mean age 45 ± 10 years) with CNV secondary to AS were treated by combination of PDT and IVTA. TA (4 mg/0.1 mL) was injected 7 days before PDT.Results: All patients completed the 12-month follow-up. CNV was subfoveal in three cases and extrafoveal in two. Median best-corrected visual acuity (BCVA) was 0.3 LogMAR (70 letters) at baseline (range 1.3–0.1), and 0.5 LogMAR (60 letters) at the final examination (range 1.0–0.1). At 12 months, one patient had severe visual deterioration, with a loss of seven lines of VA; Two patients lost up to three lines. One patient had no change in BCVA and the fifth gained nine lines of VA. Two patients received one further combination of PDT and IVTA after the first combination treatment. All eyes showed the CNV closure at the 12-month follow-up visit.Conclusions: Combination of PDT and IVTA may reduce the need for retreatment and could be potentially useful for preserving vision in some patients with CNV due to AS. Keywords: ocular corticosteroid

Efficacy and safety of anti-VEGF therapy with intravitreal ranibizumab (LUCENTIS™) for naïve retinal vein occlusion: one-year follow-up

International audiencePurpose: To evaluate the efficacy and safety of intravitreal ranibizumab in patients with retinal vein occlusion (RVO). Methods: Seventeen eyes of 17 consecutive patients received, on demand, intravitreal 0.5 mg of ranibizumab and were followed for a minimum of 12 months. Results: Nine patients with Central RVO had mean pre-treatment BCVA of 20/240 (1.08 ± 0.25 logMAR) and final BCVA of 20/46 (0.36 ± 0.16 logMAR), with significant improvement at one year of follow-up (p <0.0001). At 12 months mean BCVA improved 36.7 letters, with a gain of 6.4 lines, and OCT showed a mean reduction of 360 µm (p <0.0001) from baseline (mean 631 µm). Eight patients with Branch RVO had mean pre-treatment BCVA of 20/126 (0.80 ± 0.29 logMAR) and final BCVA of 20/50 (0.41 ± 0.23 logMAR) (p <0.0001). The mean OCT CMT had a mean reduction of 275 µm (p <0.0001) from baseline (mean 553 µm). No ocular or systemic side effects were observed. Eyes with CRVO received an average of 3 injections and those with BRVO 3.6. Conclusions: Intravitreal ranibizumab for the management of RVO can favorably modify the course of the occlusion, reducing CMT, and significantly improving visual function, with a good safety profile

Macular hemorrhage after laser exposure and cannabinoid intake during a disco party

Purpose: To describe two cases of macular hemorrhage in young patients, both occurred after laser exposure and cannabinoid intake during a disco party. Observations: Case 1: a 21-year-old man was evaluated at our Emergency Unit for sudden vision loss in the right eye (RE). Best-corrected visual acuity (BCVA) was count fingers in the RE and 20/20 in the left eye (LE). Fundus examination revealed a broad pre-retinal hemorrhage in macular region of RE, confirmed by optical coherence tomography. The patient reported vision loss, suddenly occurred after fixation of a laser source and cannabinoid intake during a disco party the night before. We administered a macular supplement and closely followed up the patient. After two months BCVA of the right eye was 20/20. Case 2: The following day another 21-year-old man was referred to our Emergency Unit complaining of sudden vision loss in LE. As in Case 1, he reported to have fixed a laser beam as well as the consumption of cannabinoids at the same disco. BCVA was count fingers in the LE and 20/20 in the RE. Fundus examination showed a broad pre-retinal hemorrhage in macular region of LE. He had taken the macular supplement for two months and then the hemorrhage was reabsorbed. Conclusion and importance: Laser exposure must be considered as a possible cause of macular hemorrhage. Furthermore, low cost of drugs and lack of formal control of laser sources may increase the emergence of new cases of retinal injuries especially among young people

Preferential Hyperacuity Perimeter in assessing responsiveness to ranibizumab therapy for exudative age-related macular degeneration

International audienceBackground: To investigate the ability of Preferential Hyperacuity Perimeter in assessing responsiveness to ranibizumab therapy for exudative age-related macular degeneration (AMD). Methods: Fourteen consecutive patients with newly diagnosed choroidal neovasularization underwent Preferential Hyperacuity Perimeter metamorphopsia test (main outcome measures), 1 hour before (baseline) and 1 hour, 1 day, 1 week and 1 month after one intravitreal injection of ranibizumab (0.05 ml/0.5mg). Best-corrected visual acuity (BCVA), and several spectral domain optical coherence tomography (OCT) parameters (secondary outcome measures) were compared to metamorphopsia test. Results: Fourteen eyes (14 patients, 78% women, mean age 83±6.2 years) were included in the analysis. Mean Preferential Hyperacuity Perimeter metamorphopsia test score significantly improved from 20.4 ±35 to 9.2 ±23, after the single ranibizumab injection (p<0.05). Mean reduction in central macular thickness, maximal retinal thickness at the fovea, maximal height of subretinal fluid, maximal diameter of the largest retinal cyst and maximal height of pigment epithelial detachment, as evaluated by spectral domain OCT, well reflected the functional improvements as evaluated by Preferential Hyperacuity Perimeter, showing a significant correlation with metamorphopsia changes (0.9 Spearman correlation, p<0.05). Mean BCVA also significantly improved from 20/80 to 20/60 (p<0.05). A significant correlation was also found between the mean BCVA changes and the mean metamorphopsia changes (0.97 Spearman correlation, p<0.05). The correlation coefficient between OCT measurements and PHP score within subjects was 0.51 (p<0.05) Conclusion: The improvement in metamorphopsia test score after intravitreal ranibizumab injection, which well correlates with improvement in several OCT parameters, suggests that Preferential Hyperacuity Perimeter may be used to monitor response to anti-VEGF treatment in patients with exudative AMD