Journal of VitreoRetinal Diseases

To evaluate the role of intravitreal aflibercept (IVA) for treating persistent central serous chorioretinopathy (CSCR) of more than 6 weeks.

AFlibercept Efficacy in Cscr Treatment (NCT01971190) was a 6-month, phase 2, multicenter, prospective, randomized, controlled clinical trial at 6 clinical sites in Korea. Forty-three patients were randomized into group 1 (29) with 3 monthly IVA administrations or group 2 (14) with sham treatment and followed for 6 months with pro re nata (PRN) IVA. Patients could be retreated with IVA when they met the eligibility criteria for this. The primary end point was a mean change in central subfield thickness (CST) from baseline. Best-corrected visual acuity (BCVA) and CST were checked monthly. Data from a subgroup with long-term follow-up in a real-life practice were also compared.

After 3 months of treatment, group 1 had a greater change in mean CST (173.97 vs 80.15 µm; P = .001) and BCVA improvement (10.38 vs 8.62 Early Treatment of Diabetic Retinopathy Study letters; P = .52) than group 2. Among patients whose disease had lasted ≥3 months, BCVA improvement was significantly better in group 1 than in group 2 after 3 months (12.0 vs −2.7 letters; P = .007), and the percentage of eyes requiring PRN IVA was lower in group 1 (50% vs 100%). These differences were attenuated at 6 months but maintained during additional 6-month follow-up.

Intravitreal aflibercept may facilitate the anatomical improvement in persistent CSCR and may improve the visual outcomes in relatively chronic cases. The IVA injection may be a therapeutic option for CSCR.

To determine whether the presenting clinical features of active myopic choroidal neovascularization (CNV), including the presence of fibrosis or atrophy, limit the ultimate visual acuity gains from intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy.

A retrospective analysis of 42 eyes with new-onset subfoveal CNV was performed. Only patients without concurrent age-related macular degeneration and with a spherical equivalent of at least −6.0 diopters were included in the study. All eyes received either intravitreal ranibizumab or bevacizumab injections as the primary treatment on a pro re nata basis for 1 year. Changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were recorded.

The mean number of ranibizumab (18 eyes) or bevacizumab (24 eyes) injections was 4.7 ± 0.5 over a mean follow-up time of 12 ± 0.4 months. The mean age of the patients was 62 ± 2.0 years. Based on optical coherence tomography staging at the initiation of treatment for active CNV, 30 had no fibrosis or atrophy (group 1), 5 had fibrotic stage, and 7 had atrophic stage CNV (the latter combined to form group 2). The BCVA for group 1 improved significantly (P < .02) but worsened for group 2 (P < .38), a statistically significant difference (P < .05). The CRT for group 1 also declined significantly more than for group 2 (P < .014).

The presence of fibrosis or atrophy in eyes with active myopic CNV at the initiation of anti-VEGF therapy was associated with limited anatomic outcomes and visual gain.

To report indications and outcomes of combined pars plana vitrectomy and penetrating keratoplasty (PPV-PKP).

A review of all patients who underwent PPV-PKP at the Illinois Eye and Ear Infirmary from January 1, 2001 to May 31, 2013, was performed. Ninety eyes of 90 patients were identified. Survival analysis was utilized to assess differences in retinal detachment (RD) and corneal graft failure rates among groups based on clinical and surgical variables.

Seventy-nine eyes met the inclusion criteria. Most common indications for vitrectomy and corneal transplantation were RD (65%) and corneal decompensation (43%), respectively. The preoperative and final visual acuity (VA) logarithm of the minimum angle of resolution values were 2.7 (0.31) and 2.5 (0.67) (hand motions; mean [SD]; P = .02); 15% of eyes were ≥20/400 and 15% gained ≥2 lines of vision following surgery. Corneal graft failure occurred in 51% (40 eyes), recurrent RD in 28% (22 eyes), and hypotony in 25% (20 eyes). Silicone oil endotamponade was associated with postoperative RD (P = .045), and previous ocular trauma was associated with postoperative corneal graft failure (P = .023).

Combined PPV-PKP surgery was likely to achieve stabilization of VA, with a minority of eyes achieving modest gains in VA.

To analyze the anatomical and functional outcomes in patients with choroidal neovascularization (CNV) secondary to pathological myopia (PM).

Retrospective review of the medical records of 40 patients with CNV secondary to PM treated exclusively with intravitreal ranibizumab 0.5 mg and at least 24 months of follow-up. The initial dose comprised 1 or 3 monthly injections followed by a pro re nata regimen. Best-corrected visual acuity (BCVA), central retinal thickness (CRT) measured with spectral domain optical coherence tomography (OCT), and ocular and systemic adverse event were recorded.

Mean patient age was 62.5 ± 12.5 years. The mean spherical equivalent refractive error was −12.3 ± 6.9 diopters, and a single intravitreal injection was initially performed in 72.5% of cases. Mean baseline BCVA was 0.33 ± 0.20 logMAR (Snellen equivalent, 20/60), and mean CRT by OCT was 340.65 ± 80 µm. Both BCVA and OCT revealed significant improvement compared to baseline at all established cutoff points (P < .001). Final BCVA was 0.50 ± 0.3 logMAR (Snellen, 20/40), and final CRT was 255.69 ± 47.7 µm (P < .001). The mean number of ranibizumab injections was 2.75 ± 1.97. No cases of endophthalmitis or retinal detachments were reported, and no serious adverse systemic events were identified.

Excellent anatomical and functional outcomes were obtained after treatment with intravitreal ranibizumab for CNV secondary to PM.

Postoperative (PO) day 1 visits can be challenging for certain patients (eg, satellite office patients). This study analyzes the proportion of eyes requiring changes in management on the first PO visit day ≥3 following vitreoretinal surgery.

A retrospective, consecutive case series of 1 vitreoretinal surgeon was conducted on 246 surgeries of 231 patients with the first PO examination day ≥3 from January 1, 2008 to December 31, 2013. Clinical parameters were statistically analyzed to identify eyes with pressure issues or early interventions. Short- and long-term outcomes were assessed at PO weeks 1 to 4 and months 3 to 8.

At the first PO visit ≥3 (mean 4.5) days, 3.3% eyes had intraocular pressure (IOP) ≤5, 3.3% IOP ≥30, 0.8% choroidal detachments, 0.4% vitreous hemorrhage, and 0% endophthalmitis. About 2.0% of eyes required intervention (IOP medications). Surgical indications, procedure, and tamponade were not predictive of pressure issues or early intervention (P > .05). At weeks 1 to 4 and month 3 to 8, 4% to 6% of eyes required additional intervention or surgery.

The first PO visit day ≥3 after vitreoretinal surgeries had low intervention rates. Few complications or additional surgeries occurred throughout the study period.

To describe circumscribed choroidal hemangioma (CCH) management in the era of intravitreal anti-vascular endothelial growth factor.

Retrospective chart review of 11 patients (4 men and 7 women; mean age: 47 years) who were treated at University of Wisconsin for CCH between January 1, 2009 and June 1, 2015, using photodynamic therapy (PDT), intravitreal bevacizumab, or a combination of both PDT and bevacizumab. We define change in visual acuity with each treatment as change in Snellen visual acuity from the day of treatment compared to the follow-up appointment closest to the 3-month posttreatment time point. We report visual acuity score (VAS) by converting Snellen visual acuity using the formula, VAS = 100 − 50 × logarithm of the minimum angle of resolution.

We treated 7 eyes with PDT only, 1 eye with bevacizumab only, and 4 eyes with combined PDT and bevacizumab. In the PDT-only group, visual acuity improved in 4 eyes, stabilized in 2 eyes, and worsened in 1 eye (average +7.8 letters by VAS). In the 1 eye treated with bevacizumab alone, visual acuity improved by 2.6 letters by VAS. In the combined group, visual acuity improved in 3 eyes and stabilized in 1 eye (average +6.2 letters by VAS).

Our study supports the effectiveness and safety of PDT as a primary treatment modality. In addition, our study suggests the independent efficacy of bevacizumab monotherapy in select patients, the synergistic response to bevacizumab with repeated PDT, and potentially reduction of PDT treatments by adding bevacizumab to the treatment protocol.