Objective To observe the clinical features of polypoidal choroidal vasculopathy (PCV) with retinal pigment epithelium (RPE) tears. Methods Twelve patients of PCV with RPE tears (12 eyes) were enrolled in this study. The patients included eight males and four females, with a mean age of 58.6 years (from 39 to 71 years old). All the patients were affected unilaterally, including eight right eyes and four left eyes. There were one eye with serous RPE detachment and 11 eyes with hemorhagic RPE detachment. All the patients were examined for fundus photography, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA), three patients were examined for optical coherence tomography (OCT). The location of RPE tear was classified as within vascular arcade, on vascular arcade, and outside vascular arcade. The shape of tear was classified as crescent, semilunar, or irregular. The features of fundus, FFA, ICGA and OCT were observed. Results Fundus examination presents a gray lesion in all eyes. The location of tear were within vascular arcade in four eyes (33.3%), on vascular arcade in five eyes (41.7%) and outside vascular arcade in three eyes (25.0%). The shape of tears were crescent (one eye, 8.3%), semilunar (ten eyes, 83.3%) or irregular (one eye, 8.3%). The RPE tear region present transimitted fluorescence of at the early stage of FFA and hyperfluorescence with a clear border at late stage. There was no leakage, and at the border of hyperfluorescence, blockage fluorescence of rolled and contracted RPE was present. In ICGA manifestation, transimitted fluorescence was found in RPE tear region at early stage, and a clear border was seen in nine eyes at late stage. There was also blockage fluorescence in ICGA of contracted RPE. In OCT manifestation, the RPE reflections were disappeared, and at the margin of tear, the contracted RPE present a dense rolled b reflection. Conclusions In PCV patients, RPE tears are semilunar and usually located within or around the vascular arcade. Fundus angiography shows transimitted fluorescence at the RPE tear region, and curl blockage fluorescence at the edges. OCT shows RPE reflection is disappeared in the tear region and a b reflection at the edges.
Objective To observe the effect of intravitreal bevacizumab (IVB) for exudative age-related macular degeneration (eAMD), and analyze the reasons for treatment failure. Methods Eighteen eyes of 17 patients with eAMD who have been diagnosed by fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were enrolled in this openlabel, single treatment group and prospective study. The patients received the first IVB treatment after diagnosis, and received the 2nd, 3rd, 4th, 5th and 6th IVB treatment at 6, 12, 24, 36, 48 weeks after the first injection. The examinations of best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscope, fundus photography, FFA, ICGA and OCT were performed before and after treatment. Non-responders were defined as patients who had BCVA loss more than 5 letters at week 52 compared with BCVA before treatment. The therapeutic effects of IVB for eAMD were observed. The central macular thickness (CMT), maximum retinal thickness (MRT) and morphological changes of FFA, ICGA and OCT before and after treatment were comparative analyzed. Results Of the 18 eyes, 12 eyes (66.67%) were effective to IVB, 6 eyes (33.33%) were non-responders. The average CMT and MRT of non-responders were 506.83, 635.33 mu;m before treatment, which decreased to 446.17, 563.67 mu;m at 52 weeks. They were reduced by 60.67 and 71.67 mu;m respectively, but there was no statistically significant differences (t=-1.572,-0.943; P=0.116, 0.345). FFA and ICGA examination found that the CNV lesions of 3 non-responder eyes located in the foveal region, and became scars after the 6th treatment. The other 3 non-responder eyes developed CNV repeatedly during the treatments, and after the 6th injections of bevacizumab the lesions were under control with less fluorescein leakage and macular retinal edema. ConclusionIVB treatment is effective for some eAMD patients, but is ineffective for patients with extensive expanded CNV and foveal CNV.
Objective To observe the efficacy of photodynamic therapy (PDT) for choroidal neovascularization (CNV) secondary to pathological myopia (PM).Methods Sixty-six patients (73 eyes) with CNV secondary to PM who had undergone PDT were enrolled in this study. PDT was performed according to the standard treatment. The patients received the examinations of best corrected visual acuity (BCVA), ophthalmoscopy, fundus fluorescein angiography (FFA) and/or indocyanine green angiography (ICGA), and optical coherence tomography (OCT) before and after the treatment.Vision results were converted into logMAR records and compared before and after the treatment. The complete records of FFA were found in 52 eyes. FFA findings, treatment effects, were judged as well, moderate or poor according to the CNV leakage or bleeding, and CNV expanding or shrinking. The complete records of OCT were found in 11 eyes. CNV regional edema and foveal thickness were analyzed based on OCT examination.Results The mean logMAR BCVA after PDT treatment was 0.74plusmn;0.51 with no significant difference compared with before treatment (t=1.11, P=0.27). There were 18 eyes (24.7%) with improved vision, 43 eyes (58.9%) with stable vision, and 12 eyes (16.4%) with decreased vision. In 52 eyes with FFA findings, 39 eyes (75.0%) with well effect, 9 eyes (17.1%) with moderate effect, and 4 eyes (7.7%) with poor effect. OCT showed that after treatment the CNV regional edema subsided in most of eyes, and there were 7 (63.64%) with decreased foveal thickness, 2 (18.18%) with stable thickness, and 2 (18.18%) with increased thickness. Conclusions PDT is an effective treatment for CNV secondary to PM. It may improve or stabilize the visual acuity.
ObjectiveTo investigate the clinical outcome and therapeutic efficacy of short-pulse pattern scan laser (PASCAL) photocoagulation for diabetic retinopathy (DR). MethodsForty-three DR patients (70 eyes) including 19 males (32 eyes) and 24 females (38 eyes) underwent short-pulse PASCAL pan-retinal photocoagulation (PRP). There were 24 patients (42 eyes) with proliferative diabetic retinopathy (PDR) and 19 patients (28 eyes) with severe non-proliferative diabetic retinopathy (NPDR). The best corrected visual acuity was better than or equal to 0.1 in 62 eyes, worse than 0.1 in 8 eyes. Diabetic macular edema was found in 18 eyes. Short-pulse PASCAL PRP was applied with multi-spot arrays. Macular edema was treated by PASCAL macular mode (MAC A + MAC B) and/or single spot. Visual acuity and fundus examinations were analyzed at the one-year follow-up procedure. ResultsOne year after short-pulse PASCAL treatment, the final visual acuity was improved in 10 eyes, stable in 53 eyes, decreased in 7 eyes; macular edema was relieved in 38 eyes, aggravated in 12 eyes, and stable in 20 eyes. Of 42 eyes with PDR, neovascularization were regressed in 20 eyes, uncontrolled in 11 eyes which experienced additional photocoagulation (1-2 times) during the follow-up. Among the 11 uncontrolled eyes, 3 eyes (3/11) received vitrectomy due to vitreous hemorrhage. ConclusionPASCAL might stabilize the progress of diabetic retinopathy safely and effectively.