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Hosokawa MM, Ouchi C, Shiode Y, Kimura S, Matoba R, Morita T, Morizane Y. Influence of submacular hemorrhage at baseline on the long-term outcomes of aflibercept treatment for typical neovascular age-related macular degeneration and polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06453-6. [PMID: 38625447 DOI: 10.1007/s00417-024-06453-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/03/2024] [Accepted: 03/08/2024] [Indexed: 04/17/2024] Open
Abstract
PURPOSE To investigate the influence of submacular hemorrhage (SMH) at baseline on long-term visual outcomes of patients with typical age-related macular degeneration (tAMD) and polypoidal choroidal vasculopathy (PCV) treated with intravitreal aflibercept (IVA). METHODS In this retrospective study, eyes of treatment-naïve patients with tAMD and PCV who initiated IVA under a treat-and-extend regimen and were followed up for ≥ 5 years were classified into the tAMD-SMH ( +), tAMD-SMH (-), PCV-SMH ( +), and PCV-SMH (-) groups based on the presence of SMH at baseline. Best-corrected visual acuity (BCVA) changes and macular fibrosis and atrophy incidences were assessed. RESULTS This study included 127 eyes (127 patients), including 51 with tAMD and 76 with PCV; 18 eyes had SMH at baseline. In the tAMD-SMH ( +) group (n = 6), the mean logMAR BCVA significantly deteriorated from 0.59 ± 0.45 at baseline to 0.88 ± 0.47 at the final visit (P = 0.024). No significant BCVA changes were observed in the tAMD-SMH (-) (n = 45), PCV-SMH ( +) (n = 12), or PCV-SMH (-) (n = 64) groups (all P > 0.05). The tAMD-SMH ( +) group showed a significantly higher incidence of macular fibrosis at the final visit than did the tAMD-SMH (-) group (P = 0.042). There was no influence of baseline SMH on the macular fibrosis incidence in eyes with PCV and the macular atrophy incidence in eyes with tAMD and PCV. CONCLUSION The presence of SMH at baseline resulted in poorer long-term visual acuity in eyes with tAMD, even with aflibercept treatment. However, no such influence was observed in eyes with PCV.
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Affiliation(s)
- Mio Morizane Hosokawa
- Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho Kita-ku, Okayama City, 700-8558, Japan.
| | - Chihiro Ouchi
- Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho Kita-ku, Okayama City, 700-8558, Japan
| | - Yusuke Shiode
- Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho Kita-ku, Okayama City, 700-8558, Japan
| | - Shuhei Kimura
- Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho Kita-ku, Okayama City, 700-8558, Japan
| | - Ryo Matoba
- Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho Kita-ku, Okayama City, 700-8558, Japan
| | - Tetsuro Morita
- Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho Kita-ku, Okayama City, 700-8558, Japan
| | - Yuki Morizane
- Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho Kita-ku, Okayama City, 700-8558, Japan
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Kuranami A, Maruko R, Maruko I, Hasegawa T, Iida T. Pachychoroid neovasculopathy has clinical properties that differ from conventional neovascular age-related macular degeneration. Sci Rep 2023; 13:7379. [PMID: 37149627 PMCID: PMC10164122 DOI: 10.1038/s41598-023-33936-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 04/21/2023] [Indexed: 05/08/2023] Open
Abstract
To determine the clinical properties of pachychoroid neovasculopathy (PNV) that differ from conventional neovascular age-related macular degeneration (nAMD) and suggest that they are different clinical entities. To accomplish this, we reviewed the medical records of 100 consecutive patients diagnosed with nAMD. All of the patients were Japanese, and their mean age was 75.5 years. There were 72 men and 28 women. For the bilateral cases, only the right eye was analyzed. An eye was diagnosed with PNV when a macular neovascularization (MNV) was detected just above the dilated choroidal vessels. The Indocyanine green angiographic (ICGA) and en face optical coherence tomographic (OCT) images were used to assess the vertical symmetry of the medium and large choroidal vessels. The subfoveal choroidal thickness (SCT) was also measured manually in the OCT images. After reclassification, there were 29 (29%) patients with typical nAMD (25 with type 1 MNV, 4 with type 2 MNV), 43 (43%) with PNV, 21 (21%) with polypoidal choroidal vasculopathy, and 7 (7%) with retinal angiomatous proliferation. Of the 43 PNV, 17 (39.5%) had polypoidal lesions and 26 (60.5%) had no polypoidal lesions. The percentage of eyes with vertical asymmetry of the medium and large choroidal vessels was significantly greater in the 35 PNV (81.4%) than in the 16 non-PNV (28.1%; P < 0.01) cases. The mean SCT was significantly thicker in the PNV eyes than in the non-PNV eyes (298 ± 96 μm vs. 228 ± 82 μm; P < 0.01). The response of PNV to anti-vascular endothelial growth factor treatments was better than that of non-PNV eyes [higher dry macula rate after the loading period (90.9% vs. 59.1%), fewer total number of injections (11.0 ± 2.9 vs. 13.4 ± 3.2), and longer treatment intervals for the anti-VEGF therapy (8.4 ± 3.1 vs. 13.4 ± 3.2 weeks) at 2 years (all P < 0.01)]. These differences in the morphology and response to anti-VEGF treatments suggest that PNV is a separate clinical entity to conventional nAMD.
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Affiliation(s)
- Ai Kuranami
- Department of Ophthalmology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Ruka Maruko
- Department of Ophthalmology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Ichiro Maruko
- Department of Ophthalmology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-Ku, Tokyo, 162-8666, Japan.
| | - Taiji Hasegawa
- Department of Ophthalmology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-Ku, Tokyo, 162-8666, Japan
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Sawada T, Yasukawa T, Imaizumi H, Matsubara H, Kimura K, Terasaki H, Ishikawa H, Murakami T, Takeuchi M, Mitamura Y, Mizusawa Y, Takamura Y, Murata T, Kogo J, Ohji M. Subtype prevalence and baseline visual acuity by age in Japanese patients with neovascular age-related macular degeneration. Jpn J Ophthalmol 2023; 67:149-155. [PMID: 36879074 DOI: 10.1007/s10384-023-00981-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 12/21/2022] [Indexed: 03/08/2023]
Abstract
PURPOSE To investigate age-specific prevalence of disease subtypes and baseline best-corrected visual acuity (BCVA) in Japanese patients with treatment-naïve neovascular age-related macular degeneration (nAMD). STUDY DESIGN Retrospective multicenter case series. METHODS We reviewed the records of patients with treatment-naïve nAMD who underwent initial treatment in 14 institutions in Japan sometime during the period from 2006 to 2015. In patients in whom both eyes were treated, only the eye treated first was included for analysis. The patients were stratified by age for the analysis. RESULTS In total, 3096 eyes were included. The overall prevalence of subtypes was as follows: typical AMD, 52.6%; polypoidal choroidal vasculopathy (PCV), 42.8%; retinal angiomatous proliferation (RAP), 4.6%. The number of eyes in each age group was as follows: younger than 60 years, 199; 60s, 747; 70s, 1308; 80s, 784; 90 years or older, 58. The prevalence of typical AMD in each age group was 51.8%, 48.1%, 52.1%, 57.7%, and 55.2%, respectively. The prevalence of PCV was 46.7%, 49.1%, 44.7%, 34.4%, and 19.0%, respectively. The prevalence of RAP was 1.5%, 2.8%, 3.2%, 7.9%, and 25.9%, respectively. The prevalence of PCV decreased with age, whilst that of RAP increased. The prevalence of RAP was higher than that of PCV in patients aged 90 years or older. The mean baseline BCVA (logMAR) was 0.53. In each age group, the mean baseline BCVA was 0.35, 0.45, 0.54, 0.62, and 0.88, respectively. The mean logMAR BCVA at baseline significantly worsened with age (P < 0.001). CONCLUSION The prevalence of nAMD subtypes differed according to age in Japanese patients. The baseline BCVA worsened with age.
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Affiliation(s)
- Tomoko Sawada
- Department of Ophthalmology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan. .,J-CREST (Japan Clinical Retinal Study Team) Study Group, Tokyo, Japan.
| | - Tsutomu Yasukawa
- Department of Ophthalmology, Nagoya City University, Aichi, Japan.,J-CREST (Japan Clinical Retinal Study Team) Study Group, Tokyo, Japan
| | - Hiroko Imaizumi
- Department of Ophthalmology, Sapporo City General Hospital, Hokkaido, Japan.,J-CREST (Japan Clinical Retinal Study Team) Study Group, Tokyo, Japan
| | - Hisashi Matsubara
- Department of Ophthalmology, Mie University, Mie, Japan.,J-CREST (Japan Clinical Retinal Study Team) Study Group, Tokyo, Japan
| | - Kazuhiro Kimura
- Department of Ophthalmology, Yamaguchi University, Yamaguchi, Japan.,J-CREST (Japan Clinical Retinal Study Team) Study Group, Tokyo, Japan
| | - Hiroto Terasaki
- Department of Ophthalmology, Kagoshima University, Kagoshima, Japan.,J-CREST (Japan Clinical Retinal Study Team) Study Group, Tokyo, Japan
| | - Hiroto Ishikawa
- Department of Ophthalmology, Hyogo College of Medicine, Hyogo, Japan.,J-CREST (Japan Clinical Retinal Study Team) Study Group, Tokyo, Japan
| | - Tomoya Murakami
- Department of Ophthalmology, University of Tsukuba, Ibaraki, Japan.,J-CREST (Japan Clinical Retinal Study Team) Study Group, Tokyo, Japan
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, Saitama, Japan.,J-CREST (Japan Clinical Retinal Study Team) Study Group, Tokyo, Japan
| | - Yoshinori Mitamura
- Department of Ophthalmology, Tokushima University, Tokushima, Japan.,J-CREST (Japan Clinical Retinal Study Team) Study Group, Tokyo, Japan
| | - Yutaro Mizusawa
- Department of Ophthalmology, Nara Medical University, Nara, Japan.,J-CREST (Japan Clinical Retinal Study Team) Study Group, Tokyo, Japan
| | - Yoshihiro Takamura
- Department of Ophthalmology, University of Fukui, Fukui, Japan.,J-CREST (Japan Clinical Retinal Study Team) Study Group, Tokyo, Japan
| | - Toshinori Murata
- Department of Ophthalmology, Shinshu University, Nagano, Japan.,J-CREST (Japan Clinical Retinal Study Team) Study Group, Tokyo, Japan
| | - Jiro Kogo
- Department of Ophthalmology, St. Marianna University School of Medicine, Kanagawa, Japan.,J-CREST (Japan Clinical Retinal Study Team) Study Group, Tokyo, Japan
| | - Masahito Ohji
- Department of Ophthalmology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.,J-CREST (Japan Clinical Retinal Study Team) Study Group, Tokyo, Japan
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Yamaguchi S, Maruko I, Maruko R, Hasegawa T, Iida T. Blood flow pattern in eye before development of type 3 macular neovascularization. PLoS One 2023; 18:e0283202. [PMID: 36928265 PMCID: PMC10019608 DOI: 10.1371/journal.pone.0283202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
PURPOSE To determine the blood flow pattern of eyes before the development of type 3 macular neovascularization (MNV) by optical coherence tomography angiography (OCTA). STUDY DESIGN Retrospective study. SUBJECTS Ten eyes of 10 patients (4 men and 6 women, mean age 80.4 years) diagnosed with unilateral Type 3 MNV who developed type 3 MNV in the fellow normal eye during the follow-up period were studied. METHODS The time of onset of type 3 MNV was defined as the time when retinal exudation was detected by OCT. The blood flow of a 3 x 3 mm or 6 x 6 mm area in the deep capillary plexus (DCP) and the outer retina (OR) including the central fovea were assessed at the onset and at 6 months prior to the onset of the type 3 MNV. RESULTS All MNVs that developed in the fellow eye were type 3 MNVs. Abnormal blood flow signals in the MNVs were detected in the DCP and/or the OR by OCTA at the onset in all cases. Eight of the 10 eyes had OCTA recordings prior to the development of the MNV: 3 eyes had non-exudative MNVs only in the DCP and 5 eyes had non-exudative MNVs in the DCP and OR. The exudation appeared on the average 3.5 months after the non-exudative MNV was observed in the fellow eyes. CONCLUSIONS A non-exudative MNV in the fellow eyes can already be observed by OCTA in eyes before the onset of the exudation. Knowing this will help clinicians not only how to treat these eyes appropriately but will also help in determining the origin of the MNV.
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Affiliation(s)
- Saya Yamaguchi
- Department of Ophthalmology, Tokyo Women’s Medical University School of Medicine, Shinjuku, Tokyo, Japan
| | - Ichiro Maruko
- Department of Ophthalmology, Tokyo Women’s Medical University School of Medicine, Shinjuku, Tokyo, Japan
- * E-mail:
| | - Ruka Maruko
- Department of Ophthalmology, Tokyo Women’s Medical University School of Medicine, Shinjuku, Tokyo, Japan
| | - Taiji Hasegawa
- Department of Ophthalmology, Tokyo Women’s Medical University School of Medicine, Shinjuku, Tokyo, Japan
| | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women’s Medical University School of Medicine, Shinjuku, Tokyo, Japan
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A case of intraocular inflammation after intravitreal brolucizumab injection monitored by laser flare-cell photometer. Am J Ophthalmol Case Rep 2022; 28:101727. [PMID: 36281264 PMCID: PMC9587367 DOI: 10.1016/j.ajoc.2022.101727] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/19/2022] [Accepted: 10/02/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose To report the efficacy of combination therapy using intravitreal injection of brolucizumab (IVbr) and sub-Tenon's injection of triamcinolone acetonide (STTA) and of monitoring with a laser flare-cell photometer (LFP) in a case of polypoidal choroidal vasculopathy (PCV) with intraocular inflammation (IOI). Observations A 72-year-old Japanese woman with PCV had her treatment switched to IVbr due to being refractory to aflibercept. Two weeks after starting IVbr, her visual acuity (VA) declined to 0.40 from 0.10 logarithm of the minimum angle of resolution (logMAR) VA at baseline. In addition, the LFP flare increased to 51.2 photon count/ms (pc/ms) compared with the baseline of 16.1 pc/ms. We diagnosed her with the onset of IOI and immediately started treatment with sub-Tenon's injection of 20 mg triamcinolone acetonide (STTA). Two weeks after receiving STTA, her VA had recovered to 0.15 logMAR, and the LFP flare had decreased to 17.9 pc/ms with dry macula. Eight weeks after the first IVbr treatment, the logMAR VA had improved to −0.18 with achievement of dry macula and stabilization of the LFP flare at 12.2 pc/ms. We administered combined therapy using IVbr and STTA to our patient, and 12 weeks later, the logMAR VA remained at 0.00 with dry macula and 18.1 pc/ms for LFP flare. We continued combination therapy, and after 8 months, her logMAR VA remained at −0.08, and optical coherence tomography showed dry macula, while the LFP flare had stabilized at 16.6 pc/ms. Conclusions and Importance Combination therapy of IVbr and STTA stabilized IOI and achieved dry macula. The LFP flare score clearly showed the degree of and changes in inflammation.
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