ABSTRACT: To determine the prognostic factors associated with anatomical success in the treatment of retinal detachment (RD) due to myopic macular hole by pars plana vitrectomy (PPV) and perfluoropropane (C3F8) gas tamponade.
Retrospective, interventional, comparative case series.
In an institutional setting, 57 eyes with myopic macular hole RDs treated by PPV and C3F8 tamponade, with or without concomitant internal limiting membrane (ILM) peeling, endolaser photocoagulation, and/or phacoemulsification, were analyzed. Outcome measures were anatomical success, defined as closure of macular hole with reattachment of the surrounding retina, and postoperative best-corrected visual acuity (BCVA).
The mean postoperative follow-up was 26.9 +/- 16.5 months. The anatomical success rate after primary PPV and C3F8 tamponade was 63.2%. Regression analysis showed that shorter axial lengths (odds ratio [OR] = 6.73, 95% confidence interval [95% CI] 1.86 to 12.22, P = .010), concomitant ILM peeling (OR 1.59, 95% CI 1.14 to 2.38, P = .013), and shorter duration of macular hole RD (OR 0.81, 95% CI 0.67 to 0.98, P = .033) were associated with a higher anatomical success. The mean pre- and postoperative BCVAs were 1.430 +/- 0.273 (range, 0.523 to 1.700) and 1.403 +/- 0.271 (range, 0.699 to 1.800) logarithm of minimal angle of resolution units, respectively. The postoperative BCVA was significantly better in eyes with macular hole closure than in eyes without (P = .021).
Axial length, concomitant ILM peeling, and duration were important prognostic factors for PPV and C3F8 tamponade in the treatment of myopic macular hole RDs.
American Journal of Ophthalmology 01/2007; 142(6):938-44. · 4.22 Impact Factor
ABSTRACT: To determine the efficacy of photodynamic therapy (PDT) with verteporfin as a treatment for symptomatic polypoidal choroidal vasculopathy (PCV).
Prospective consecutive, 2-centered, noncomparative interventional case series.
Twenty-one Asian patients with 22 eyes presenting with serosanguinous maculopathy due to PCV and an initial best-corrected visual acuity (BCVA) of 20/40 or worse were recruited prospectively. All patients had angiographic leakage seen on fluorescein angiograms (FAs) and features of PCV seen with indocyanine green (ICG) angiography.
Intravenous infusion of verteporfin at a dose of 6 mg/m(2) of body surface area over 10 minutes was administered. Five minutes after the completion of infusion, a 689-nm laser was applied for 83 seconds, with a light dose of 50 J/cm(2). The laser spot size was chosen to cover the polyps and the surrounding abnormally dilated choroidal vessels shown on ICG angiography plus an extra 1000-microm margin. Photodynamic therapy retreatment was performed if leakage from the polyps was found on both repeat FAs and ICG angiography at regular 3-month follow-up intervals.
The proportion of eyes with stable or improved vision at a 1-year follow-up. Secondary outcome measures included change in mean BCVA and the changes in clinical and angiographic features in FAs and ICG angiography. The total number of PDT sessions and any complications were also recorded.
Stable or improved vision was achieved in 21 (95%) of the 22 eyes at the 1-year follow-up. Ten (45%) eyes had a moderate gain in vision (improved by > or =3 lines), whereas 1 (5%) eye suffered a moderate visual loss (decrease by > or =3 lines). The mean BCVA improved from a logarithm of the minimum angle of resolution(logMAR) of 0.73 to 0.60, an equivalent of 1.3 lines of improvement. The change in logMAR BCVA at 12 months was statistically significant (Wilcoxon signed-ranks test, P = 0.009). Complete absence of leakage in FAs and total regression of the polyps in ICG angiography were observed in 20 (91%) and 21 (95%) eyes, respectively. Severe loss of vision due to massive subretinal hemorrhage occurred in 1 eye; otherwise, there were no other serious treatment-related adverse events.
The 1-year results of PDT in treating PCV of the macular type with serosanguinous presentations are encouraging. Further studies with longer follow-up and randomized controlled trials are warranted to assess the long-term safety and efficacy of PDT relative to observation or other treatment modalities.
Ophthalmology 09/2004; 111(8):1576-84. · 5.45 Impact Factor
ABSTRACT: To study the safety and efficacy of photodynamic therapy (PDT) with verteporfin in treating subfoveal choroidal neovascularization (CNV) of idiopathic cause.
A prospective, noncomparative, consecutive, open-label, two-center, interventional case series.
Patients aged 50 years or younger with the diagnosis of idiopathic CNV by exclusion of other related causes together with the CNV extending under the geometric center of the foveal avascular zone.
Seventeen eyes from 17 patients received PDT with verteporfin according to a standardized protocol. Retreatment was considered if fluorescein leakage from the CNV was shown in fluorescein angiography at every 3-month follow-up. The visual, clinical, and angiographic responses were observed. Complications from treatment were monitored and documented.
The changes in the best-corrected visual acuity (BCVA) at the 1-year follow-up. The proportion of patients with improved (gained 2 lines or more), stable, and dropped (lost 2 lines or more) vision and the mean number of treatments required during the 1-year interval were measured. Complications were monitored and tabulated.
Seventeen eyes with complete 1-year follow-up were analyzed. The mean logarithm of the minimum angle of resolution BCVA improved from 0.64 to 0.41 (Wilcoxon signed-ranks test, P = 0.007). Sixteen eyes (94%) had stable or improved vision. Only one patient (6%) had moderate loss of vision. The mean number of PDT treatment was 1.8 per eye over the 1-year period. Patients with smaller lesion size or active vascular CNV on presentation were more likely to have a final BCVA of 20/100 or better (Fisher's exact test, P = 0.006 and P = 0.015, respectively). No serious local or systemic complications were encountered.
PDT seems to be a promising treatment strategy in achieving a stable or improved vision for subfoveal idiopathic CNV. The treatment was well tolerated. Further studies and longer follow-up are warranted to assess the long-term safety and efficacy of PDT compared with observation or other treatment modalities.
Ophthalmology 01/2004; 110(12):2395-402. · 5.45 Impact Factor