Purpose:The purpose of this study was to study the clinico-demographic characteristics of Mactel patients and to correlate its clinical findings with FFA and OCT findings.Methods: This prospective study was conducted in 30 Mactel patients at a tertiary eye care centre in south Kerala between May 2014 and May 2016. Clinical staging of the disease was done based on Gass and Blodi classification. In FFA, disease was classified into those with < 180 degrees leakage, > 180 degrees leakage and CNVM leakage. OCT findings were also noted. Routine blood investigations were carried out in all the patients. These were arbitrarily divided into convenient groups for the statistical analysis. Results:The mean age of MacTel patients was 57 years with a female predominance in study group. Out of this, 86.71% had overt diabetes mellitus, 36.67% had hypertension and 16.7% had familial hypercholesterolemia. Most of the patients had stage 2 disease (48.33%) while none of them had Stage 1 disease. 46.67% in the study had < 180 degrees leakage on FFA while 48.33% had > 180 degrees. 3 eyes (5%) had CNVM type of leakage. Degree of leakage on FFA tended to correlate with the stage of disease. Common OCT findings were normal OCT (43.3%), Inner Lamellar Hole in 23.33%, Outer Lamellar Hole in 15%, full thickness hole in 1.67%, foveal pigmentation in 11.67% and CNVM in 5%. However central foveal thickness did not show a correlation with vision loss. Conclusion:The coexistence of high prevalence of diabetes mellitus and hypertension was suggestive of the fact that the vascular stress in these conditions may add to the pathogenesis of Mactel. Further research is required to establish the significance of the higher prevalence of dyslipidemia in Mactel l patients as found in our study. As the disease progresses, the degree of FFA leakage seems to suggest greater disease severity. OCT characteristics, however, failed to demonstrate such a correlation. Central foveal thickness in OCT may not be a good index to correlate with visual prognosis in these patients.
To evaluate and compare the efficacy of reduced-fluence photodynamic therapy (PDT) with standard-fluence photodynamic therapy in treating polypoidal choroidal vasculopathy. Twenty-eight eyes (27 patients) with polypoidal choroidal vasculopathy were retrospectively analysed; 14 eyes received Indocyanine green angiography-guided standard-fluence (SF) PDT (50 J/cm) and 14 eyes received Indocyanine green angiography-guided reduced-fluence (RF) PDT (25 J/cm). Primary outcome measured after 6 months of treatment were the changes in mean BCVA, polyp regression, polyp PED height, central choroidal thickness (CCT), post PDT intravitreal anti VEGF injection need and complications. Results of both the groups were comparable at 6 months follow up. Mean change in log mar visual acuity at 6 months for the SF PDT group was 0.12 compared to 0.13 for the RF PDT group (p = 0.919). Mean change in PED height at 6 months for the SF PDT group was 159 μm compared to 172 μm for the RF PDT group (p = 0.06). Mean change in CCT at 6 months for the SF PDT group was 45μm compared to 10μm for the RF PDT group (p = 0.96). While the SF PDT group needed a mean of 2 injections post PDT, the RF PDT group required a mean of 3 injections during the course of 6 months follow up. Neither of the group reported any adverse effects following the procedure. Our study demonstrated that reduced-fluence PDT is at least on par with standard-fluence PDT in management of PCV.
Aim:To study the morphological patterns of nAMD on OCTA, compare with ICGA the gold standard and to ascertain whether pattern identification can help in prognosis of the disease and follow up. Materials and Methods:Retrospective study of 103 nAMD patients who visited retina clinic at Chaithanya eye hospital, Trivandrum.Patients who underwent comprehensive fundus evaluation including FFA/ICGA, SD-OCT and OCTA on Heidelberg platform with minimal follow up of 1 year were analyzed. Vascular networks patterns identified on OCTA were analyzed. Area of the lesion on OCTA was correlated with FFA/ICGA at baseline and during treatment. Patients underwent 3 loading anti VEGF injections, followed by PRN on basis of OCT/ICGA findings and the data correlated with OCTA findings. On OCTA, good anatomical outcome was defined as decreased membrane size and decreased/absent SRF during follow up.Results: Network patterns were more discernable on OCTA than ICGA -Sea fan (42%), filamentous (20%), Fish net (17%), ill-defined (13%) and lacy wheel (8%). Out of 8 eyes with ill-defined membranes on ICGA, OCTA revealed fish-net pattern in 2 eyes while 6 remained ill-defined. Size of lesion was comparable between OCTA and ICGA (Mean horizontal and vertical diameters 2621 Vs 2445 and 2535 Vs 2189 μm respectively). Post treatment size of network decreased on OCTA. Good anatomical outcomes were seen in 100% Lacy wheel eyes, 84.6% of sea-fan, 50% of filamentous and 50% of ill-defined pattern eyes. Fish net pattern was resistant to anti-VEGF therapy. Conclusion:OCTA could classify nAMD lesions morphologically into various patterns more clearly and elaborately. Certain morphologies on OCTA had better anatomical outcomes and identification of these at baseline could help in prognostication and patient counseling. OCTA Fish net pattern not described in literature were found to be resistant to Anti-VEGF therapy.
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