Optimal Management of Pigment Epithelial Detachments in Eyes With Neovascular Age-Related Macular Degeneration

Khanani, Arshad M.; Eichenbaum, David; Schlottmann, Patricio G.; Tuomi, Lisa; Sarraf, David

doi:10.1097/iae.0000000000002195

Cited by 39 publications

(44 citation statements)

References 49 publications

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“…The regression analysis in our current study showed similar results. A literature review also showed that fibrovascular PED was more resistant to antiangiogenic therapy and may be associated with a poorer visual outcome 30 . Additionally, pachychoroid neovasculopathy has also been described after the introduction of enhanced‐depth OCT, and many studies have compared the difference between CNV with or without pachychoroid.…”

Section: Discussionmentioning

confidence: 99%

Comparison of different morphologies of choroidal neovascularization evaluated by ocular coherence tomography angiography in age‐related macular degeneration

Tew

Lai

Hsieh

et al. 2020

Clinical Exper Ophthalmology

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Importance: The clinical implications of different morphologies of choroidal neovascularization (CNV), as evaluated by ocular coherence tomography angiography (OCTA) in neovascular age-related macular degeneration (nAMD), are lacking. Background: To describe the morphology of CNV in nAMD using OCTA, and to compare the visual prognosis and other structural OCT biomarkers between different morphologic patterns. Design: Retrospective cohort study. Participants: One hundred and forty eyes with nAMD treated with anti-vascular endothelial growth factor (VEGF). Methods: Patients were examined using OCTA prior to and at 3, 6 and 12 months after receiving anti-VEGF therapy. Main Outcome Measures: Best-corrected visual acuity (BCVA) and morphologic retinal features. Results: Organized CNV was identified in 110/140 eyes (78.6%) using OCTA. These CNV complexes could be divided into three OCTA patterns: the 'medusa' pattern (n = 41), characterized by branching vessels radiating in all directions; the 'seafan' pattern (n = 43), characterized by branching vessels radiating to one side of the lesion; and the 'tangled' pattern (n = 26), characterized by globular entwined vessels without a main trunk. At baseline, the eyes with the tangled pattern were from younger patients (P = .031) with better BCVA (P = .007). There were also fewer intraretinal cysts (P = .021), less fibrovascular pigment epithelial detachment (P = .009), and more pachychoroid (P = .007) in eyes with the tangled pattern on OCT. At 12 months post-treatment, patients with the tangled CNV pattern also showed greater visual improvement than patients with the other two patterns (P = .049).

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Section: Discussionmentioning

confidence: 99%

Comparison of different morphologies of choroidal neovascularization evaluated by ocular coherence tomography angiography in age‐related macular degeneration

Tew

Lai

Hsieh

et al. 2020

Clinical Exper Ophthalmology

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“…A RPE tear may develop in 15% to 20% of eyes with PEDs after anti-VEGF therapy; however, vision may stabilize with continued therapy. Atrophy may complicate eyes with PED and nAMD after anti-VEGF therapy, especially in association with complete PED resolution [55,56].…”

Section: Discussionmentioning

confidence: 99%

Surgical management of submacular hemorrhage due to n-AMD: a comparison of three surgical methods

et al. 2020

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Background: To compare and assess the efficacy of three surgical methods for the treatment of acute submacular hemorrhage (ASH): pneumatic displacement with C2F6, in combination with intravitreal injection of bevacizumab and rtPA, pars plana vitrectomy (PPV) with intravitreal injection of gas (C2F6), bevacizumab and subretinal injection of recombinant tissue plasminogen activator (rtPA), pars plana vitrectomy (PPV) with intravitreal injection of gas (C2F6), bevacizumab and intravitreal injection of recombinant tissue plasminogen activator (rtPA). Methods: The study included 85 patients with ASH. In the group without PPV (A), patients were treated with intravitreal injection of C2F6, bevacizumab and rtPA. In the second and third group, patients underwent a PPV, intravitreal injection of bevacizumab, pneumatic displacement with C2F6 and a subretinal (B) or intravitreal (C) injection of recombinant tissue plasminogen activator (rt PA). Results: In group A, mean BCVA increased from preop logMAR 1.41 to 1.05, in group B from 1.46 to 1.28 and in group C from 1.63 to 1.33. In group A, CFT changed from 764 ± 340 μm at time point 0 to 246 ± 153 μm at time point 1, in group B from 987 ± 441 μm to 294 ± 166 μm and in group C from 642 ± 322 μm to 418 ± 364 μm. Patients had an average of 5 injections after surgery. Conclusion: Our study demonstrates that the three methods are equally effective in improving the morphology and the BCVA of patients with ASH.

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“…The presence of new onset or residual IRF is consistently associated with worse visual outcomes (Jaffe et al 2013; Lambert et al 2016). Similarly, PED can be associated with visual loss; therefore, current recommendation is that unstable PED or PED with concurrent IRF or SRF should be treated (Khanani et al 2018). Nevertheless, dietary β‐carotene intake was not significantly associated with VA over 12 months in this cohort of patients.…”

Section: Discussionmentioning

confidence: 99%

Dietary antioxidants are associated with presence of intra‐ and sub‐retinal fluid in neovascular age‐related macular degeneration after 1 year

Detaram

Liew

Russell

et al. 2020

Acta Ophthalmologica

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To assess whether dietary intake of antioxidants, fruits, vegetables and fish is associated with 12-month treatment outcomes in neovascular age-related macular degeneration (nAMD) patients. Methods: A total of 547 participants were diagnosed with nAMD at baseline, of whom 494 were followed up after 12 months of antivascular endothelial growth factor therapy. Dietary intakes were determined using a validated food frequency questionnaire. Presence of intra-retinal and sub-retinal fluid (IRF, SRF), pigment epithelial detachment (PED) and central macular thickness (CMT) were recorded from optical coherence tomography images. Best-corrected visual acuity was recorded using log of the Minimum Angle of Resolution (LogMAR) charts. Results: Participants in the upper three quartiles combined compared to those in the first quartile of baseline dietary zinc intake had 49% reduced odds of SRF 12 months later, multivariable-adjusted odds ratio (OR) 0.51 [95% confidence interval (CI) 0.30-0.89]. The upper three quartiles combined compared to the first quartile of b-carotene intake had 90% greater odds of IRF presence at 12-month follow-up, multivariable-adjusted OR 1.90 (95% CI 1.04-3.46). The highest versus lowest quartile of dietary b-carotene intake had a nearly twofold greater odds of PED presence, multivariable-adjusted OR 1.99 (95% CI 1.03-3.84). Conclusion: A higher intake of dietary zinc was associated with a reduced likelihood of SRF at 1 year. Conversely, a higher intake of dietary b-carotene was associated with an increased risk of IRF and PED. These findings underscore the importance of ongoing nutritional advice for nAMD patients presenting for treatment.

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Optimal Management of Pigment Epithelial Detachments in Eyes With Neovascular Age-Related Macular Degeneration

Cited by 39 publications

References 49 publications

Comparison of different morphologies of choroidal neovascularization evaluated by ocular coherence tomography angiography in age‐related macular degeneration

Comparison of different morphologies of choroidal neovascularization evaluated by ocular coherence tomography angiography in age‐related macular degeneration

Surgical management of submacular hemorrhage due to n-AMD: a comparison of three surgical methods

Dietary antioxidants are associated with presence of intra‐ and sub‐retinal fluid in neovascular age‐related macular degeneration after 1 year

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