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Purpose: To describe a patient with venous overload choroidopathy in whom venous bulbosities masqueraded as polyps and intervortex venous anastomosis mimicked a branching vascular network, giving the appearance of polypoidal choroidal vasculopathy. Methods: The patient had complete ophthalmic examination including indocyanine green angiography and optical coherence tomography. Venous bulbosities were defined on indocyanine green angiography as focal dilations in which the diameter of the dilation is two times that of the host vessel. Results: A 75-year-old woman presented with combined subretinal and subretinal pigment epithelium hemorrhages in the right eye. During indocyanine green angiography, focal nodular hyperfluorescent lesions connected to a network of vessels were observed, which looked like polyps and branching vascular network in polypoidal choroidal vasculopathy. In both eyes, the midphase angiogram had multifocal choroidal vascular hyperpermeability. There was late-phase placoid staining nasal to the nerve in the right eye. During enhanced depth imaging-optical coherence tomography evaluation, there were no retinal pigment epithelium elevations that would be expected with polyps or branching vascular network in the right eye. A double-layer sign was seen corresponding to the placoid area of staining. Diagnosis of venous overload choroidopathy and choroidal neovascularization membrane was made. She was treated with intravitreal antivascular endothelial growth factor injections for the choroidal neovascularization membrane. Conclusion: Indocyanine green angiography findings in venous overload choroidopathy may mimic polypoidal choroidal vasculopathy, but differentiation is essential because it has implications for treatment. Similar findings may have been misinterpreted in the past and may have previously contributed to conflicting clinical and histopathologic descriptions of polypoidal choroidal vasculopathy. [ABSTRACT FROM AUTHOR]

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The authors describe a case of pachychoroid disease and polypoidal choroidal vasculopathy coexisting with subretinal drusenoid deposits and geographic atrophy which are seen in advanced age-related macular degeneration. Purpose: To report an atypical case of pachychoroid spectrum disease associated with subretinal drusenoid deposits and geographic atrophy. Methods: Case report. Results: A 67-year-old woman presented for a routine examination. Her best-corrected visual acuity was 20/20 in both eyes. Based on fundus examination and multimodal imaging findings, the presence of subretinal drusenoid deposits and geographic atrophy was seen in the right eye, which was associated with pachychoroid. The left eye revealed two active polypoidal lesions suggestive of polypoidal choroidal vasculopathy with subretinal drusenoid deposits, geographic atrophy, and a thick choroid with dilated outer choroidal vessels. She underwent an intravitreal injection of ranibizumab followed by focal laser to the polypoidal lesion in the left eye. At 3-month posttreatment, her best-corrected visual acuity was maintained at 20/20 in the left eye, with a good anatomical outcome. Conclusion: This case highlights a previously unreported unique association of a pachychoroid disease spectrum with geographic atrophy and with subretinal drusenoid deposits. [ABSTRACT FROM AUTHOR]

This work aimed to evaluate the performance of deep learning algorithms for an automated differentiation between polypoidal choroidal vasculopathy (PCV) and wet age-related macular degeneration (wet-AMD) by optical coherence tomography (OCT) images of macula. The automated classification model was developed with the self-supervised learning technique and was analyzed for the model performance. It learned visual representations from unlabeled data prior to fitting with labeled data. This technique was shown to provide desirable performance based only on a small proportion of labeled data. The final ensemble model trained with this technique with selected parameters yielded promising performance. Particularly, the proposed model provided 0.71 AUC with 0.67 sensitivity and 0.8 specificity on test set which were better than the traditional supervised learning models used as baseline approached in this study. [ABSTRACT FROM AUTHOR]

Immunotherapy combined with effective therapeutics such as chemotherapy and photodynamic therapy have been shown to be a successful strategy to activate anti-tumor immune responses for improved anticancer treatment. However, developing multifunctional biodegradable, biocompatible, low-toxic but highly efficient, and clinically available transformed nano-immunostimulants remains a challenge and is in great demand. Herein, we report and design of a novel carrier-free photo-chemotherapeutic nano-prodrug COS-BA/Ce6 NPs by combining three multifunctional components—a self-assembled natural small molecule betulinic acid (BA), a water-soluble chitosan oligosaccharide (COS), and a low toxic photosensitizer chlorin e6 (Ce6)—to augment the antitumor efficacy of the immune adjuvant anti-PD-L1-mediated cancer immunotherapy. We show that the designed nanodrugs harbored a smart and distinctive "dormancy" characteristic in chemotherapeutic effect with desired lower cytotoxicity, and multiple favorable therapeutic features including improved 1O 2 generation induced by the reduced energy gap of Ce6, pH-responsiveness, good biodegradability, and biocompatibility, ensuring a highly efficient, synergistic photochemotherapy. Moreover, when combined with anti-PD-L1 therapy, both nano-coassembly based chemotherapy and chemotherapy/photodynamic therapy (PDT) could effectively activate antitumor immunity when treating primary or distant tumors, opening up potentially attractive possibilities for clinical immunotherapy. Natural small-molecule-mediated photosensitive pro-drug nano-assemblies that harbored a distinctive chemotherapeutic dormancy function, which can effectively generate robust immunological responses with the assistance of anti-PD-L1 to cause highly efficient, safe, and synergistic anti-tumor chemotherapy/photodynamic therapy/immunotherapy. [Display omitted] [ABSTRACT FROM AUTHOR]

Axillary lymph node dissection (ALND) in patients with breast cancer has potential side effects, including upper-limb lymphedema. Axillary reverse mapping (ARM) is a technique that enables discrimination of the lymphatic drainage of the upper limb in the axillary lymph node basin from that of the breast. We aimed to evaluate ARM node identification by near-infrared (NIR) fluorescence imaging during total mastectomy with ALND and then to analyze potential predictive factors of ARM node involvement. The study enrolled 119 patients diagnosed with invasive breast cancer with an indication for ALND. NIR imaging using indocyanine green dye was performed in 109 patients during standard ALND to identify ARM nodes and their corresponding lymphatic ducts. 94.5% of patients had ARM nodes identified (95%CI = [88.4–98.0]). The ARM nodes were localized in zone D in 63.4% of cases. Metastatic axillary lymph nodes were found in 55% in the whole cohort, and 19.4% also had metastasis in ARM nodes. Two patients had metastatic ARM nodes but not in the remaining axillary lymph nodes. No serious adverse events were observed. Only the amount of mitosis was significantly associated with ARM node metastasis. ARM by NIR fluorescence imaging could be a reliable technique to identify ARM nodes in real-time when ALND is performed. The clinical data compared with ARM node histological diagnosis showed only the amount of mitosis in the diagnostic biopsy is a potential predictive factor of ARM node involvement. NCT02994225. [ABSTRACT FROM AUTHOR]

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Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

X-linked retinoschisis (XLRS) has been associated with retinal vascular abnormalities, but retinal vasoproliferative tumor (RVPT) has been rarely reported in this context. We describe the case of a 12-month-old boy presenting with esotropia of his left eye due to extensive exudation secondary to RVPT. Right eye examination revealed macular and bullous peripheral retinoschisis. Combining laser photocoagulation and intravitreal injections of anti-vascular endothelial growth factor allowed control of the exudative process at 12 months follow-up. RVPT could be the first sign of XLRS. [ABSTRACT FROM AUTHOR]

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PURPOSE: The aim of this study was to evaluate the effectiveness of intravitreal ziv-aflibercept (IVZ) in the treatment of polypoidal choroidal vasculopathy (PCV) and its efficacy in regard to polyp regression using optical coherence tomography (OCT) and indocyanine green angiography (ICGA). METHODS: This was a retrospective study of eight eyes of eight patients with treatment-naïve PCV. Patients received IVZ on pro re nata protocol. OCT and ICGA parameters were assessed at baseline and subsequent visits with a minimum follow-up of 6 months. ICGA was repeated at 3-6 months to determine the disease activity and quantify the changes in branching vascular network (BVN) polyps. Quantifiable OCT parameters included central macular thickness, pigment epithelial detachment (PED) height, and subfoveal choroidal thickness. RESULTS: The mean age of the study cohort was 62.3 ± 7.7 years, with a mean follow-up of 7.1 ± 1.2 months. The baseline best-corrected visual acuity improved from 0.70 ± 0.36 logarithm of the minimum angle of resolution (Snellen's equivalent 20/100) to 0.63 ± 0.34 (20/80) at last follow-up which was statistically insignificant (P = 0.5). Post IVZ injections (mean ± standard deviation: 2.6 ± 0.7), the total number of polyps reduced significantly from 3 ± 3.5 to 1 ± 1.7 (P = 0.03) along with a reduction in BVN size (3.9 ± 4.8 to 2.7 ± 3.8mm²; P = 0.07). OCT analysis revealed a significant reduction in PED height from 462.5 ± 353.8 μ to 169.9 ± 127.2 μ (P = 0.02). CONCLUSION: IVZ leads to significant morphological changes on ICGA and OCT in terms of polyp regression and reduction of PED height, respectively, with a limited change in visual acuity. IVZ may serve as a cost-effective alternative to treat eyes with PCV. [ABSTRACT FROM AUTHOR]

PURPOSE: To report the 12 months outcomes of treatment naïve polypoidal choroidal vasculopathy (PCV) in patients with ≥20/40 Snellen's best-corrected visual acuity (BCVA). METHODS: This was a retrospective study including eyes treated with monotherapy of anti-vascular endothelial growth factors (VEGF) agents (bevacizumab, ranibizumab, aflibercept, and ziv-aflibercept) on a pro-re-nata (PRN) protocol. Photodynamic therapy using verteporfin (vPDT) was used as rescue therapy. The primary study objective was change in BCVA at 12 months. Secondary objectives included change in optical coherence tomography parameters: central macular thickness (CMT) and pigment epithelial detachment (PED) height, the mean number of injections, and treatment-free interval at 12 months. RESULTS: A total of 18 eyes of 18 patients (7 males, 11 females) were included. The mean age was 58.0 ± 12.0 years. BCVA at baseline and 12 months were 0.16 ± 0.08 (Snellen equivalent 20/30) and 0.15 ± 0.15 logarithm of the minimum angle of resolution (20/30), respectively. Twelve (66.6%) eyes either improved or maintained BCVA. Mean (±standard deviation [SD]) CMT at baseline and 12 months were 188.2 ± 61.1 μ and 161.7 ± 47.4 μ (P = 0.15), respectively. PED height improved to 236.4 ± 208.7 μ at 12 months (P = 0.05). The mean (±SD) number of injections was 3.28 ± 1.96 with a treatment-free period of 6.83 ± 3.63 months. Three eyes required vPDT (4 treatment sessions; mean: 1.33) as a rescue therapy through 12 months. CONCLUSION: PRN anti-VEGF monotherapy in real-life situations for the treatment of naïve PCV eyes with good visual acuity (≥20/40) achieves maintenance or improvement of visual acuity through 12 months follow-up. [ABSTRACT FROM AUTHOR]

The article focuses on diagnosis and management of age-related macular degeneration (AMD). Topics include the macula's non-renewing cells are subject to a lifetime of oxygen free radical damage and latterly inflammatory processes, and the atrophic AMD is the sum of these degenerative processes, while neovascular or wet AMD (NvAMD) is a neovascular response in which new abnormal blood vessel growth can cause rapid damage.

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Polypoidal choroidal vasculopathy (PCV) is a prevalent retinal disease predominantly occurs in Asians that shares some similarities seen in neovascular age-related macular degeneration. Recent large multicenter clinical trials on intravitreal anti-vascular endothelial growth factor (VEGF) agents and photodynamic therapy (PDT) have shed lights on the management of PCV. The Taiwan National Health Insurance had granted limited anti-VEGF agents and PDT for patients with PCV after the approval of required data submission, especially fundus angiography, optical coherence tomography, and visual acuity. In order to best utilize these limited resources for the patients, an expert meeting was held to provide updated Taiwan consensus recommendations for the management of PCV, including initial therapy selection, assessment of treatment response, re-treatment/rescue treatment, and determination of treatment extension/follow-up schedule. An algorithm for treatment allocation under both initial and re-treatment setting was proposed. Further mechanistic and clinical studies are required to investigate the prognostic factors and optimal treatment protocols that will improve healthcare quality and reduce burden of disease and treatment for patients with PCV. [ABSTRACT FROM AUTHOR]

Purpose: To report two cases of choroidal nevi associated with focal choroidal excavation (FCE) and polypoidal choroidal neovascularization (PCN). Methods: Report of two patients with choroidal nevi showing FCE and PCN who underwent multimodal imaging including color fundus photography, fluorescein angiography, indocyanine green angiography, fundus autofluorescence, spectral domain optical coherence tomography, swept-source optical coherence tomography, and optical coherence tomography angiography. Results: Two patients presented with choroidal nevi associated with FCE and PCN. In the first case, a 74-year-old woman, the nevus had sharp margins, a deep FCE, surrounding drusen, and subretinal exudation at its inferior edge due to PCN that responded well to intravitreal anti–vascular endothelial growth factor therapy. In the second case, a 64-year-old woman, the nevus had ill-defined margins, a shallow FCE, and angiographic evidence of PCN without associated exudation. Conclusion: There have been several reports showing an association of either choroidal nevi or FCE with PCN. To our knowledge, there have been no previous reports of FCE identified within choroidal nevi, with or without associated PCN. Since, in one of our cases, the FCE was not apparent on clinical examination, the prevalence of FCE within nevi may be underdiagnosed. [ABSTRACT FROM AUTHOR]

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Although the indocyanine green angiography (ICGA) has been used for years in the assessment of Deep Inferior Epigastric Perforator (DIEP) perfusion, it has not yet been established when it should be performed during the surgery. The aim of this study is to evaluate whether it is better to perform the test on the donor or recipient sites. Intraoperative perfusion of 46 DIEP flaps was assessed twice, on the donor and recipient sites. Differences between both ischemic areas of each flap were statistically analyzed. In addition, perforator location and risk factors were evaluated in order to assess whether they are associated with changes in the perfusion of the flap between both sites. Differences between ischemic areas on the donor and recipient sites were statistically significant (p = 0.012). However, in most cases (82.6%) the ischemic area was the same on both sites, and the final flap design only changed in two cases (4.3%) because of the ICGA findings on the recipient site. Besides, performing the ICGA on the donor site facilitated the identification of the best perfused areas, allowed a better planning of its placement into the recipient site, and also can be useful to choose the best perforator. Bilateral DIEP flap, lateral location of the perforator and tobacco use had a statistically significant association with lower probability to increase the perfusion area between both sites. several advantages have been found in performing the ICGA on the donor site to assess the perfusion of the DIEP flap. • In most cases the ischemic area was the same on donor and recipient sites. • When there are differences, the well perfused area was larger at the recipient site. • Risk factors were bilateral flaps, lateral perforator vessels and tobacco use. • Performing ICGA on donor site to assess perfusion of flaps has several advantages. [ABSTRACT FROM AUTHOR]

• Polypoidal choroidal vasculopathy may cause profound visual loss. • Ranibizumab and verteporfin photodynamic therapy can be the treatment of choice. • Outcomes of two loading doses ranibizumab is comparable to other regimens. • Recurrent hemorrhage is associated with poor visual improvement. • Complete polyp eradication is associated with a lower risk of recurrent hemorrhage. To investigate the prognostic factors for the combined therapy of ranibizumab and prompt verteporfin photodynamic therapy (vPDT) for eyes with polypoidal choroidal vasculopathy (PCV). Sixty-two PCV eyes of 62 patients that received the initial treatment of intravitreal ranibizumab followed by vPDT within 1 week plus a 2nd intravitreal ranibizumab 1 month later in one single medical center were retrospectively enrolled. Best-corrected visual acuity (BCVA) and parameters obtained from optical coherence tomography at baseline, 3 months, 6 months and 1 year were measured and compared. Factors associated with polyp regression, recurrent hemorrhage and visual improvement were analyzed. After the loading treatment, complete and partial polyp regression was achieved in 53.6% and 39.3% of cases, respectively at Month 3. The mean logarithm of the minimum angle of resolution of BCVA improved from 0.64 ± 0.38 to 0.55 ± 0.46 (P = 0.008) at Month 12. Recurrent hemorrhage (P = 0.001) and previous anti-vascular endothelial growth factor (VEGF) treatment (P = 0.017) were associated with poorer visual improvement at Month 12. Incomplete polyp regression (P = 0.038) and previous anti-VEGF treatment (P = 0.005) were associated with a higher risk of recurrent hemorrhage. Recurrent hemorrhage was associated with poor visual improvement after combined ranibizumab and vPDT for PCV. Complete polyp eradication was associated with a lower risk of recurrent hemorrhage. Patients who had previously received anti-VEGF were associated with recurrent hemorrhage and poor visual improvement; more frequent follow-ups and more aggressive subsequent treatments may be needed for these cases. [ABSTRACT FROM AUTHOR]

• Unilateral and bilateral PCV had different imaging characteristics based on confocal scanning laser ophthalmoscopes. • Partial fellow eyes of the unilateral PCV were involved. • The association between ARMS2 A69S genotype and imaging characteristics remains to be investigated. To investigate the different imaging characteristics between unilateral and bilateral polypoidal choroidal vasculopathy (PCV) cases, based on confocal scanning laser ophthalmoscope assessment. For this retrospective case series study, diagnostic indocyanine green angiography (ICGA) and spectral domain optical coherence tomography (SD-OCT) were performed to assess the eligible PCV eyes. Among the 53 patients at baseline, 14 showed bilateral PCV lesions, including two cases of branching vessel network (BVN) without leakage. Concerning the subfoveal choroidal thickness (SFCT), unilateral PCV eyes (326 [155–547] μm) were statistically comparable to their fellow eyes (330 [163–477] μm) (p = 0.257). However, the SFCT (228[141–273] μm) from the bilateral PCV group was significantly lower compared with both the PCV (p = 0.002) and fellow eyes (p < 0.001) from the unilateral group. Moreover, ICGA related hyperfluorescent spots were shown to have a significant positive correlation with SFCT in the unilateral PCV eyes and their fellow eyes, other than bilateral PCV cases. In addition, the drusens tended to prevail in the fellow eyes of the unilateral PCV group (46.2%), compared with bilateral cases. Our results indicate that SFCT, ICGA related hyperfluorescent spots, and drusen were the three main imaging characteristic differences between unilateral and bilateral PCV cases. [ABSTRACT FROM AUTHOR]

Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration (nAMD), commonly seen in the Asian population. It is dissimilar in epidemiology, genetic heterogeneity, pathogenesis, natural history, and response to treatment in comparison to nAMD. Confocal scanning laser ophthalmoscopy-based simultaneous fluorescein angiography and indocyanine green angiography, spectral-domain optical coherence tomography (OCT) with enhanced depth imaging, swept-source OCT, and OCT angiography have improved the ability to detect PCV, understand its pathology, and monitor treatment response. A plethora of literature has discussed the efficacy of photodynamic therapy, anti-vascular endothelial growth factor (VEGF) monotherapy, and combination of both, but only a few studies with higher level of evidence and limited follow-up duration are available. This review discusses the understanding of PCV with respect to epidemiology, pathogenesis, clinical features, natural history, imaging techniques, and various treatment options. Recent clinical trials (EVEREST-II and PLANET study) have emphasized that either anti-VEGF monotherapy or combination treatment is equally capable to strike a balance between polyp regression and stabilization of visual acuity. The recurrent nature of the disease, the development of macular atrophy, and the long-term poor visual prognosis despite treatment are concerns that open avenues for further research. [ABSTRACT FROM AUTHOR]

Highlights • Optical coherence tomography angiography (OCTA) is a non-invasive, easy and quick method to take image choriocapillaris without any adverse effect. • In polypoidal choroid vasculopathy, photodynamic therapy leads to decreased choriocapillaris perfusion in the very early period after the photodynamic therapy as imaged via OCTA. • Photodynamic therapy and anti-VEGF combination treatment could cause choroidal ischemia in the very early period. • Early side effects could detect via OCTA quickly and easily. Abstract Purpose To evaluate the early retinal and choroidal effects of the anti-vascular endothelial growth factor (anti-VEGF) therapy combined with photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV). Methods Patients diagnosed as having PCV were included in the study. In group 1, intravitreal ranibizumab and PDT was applied to six eyes. In group 2, PDT treatment only was applied to four eyes. Optical coherence tomography (OCT) angiography images and best-corrected visual acuity (BCVA) were taken from all patients before treatment and 3 days after surgery. Results The mean age of the patients was 66.00 ± 6.28 years. In group 1, the initial BCVA was 0.70 ± 0.35 logMAR and the final BCVA was 1.1 ± 0.78 logMAR. In group 2, the initial BCVA was 0.47 ± 0.17 logMAR and the final BCVA was 0.50 ± 0.21 logMAR. In group 1, flow rate significantly decreased in the superficial area (p = 0.028), the flow rate also decreased in other layers but they were not statistically significant (p < 0.05). In group 2, the flow rate decreased but these changes were not statistically significant (p > 0.05). Vascular constriction and choroidal ischemia were seen in two patients in group 1. Conclusion In the short term, retinal and choroidal blood flow decreased after PDT treatment. However, statistically significant changes were seen only in the superficial area in group 1. [ABSTRACT FROM AUTHOR]

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Purpose To perform a systematic review and meta-analysis to compare the outcome and serious adverse effects of intravitreal ranibizumab (IVR) monotherapy vs . combined treatment of IVR and photodynamic therapy (PDT) on polypoidal choroidal vasculopathy (PCV). Methods A computerized online search was performed using PubMed, EMBASE, Cochrane Library, Web of Science and China National Knowledge Infrastructure (CNKI) database. The quality of included studies was evaluated according to the Newcastle-Ottawa Scale. Stata 11.0 software was used to do the Meta-analysis. Results After a detailed systematic review, 4 articles (5 study samples) were included for this meta-analysis. PCV eyes treated with PDT combined with IVR achieved better best-corrected visual acuity (BCVA) than IVR monotherapy group throughout a follow-up of 12(th) month (weight mean difference [WMD] in BCVA, 0.132; 95% CI, 0.029–0.234, p = 0.012). Further meta-analysis including studies with 24-month follow up period showed that BCVA at 24(th) month was also better in the combined treatment group than the monotherapy group (WMD in BCVA = 0.234; 95% CI, 0.071–0.398, p = 0.005). There were no significant differences both in serious ocular adverse effects and non-ocular adverse effects (p > 0.05) between two groups. Conclusions Treatment of PCV by PDT combine with IVR is valuable in improving visual acuity and maintaining long term effectiveness. Given the inherent limitations of the included research, future studies are needed to further validate and update the findings in this area. [ABSTRACT FROM AUTHOR]

Various diseases of the urinary bladder can be demonstrated as being polypoid, a nodular bladder mass or as focal bladder wall thickening. This includes malignant or benign neoplasms, urinary stones, or other inflammatory bladder conditions. In daily practice many of these bladder diseases are easily confused with bladder cancer. On the other hand, ultrasonography (US) is safe and can be easily applied as a screening modality or an initial evaluating tool for urinary bladder disease. Furthermore, additional three-dimensional (3D) volumetric techniques can support more delicate delineation of these lesions. This study presents a 3D volumetric US for bladder lesions, and demonstrates various pathological conditions of the urinary bladder ranging from bladder cancer to other benign lesions. [ABSTRACT FROM AUTHOR]

Purpose: To present a unique case of polypoidal choroidal vasculopathy presenting as a blind, painful eye with a suspected intraocular mass, and to correlate clinical findings with histopathologic studies. Methods: Clinical case report and literature review. Results: A 58-year-old Vietnamese man presented with a blind, painful eye with concern for an intraocular mass. B-scan ultrasonography showed massive intraocular hemorrhage and could not rule out a tumor. The patient underwent enucleation and the histopathologic findings were consistent with polypoidal choroidal vasculopathy. Conclusion: Polypoidal choroidal vasculopathy can present with dense vitreous hemorrhage and may masquerade as an intraocular mass. It can progress rapidly and lead to profound, irreversible vision loss. A diagnosis of polypoidal choroidal vasculopathy should be considered in patients of African or East Asian origin presenting with vitreous hemorrhage. [ABSTRACT FROM AUTHOR]

The ophthalmologic complications of optic nerve head drusen (ONHD) in adults have been documented, whereas data on the degree of visual morbidity from OHND in children are limited. The medical records of all patients diagnosed with ONHD at a single, tertiary care ophthalmology department from January 1, 2010, until July 1, 2018, were reviewed retrospectively. Patients were identified using ICD-9 and ICD-10 codes. Inclusion criteria were age ≤18 years of age and formal documentation of ONHD by ancillary testing. A total of 213 patients (386 eyes with ONHD) met inclusion criteria. Mean age at diagnosis was 10.13 ± 4.09 years, and mean follow-up was 2.76 ± 2.91 years. Formal visual fields were available for 208 eyes. Repeatable visual field defects were noted in 24 eyes (11.5%). The most common defect was a nasal step, which occurred in 11 eyes (45.8%). Fifteen eyes had visual field defects at presentation, and 9 eyes developed field loss within 1.39 ± 0.55 years of diagnosis. There was no correlation found between intraocular pressure and degree of visual field loss. Choroidal neovascular membranes were clinically apparent in 5 eyes and treatment was required in 3 eyes. Nonarteritic ischemic optic neuropathy developed in 2 eyes. Visual morbidity associated with ONHD in children is common and may develop in a short period of time after initial diagnosis. There was no correlation found with intraocular pressure. [ABSTRACT FROM AUTHOR]

To assess the impact of varying levels of choroidal invasion on survival from retinoblastoma. A retrospective nationwide analysis of retinoblastoma cases diagnosed between 2004-2016 using the Surveillance, Epidemiology, and End Results database was conducted. Overall survival, cause-specific survival, and all-cause mortality risk were assessed as primary outcomes. A total of 393 retinoblastoma patients were included, of whom 268 (68.2%) had no choroidal invasion, 91 (23.2%) had focal choroidal invasion, and 34 (8.7%) had massive choroidal invasion on enucleation. A total of 6 deaths occurred throughout an average follow-up period of 72.2 ± 47.1 months: 4 deaths were cancer related. Adjusted Cox regression demonstrated higher all-cause mortality in patients with massive choroidal invasion (HR, 41.29; 95% CI, 4.05-420.49; P = 0.002) relative to those without choroidal invasion; however, those with focal choroidal invasion (HR, 2.69; 95% CI, 0.17-43.09; P = 0.484) demonstrated no difference in all-cause mortality. On further stratification by level of optic nerve invasion (ONI), all cancer-related deaths (4/4) were found to have occurred in patients with massive choroidal invasion and concomitant postlaminar ONI (PLONI). Patients with massive choroidal invasion without PLONI demonstrated 5-year overall and cause-specific survival of 100%, whereas patients with massive choroidal invasion and PLONI demonstrated 5-year overall and cause-specific survival of 80.2%. All retinoblastoma-related deaths occurred in patients with both massive choroidal invasion and PLONI. These findings could not establish that massive choroidal invasion is an independent risk factor for poor outcome. [ABSTRACT FROM AUTHOR]

To evaluate refractive and structural outcomes for patients treated for retinopathy of prematurity (ROP) with the anti–vascular endothelial growth factor (anti-VEGF) agent ranibizumab and "delayed laser," defined as any laser photocoagulation treatment administered at least 2 weeks and <1 year after the initial anti-VEGF injection. The medical records of infants with type 1 ROP treated between 2015 and 2020 with intravitreal 0.25 mg ranibizumab followed by delayed laser photocoagulation, with a minimum of 6 months' follow-up, were reviewed retrospectively. Refractive and structural outcomes were extracted from the record. A total of 68 eyes of 34 neonates were included, with median gestational age of 24 weeks and birthweight of 657 g. Patients were aged 0.9 to 4.4 years at last follow-up; mean follow-up interval was 2.7 ± 1.02 years. There was no progression to stage 4 or 5 following treatment during the study period. At 2 years' follow-up (mean age, 2.41 ± 0.23 years), median spherical equivalent (SE) was −0.13 D (IQR, 4.20 D). At most recent examination (mean age, 2.70 ± 1.02 years), the most common ocular findings included strabismus (32%), optic atrophy (24%), amblyopia (21%), high myopia (7%), and nystagmus (4%). In our small cohort, neonates with type 1 ROP treated with intravitreal ranibizumab and delayed laser demonstrated good structural outcomes, with no progression to retinal detachment. We found lower rates of high myopia compared with previous reports of laser photocoagulation monotherapy.▪ [ABSTRACT FROM AUTHOR]

Background: Piroplasmosis and tripanosomiasis are debilitating diseases of great economic impact on the equine industry of Latin America. Aim: Considering the lack of studies of the northeastern part of Colombia, this study aims to determine the clinical and epidemiological features associated with infection of the Babesia, Theileria, and Trypanosoma genera in horses from this geographical area. Methods: A total of 280 horses from Arauca, Meta, and Santander departments were molecularly analyzed to detect infection by Babesia caballi, Theileria equi, Trypanosoma evansi, and T. vivax. Furthermore, clinical and epidemiological analyses were carried out on the data sets. Results: Molecular analysis showed a prevalence of 25.7% and 3.9% for T. equi and T. evansi, respectively, without positive animals for B. caballi and T. vivax. Higher prevalences of T. equi were detected in Santander and Meta, whereas T. evansi was detected exclusively in Santander. Clinical analyses showed significant alterations in PCV, red blood cells, mean corpuscular volume, and body condition in positive animals, while epidemiological analyses showed a significant association of tick infestation and lack of insect control with the infection by T. equi and T. evansi, respectively. Conclusions: Our analysis shows a considerable infection rate by T. equi in horses from northeastern Colombia, which affects the clinical and body condition of these animals. Control of ticks and treatment of sintomatic animals should be considered to reduce the economic impact of this industry. [ABSTRACT FROM AUTHOR]

Purpose: Choroidal nevus is the most common ocular fundus tumor in adults. Previous studies have widely discussed the features of choroidal neovascularization secondary to nevus and its treatment options. Polypoidal choroidal vasculopathy (PCV) is an exudative chorioretinopathy that is often underdiagnosed. Clinical features, natural history, and treatment response of PCV are distinct from occult choroidal neovascularization. Polypoidal choroidal vasculopathy secondary to choroidal nevus has not been previously documented. We report a patient with a history of stable choroidal nevus who developed a polypoidal lesion at the edge of the nevus lesion. Methods: A white woman who presented with a choroidal nevus and clinical features of PCV was examined using fundoscopy, optical coherence tomography, fluorescein angiography, and indocyanine green angiography. Results: A polypoidal lesion with an associated branching vascular network adjacent to the nevus was demonstrated by optical coherence tomography, fluorescein angiography, and indocyanine green angiography. The patient was asymptomatic and was managed conservatively. Conclusion: Our case showed that PCV developing in association with a stable choroidal nevus. Pathogenic mechanisms of this condition may include chronic degenerative or inflammatory changes at the level of the retinal pigment epithelium resulting in vascular changes. Unlike treatment of occult choroidal neovascularization secondary to nevus, optimal management of PCV secondary to nevus may vary. Indocyanine green angiography is the gold standard for the diagnosis of PCV and is a useful investigation in atypical choroidal neovascularization. [ABSTRACT FROM AUTHOR]

Background Submacular hemorrhage associated with polypoidal choroidal vasculopathy (PCV) may cause severe visual loss. The purpose of this study is to report the visual prognosis of massive submacular hemorrhage in patients with PCV. Methods Twenty patients with PCV and submacular hemorrhage who received either subretinal tissue plasminogen activator (TPA) with vitrectomy or intravitreal injection of TPA and gas to achieve pneumatic displacement of the hemorrhage were enrolled. Additionally, combination treatment with either photodynamic therapy (PDT) or intravitreal injection of vascular endothelial growth factor inhibitors (anti-VEGF) was performed to treat the underlying PCV. Results Five patients received subretinal TPA with vitrectomy and 15 patients received intravitreal injection of TPA and gas to remove or displace the submacular hemorrhage. Combination treatment with PDT and intravitreal anti-VEGF was performed in three patients and intravitreal anti-VEGF injection alone in 13 patients. The mean logarithm of the minimal angle of resolution converted from the best corrected visual acuity (BCVA) were improved at 3 months, 6 months, and 12 months. Better initial BCVA, smaller size of submacular hemorrhage and younger age were statistically significant predictors for BCVA. Combination treatment with PDT showed significant efficacy in the improvement of BCVA. Conclusion Combination treatment of submacular hemorrhage secondary to PCV may yield visual and anatomic improvements. Initial BCVA, the initial size of submacular hemorrhage and age were significant predictors for visual prognosis. [ABSTRACT FROM AUTHOR]

Purpose: To describe the management of a subfoveal polypoidal choroidal vasculopathy case refractory to antiangiogenic treatment and to photodynamic therapy. Methods: Case report. A 65-year-old male patient presented with a diagnosis of exudative age-related macular degeneration of his left eye and unsuccessful response to eight antiangiogenic injections. Visual acuity was 20/33. Fluorescein angiography, spectral domain optical coherence tomography, and indocyanine green angiography confirmed the diagnosis of polypoidal choroidal vasculopathy. Two photodynamic therapy sessions along with two ranibizumab injections were performed, but no response was obtained. Identification and photocoagulation of the polyp feeder vessels was performed. Results: Polypoidal structures regressed, intraretinal and subretinal exudation resolved, and visual acuity was preserved with no adverse events. Conclusion: Indocyanine green angiography--guided feeder vessel diode laser photocoagulation in selected cases of polypoidal choroidal vasculopathy may be considered an effective alternative therapy, especially in those refractory to both photodynamic therapy and antiangiogenic therapy. [ABSTRACT FROM AUTHOR]

Purpose To determine the role of systemic steroids in improving visual acuity, preventing recurrence and hastening pigment epithelial detachment resolution in IPCV patients. Methods Retrospective computer assisted comparative case series of consecutive patients with documented IPCV who did and did not receive systemic steroids as part of their treatment regimen between 2007 and 2012. Patients who had systemic contraindication to steroid therapy were excluded from the steroid arm. Data collected included demographics, the best corrected visual acuity, details of the ocular and systemic exam, the treatment offered, the follow-up period and the final visual and anatomic outcomes. Outcome measures included the final BCVA, the time to resolution of the associated pigment epithelial detachment (PED, if present), the recurrence rate and the associated side effects, if any. Appropriate statistical analysis was done. Statistical significance: p < 0.05. Results 14 patients (14 eyes) had received systemic steroids in the stated period; these were compared with 26 consecutive patients (26 eyes) who did not. Mean age: 59.24 vs 62.38 years (A vs B). Mean baseline BCVA: 1.86 ± 1.24 logMAR vs 2.12 ± 1.48 logMAR (A vs B). 8 females in Group A and 14 in Group B. 11 patients in group A and 19 in group B had associated systemic hypertension. Therapy consisted of laser photocoagulation, anti-vascular endothelial growth factor therapy, photodynamic therapy or a combination of these. Mean follow-up: 43.21 ± 11.32 months (Group A) vs 48.24 ± 9.75 months (Group B). BCVA at three months was significantly better (0.84 ± 0.74 logMAR vs 1.16 ± 0.89 ( p = 0.039). Final BCVA: 0.86 ± 0.78 logMAR (Group A) vs 1.29 ± 0.92 (Group B, p = 0.042). 7 patients in group A and 12 in Group B had a recurrence (insignificant difference). 1 patient in Group A and 7 in Group B had unresolved disease (persistent PED) at the end of follow-up (OR: 4.60; 95% CI 1.7–11.10). Conclusion Steroids appear to improve visual acuity and accelerate the resolution of the PEDs in patients with IPCV and large PEDs, but do not seem to influence recurrence. [ABSTRACT FROM AUTHOR]

The article presents case study of 62-year-old male patient, who had been treated and followed up for diabetic macular edema in the retina unit of clinic for 2 years. It mentions sudden hearing loss in his right ear 4 days after the last IV treatment; and also mentions normal external auditory canals and tympanic membranes on both sides.

The article discusses an approach of optical coherence tomography (OCT) technology, namely en face OCT, in relation to OCT B-scans in the diagnosis of cystoid macular edema (CME), multiple evanescent white dot syndrome (MEWDS), and polypoidal choroidal vasculopathy.

Background/Purpose The purpose of this study is to share experiences diagnosing and treating choroidal neovascularization (CNV) in young patients (age ≤ 50 years) at our hospital. Methods The study reviewed retrospective data of patients (≤ 50 years old) with CNV who received antivascular endothelial growth factor treatment (anti-VEGF) between January 2007 and August 2012 at Shin Kong Wu Ho-Su Memorial Hospital. We recorded the total number of injections, types of drugs, preoperative and final best-corrected visual acuity (BCVA), central retinal thickness (CRT) in optical coherence tomography (OCT), and total follow-up times, and then used two-tailed paired t tests to compare mean changes in BCVA and CRT on OCT. Results The study enrolled 59 patients ≤ 50 years of age with CNV diagnosed in 67 eyes. The mean age was 36.9 ± 10.0 years (range, 8–50 years). Twenty-one patients were male and 38 patients were female. Forty-two CNV lesions were subfoveal, 19 were juxtafoveal, and five were extrafoveal. The mean total follow-up time was 18.5 ± 19.9 months (range, 0.5–71 months). Pathologic myopia was the most common cause of CNV in this study (47.8%), followed by punctate inner choroidopathy (17.9%), idiopathic CNV (16.4%), polypoidal choroidal vasculopathy (13.4%), angioid streaks (3.0%), and choroidal rupture (1.5%). After anti-VEGF treatment, the mean BCVA improved from 0.69 ± 0.61 to 0.42 ± 0.59 ( p < 0.05). CRT decreased from 257.5 ± 48.2 to 210.3 ± 35.7 ( p < 0.05). The mean number of injections was 1.9 ± 1.6 (range, 1–9). Conclusion In this study we found that pathologic myopia, punctate inner choroidopathy, and idiopathic and polypoidal choroidal vasculopathy comprised the four most common causes of CNV in patients ≤ 50 years of age in Taiwan. We also revealed that anti-VEGF treatment is highly effective in the treatment of CNV in this age group. [ABSTRACT FROM AUTHOR]

The article discusses ways to diagnose and manage polypoidal choroidal vasculopathy and retinal angiomatous proliferation properly, dealing with topics including diagnostic tools, treatment options, and several studies on the optimum treatment for both diseases.

Abstract: Background: Photodynamic therapy (PDT) has previously been reported to be effective in treating polypoidal choroidal vasculopathy (PCV), with satisfactory polyp regression. However, the optimum treatment protocol remains controversial. This study compared the effect of reduced-fluence PDT combined with intravitreal bevacizumab (rPDT/IVB) and standard-fluence PDT (sPDT) alone for treating symptomatic PCV in Chinese patients. Methods: A retrospective review was carried out of the medical records of patients with PCV who were treated with rPDT/IVB (14 eyes of 13 patients) or sPDT (12 eyes of 12 patients) with at least 6 months of follow-up. Results: The mean best-corrected visual acuity of the rPDT/IVB group improved significantly at the 6-month follow-up (p = 0.041). Only one eye (7.1%) in the rPDT/IVB group showed a decrease in visual acuity, compared with four eyes (33.3%) in the sPDT group. A total of 40.0% of eyes in the sPDT group showed increased lipid exudate at follow-up 1 month after treatment, whereas no increase in lipid exudate was observed in the rPDT/IVB group (p = 0.015). The mean maximum area of post-treatment hemorrhage in the rPDT/IVB group was smaller than that in the sPDT group (2.57 ± 2.74 mm2 vs. 12.69 ± 10.28 mm2, p = 0.042). Conclusion: Combination therapy with rPDT/IVB for patients with PCV showed encouraging results in vision improvement, a lower decrease in visual acuity, significantly less post-treatment lipid exudate and a smaller area of post-treatment hemorrhage at the 6-month follow-up than patients treated with sPDT. [Copyright &y& Elsevier]

The article presents the case of a 63-year-old male who was presented with three days' history of visual disturbance in the right eye. A thick submacular hemorrhage (SMH) was seen on fundus examination in the right eye. It claims that the SMH was caused by a polypoidal choroidal vasculopathy that was treated successfully with a subretinal tenecteplase injection.

Abstract: Purpose: The purpose of this study was to investigate the treatment efficacy of photodynamic therapy (PDT) with verteporfin for patients suffered from polypoidal choroidal vasculopathy. Methods: In this retrospective comparative study, we included 25 eyes of 25 patients with macula-involved polypoidal choroidal vasculopathy. All patients had follow-up of more than 3 years. We compared the best-corrected visual acuity (BCVA) in logarithm of minimal angle of resolution (logMAR) scale at each follow-up time points with initial baseline BCVA. We also investigated the factors influencing final BCVA at the 36-month follow-up time point. Results: At 6 months, the mean BCVA improved from 0.77 to 0.68 (p = 0.024). All the mean BCVAs after the 6-month follow-up time points were still better than baseline mean BCVA, but the improvements were not significant statistically. The mean BCVAs became 0.68, 0.74, 0.75, 0.73, and 0.72 respectively at 12-month, 18-month, 24-month, 30-month, and 36-month follow-up time points. Better initial BCVA (p = 0.012) and smaller lesion size (p = 0.031) significantly predicted the better final visual improvement at 36 months rather than sex (p = 0.7) and age (p = 0.206). Conclusion: Although the visual improvement after treatment of PDT with verteporfin was only temporarily significant, the prevention of visual deterioration in these patients persisted during a 3-year follow-up. Better initial BCVA and smaller lesion size were significant factors influencing final visual improvement, and early treatment might be suggested. [Copyright &y& Elsevier]

The article discusses the case of a 59-year-old woman who received photodynamic treatment for polypoidal choroidal vasculopathy (PCV) linked to choroidal nevus. She was subjected to optical coherence tomography (OCT), fluorescein angiography and indocyanine angiography. She received photodynamic treatment for choroidal neovascularization secondary to age-related macular degeneration (AMD) in the right eye.

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The article reports on the case of a 56-year-old woman with retinoblastoma treated with radiation in the right eye and was presented with a progressively enlarging lesion in the macula associated with subretinal fluid. A vacular lesion with prominent saccular dilations were revealed after observation. Results indicate the presence of complications of rubeosis and atypical polypoidal neovascularization from radiation retinopathy.