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Purpose. To investigate the effect and underlying mechanism of intravitreal antivascular endothelial growth factor (VEGF) in patients with putative or visible choroidal neovascularization (CNV) secondary to central serous chorioretinopathy (CSCR) with optical coherence tomography angiography (OCTA). Methods. In a retrospective cohort study, 16 eyes of 15 treatment-naïve CSCR patients were included and divided into two groups: a putative CNV group with nonhomogenous hyperreflectivity in the slab of choriocapillaris and a visible CNV group with obvious tangled vascular network in the slab of choriocapillaris in OCTA. Patients were recorded with best-corrected visual acuity (BCVA). The parameters, evaluated by OCTA, included central macular thickness (CMT), the height of subretinal fluid (SRF), the number of hyperreflective foci (HRF), and the area of putative or visible CNV. Results. Compared with the baseline, visual acuity was improved significantly at the last follow-up, and CMT and the height of SRF were decreased significantly (P < 0.0001). The number of HRF was also declined in the outer retina and the choriocapillaris layer (P = 0.0343). Although the visible CNV area in the eyes represented virtually unchanged during anti-VEGF treatment (P = 0.4015), the area of putative CNV displayed an obvious reduction (P = 0.0081). Conclusion. Anti-VEGF is effective in treating CSCR coexisting putative or visible CNV. Early initiation of anti-VEGF therapy benefits CSCR patients with putative CNV detected by OCTA. Translational relevance nonhomogenous hyperreflectivity in the choriocapillaris layer in OCTA indicates putative CNV in patients with CSCR, implying early treatment with anti-VEGF. [ABSTRACT FROM AUTHOR]

Purpose. To investigate the vascular density of the optic nerve head (ONH) and macula using optical coherence tomography angiography (OCTA) in patients undergoing vitrectomy for rhegmatogenous retinal detachment (RRD) and to evaluate associations with visual outcomes. Methods. Patients with RRD, successfully treated with a pars plana vitrectomy (PPV) and a minimum three-month follow-up were included in this study. The vessel density (VD) of the ONH and peripapillary regions, foveal avascular zone (FAZ), foveal flow density (FFD), and parafoveal flow density (PFD) were evaluated using OCTA and compared to the fellow eye. Multivariate linear regression analysis was performed to determine correlations with visual outcomes. Results. Thirty-one patients with macula-off RRD were included in the study. Compared with the fellow eyes, eyes after RRD surgery had a lower peripapillary VD (P < 0.01). No significant difference in superficial and deep FFD, PFD, and FAZ area was found compared to the fellow eyes. Postoperative peripapillary VD and baseline BCVA were significantly associated with BCVA three months after PPV (P < 0.05). Conclusion. Rhegmatogenous retinal detachment eyes successfully treated with PPV had lower peripapillary vessel density than fellow healthy eyes. Postoperative BCVA was related to postoperative peripapillary VD. [ABSTRACT FROM AUTHOR]

Topic. The aim of this study is to evaluate the efficacy of conbercept in PCV, which will optimize the management for PCV patients. Clinical Relevance. The use of antivascular endothelial growth factor (VEGF) therapy in polypoidal choroidal vasculopathy (PCV), a subtype of neovascular age-related macular degeneration (nAMD), has been well established in randomized clinical trials. This meta-analysis has evaluated the efficacy of a novel anti-VEGF agent, conbercept, in the management of PCV using ranibizumab and aflibercept as the reference agents. Methods. Thirty studies with 1308 eyes were identified and included in this study. The primary outcome measures were best-corrected visual acuity (BCVA), and secondary outcomes were optical coherence tomography characteristics and polyp regression rates. The pooled results were calculated by the random-effect or fixed-effect model according to the heterogeneity of the data. Results. Despite a large standard deviation in means (SMD) improvement for BCVA and central retinal thickness (CRT) in the conbercept group, there was no statistically significant difference in the other outcomes compared to ranibizumab and aflibercept. However, there was a greater polyp regression rate in the conbercept group at 12 months. Conclusions. This systematic review indicates that conbercept may achieve similar BCVA and CRT improvements as ranibizumab and aflibercept, with a superior rate of polyp regression at 12 months. [ABSTRACT FROM AUTHOR]

Choroidal neovascularization (CNV) is a leading cause of blindness in the elderly in developed countries and is particularly associated with age-related macular degeneration (AMD). Cabozantinib (CBZ) hinders the activation of multiple receptor tyrosine kinases involved in tumor angiogenesis, such as hepatocyte growth factor receptor (MET) and vascular endothelial growth factor receptor 2 (VEGFR2). We aimed to investigate the role and mechanism of CBZ in a mouse laser-induced CNV model. In zebrafish embryos, CBZ perturbed intersegmental vessel (ISV) formation without obvious neurodevelopment impairment. In the mouse laser-induced CNV model, phosphorylated hepatocyte growth factor receptor (p-MET) and phosphorylated vascular endothelial growth factor receptor 2 (p-VEGFR2) were increased in the CNV region. CBZ intravitreal injection or oral gavage alleviated CNV leakage and the CNV lesion area without obvious intraocular toxicity, as well as disturbed the phosphorylation of MET and VEGFR2. Additionally, CBZ downregulated the expression of the hepatocyte growth factor (HGF) with no effect on the expression of the vascular endothelial growth factor (VEGF). CBZ downregulated HGF, p-MET, and p-VEGFR2 expressions in vitro, as well as inhibited the proliferation, migration, and tube formation of b-End3 cells. In summary, CBZ alleviates mouse CNV formation possibly via inhibiting the activation of MET and VEGFR2. The findings provide a novel potential therapy method for CNV patients. [ABSTRACT FROM AUTHOR]

Purpose. To compare the functional and anatomical outcomes of one dose and three loading doses followed by the pro re nata (PRN) regimen in Chinese neovascular age-related macular degeneration (nvAMD) (including polypoidal choroidal vasculopathy (PCV)) patients. Methods. In this multicenter, prospective, open-label, controlled, 12-month study (ClinicalTrials.gov: NCT02810808), patients were randomized (1 : 1) to 1 dose + PRN (PRN group) or 3 loading doses + PRN (LD group) using intravitreal ranibizumab treatment. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were evaluated. The main outcome was the change in BCVA. The noninferiority limit was 5 letters. Results. Forty-five patients in the PRN group and 49 patients in the LD group finished 12-month follow-up. Each group included 4 PCV patients. The mean change in BCVA from baseline was 7.8 letters in the PRN group, compared with 10.9 letters in the LD group (P=0.344). There were no significant differences between two groups in the mean change of CRT (−159.3 μm vs. −120.5 μm) at month 12. The mean number of injections during the 12-month follow-up was 6.0 in the PRN group and 6.8 in the LD group. The proportion of patients who gained an improvement in visual acuity by 15 or more letters was 28.9% in the PRN group and 44.9% in the LD group (P=0.066). Conclusion. One dose + PRN showed noninferior visual gains than 3 loading doses + PRN regimen using ranibizumab in Chinese nvAMD and PCV patients. Number of injections in the PRN group was similar as that in the LD group but remained a potential risk of vision instability during one-year follow-up using OCT-guided retreatment criteria. This trial is registered with NCT02810808. [ABSTRACT FROM AUTHOR]

Purpose. To investigate the choroidal thickness (CT) and retinal thickness (RT) in highly myopic tessellated eyes. Methods. In this study, 115 highly myopic eyes were recruited and divided as tessellated fundus (n=93) and normal fundus (n=22). RT and CT were quantified using optical coherence tomography with enhanced depth imaging (EDI-OCT). Correlation between subfoveal CT (SFCT) and tessellation was analyzed using logistic regression models. Results. Tessellated fundus eyes had thinner CT than did normal fundus eyes, while RT was not statistically different across groups. The tessellated eyes had a thinner choroid than did the control eyes at all measured macular locations (all P<0.05). After adjustment for AL, age, and gender, the SFCT was significantly associated with tessellation. The odds ratio (OR) and 95% confidence interval (CI) was 0.975 (0.960–0.990, P=0.001, binary logistics regression) and 0.991 (0.984–0.999, P=0.022, Cox regression). The area under the curve (AUC) of SFCT was the greatest for detecting tessellation (AUC = 0.824, P<0.001). For sensitivity and specificity analyses, SFCT had the highest diagnostic value (sensitivity = 81.8%, specificity = 74.2%). Conclusions. Highly myopic eyes with tessellation have thinner CT than do normal highly myopic eyes. CT may serve as an early pathologic predictor of high myopia. [ABSTRACT FROM AUTHOR]

Purpose. To quantify macular vascular density using optical coherence tomography angiography (OCTA) and to investigate its relationship with retinal thickness in myopic eyes of young adults. Methods. In this cross-sectional study, 268 myopic eyes without pathological changes were recruited and divided into three groups: mild myopia (n=81), moderate myopia (n=117), and high myopia (n=70). Macular vascular density was quantified by OCTA and compared among three groups. Average retinal thickness, central subfield thickness, and macular ganglion cell complex (mGCC) thickness were also evaluated and compared. Correlations among these variables were analyzed. Results. There was no statistical difference in superficial (62.3 ± 5.7% versus 62.7 ± 5.9% versus 63.8 ± 5.5%) and deep macular vascular densities (58.3 ± 9.6% versus 59.2 ± 9.3% versus 60.9 ± 7.9%) among mild-myopia, moderate-myopia, and high-myopia groups (both P>0.05). Superficial and deep macular vascular densities both had correlations with mean arterial pressure. Furthermore, superficial macular vascular density was significantly correlated with mGCC thickness. Conclusions. Varying degrees of myopia did not affect macular vascular density in young healthy adults. In addition, superficial macular vascular density, as an independent factor, was positively correlated with mGCC thickness. [ABSTRACT FROM AUTHOR]

Purpose. To describe the morphological characteristics and efficacy of OCTA in detecting CNV in nAMD. We retrospectively reviewed 53 patients (86 eyes) with suspected CNV secondary to wet AMD. All the patients underwent a multimodal assessment for CNV. Two independent readers calculated the sensitivity and specificity of OCTA in detecting CNV compared with FA. A qualitative analysis of OCTA was also performed to describe the morphological appearance of CNV. Among 86 eyes of 53 patients, 52 eyes were diagnosed as having CNV based on the FA imaging analysis. According to FA, CNV was classified as classic in 28 eyes, predominantly classic in 6 eyes, minimally classic in 9 eyes, and occult in 9 eyes. In 56 eyes, CNV was visualized on OCTA and corresponding OCT B-scans. In total, 46.4% (26/56) had well-circumscribed vessels, and 53.6% (30/56) showed poorly circumscribed vessels. There were 11 false positives and 7 false negatives using OCTA. The specificity of OCTA for the detection of CNV was 67.6%, with sensitivity of 86.5%. OCTA may help in the noninvasive diagnosis of CNV and may provide a method for monitoring the evolution of CNV. [ABSTRACT FROM AUTHOR]