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Idiopathic central serous chorioretinopathy (ICSC) is a disease that typically affects middleaged adults and involves the sensory retina, the retinal pigment epithelium (RPE) and the choroid. Patients usually have mild visual loss. ICSC generally resolves without therapy, although the disease can become chronic with ensuing RPE decompensation. Some patients, particularly older adults, can also develop choroidal subretinal neovascularisations (CNV), which may lead to a severe loss in visual acuity. Although the aetiopathogenesis of the disease is still incompletely understood, a correlation with psychophysical stress supports the idea that the disease may be "adrenergically conditioned", leading to the development of one or several defects in the RPE, with subsequent focal leakage of serous fluid and its retention in the subretinal space. An association between ICSC and the Helicobacter pylori (HP) infection has also been recently documented, suggesting that this organism may possibly be involved in the development of some cases of ICSC. Pathogenetic mechanisms that may explain the contribution of HP in the development of ICSC are postulated.

PURPOSE: To report two cases of exudative idiopathic polypoidal choroidal vasculopathy treated by photodynamic therapy with verteporfin. DESIGN: Interventional case reports. METHODS: Two patients, a man aged 58 years and a woman aged 57 years, with recent visual impairment in the right eye (OD) (both eyes best-corrected visual acuity: 10/50 and Pelli-Robson contrast sensitivity 1.35 and 1.20) and angiographically proved subfoveal idiopathic polypoidal choroidal vasculopathy were treated with photodynamic therapy using verteporfin (Visudyne; Novartis SA, Rueil Malmaison, France). Functional and angiographic outcomes were assessed 6 weeks and 3, 6, and 12 months after treatment. RESULTS: In Patient 1, 3 months after treatment, best-corrected visual acuity and contrast sensitivity improved (10/16 and 1.50) and then remained stable throughout the 12 months after treatment. In Patient 2, 6 weeks after treatment, vision and contrast sensitivity were 10/20 and 1.35; and at 3 months, were improved and stabilized at 10/12.5 and 1.50. Angiographically, photodynamic therapy with verteporfin was associated with nonperfusion and occlusion of the exudative polypoidal dilations. No acute recurrence was noted during the follow-up period. CONCLUSION: In subfoveal exudative idiopathic polypoidal choroidal vasculopathy, photodynamic therapy with verteporfin may be associated with beneficial functional results.

PURPOSE: To evaluate the safety, tolerability and bioactivity of ascending doses of MP0112, a designed ankyrin repeat protein (DARPin) that binds with high affinity to vascular endothelial growth factor-A (VEGF-A), in treatment-naive patients with exudative age-related macular degeneration (AMD). DESIGN: Phase I/II, open-label, multicenter, dose-escalation study. METHODS: Patients were to receive a single intravitreal injection of MP0112 at doses ranging from 0.04 to 3.6 mg and be monitored for 16 weeks for safety, efficacy, pharmacokinetics, and dose response. RESULTS: Altogether, 32 patients received a single injection of MP0112. The maximum tolerated dose was 1.0 mg because of a case of endophthalmitis in the 2.0 mg cohort. Drug-related adverse events were reported by 13 (41%) of 32 patients; they included ocular inflammation in 11 patients (7 mild, 4 moderate in severity). Visual acuity scores were stable or improved compared with baseline for >= 4 weeks following injection; both retinal thickness and fluorescein angiography leakage decreased in a dose-dependent manner. Rescue therapy was administered to 20 (91%) of 22 patients who received 0.04-0.4 mg MP0112 compared with 4 of 10 (40%) patients who received 1.0 or 2.0 mg. Of patients in the higher-dose cohorts who did not require rescue treatment, 83% (5/6) maintained reductions in central retinal thickness through week 16. CONCLUSIONS: A single injection of 1.0 or 2.0 mg MP0112 resulted in mean decreases in retinal thickness and leakage area despite ocular inflammation. larger-scale studies are warranted to confirm these observations. (C) 2014 The Authors. Published by Elsevier Inc. All rights reserved. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/). PURPOSE: To evaluate the safety, tolerability and bioactivity of ascending doses of MP0112, a designed ankyrin repeat protein (DARPin) that binds with high affinity to vascular endothelial growth factor-A (VEGF-A), in treatment-naive patients with exudative age-related macular degeneration (AMD). DESIGN: Phase I/II, open-label, multicenter, dose-escalation study. METHODS: Patients were to receive a single intravitreal injection of MP0112 at doses ranging from 0.04 to 3.6 mg and be monitored for 16 weeks for safety, efficacy, pharmacokinetics, and dose response. RESULTS: Altogether, 32 patients received a single injection of MP0112. The maximum tolerated dose was 1.0 mg because of a case of endophthalmitis in the 2.0 mg cohort. Drug-related adverse events were reported by 13 (41%) of 32 patients; they included ocular inflammation in 11 patients (7 mild, 4 moderate in severity). Visual acuity scores were stable or improved compared with baseline for >= 4 weeks following injection; both retinal thickness and fluorescein angiography leakage decreased in a dose-dependent manner. Rescue therapy was administered to 20 (91%) of 22 patients who received 0.04-0.4 mg MP0112 compared with 4 of 10 (40%) patients who received 1.0 or 2.0 mg. Of patients in the higher-dose cohorts who did not require rescue treatment, 83% (5/6) maintained reductions in central retinal thickness through week 16. CONCLUSIONS: A single injection of 1.0 or 2.0 mg MP0112 resulted in mean decreases in retinal thickness and leakage area despite ocular inflammation. larger-scale studies are warranted to confirm these observations. (C) 2014 The Authors. Published by Elsevier Inc. All rights reserved. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

Age-related macular degeneration (ARMD) is the leading cause of visual loss among patients over 65 in industrialized countries. In it, the most severe visual loss results from onset of choroidal neovascularization (CNV) (Bressler et al 1988). Fluorescein angiography (FA) data reveal three CNV subgroups according to Macular Photocoagulation Study (MPS) guidelines (Macular Photocoagulation Study Group 1996): classic without occult CNV, occult without classic CNV, and mixed (classic CNV associated with occult CNV). All types of CNV can be associated with pigment epithelium detachment (PED). Recently, indocyanine green angiography (ICG) has contributed to better recognition of clinical forms of CNV.

Background/aims—Radiotherapy has been proposed as an alternative treatment for patients with subfoveal choroidal neovascularisation (CNV) that is untreatable according to macular photocoagulation study guidelines. This prospective study was designed to evaluate whether radiotherapy may aVect the functional and anatomical outcome in a large cohort of patients aVected by subfoveal CNV, with a follow up period up to 24 months. Methods—212 patients (231 eyes) with newly diagnosed subfoveal CNV not amenable to laser therapy were included in this study. Two radiotherapy methods, the lateral beam technique (6 MV, 20 Gy in five fractions) and lateral arc therapy (25 MV, 16 to 20 Gy, in four or five fractions), were used. Comparisons of best corrected visual acuity (VA), fluorescein (FA) and indocyanine green (ICG) angiography, at inclusion and 6, 12, 18, and 24 months after radiotherapy were performed using univariate analysis. Results—A VA improvement of two or more lines was observed in 34% at 12 months, 31% at 18 months, and 32% of the eyes at 24 months. Paired comparisons of CNV areas in FA and ICG showed no significant change between baseline and each visit. However, 12 and 18 months after treatment, 47% of the eyes showed a decrease of 10% or more in CNV size both in ICG and FA. Radiation side eVects included radiation retinopathy (eight eyes), optic neuropathy (four eyes), choroidal vasculopathy (five eyes), and branch retinal vein occlusion (three eyes). Conclusion—Compared with the natural course of subfoveal CNV, the results of this prospective study suggest that radiotherapy could stabilise visual and anatomical outcome in selected cases. (Br J Ophthalmol 1999;83:923‐928)

Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in adults aged over 50 years in developed countries. In 2006, the use of intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) drugs revolutionised the therapeutic approach to treating neovascular AMD. However, it is essential to detect the frequent diagnostic pitfalls encountered in this therapeutic domain to apply anti-VEGF therapy successfully and thereby avoid useless treatments. Classic pitfalls include – retinal pigmented epithelium-photoreceptor abnormalities mimicking choroidal neovascularisation; persistent serous retinal detachment; pseudocysts and cystoid cavities mimicking retinal oedema; and outer retinal tubulations. Current imaging technologies, such as colour fundus photography, autofluorescence (FAF) and infrared imaging, fluorescein (FA) and indocyanine green (ICGA) angiographies, spectral domain optical coherence tomography (SD-OCT) and enhanced depth imaging OCT (EDI-OCT), can help overcome these pitfalls. Even if anti-VEGF treatments are mostly based on SD-OCT data, the consolidation and correlational analysis of all the available patient data is essential for accurate diagnosis.

Objectif Evaluer l’effet protecteur de la Superoxyde dismutase (SOD) orale en prevention secondaire sur le pourcentage de bi-lateralisation de DMLA neovasculaire apres un an de traitement. Materiels et Methodes Etude pilote prospective randomisee en double aveugle. Quarante-sept patients presentant une DMLA neovasculaire unilaterale et une acuite visuelle de l’œil sain > 5/10, ont experimente un traitement par SOD orale – Glisodine® (groupe b) versus placebo (groupe a) durant un an. Suivi clinique et angiographique trimestriel. La cotation de la maculopathie s’est faite selon l’echelle simplifiee d’AREDS. Resultats A deux ans : 22 patients placebo (groupe a) et 20 patients traites par Glisodine® (groupe b) sans difference significative de distribution initiale du score AREDS. 28 % de patients du groupe a versus 32 % de patients du groupe b ont presente une neo-vascularisation sur le deuxieme œil. Le score AREDS des deux groupes s’aggrave de facon significative. Le score du groupe traite s’aggrave plus que celui du groupe placebo. Discussion L’inefficacite de la SOD peut etre expliquee soit par un manque de puissance statistique du au faible echantillon des patients soit par un emballement de la chaine anti-oxydante, necessitant d’autres enzymes pour detoxifier definitivement les radicaux libres. Conclusion La SOD parait inefficace dans la prevention secondaire de la DMLA.

Purpose To investigate whether individuals, with no family history of ataxia telangiectasia (AT), in whom idiopathic or radiation-induced ocular telangiectasia developed are carriers of ATM gene mutations. Methods The ATM cDNA from lymphoblastoid cell lines established from 16 patients with idiopathic retinal or choroidal telangiectasia and 14 patients with radiation-induced telangiectasia after radiotherapy for age-related macular degeneration (AMD) was screened using the restriction endonuclease fingerprinting technique. The frequency of each detected variant was determined in the French population by either a mass spectrometry-based technique or variant-specific endonuclease digestion. Results Twenty-one ATM missense alterations, at 10 different sites, 8 of which would result in an amino acid substitution at a conserved position in the ATM protein were found. Four were novel changes, three of which were not detected in the 128 French control subjects screened. Eleven of 16 of the individuals with either idiopathic polypoidal choroidal vasculopathy or juxtafoveolar retinal telangiectasis and 6 of 14 individuals that had choroidal telangiectasis after radiotherapy for AMD carried ATM sequence variants. These latter six individuals had a significantly shorter delay time before the presentation of this vasculopathy compared with those individuals who had a wild-type ATM (11.8 +/- 3.4 months vs. 17.5 +/- 4.5 months, P = 0.024). They had also received a lower average dose of X-rays, although this difference did not reach statistical significance (18.7 +/- 3.9 Gy vs. 23.7 +/- 5.6 Gy, P = 0.09). Conclusions ATM missense variants could confer an AT-like phenotype and influence the formation of retinal and choroidal vascular abnormalities.