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      Comparison between 1-year outcomes of aflibercept with and without photodynamic therapy for polypoidal choroidal vasculopathy: Retrospective observation study

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          Abstract

          Polypoidal choroidal vasculopathy (PCV) is characterized by polyp-like choroidal neovascularization and a branching vascular network. Intravitreal aflibercept injection (IAI) or photodynamic therapy (PDT) is used for treatment. We retrospectively compared the 1-year outcomes of IAI monotherapy and its combination with initial PDT for PCV. Twelve eyes with naïve PCV received three IAIs and a single PDT after the first IAI and as needed injection (combination group); 11 eyes with naïve PCV received three IAIs and as needed injections (IAI group). Significant improvements in visual acuity after 2 months and in CRT after 1 month were maintained at 12 months in both groups (both P < 0.05); groups did not differ significantly at any time point. CCT significantly reduced after 3 and 12 months in the combination group (both P < 0.05) but not in the IAI group. A mean of 3.7 ± 0.9 and 5.6 ± 2.0 injections was administered to the combination and IAI groups, respectively ( P = 0.013). Within a 1-year period, combination therapy was found to yield similar visual acuity and retinal structure improvements and maintenance as IAI monotherapy while requiring fewer IAIs.

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          An optical coherence tomography-guided, variable dosing regimen with intravitreal ranibizumab (Lucentis) for neovascular age-related macular degeneration.

          To evaluate an optical coherence tomography (OCT)-guided, variable-dosing regimen with intravitreal ranibizumab for the treatment of patients with neovascular age-related macular degeneration (AMD). Open-label, prospective, single-center, nonrandomized, investigator-sponsored clinical study. In this two-year study, neovascular AMD patients with subfoveal choroidal neovascularization (CNV) (n = 40) and a central retinal thickness of at least 300 microm as measured by OCT were enrolled to receive three consecutive monthly intravitreal injections of ranibizumab (0.5 mg). Thereafter, retreatment with ranibizumab was performed if one of the following changes was observed between visits: a loss of five letters in conjunction with fluid in the macula as detected by OCT, an increase in OCT central retinal thickness of at least 100 microm, new-onset classic CNV, new macular hemorrhage, or persistent macular fluid detected by OCT at least one month after the previous injection of ranibizumab. At month 12, the mean visual acuity improved by 9.3 letters (P < .001) and the mean OCT central retinal thickness decreased by 178 microm (P < .001). Visual acuity improved 15 or more letters in 35% of patients. These visual acuity and OCT outcomes were achieved with an average of 5.6 injections over 12 months. After a fluid-free macula was achieved, the mean injection-free interval was 4.5 months before another reinjection was necessary. This OCT-guided, variable-dosing regimen with ranibizumab resulted in visual acuity outcomes similar to the Phase III clinical studies, but required fewer intravitreal injections. OCT appears useful for determining when retreatment with ranibizumab is necessary.
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            Novel method for analyzing snellen visual acuity measurements.

            Most retrospective reviews convert Snellen visual acuity measurements obtained during routine clinic visits to logarithm of the minimum angle of resolution (logMAR) units so that statistical manipulations can be performed. However, visual acuity measurements expressed as logMAR units are not intuitively interpretable by clinicians. A more intuitive approach is presented here which uses the conversion of Snellen visual acuity fractions to Early Treatment Diabetic Retinopathy Study (ETDRS) letter scores for statistical manipulations. Snellen visual acuity measurements were converted to approximate ETDRS (approxETDRS) letter scores for statistical manipulations and then converted back to Snellen equivalent fractions. The formula to convert Snellen visual acuity measurements to approxETDRS letter scores is 85 + 50 x log (Snellen fraction), which may be rounded to the nearest letter. A linear relationship exists between true ETDRS letter scores, approxETDRS letter scores, and logMAR units. The interconversion between Snellen visual acuity measurements, logMAR units, and approxETDRS letter scores was prepared in a tabular form for easy reference. The same outcomes (in Snellen fractions) were obtained with statistical manipulation of either approxETDRS letter scores or logMAR conversions. Conversion of Snellen visual acuity fractions to approxETDRS letter scores for the purpose of performing statistical manipulations provides more readily interpretable outcomes compared with the current strategy of converting Snellen visual acuity fractions to logMAR units.
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              Idiopathic polypoidal choroidal vasculopathy (IPCV).

              Eleven patients, 40 to 71 years old, had a choroidal vasculopathy that led to hemorrhagic and exudative macular degeneration. The patients had peculiar polypoidal, subretinal, vascular lesions associated with serious and hemorrhagic detachments of the retinal pigment epithelium. This macular disorder, which we have named idiopathic polypoidal choroidal vasculopathy (IPCV), appears to represent a distinct entity that differs clinically and demographically from age-related macular degeneration (AMD) and other macular diseases associated with subretinal neovascularization. Recognition of this condition is important because it may have specific risk factors, natural course, and management considerations that differ from those of age-related macular degeneration.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                3 May 2017
                2017
                : 12
                : 5
                : e0176100
                Affiliations
                [1 ]Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
                [2 ]Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
                Massachusetts General Hospital, UNITED STATES
                Author notes

                Competing Interests: HT received personal fees from Bayer HealthCare, Novartis, Santen, Wakamoto, and Pfizer, as well as research funding from Novartis, Santen, Wakamoto, and Pfizer. There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials.

                • Conceptualization: KT HK.

                • Data curation: KT HF.

                • Formal analysis: HK.

                • Funding acquisition: HK HT.

                • Investigation: KT FH HF TT.

                • Methodology: KK YI.

                • Project administration: YI.

                • Resources: KH FH.

                • Software: ER KT.

                • Supervision: HT.

                • Validation: KH.

                • Visualization: KT.

                • Writing – original draft: KT.

                • Writing – review & editing: KT HK YI HT.

                Author information
                http://orcid.org/0000-0003-0731-6465
                Article
                PONE-D-17-02840
                10.1371/journal.pone.0176100
                5415056
                28467427
                c0a2a723-ea5e-49bd-a56e-f3c79b9697cd
                © 2017 Takayama et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 21 January 2017
                : 5 April 2017
                Page count
                Figures: 4, Tables: 3, Pages: 12
                Funding
                Funded by: Grants-in-Aid for Scientific Research B
                Award ID: 15H04994
                Award Recipient :
                Funded by: Grant-in-Aid for Young Scientists B
                Award ID: 16K20313
                Award Recipient :
                Funded by: Chukyo longevity medical and promotion foundation
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100006680, Takeda Medical Research Foundation;
                Award Recipient :
                Funded by: The Hori Science and Arts Foundation
                Award Recipient :
                Funded by: Grant-in-Aid for Young Scientists B
                Award ID: 17K16964
                Award Recipient :
                The study was supported by a grant from the Grants-in-Aid for Scientific Research B (H. Terasaki, 15H04994), Grant-in-Aid for Young Scientists B (K. Kataoka, 16K20313), Grant-in-Aid for Young Scientists B (K. Takayama,17K16964), Chukyo longevity medical and promotion foundation (H. Kaneko), and Takeda Medical Research Foundation (H.Kaneko). There are no patents, products in development or marketed products to declare. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
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