Korean J Ophthalmol.  2019 Jun;33(3):228-237. 10.3341/kjo.2018.0125.

Outcomes of Anti-vascular Endothelial Growth Factor Treatment for Foveal Serous Retinal Detachment Associated with Inferior Staphyloma

Affiliations
  • 1Department of Ophthalmology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.
  • 2Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. hgonyu@snu.ac.kr

Abstract

PURPOSE
To evaluate the efficacy of anti-vascular endothelial growth factor (VEGF) treatment of eyes with foveal serous retinal detachment (SRD) associated with inferior staphyloma and to investigate choroidal thickness changes following anti-VEGF therapy.
METHODS
In this observational case series, eyes with inferior staphyloma accompanied by foveal SRD were treated with a single intravitreal anti-VEGF injection, followed by further injections as needed. Changes in height and width of subretinal fluid (SRF) and visual acuity after treatment were assessed. Choroidal thickness was measured at the subfovea, 1.5 mm superior and inferior to the fovea using enhanced depth imaging optical coherence tomography at baseline and 1 month after initial anti-VEGF therapy.
RESULTS
Six eyes from six patients were included. One month after the initial injection, the mean SRF height and width had decreased significantly from 112.5 ± 40.1 to 44.5 ± 48.7 µm (p = 0.046) and from 1,401.8 ± 627.3 to 690.7 ± 634.7 µm (p = 0.028), respectively. Mean choroidal thickness at the superior point decreased from 218.7 ± 59.3 to 200.5 ± 61.0 µm (p = 0.046). SRF resolved completely in three of the six eyes (50%) with a mean of 6.8 ± 5.9 injections (range, 1 to 15). All eyes experienced at least one recurrence of exudation, at a mean interval of 4.8 months. Mean visual acuity improvement was 0.17 logarithm of the minimum angle of resolution units at a mean of 28.7 months follow-up.
CONCLUSIONS
Anti-VEGF therapy resulted in an SRF decrease and modest visual improvement in eyes with foveal SRD associated with inferior staphyloma. Reduction in superior choroidal thickness appeared to contribute to the clinical improvements that were observed.

Keyword

Anti-vascular endothelial growth factor therapy; Choroidal thickness; Inferior staphyloma; Serous retinal detachment; Tilted disc syndrome

MeSH Terms

Choroid
Endothelial Growth Factors*
Follow-Up Studies
Humans
Recurrence
Retinal Detachment*
Retinaldehyde*
Subretinal Fluid
Tomography, Optical Coherence
Visual Acuity
Endothelial Growth Factors
Retinaldehyde

Figure

  • Fig. 1 An enhanced depth imaging optical coherence tomography image demonstrating the morphologic parameters measured in this study. The dotted line indicates the posterior edge of the choroid, and the white double arrows indicate the choroidal thickness. SRF = subretinal fluid.

  • Fig. 2 A 52-year-old man (case 1) with foveal serous retinal detachment associated with inferior staphyloma. (A) Fundus photograph revealed inferior staphyloma and inferior peripapillary crescent (arrow). (B) Fluorescein angiography showed a belt-shaped area of granular hyperfluorescence (arrowheads) corresponding to the border of the inferior staphyloma. (C) Indocyanine green angiography demonstrated a hypofluorescent band (arrowheads). (D) Baseline spectral-domain optical coherence tomography showed foveal serous retinal detachment. (E) After two bevacizumab injections, subretinal fluid (SRF) resolved completely. (F) The patient experienced a mild recurrence and resolution after the injection, and he received four bevacizumab injections over a period of 2 years. Thereafter, SRF recurred. (G) After two more injections, SRF decreased. (H) Seven additional bevacizumab injections were performed with repeated recurrence and resolution, and no SRF was observed at the last visit.

  • Fig. 3 A 41-year-old man (case 2) with foveal serous retinal detachment (SRD) associated with inferior staphyloma. (A) Fundus photograph showed inferior staphyloma with a superior border across the macula. (B) Fluorescein angiography revealed multiple pinpoint staining (arrowheads). (C) Indocyanine green angiography demonstrated subtle hypofluorescence (arrowheads). (D) Baseline spectral-domain optical coherence tomography showed foveal SRD. (E) After three bevacizumab injections, subretinal fluid (SRF) decreased slightly, but persisted. (F) Complete resolution of SRF was noted after three more bevacizumab injections. (G) SRD recurred 3 months later. (H) After one more injection, SRF decreased, but remained present.

  • Fig. 4 A 68-year-old woman (case 3) with foveal serous retinal detachment associated with inferior staphyloma. (A) Fundus photograph showed inferior staphyloma and inferior peripapillary crescent (arrow). (B) Fluorescein angiography revealed multiple pinpoint staining (arrowheads). (C) Baseline spectral-domain optical coherence tomography demonstrated foveal serous retinal detachment. (D) After one ranibizumab injection, the subretinal fluid (SRF) resolved completely. (E) The patient experienced repeated mild recurrence and resolution after the injection, and she received nine ranibizumab injections over a period of 3 years. Thereafter, a small amount of SRF accumulated again. (F) After two additional injections for 8 months, no SRF was observed at the last visit.

  • Fig. 5 A 59-year-old woman (case 4) with foveal serous retinal detachment associated with inferior staphyloma. (A) Fundus photograph showed inferior staphyloma and inferior peripapillary crescent (arrow). (B) Fluorescein angiography revealed multiple pinpoint staining (arrowheads). (C) Baseline spectral-domain optical coherence tomography demonstrated foveal serous retinal detachment. (D) After one bevacizumab injection, subretinal fluid (SRF) resolved completely. (E) SRF increased 10 months later. (F) After one more bevacizumab injection, the SRF was completely absorbed.

  • Fig. 6 A 36-year-old man (case 5) with foveal serous retinal detachment (SRD) associated with inferior staphyloma. (A) Fundus photograph showed inferior staphyloma and inferior peripapillary crescent (arrow). (B) There was no evidence of leakage or staining on fluorescein angiography. (C) Indocyanine green angiography demonstrated subtle hypofluorescence (arrowheads). (D) Baseline spectral-domain optical coherence tomography showed foveal SRD. (E) One aflibercept injection decreased the amount of subretinal fluid (SRF) slightly, but the SRF persisted. (F) The SRF had increased 4 months later. (G) The patient declined further injections. At the final visit, the foveal SRD remained.

  • Fig. 7 A 76-year-old woman (case 6) with foveal serous retinal detachment associated with inferior staphyloma. (A) Fundus photograph showed inferior staphyloma and inferior peripapillary crescent (arrow). (B) Fluorescein angiography revealed multiple pinpoint staining (arrowheads). (C) Baseline spectral-domain optical coherence tomography showed foveal serous retinal detachment. (D) Two bevacizumab injections reduced the amount of subretinal fluid (SRF), but SRF was still present. (E) SRF had increased 2 months later. (F) After one more bevacizumab injection, SRF decreased slightly, but remained. (G) The patient declined further injections. At the final visit, little SRF remained.

  • Fig. 8 Comparison of measurements at baseline and 1 month after the initial anti-vascular endothelial growth factor injection. (A) Central foveal thickness, (B) height and (C) width of subretinal fluid (SRF), and (D) choroidal thicknesses measured 1.5 mm inferior to the fovea, (E) at the subfovea, and (F) 1.5 mm superior to the fovea. Box plots indicate median values with 5th and 95th percentiles. Tx = treatment. *p < 0.05 by Wilcoxon signed rank test.


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