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Multimodal imaging of bilateral diffuse uveal melanocytic proliferation associated with an iris mass lesion

Naysan, Jonathan; Pang, Claudine E; Klein, Robert W; Freund, K Bailey
BACKGROUND: Bilateral diffuse uveal melanocytic proliferation (BDUMP) is a rare, paraneoplastic syndrome characterized by bilateral painless visual loss and proliferation of choroidal melanocytes in association with an underlying systemic malignancy. We report a case of bilateral diffuse uveal melanocytic proliferation associated with an underlying gynecological malignancy that also features the infrequent finding of an iris mass lesion, using multimodal imaging including ultra-widefield imaging, spectral domain and swept-source optical coherence tomography. CASE PRESENTATION: A 59-year-old white female with a prior history of gynecological malignancy in remission presented with progressive bilateral visual loss over several weeks. The patient was noted to have a focal iris mass lesion in her right eye. Ultra-widefield color fundus photography showed a characteristic bilateral 'giraffe pattern' of pigmentary changes extending into the periphery as well as multiple discrete deeply pigmented lesions. Ultra-widefield autofluorescence was useful for visualizing the full extent of involvement. Indocyanine green angiography helped to demarcate the discrete pigmented choroidal lesions. Swept-source OCT clearly delineated the alternating zones of retinal pigment epithelium (RPE) thickening and RPE loss, as well as the prominent choroidal infiltration and thickening. CONCLUSIONS: BDUMP is an important diagnosis to consider in the presence of multiple discrete melanocytic choroidal lesions, diffuse choroidal thickening, characteristic RPE changes, iris mass lesions and exudative retinal detachment. Ultra-widefield imaging may demonstrate more extensive lesions than that detected on clinical examination or standard field imaging. Imaging with SS-OCT shows choroidal and RPE characteristics that correlate well with known histopathology of this entity.
PMCID:5088479
PMID: 27847631
ISSN: 2056-9920
CID: 2310572

Building of an empire [Historical Article]

Fisher, Yale L; Sorenson, John; Slakter, Jason S; Spaide, Richard S; Freund, K Bailey; Klein, Robert W
PMID: 22270782
ISSN: 0275-004x
CID: 811452

Longer-term outcomes of a prospective study of intravitreal ranibizumab as a treatment for decreased visual acuity secondary to central retinal vein occlusion

Chang, Louis K; Spaide, Richard F; Klancnik, James M; Sorenson, John; Slakter, Jason S; Freund, K Bailey; Yannuzzi, Lawrence A; Tseng, Joseph J; Klein, Robert
PURPOSE: To evaluate long-term effectiveness and safety of intravitreal injection of ranibizumab as a potential treatment for decreased visual acuity secondary to central retinal vein occlusion. METHODS: In this prospective interventional case series, patients with central retinal vein occlusion were administered intravitreal ranibizumab 0.5 mg at baseline and monthly for 2 additional doses. Thereafter, the patients were given additional ranibizumab if they had macular edema by optical coherence tomography, leakage during fluorescein angiography, or any intraretinal hemorrhage. RESULTS: There were 35 eyes of 35 patients who at baseline had a mean visual acuity of 44.2 Early Treatment Diabetic Retinopathy Study letters and a mean central macular thickness of 638 mum. At 12 months, mean visual acuity of 32 eyes improved by 16.5 letters and macular thickness decreased to 164 mum (P < 0.001 vs. baseline for each). At 24 months, mean visual acuity of 24 eyes improved by 17.8 letters and macular thickness was 263 mum (P < 0.001 vs. baseline for each). Patients received an average of 10.2 injections during the first year and 6.6 injections during the second year. No cases of endophthalmitis, retinal detachment, or neovascularization were observed. CONCLUSION: Intravitreal ranibizumab caused a significant improvement in visual acuity and central retinal thickness, which persisted for up to 2 years with minimal side effects
PMID: 21317833
ISSN: 1539-2864
CID: 141292

Prevalence of respiratory syncytial virus (RSV) risk factors and cost implications of immunoprophylaxis to infants 32 to 35 weeks gestation for health plans in the United States

Krilov, Leonard R; Palazzi, Debra L; Fernandes, Ancilla W; Klein, Robert W; Mahadevia, Parthiv J
BACKGROUND: During the period of this study, the American Academy of Pediatrics (AAP) 2006 guidelines recommended respiratory syncytial virus (RSV) prophylaxis for infants 32 to 35 weeks gestation age (wGA) with two or more of five risk factors (RFs). New recommendations have recently been published in 2009. The cost implications of expanding this list of RFs to include other evidence-based RFs like passive smoke exposure (PSE), crowded living conditions (CLCs), and young chronological age (YCA) are unclear. METHODS: We estimated the prevalence of RSV RFs in a US sample of infants 32 to 35 wGA referred for prophylaxis from nine specialty pharmacy providers during the 2007-2008 season. We estimated the percent eligible for RSV prophylaxis under various potential RF coverage policies. Using a budget impact model, we calculated the per-member-per-month (PMPM) cost for each policy in 2007 USD for a hypothetical one million member plan. RESULTS: Infants 32 to 35 wGA represented 0.08% of the plan. Approximately 20.2% of these infants met at least two or more of five AAP RFs. Expanding this list to include one additional RF of PSE, CLC, or YCA increased the percent of infants potentially prophylaxed to 29.9%, 23.9%, and 47%, respectively. Adding all three RFs to the list (two or more of eight) increased the percent of infants potentially prophylaxed to 55.6%, and increased payer costs by 9 cents PMPM. CONCLUSION: Expanding the AAP RF criteria to include PSE, CLC, and YCA would identify more 32 to 35 wGA infants at high risk for severe RSV disease at an acceptable budget impact.
PMID: 19706010
ISSN: 1098-3015
CID: 947252

Prospective study of intravitreal ranibizumab as a treatment for decreased visual acuity secondary to central retinal vein occlusion

Spaide, Richard F; Chang, Louis K; Klancnik, James M; Yannuzzi, Lawrence A; Sorenson, John; Slakter, Jason S; Freund, K Bailey; Klein, Robert
PURPOSE: To evaluate intravitreal injection of ranibizumab as a potential treatment for decreased visual acuity (VA) secondary to central retinal vein occlusion (CRVO). DESIGN: Prospective, interventional case series. METHODS: Patients with CRVO prospectively recruited from a practice were administered intravitreal ranibizumab 0.5 mg (Lucentis; Genentech Inc, South San Francisco, California, USA) at baseline and monthly for two additional doses. The patients were given additional ranibizumab if they had macular edema as determined by optical coherence tomography or any new intraretinal hemorrhage. Patients were evaluated for number of required injections, side effects, changes in VA, and macular thickness. RESULTS: There were 20 eyes of 20 patients who at baseline had a mean age of 72.1 years, a mean VA of 45.8 Early Treatment of Diabetic Retinopathy letters, and a mean central macular thickness of 574.6 microm. Of the 20 eyes, five previously had received intravitreal triamcinolone and 11 had received intravitreal bevacizumab (Avastin; Genentech Inc). At 12 months of follow-up, the mean VA improved to 64.3 letters and the central macular thickness decreased to 186 microm (both different than baseline values; P < .001) using a mean of 8.5 injections. The change in macular thickness was not correlated with the change in VA. In one patient with a history of transient ischemic attack, an ischemic stroke developed but no sequela resulted. In another patient, vitreomacular traction developed, but the patient had improved acuity as compared with baseline. There were no infections, retinal tears, or detachments. CONCLUSIONS: Intravitreal ranibizumab used over a period of one year improved mean VA, with low rates of adverse events, in patients with CRVO
PMID: 18929354
ISSN: 1879-1891
CID: 94064

Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration: Two-year results of a randomized clinical trial including lesions with occult with no classic choroidal neovascularization-verteporfin in photodynamic therapy report 2

Arnold J; Kilmartin D; Olson J; Neville S; Robinson K; Laird A; Richmond C; Farrow A; McKay S; McKechnie R; Evans G; Aaberg TM; Brower J; Waldron R; Loupe D; Gillman J; Myles B; Saperstein DA; Schachat AP; Bressler NM; Bressler SB; Nesbitt P; Porter T; Hawse P; Harnett M; Eager A; Belt J; Cain D; Emmert D; George T; Herring M; McDonald J; Mones J; Corcostegui B; Gilbert M; Duran N; Sisquella M; Nolla A; Margalef A; Miller JW; Gragoudas ES; Lane AM; Emmanuel N; Holbrook A; Evans C; Lord US; Walsh DK; Callahan CD; DuBois JL; Moy J; Kenney AG; Milde I; Platz ES; Lewis H; Kaiser PK; Holody LJ; Lesak E; Lichterman S; Siegel H; Fattori A; Ambrose G; Fecko T; Ross D; Burke S; Conway J; Singerman L; Zegarra H; Novak M; Bartel M; Tilocco-DuBois K; Ilc M; Schura S; Joyce S; Tanner V; Rowe P; Smith-Brewer S; Greanoff G; Daley G; DuBois J; Lehnhardt D; Kukula D; Fish GE; Jost BF; Anand R; Callanan D; Arceneaux S; Arnwine J; Ellenich P; King J; Aguado H; Rollins R; Anderson T; Nork C; Duignan K; Boleman B; Jurklies B; Pauleikhoff D; Hintzmann A; Fischer M; Sowa C; Behne E; Pournaras CJ; Donati G; Kapetanios AD; Cavaliere K; Guney-Wagner S; Gerber N; Sickenberg M; Sickenberg V; Gans A; Hosner B; Sbressa A; Kozma C; Curchod M; Ardoni S; Harding S; Yang YC; Briggs M; Briggs S; Phil EB; Tompkin V; Jackson R; Pearson S; Natha S; Sharp J; Tompkin A; Lim JI; Flaxel C; Padilla M; Levin L; Walonker F; Cisneros L; Nichols T; Schmidt-Erfurth U; Barbazetto I; Laqua H; Kupfer R; Bulow R; Glisovic B; Bredfeldt T; Elsner H; Wintzer V; Bahlmann D; Michels S; Gordes R; Neppert B; Grote M; Honnicke K; Blumenkranz MS; Little HL; Jack R; Espiritu LM; Unyi L; Regan J; Lamborn L; Silvestri C; Rosa RH; Rosenfeld PJ; Lewis ML; Rodriguez B; Torres A; Munoz N; Contreras T; Galvez M; Hess D; Cubillas T; Rams I; Slakter JS; Sorenson JA; Bruschi PA; Burke K; Schnipper E; Maranan L; Scolaro M; Riff M; Agresta E; Napoli J; Johansson I; Dedorsson I; Stenkula S; Hvarfner C; Carlsson T; Liljedahl AM; Fallstrom S; Jacobsson E; Hendeberg K; Soubrane G; Kuhn D; Oubraham H; Benelhani A; Kunsch A; Delhoste B; Ziverec G; Lasnier M; Debibie C; Lobes LA; Olsen K; Bahr BJ; Worstell NT; Wilcox LA; Wellman LA; Vagstad G; Steinberg D; Campbell A; Ma C; Dreyer R; Williamson B; Johnson M; Crider H; Anderson H; Brown T; Jelinek K; Graves D; Pope S; Boone R; Beaumont W; Margherio RR; Williams GA; Zajechowski M; Stanley C; Kulak M; Streasick P; Szdlowski L; Falk R; Shoichet S; Regan G; Manatrey P; Cumming K; Fadel R; Mitchel B; Vandell L; Yesestrepsky D; Medina T; Bridges C; Huston G; Koenig F; Benchaboune M; Mezmate K; Fontanay S; Meredith T; Binning J; Gualdoni J; Boyd L; Ort E; Barts B; Allen R; Dahl J; Holle T; Harvey PT; Kaus L; Leuschner D; Bolychuk S; Hewitt I; Voyce J; Menchini U; Bandello F; Virgili G; Lanzetta P; Ambesi M; Pirracchio A; Tedeschi M; Potter MJ; Sahota B; Hall L; Le G; Rai S; Johnson D; Stur M; Lukas J; Tittl M; Docker S; Vogl K; Bressler SB; Bressler NM; Pieramici DJ; Manos KS; Cooper R; Denbow RL; Lowery ER; Phillips DA; Thibeault SK; Tian Y; Alexander J; Harnett M; Hawse P; Orr PR; Black N; Escartin P; Hartley D; Haworth P; Hecker T; Hiscock D; Jamali F; Maradan N; North J; Norton B; Stapleton-Hayes T; Taylor R; Huber G; Deslandes JY; Fsadni M; Hess I; de Pommerol H; Bobillier A; Reaves A; Banasik S; Birch R; Koester J; Stickles R; Truett K; McAlister L; Parker F; Strong HA; Azab M; Buskard N; Gray T; Manjuris U; Hao Y; Su XY; Mason M; Taylor R; Hynes L; Arnold J; Barbezetto I; Birngruber R; Bressler NM; Bressler SB; Donati G; Fish GE; Flaxel CJ; Gragoudas ES; Harvey P; Kaiser PK; Koester JM; Lewis H; Lim JI; Ma C; Meredith TA; Miller JW; Mones J; Murphy SA; Pieramici DJ; Potter MJ; Reaves A; Rosenfeld PJ; Schachat AP; Schmidt-Erfurth U; Singerman L; Strong A; Stur M; Williams GA; Bressler NM; Ulrike M; Reaves A; Strong A; Beck RW; Bird AC; Coscas G; Deutman A; Jampol L; Klein R; Maguire M; Bressler NM; Bressler SB; Deslandes JY; Huber G; Manjuris U; Miller JW; Sickenberg M; Schmidt-Erfurth U; Strong A; Reaves A; Rosenfeld P; Stur M; Acreneaux S; Margherio RP; Staflin P; Bressler NM; Lim JI; Potter MJ; Mones JM; Rosenfeld PJ; Gragoudas ES; Miller JW; Schmidt-Erfurth U
PURPOSE: To determine if photodynamic therapy with verteporfin (Visudyne; Novartis AG, B├╝lach, Switzerland), termed verteporfin therapy, can safely reduce the risk of vision loss compared with a placebo (with sham treatment) in patients with subfoveal choroidal neovascularization caused by age-related macular degeneration who were identified with a lesion composed of occult with no classic choroidal neovascularization, or with presumed early onset classic choroidal neovascularization with good visual acuity letter score. METHODS: This was a double-masked, placebo-controlled (sham treatment), randomized, multicenter clinical trial involving 28 ophthalmology practices in Europe and North America. The study population was patients with age-related macular degeneration, with subfoveal choroidal neovascularization lesions measuring no greater than 5400 microm in greatest linear dimension with either 1) occult with no classic choroidal neovascularization, best-corrected visual acuity score of at least 50 (Snellen equivalent approximately 20/100), and evidence of hemorrhage or recent disease progression; or 2) evidence of classic choroidal neovascularization with a best-corrected visual acuity score of at least 70 (better than a Snellen equivalent of approximately 20/40); assigned randomly (2:1) to verteporfin therapy or placebo therapy. Verteporfin (6 mg per square meter of body surface area) or placebo (5% dextrose in water) was administered by means of intravenous infusion of 30 ml over 10 minutes. Fifteen minutes after the start of the infusion, a laser light at 689 nm delivered 50 J/cm(2) by application of an intensity of 600 mW/cm(2) over 83 seconds using a spot size with a diameter 1000 microm larger than the greatest linear dimension of the choroidal neovascularization lesion on the retina. At follow-up examinations every 3 months, retreatment with the same regimen was applied if angiography showed fluorescein leakage. The main outcome measure was at least moderate vision loss, that is, a loss of at least 15 letters (approximately 3 lines), adhering to an intent-to-treat analysis with the last observation carried forward to impute for missing data. RESULTS: Two hundred ten (93%) and 193 (86%) of the 225 patients in the verteporfin group compared with 104 (91%) and 99 (87%) of the 114 patients in the placebo group completed the month 12 and 24 examinations, respectively. On average, verteporfin-treated patients received five treatments over the 24 months of follow-up. The primary outcome was similar for the verteporfin-treated and the placebo-treated eyes through the month 12 examination, although a number of secondary visual and angiographic outcomes significantly favored the verteporfin-treated group. Between the month 12 and 24 examinations, the treatment benefit grew so that by the month 24 examination, the verteporfin-treated eyes were less likely to have moderate or severe vision loss. Of the 225 verteporfin-treated patients, 121 (54%) compared with 76 (67%) of 114 placebo-treated patients lost at least 15 letters (P =.023). Likewise, 67 of the verteporfin-treated patients (30%) compared with 54 of the placebo-treated patients (47%) lost at least 30 letters (P =.001). Statistically significant results favoring verteporfin therapy at the month 24 examination were consistent between the total population and the subgroup of patients with a baseline lesion composition identified as occult choroidal neovascularization with no classic choroidal neovascularization. This subgroup included 166 of the 225 verteporfin-treated patients (74%) and 92 of the 114 placebo-treated patients (81%). In these patients, 91 of the verteporfin-treated group (55%) compared with 63 of the placebo-treated group (68%) lost at least 15 letters (P =.032), whereas 48 of the verteporfin-treated group (29%) and 43 of the placebo-treated group (47%) lost at least 30 letters (P =.004). Other secondary outcomes, including visual acuity letter score worse than 34 (approximate Snellen equivalent of 20/200 or worse), mean change in visual acuity letter score, development of classic choroidal neovascularization, progression of classic choroidal neovascularization and size of lesion, favored the verteporfin-treated group at both the month 12 and month 24 examination for both the entire study group and the subgroup of cases with occult with no classic choroidal neovascularization at baseline. Subgroup analyses of lesions composed of occult with no classic choroidal neovascularization at baseline suggested that the treatment benefit was greater for patients with either smaller lesions (4 disc areas or less) or lower levels of visual acuity (letter score less than 65, an approximate Snellen equivalent of 20/50(-1) or worse) at baseline. Prospectively planned multivariable analyses confirmed that these two baseline variables affected the magnitude of treatment benefit. (ABSTRACT TRUNCATED
ISI:000168609900001
ISSN: 0002-9394
CID: 130403

Photodynamic therapy of subfoveal choroidal neovascularization in pathologic myopia with verteporfin - 1-year results of a randomized clinical trial - VIP report no. 1

Arnold J; Kilmartin D; Olson J; Neville S; Robinson K; Laird A; Richmond C; Farrow A; McKay S; Saperstein DA; Aaberg TM; Johnson JB; Waldron R; Loupe D; Gillman J; Myles B; Schachat AP; Bressler NM; Bressler SB; Nesbitt P; Porter T; Hawse P; Hartnett M; Eager A; Belt J; Cain D; Emmert D; George T; Herring M; McDonald J; Mones J; Corcostegui B; Gilbert M; Duran N; Sisquella M; Nolla A; Margalef A; Miller JW; Gragoudas ES; Lane AM; Emmanuel N; Holbrook A; Evans C; Lord US; Walsh DK; Callahan CD; DuBois JL; Lewis H; Kaiser PK; Holody LJ; Lesak E; Lichterman S; Siegel H; Fattori A; Ambrose G; Fecko T; Ross D; Burke S; Singerman L; Zegarra H; Novak M; Bartel M; Tilocco-DuBois K; Iic M; Schura S; Mayes SJ; Tanner V; Rowe P; Smith-Brewer S; Kukula D; Greanoff G; Daley G; DuBois J; Lehnhardt D; Fish GE; Jost BF; Anand R; Callanan D; Arceneaux S; Arnwine J; Ellenich P; King J; Aguado H; Rollins R; Jurklies B; Pauleikhoff D; Hintzmann A; Fischer M; Sowa C; Behne E; Pournaras CJ; Donati G; Kapetanios AD; Cavaliere K; Guney-Wagner S; Gerber N; Sickenberg M; Sickenberg V; Gans A; Hosner B; Sbressa A; Kozma C; Curchod M; Cancelli SA; Harding S; Yang YC; Briggs M; Briggs S; Tompkin V; Jackson R; Pearson S; Natha S; Sharp J; Lim JI; Flaxel C; Padilla M; Levin L; Walonker F; Cisneros L; Nichols T; Schmidt-Erfurth U; Barbazetto I; Laqua H; Kupfer R; Bulow R; Glisovic B; Bredfeldt T; Elsner H; Wintzer V; Bahlmann D; Michels S; Blumenkranz MS; Little HL; Jack R; Espiritu LM; Unyi L; Regan J; Lamborn L; Silvestri C; Rosa RH; Rosenfeld PJ; Lewis ML; Rodriguez B; Torres A; Munoz N; Contreras T; Galvez M; Hess D; Cubillas T; Rams I; Slakter JS; Sorenson JA; Bruschi PA; Burke K; Schnipper E; Maranan L; Scolaro M; Riff M; Agresta E; Johansson I; Dedorsson I; Stenkula S; Hvarfner C; Carlsson T; Liljedahl AM; Fallstrom S; Jacobsson E; Soubrane G; Kuhn D; Oubraham H; Benelhani A; Kunsch A; Delhoste B; Ziverec G; Lasnier M; Lobes LA; Olsen K; Bahr BJ; Worstell NT; Wilcox LA; Wellman LA; Vagstad G; Steinberg D; Campbell A; Dreyer R; Williamson B; Johnson M; Crider H; Margherio RR; Williams GA; Zajechowski M; Stanley C; Kulak M; Streasick P; Szdlowski L; Falk R; Shoichet S; Regan G; Manatrey P; Cumming K; Koenig F; Benchaboune M; Mezmate K; Fontanay S; Meredith T; Binning J; Gualdoni J; Boyd L; Ort E; Barts B; Allen R; Dahl J; Holle T; Harvey PT; Kaus L; Leuschner D; Bolychuk S; Hewitt I; Menchini U; Bandello F; Virgili G; Lanzetta P; Ambesi M; Pirracchio A; Tedeschi M; Potter MJ; Sahota B; Hall L; Stur M; Lukas J; Tittl M; Docker S; Vogl K; Bressler SB; Bressler NM; Pieramici DJ; Manos KS; Cooper R; Denbow RL; Lowery ER; Phillips DA; Thibeault SK; Tian Y; Harnett M; Hawse P; Black N; Escartin P; Hartley D; Haworth P; Hecker T; Hiscock D; Jamali F; Maradan N; North J; Norton B; Stapleton-Hayes T; Taylor R; Huber G; Deslandes JY; Fsadni M; Hess I; de Pommerol H; Bobillier A; Reaves A; Banasik S; Koester J; Gray T; Truett K; Baker J; McAlister L; Birch R; Strong A; Azab M; Buskard N; Manjuris U; Hao Y; Mason M; McCurry U; Barbazetto I; Birngruber R; Bressler SB; Bressler NM; Donati G; Fish GE; Gragoudas ES; Harvey P; Kaiser PK; Koester JM; Lewis H; Lim JI; Ma C; Miller JW; Mones J; Murphy SA; Pieramici DJ; Potter MJ; Pournaras CJ; Schachat AP; Schmidt-Erfurth U; Singerman L; Slakter JS; Soubrane S; Strong HA; van den Berg H; Williams GA; Bressler NM; Manjuris U; Strong HA; Beck RW; Bird AC; Coscas G; Deutman A; Jampol L; Klein R; Maguire M; Deslandes JY; Huber G; Miller JW; Sickenberg M; Rosenfeld P; Stur M; Arceneaux S; Margherio RP; Staflin P
Objective: To determine if photodynamic therapy with verteporfin (Visudyne; CIBA Vision Corp, Duluth, GA) can improve the chance of stabilizing or improving vision (<8 letter loss) safely in patients with subfoveal choroidal neovascularization (CNV) caused by pathologic myopia. Design: Multicenter, double-masked, placebo-controlled, randomized clinical trial at 28 ophthalmology practices in Europe and North America. Participants: One hundred twenty patients with subfoveal CNV caused by pathologic myopia with a greatest linear dimension no more than 5400 <mu>m and best-corrected visual acuity (Snellen equivalent) of approximately 20/100 or better. Intervention: Patients were randomly assigned (2:1) to verteporfin (6 mg per square meter of body surface area; n = 81) or placebo (5% dextrose in water, n = 39) administered via intravenous infusion of 30 ml over 10 minutes. Fifteen minutes after the start of the infusion, a laser light at 689 nm was delivered at an intensity of 600 mW/cm(2) over 83 seconds to give a light dose of 50 J/cm(2) to a round spot size on the retina with a diameter of 1000 mum larger than the greatest linear dimension of the choroidal neovascular lesion. At follow-up examinations every 3 months, retreatment with either verteporfin or placebo (as assigned at baseline) was applied to areas of fluorescein leakage if present. Main Outcome Measures: The primary outcome was the proportion of eyes at the follow-up examination 12 months after study entry with fewer than eight letters (approximately 1.5 lines) of visual acuity lost, adhering to an intent-to-treat analysis. Results: At baseline, move than 90% of each group had evidence of classic CNV (regardless of whether occult CNV was present) and only 12 (15%) and 5 (13%) cases in the verteporfin and placebo groups, respectively, had occult CNV (regardless of whether classic CNV was present). Seventy-nine of the 81 verteporfin-treated patients (98%) compared with 36 of the 39 placebo-treated patients (92%) completed the month 12 examination. Visual acuity, contrast sensitivity, and fluorescein angiographic outcomes were better in the verteporfin-treated eyes than in the placebo-treated eyes at every follow-up examination through the month 12 examination. At the month 12 examination, 58 (72%) of the verteporfin-treated patients compared with 17 (44%) of the placebo-treated patients lost fewer than eight letters (P < 0.01), including 26 (32%) versus 6 (15%) improving at least five letters (<greater than or equal to>1 line). Seventy (86%) of the verteporfin-treated patients compared with 26 (67%) of the placebo-treated patients lost fewer than 15 letters (P = 0.01), Few ocular or other systemic adverse events were associated with verteporfin therapy compared with placebo treatment. Conclusions: Because photodynamic therapy with verteporfin can safely increase the chance of stabilizing or improving vision in patients with subfoveal CNV from pathologic myopia compared with a placebo, we recommend ophthalmologists consider verteporfin therapy for treatment of such patients. Ophthalmology 2001; 108:841-852 (C) 2001 by the American Academy of Ophthalmology. $$:
ISI:000168315500020
ISSN: 0161-6420
CID: 130404

The effect of indomethacin pretreatment on aphakic cystoid macular edema

Klein, R M; Katzin, H M; Yannuzzi, L A
In patients treated with oral indomethacin for four weeks after intracapsular cataract extraction, five of 57 eyes (9%) had cystoid macular edema four to six weeks postoperatively as shown by fluorescein angiography. In a control group not treated with indomethacin, 15 of 34 eyes (44%) had cystoid mascular edema. Oral indomethacin, therefore, caused a statistically significant decrease in the incidence of aphakic cystoid macular edema
PMID: 443312
ISSN: 0002-9394
CID: 103509

Ineffectiveness of indomethacin in the treatment of chronic cystoid macular edema

Yannuzzi, L A; Klein, R M; Wallyn, R H; Cohen, N; Katiz, I
A controlled, double-masked study in which patients with cystoid macular edema of more than four months' duration were treated with indomethacin failed to demonstrate a significant visual improvement when compared to patients who were treated with placebo
PMID: 333921
ISSN: 0002-9394
CID: 103511