title: Longitudinal anatomical response of retinal-choroidal anastomosis to anti-vascular endothelial growth factor therapy.
abstract: OBJECTIVE
  To evaluate the longitudinal anatomical response of retinal-choroidal anastomosis (RCA) to intravitreal ranibizumab injection using spectral-domain optical coherence tomography (SD-OCT).
  
  
  METHODS
  We reviewed the medical records of 21 consecutive patients with RCA who underwent intravitreal ranibizumab injections at the University Eye Clinic of Creteil between January 2009 and June 2010. The SD-OCT features at baseline, at 3 months, and at 12 months were retrospectively analyzed. Based on SD-OCT, RCAs were classified as showing a focal retinal pigment epithelium (RPE) erosion ("erosion sign") over a small, localized RPE elevation; a focal RPE break leaving two free RPE flaps ("flap sign") at the level of a small, localized RPE elevation; or a large convex RPE prominence and a focal funnel-shaped RPE kissing an inverted focal funnel-shaped inner neuroepithelium ("kissing sign").
  
  
  RESULTS
  Twenty-one eyes of 21 patients (3 men and 18 women, aged 81.6 ± 6.8 years) diagnosed with RCA naive to any treatment were included for analysis. Spearman ρ correlation between best-corrected visual acuity and lesion classification was 0.54 (P = 0.01) at Month 3 and 0.85 (P < 0.001) at Month 12. Eyes showing the flap sign at baseline underwent significantly less ranibizumab injections after the loading phase (2.14 ± 0.89 vs. 3.40 ± 0.96, P = 0.007) and showed a greater improvement in best-corrected visual acuity at Month 12 (from 0.52 ± 0.14 to 0.38 ± 0.15, P = 0.03) compared with eyes showing the kissing sign. At 12 months, 3 of 10 eyes with flap sign at baseline showed RCA activity, whereas 7 of 10 regressed to erosion sign phase. Of the 10 eyes with kissing sign at baseline, 6 progressed to a fibroglial scar.
  
  
  CONCLUSIONS
  A flap sign of RCA at baseline seems a favorable prognostic factor as concerns best-corrected visual acuity improvement and the need for retreatment.
authors.affiliation: Department of Ophthalmology, University of Paris XII, Centre Hospitalier Intercommunal de Creteil, Creteil, France. giuseppe.querques@hotmail.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Querques
authors.forename: Antoine
authors.initials: A
authors.lastname: Rousseau
authors.forename: Raimondo
authors.initials: R
authors.lastname: Forte
authors.forename: Claire
authors.initials: C
authors.lastname: Scemama
authors.forename: Violane
authors.initials: V
authors.lastname: Caillaux
authors.forename: Lea
authors.initials: L
authors.lastname: Querques
authors.forename: Eric H
authors.initials: EH
authors.lastname: Souied
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001163:Arteriovenous Anastomosis / Q000187:drug effects*; D002829:Choroid / Q000098:blood supply*; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008137:Longitudinal Studies; D008268:Macular Degeneration / Q000188:drug therapy*; D008297:Male; D011379:Prognosis; D000069579:Ranibizumab; D012171:Retinal Vessels / Q000187:drug effects*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014792:Visual Acuity / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab