Subject(s)
Fluorescein Angiography/methods , Interferometry/methods , Macular Edema/diagnosis , Retinal Degeneration/complications , Acetazolamide/therapeutic use , Administration, Oral , Adult , Carbonic Anhydrase Inhibitors/therapeutic use , Female , Humans , Light , Macular Edema/drug therapy , Macular Edema/etiology , Male , Middle Aged , TomographyABSTRACT
PURPOSE: To determine the efficacy of transpupillary thermotherapy (TTT) in the treatment of occult subfoveal choroidal neovascularization in patients with age-related macular degeneration (ARMD). METHODS: We conducted a retrospective review of patients with ARMD treated with TTT from June, 1999 through July, 2000 at a retina referral practice. TTT was delivered through a slit-lamp using a modified diode laser at 810 nm wavelength and a spot size of 3 mm delivered at one location for a minimum of 60 seconds duration. Re-treatment was performed at 2-month intervals if indicated. RESULTS: 81 eyes of 77 patients were included in the study. Vision improved greater than one line Snellen in 18 eyes (22%), vision was stable within one line Snellen in 38 (47%), and worsened greater than one line Snellen in 25 (31%). Patients had a mean follow-up of 9 months. The average number of treatments was 1.37 (range 1 to 4). Pretreatment vision was less than or equal to 20/200 in 54% of eyes. CONCLUSIONS: Transpupillary thermotherapy may stabilize visual acuity in a majority of patients with occult subfoveal choroidal neovascularization secondary to ARMD. Proof of therapeutic benefit is best determined by a randomized clinical trial that is currently underway (TTT4CNV).
Subject(s)
Choroidal Neovascularization/therapy , Fovea Centralis , Hyperthermia, Induced/methods , Macular Degeneration/therapy , Aged , Aged, 80 and over , Choroidal Neovascularization/etiology , Choroidal Neovascularization/physiopathology , Female , Humans , Macular Degeneration/complications , Macular Degeneration/physiopathology , Male , Middle Aged , Pupil , Retrospective Studies , Treatment Outcome , Visual Acuity/physiologyABSTRACT
AIMS: To determine the prevalence of polypoidal choroidopathy in consecutive patients presenting with large haemorrhagic and exudative neurosensory retinal and retinal pigment epithelial detachments (PEDs) of over 2 mm in diameter in the absence of drusen. METHODS: 40 patients were identified over a 5 month period of which 29 had haemorrhagic detachments, and 11 had purely exudative detachments. All had indocyanine green (ICG) angiography, and the presence was sought of large blood vessels in the choroid associated with localised dilated terminals that filled slowly and leaked ICG. RESULTS: In 34 cases (85%) there was an appearance consistent with previous descriptions of idiopathic polypoidal choroidal vasculopathy. Of the six without polypoidal lesions the disorder was attributed to choroidal neovascularisation in four, chorioretinitis in one, and a fibrovascular PED in one. Of those with polypoidal lesions 20 (65%) were female, the mean age was 65.4 years (range 44-88), and 25 (74%) were white, seven (20%) black, and two (6%) east Asian. Eight had a history of hypertension. Visual acuity varied from 6/6 to counting fingers in the involved eye (mean 6/24). Bilateral polypoidal choroidal lesions were demonstrated in 16 patients (47%). The predominant location for these lesions was the macular region in 23 patients (68%). Polypoidal vasculopathy was found in 16 patients (47%) who had a previous diagnosis of age related macular disease (AMD). No patients had evidence of intraocular inflammation. CONCLUSIONS: In a largely white patient population a high proportion of patients with haemorrhagic and exudative PEDs has evidence of polypoidal lesions on ICG angiography.
Subject(s)
Choroid/blood supply , Peripheral Vascular Diseases/etiology , Retinal Detachment/complications , Adult , Aged , Aged, 80 and over , Coloring Agents , Exudates and Transudates , Female , Fluorescein Angiography , Humans , Indocyanine Green , Male , Middle Aged , Peripheral Vascular Diseases/diagnosis , Prospective Studies , Retinal Hemorrhage/complications , Retinal Hemorrhage/diagnosisABSTRACT
BACKGROUND AND PURPOSE: The aim of our study was to evaluate the causes of retinal arterial occlusive disease in African American patients and to compare these etiologies with those observed in Caucasian patients with retinal ischemic symptoms. METHODS: We performed a retrospective analysis of a series of consecutive patients evaluated by both the ophthalmology department and the neurology/stroke clinic. Patients had a diagnosis of amaurosis fugax, branch retinal artery occlusion, central retinal artery occlusion, or intra-arterial retinal plaques. RESULTS: Twenty-nine African American patients and 17 Caucasian patients were evaluated. African American patients had a mean age of 61 years (range, 30 to 77 years) and Caucasian patients a mean age of 73 years (range, 56 to 94 years) (P=0.003). There was no statistically significant difference between the 2 groups with respect to visible emboli on funduscopy (P=0.462). After adjusting for age, there was also no difference between the 2 groups with regards to risk factors for arterial occlusive disease such as hypertension, coronary artery disease, hypercholesterolemia, tobacco use, and history of stroke or transient ischemic attacks. Caucasian patients had a 41% incidence (7/17) of high-grade ipsilateral internal carotid artery stenosis, measured by carotid duplex, compared with 3.4% incidence (1/29) in African American patients (P=0.002). CONCLUSIONS: There are racial differences in the causes of retinal arterial occlusion. African American patients have a low prevalence of moderate to severe extracranial carotid stenosis, and a high proportion of African American patients have cryptogenic retinal ischemia. In Caucasian patients there is a stronger association between extracranial carotid artery disease and retinal arterial occlusion.
Subject(s)
Black People , Retinal Artery Occlusion/etiology , White People , Adult , Aged , Aged, 80 and over , Arteriosclerosis/complications , Arteriosclerosis/diagnosis , Arteriosclerosis/ethnology , Carotid Stenosis/complications , Carotid Stenosis/diagnosis , Carotid Stenosis/ethnology , Female , Follow-Up Studies , Humans , Incidence , Magnetic Resonance Angiography , Male , Middle Aged , Prevalence , Retinal Artery Occlusion/diagnosis , Retinal Artery Occlusion/ethnology , Retrospective Studies , Risk Factors , Ultrasonography, Doppler , United States/epidemiologyABSTRACT
PURPOSE: To compare the incidence of corneal decompensation after Molteno shunt to trabeculectomy. METHODS: We conducted a retrospective analysis of the corneal status of 55 patients with primary open angle glaucoma. We compared 24 eyes of 24 patients who underwent Molteno tube shunt placement (Group 1) to fifteen eyes of 14 patients with multiple surgical procedures, including a trabeculectomy (Group 2). We also compared Group 1 to 28 eyes of 17 patients who underwent only one trabeculectomy (Group 3). RESULTS: The three groups were similar with respect to age, sex, and intraocular pressure (IOP). The average follow-up time from the last surgery in Group 1 was 17.9 months (1-90 months), 22.4 months (2-63 months) in Group 2, and 19.6 months (1-37 months) in Group 3. The average number of surgeries was 3.0 (1-4) in Group 1 and 2.53 (1-4) in Group 2. The surgeries included trabeculectomy, cataract extraction, combined procedures, penetrating keratoplasty, pars plana vitrectomy, and scleral buckle. The incidence of corneal edema was 50% (12/24)in Group 1, 6.7% (1/15) in Group 2, and 0% in Group 3 (0/28). The average time to corneal decompensation was 21 months in Group 1 (1-120 months) and 15 months in Group 2. CONCLUSION: Patients undergoing Molteno shunt placement have a higher rate of corneal decompensation compared to patients undergoing trabeculectomy.
