Foveal sparing photocoagulation for exudative age-related macular degeneration.

BACKGROUND: The use of laser photocoagulation with sparing of foveal photoreceptors to control exudative age-related macular degeneration (AMD) with subfoveal involvement was investigated. METHODS: Patients with exudative AMD and visual acuity of 20/100 or worse were treated with foveal-sparing laser photocoagulation. The full extent of the choroidal neovascular membrane was treated with laser photocoagulation in addition to any associated retinal pigment epithelial detachment, with sparing of the foveal avascular zone. Three cases in which visual acuity improved dramatically are presented. RESULTS: Laser photocoagulation resulted in control of the exudative process in all patients. The three patients whose cases are presented had dramatic visual improvement. CONCLUSION: Foveal-sparing laser photocoagulation is an alternative treatment modality in patients with exudative AMD involving the fovea. The definitive value of this treatment modality can only be determined by a prospective, randomized, clinical trial.

Iatrogenic choroidal neovascularization after krypton red laser photocoagulation.

A major cause for failure of krypton red laser photocoagulation in patients with exudative age-related macular degeneration has been the development of recurrent choroidal neovascularization adjacent to the previously treated areas. After reviewing the possible causes of recurrences, it is apparent that a certain number are iatrogenic, ie, induced by krypton red laser causing disruption and damage to the pigment epithelium-Bruch's membrane-choroidal complex. We describe three separate episodes in two patients of iatrogenic recurrent choroidal neovascularization after krypton red laser photocoagulation.

Branch retinal vein occlusion associated with optic nerve drusen: a case report.

Proliferative retinopathy secondary to a branch vein occlusion developed in an otherwise healthy 24-year-old women who also had optic nerve drusen. Since the patient sustained a preretinal hemorrhage, quadrantic photocoagulation was applied to the nonperfused quadrant of the retina involved in the occlusion. This case illustrates that compression of a branch retinal vein is another potential complication of optic nerve drusen.

Macular hamartomas of the retinal pigment epithelium and retina.

Four patients with macular hamartomas of the retinal pigment epithelium and retina are described. Associated choroidal neovascularization was noted in one patient. The clinical, fluorescein angiographic, and histopathologic findings of this entity are reviewed.

Metastatic fungal chorioretinitis developing during Trichosporon sepsis.

A 70-year-old woman treated for acute myelogenous leukemia developed systemic trichosporosis and presumptive trichosporon chorioretinitis. The elevated choroidal lesion appeared during an episode of trichosporon sepsis and increased in size during immunosuppression. Possible retinal vein occlusion and neovascularization were further complications that may be due to the angioinvasive properties of the organism.

Autosomal dominant vitreoretinochoroidopathy.

Autosomal dominant vitreoretinochoroidopathy is a newly described fundus dystrophy characterized by abnormal chorioretinal hypopigmentation and hyperpigmentation, usually lying between the vortex veins and the ora serrata for 360 degrees. In this zone, there are a discrete posterior boundary, preretinal punctate white opacities, retinal arteriolar narrowing and occlusion, and, in some cases, choroidal atrophy. Most affected family members have diffuse retinal vascular incompetence, cystoid macular edema, and presenile cataracts. The vitreous is characterized by fibrillar condensation and a moderate number of cells. Electroretinograms are normal in younger affected individuals and are only moderately abnormal in older ones. Preretinal neovascularization, present in the posterior pole, is progressive in the proband. There are no identifiable systemic or skeletal abnormalities, high myopia, optically empty vitreous, lattice degeneration, areas of white-without-pressure, retinal breaks, or retinal detachment; thus, previously described vitreoretinopathies can be excluded from diagnostic consideration. Progression of this diagnostic seems to be extremely slow in most family members.

Management of breakthrough vitreous hemorrhage from presumed extramacular subretinal neovascularization.

Three patients developed vitreous hemorrhage secondary to breakthrough bleeding from presumed extramacular subretinal neovascularization. In one patient, the vitreous hemorrhage cleared spontaneously. In two other patients, trans-pars plana vitrectomy was performed. All patients regained 20/30 vision or better. Residual peripheral retinal pigment epithelial atrophy, organized subretinal hemorrhage, and/or subretinal fibrous membranes were present in all patients. A definite extramacular subretinal neovascular membrane was identified in one patient. Ocular diseases associated with subretinal neovascularization are tabulated. Indications for trans-pars plana vitrectomy in patients with breakthrough vitreous hemorrhage secondary to presumed extramacular subretinal neovascularization are proposed.

Rubella maculopathy.

Three patients with known history of congenital rubella and sudden decrease of vision are presented. Two of the 3 patients had previous eye examinations which showed typical rubella (salt and pepper) retinopathy. All 3 showed macular lesions associated with presumed subretinal neovascularisation.

Optic disc neovascularisation in diabetic retinopathy: II. Natural history and results of photocoagulation treatment.

A follow-up study on 67 diabetic patients with new proliferation on the nerve head (neovascularisation of the disc and fibrous proliferation of the disc) was carried out for 4 years. The patients were randomly assigned for treatment with argon laser and xenon photocoagulation in only one eye, with the other eye serving as a control. The disc condition was periodically evaluated for NVD, FPD, and for the relations between them according to a grading taxonomy which was previously established. It was found that there were significant differences in NVD and FPD evolution between treated and untreated eyes. The various parameters concerned with these differences were observed, analysed, and correlated.

Optic disc neovascularisation in diabetic retinopathy: I. A system for grading proliferation at the optic nerve head in patients with proliferative diabetic retinopathy.

An anatomical taxonomy for neovascular proliferation of the optic nerve head in patients with proliferative diabetic retinopathy is presented. The technique consists in comparing (A) number of involved quadrants, (B) calibre of vessels, (C) neovascular density, (D) neovascular area, (E) plane of proliferation, and (F) fluorescein angiographic findings. A similar taxonomy is used to describe fibrous tissue proliferation at the disc. With these criteria a series of standard photographs have been utilised in a numerical grading system. This system has proved useful in documenting the natural history and response to photocoagulation therapy for diabetic disc neovascularisation.

Retinal branch vein occlusion.

Obstruction of a major temporal branch vein, or one of its macular tributaries, presents a significant threat to vision. Visual acuity may be reduced by macular edema or the consequences of retinal neovascularization, and these afflictions frequently become irreversible. Since the complicating macular edema and retinal neovascularization respond, at least in part, to argon laser therapy in some other conditions, some investigators have begun to treat branch vein occlusions with this modality. However, since the pathogenesis and natural history of the disorder have not yet been elucidated by prospective studies, it is not clear whether such treatment is indicated. Clinical and experimental studies are reviewed, and treatment rationale and techniques are discussed. The authors emphasize the need for well-controlled randomized studies to evaluate the natural history of branch vein occlusion and the efficacy of photocoagulation in its treatment.

Clarification of foveomacular nomenclature and grid for quantitation of macular disorders.

Standardization of terminology and precise localization of lesions are imperative in the study of the natural course of various retinal vascular and macular disorders. The RAZ localizing system provides an easy and accurate way of documenting and following lesions of the posterior pole in terms of RAZ diameters rather than disc diameters. This type of quantitation is important because consideration regarding prognosis and management is often in terms of involvement of the retinal avascular zone. This type of grid system also permits the clinician to measure and follow the size of some choroidal masses. Based on our preliminary studies, it appears that at this stage of development, this method of studying and recording posterior pole lesions is of useful accuracy. Hopefully, certain guidelines, such as how close one may approach the retinal avascular zone with photocoagulation and still maintain reasonably good vision, can be more accurately determined.

Subretinal neovascularization developing after prophylactic argon laser photocoagulation of atrophic macular scars.

Two patients who had lost central vision in one eye due to a histoplasmic disciform macular scar received prophylactic argon laser photocoagulation to one or more atrophic lesions (histo spots) in the second macula in an effort to reduce the risk of developing active neovascularization in the second eye. Despite this prophylactic treatment, both patients developed a choroidal neovascular membrane from the photocoagulation scar.