Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 17 de 17
Filter
1.
Retin Cases Brief Rep ; 17(2): 181-185, 2023 Mar 01.
Article in English | MEDLINE | ID: mdl-36821472

ABSTRACT

PURPOSE: To report a case of laser photocoagulation for the treatment of a combined coloboma and optic nerve head pit-related maculopathy in a patient with bilateral chorioretinal coloboma. METHODS: A case report. RESULTS: A 15-year-old woman, presented with the visual acuity of 20/100 in her right eye for six weeks. She was diagnosed with macular detachment secondary to optic nerve head pit in her right eye and bilateral chorioretinal coloboma. Multimodal imaging, including color photography, fluorescein angiography, and spectral-domain optical coherence tomography, was used to identify and demonstrate the location of the tract of fluid from the optic nerve head pit, isolated from the coloboma. Optical coherence tomography-guided laser photocoagulation treatment at the location of the tract resulted in complete resolution of macular fluid with visual recovery to 20/25. CONCLUSION: Our case stresses the value of correct diagnosis directing photocoagulation treatment of combined optic nerve head pit-related maculopathy in eyes with chorioretinal coloboma using multimodal imaging.


Subject(s)
Coloboma , Macular Degeneration , Optic Disk , Retinal Diseases , Female , Humans , Adolescent , Coloboma/diagnosis , Retinal Diseases/diagnosis , Light Coagulation , Macular Degeneration/complications , Tomography, Optical Coherence/methods , Lasers
2.
J Ophthalmol ; 2017: 7535320, 2017.
Article in English | MEDLINE | ID: mdl-28584665

ABSTRACT

OBJECTIVE: To describe an unusual cluster of multiple evanescent white dot syndrome (MEWDS) encountered within a 3-month period. METHODS: This retrospective observation study is comprised of seven patients who presented with MEWDS in a 3-month period in central Israel. Data were collected from patients' medical records on clinical, multimodal imaging, and viral serology findings. RESULTS: Six women and one man of mean age 31.5 ± 7.2 years. Three reported a precedent viral infection. All had unilateral decreased vision. Funduscopy revealed foveal granularity. MAIN IMAGING FINDINGS: Hyperfluorescent spots on blue autofluorescence (BAF), hypofluorescent spots on indocyanine green angiography, dark lesions on infrared photos, and ellipsoid zone irregularities on spectral domain optical coherence tomography (SD-OCT). Resolution of the spots on BAF correlated with anatomic (SD-OCT) and visual recovery. OCT angiography performed following the convalescence stage demonstrated intact retinal and choroidal flow. Serologic findings were inconclusive. CONCLUSION: We report a unique cluster of MEWDS patients presented in a short period of time. SD-OCT findings of ellipsoid zone disruption in combination with other multimodal imaging modalities are outlined meticulously. Recognizing these imaging features along with high index of clinical suspicion is important for the diagnosis of MEWDS. Serologic testing might be considered in future patients.

3.
Curr Eye Res ; 41(10): 1387-1392, 2016 10.
Article in English | MEDLINE | ID: mdl-26862944

ABSTRACT

PURPOSE: To evaluate the efficacy and safety of pars plana vitrectomy (PPV) in patients with epiretinal membrane (ERM) and preoperative visual acuity (VA) of 20/40 or better. METHODS: 44 eyes that underwent PPV and ERM peeling were included in this retrospective study. Data retrieved included demographic information, VA and intraocular pressure (IOP) preoperatively, after 1 month, 6 months and at final visit, presence of metamorphopsia, surgical reports, and occurrence of any complications. RESULTS: Mean preoperative VA was 20/36 (0.24 ± 0.08 logMAR) and had improved to 20/27 (0.13 ± 0.11 logMAR) at the final follow-up (p < 0.001). Thirty (68.1%) eyes had improved by 1 line of vision or more, and 10 (22.7%) achieved final 20/20 vision. Significant improvement in vision was achieved earlier in eyes that underwent vitrectomy combined with cataract extraction. Preoperative OCT scans demonstrated preserved outer retinal layer structure. CONCLUSIONS: PPV and ERM peeling is a safe and effective procedure in eyes with very good preoperative VA. PPV combined with cataract extraction offers a faster improvement in VA than PPV alone with deferred cataract surgery. PPV should be considered in symptomatic eyes with ERM and VA of 20/40 or better, in order to preserve and even improve the VA.


Subject(s)
Basement Membrane/surgery , Epiretinal Membrane/surgery , Retina/surgery , Tomography, Optical Coherence/methods , Visual Acuity , Vitrectomy/instrumentation , Adult , Aged , Basement Membrane/pathology , Epiretinal Membrane/diagnosis , Epiretinal Membrane/physiopathology , Equipment Design , Female , Follow-Up Studies , Humans , Intraocular Pressure , Male , Microsurgery , Middle Aged , Retina/pathology , Retrospective Studies , Time Factors , Treatment Outcome
4.
Graefes Arch Clin Exp Ophthalmol ; 253(6): 949-57, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25631844

ABSTRACT

PURPOSE: To describe the spectral-domain optical coherence tomographic (SD-OCT) features of inflammatory choroidal neovascular membranes (iCNV) in multifocal choroiditis and punctate inner choroidopathy, and to compare them to those of the acute inflammatory lesions in the same underlying diseases. This is a retrospective, consecutive, observational case series. METHODS: Each patient underwent a comprehensive eye examination, fundus photography, and fluorescein angiography (FA) on the initial visit. SD-OCT features of iCNV were reviewed at presentation and 4 weeks later, and were compared to SD-OCT features of the inflammatory lesions. There were ten eyes with iCNV and eight eyes with the acute lesions of chorioretinitis. RESULTS: All iCNV had a sub-retinal pigment epithelium (sub-RPE) component and a subretinal or retinal component that infiltrated the outer retinal layers to different extents. All iCNV had associated fluid exudation, and all showed RPE and inner segment/outer segment junction layer (IS/OS) disruption. On the other hand, approximately half of the inflammatory lesions were confined between Bruch's membrane and RPE; the rest showed infiltration into the outer retinal layers in a pattern similar to iCNV, with no fluid exudation but with associated choroidal hyperreflectivity. In most of them, disruption of RPE and IS/OS was also noted. CONCLUSIONS: The acute lesions of chorioretinitis can be difficult to distinguish from iCNV based on clinical examination and FA. However, iCNV demonstrate characteristic SD-OCT features not seen with the inflammatory lesions. These findings may help to differentiate these two entities that typically require different treatments.


Subject(s)
Chorioretinitis/diagnosis , Choroidal Neovascularization/diagnosis , Choroiditis/diagnosis , Tomography, Optical Coherence , Adolescent , Adult , Angiogenesis Inhibitors/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Bevacizumab , Child , Chorioretinitis/complications , Chorioretinitis/drug therapy , Choroidal Neovascularization/drug therapy , Choroidal Neovascularization/etiology , Choroiditis/complications , Choroiditis/drug therapy , Female , Fluorescein Angiography , Glucocorticoids/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Male , Multifocal Choroiditis , Retrospective Studies , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity , Young Adult
5.
Ocul Immunol Inflamm ; 22(5): 349-55, 2014 Oct.
Article in English | MEDLINE | ID: mdl-24329681

ABSTRACT

PURPOSE: To describe fundus autofluorescence (FAF) imaging and its correlation to spectral-domain optical coherence tomography (SD-OCT) in retinal areas that appear clinically noninvolved in patients with multifocal choroiditis/punctate inner choroidopathy (MFC/PIC). METHODS: Six patients with MFC or PIC were evaluated during the disease course with multimodal imaging, which included fluorescein angiography, FAF imaging, indocyanine green angiography, and SD-OCT. RESULTS: Five patients had acute and/or scarred chorioretinal spots at presentation. Five patients had choroidal neovascularization. FAF imaging in all patients disclosed diffuse peripapillary and/or posterior-pole hyperautofluorescent plaques in areas that appeared clinically to be noninvolved. Corresponding SD-OCT scans revealed severe disruption of the inner segment/outer segment junction. Findings resolved with corticosteroid treatment Conclusions: FAF imaging of patients with MFC/PIC reveals extensive pathology beyond the clinically apparent spots. FAF findings highlight the areas of corresponding anatomic disruption of the photoreceptor-retinal pigment epithelium complex.


Subject(s)
Choroiditis/diagnosis , Fluorescein Angiography/methods , Indocyanine Green , Retinal Pigment Epithelium/pathology , Tomography, Optical Coherence/methods , Adult , Choroiditis/drug therapy , Coloring Agents , Female , Follow-Up Studies , Fundus Oculi , Glucocorticoids/therapeutic use , Humans , Male , Multifocal Choroiditis , Prognosis , Retrospective Studies , Young Adult
6.
Graefes Arch Clin Exp Ophthalmol ; 252(4): 633-40, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24366669

ABSTRACT

BACKGROUND: The use of anti-tumor necrosis factor (TNF)-α agents for uveitis has been increasing since the first efficacy studies in 2004. However, information on their specific role in cystic macular edema remains sparse. The aim of this study was to evaluate the efficacy of anti-TNF-α agents for the treatment of uveitis-related refractory cystoid macular edema. METHODS: The files of 23 consecutive patients treated for cystoid macular edema at the uveitis services of two tertiary medical centers in 2006-2011 were reviewed for demographic data, visual acuity, and optical coherence tomography measurements at baseline and 3, 6, and 12 months after treatment. Changes in mean visual acuity and macular thickness were analyzed. Findings were compared between patients treated with a conventional immunosuppressive regimen only (n = 18, 27 eyes) and patients treated with an anti-TNF-α agent after proving refractory to conventional treatment (n = 9, 15 eyes). RESULTS: Mean duration of cystoid macular edema before initiation of anti-TNF-α therapy was 12 ± 8 months. The two groups had similar baseline values of mean central macular thickness and visual acuity. Significant improvement in macular thickness was noted at 3 months in both groups, with a maximal effect at 6 months for the anti-TNF-α group (p = 0.002). Maximal improvement in visual acuity was achieved at 3 months in both groups, with a reduced effect towards 12 months. Mean visual acuity at 12 months was similar in both groups. CONCLUSIONS: Anti-TNF-α agents may serve as an effective lasting treatment for long-standing refractory uveitis-related cystoid macular edema. Their role as first-line therapy in this setting warrants further investigation.


Subject(s)
Anti-Inflammatory Agents/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Antibodies, Monoclonal/therapeutic use , Macular Edema/drug therapy , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Uveitis/drug therapy , Adalimumab , Adolescent , Adult , Aged , Child , Child, Preschool , Drug Resistance , Female , Humans , Infliximab , Macula Lutea/pathology , Macular Edema/physiopathology , Male , Middle Aged , Recurrence , Tomography, Optical Coherence , Treatment Outcome , Uveitis/physiopathology , Visual Acuity/physiology , Young Adult
7.
J Glaucoma ; 22(3): 238-42, 2013 Mar.
Article in English | MEDLINE | ID: mdl-21946551

ABSTRACT

PURPOSE: One of the leading methods for optic nerve head assessment in glaucoma remains stereoscopic photography. This study compared conventional film and digital stereoscopy in the quantitative and qualitative assessment of the optic nerve head in glaucoma and glaucoma suspect patients. METHODS: Fifty patients with glaucoma or suspected glaucoma underwent stereoscopic photography of the optic nerve head with a 35-mm color slide film and a digital camera. Photographs/images were presented in random order to 3 glaucoma specialists for independent analysis using a standardized assessment form. Findings for the following parameters were compared among assessors and between techniques: cup/disc (C/D) ratio, state of the optic rim, presence of peripapillary atrophy and appearance of the retinal nerve fiber layer, blood vessels, and lamina cribrosa. The film-based and image-based diagnoses (glaucoma yes/no) were compared as well. RESULTS: Despite high level of agreement across graders using the same method for the horizontal and vertical C/D ratio, (intraclass correlations 0.80 to 0.83), the agreement across graders was much lower for the other parameters using the same method. Similarly the agreement between the findings of the same grader using either method was high for horizontal and vertical C/D ratio, but low for the other parameters. The latter differences were reflected in the disagreement regarding the final diagnosis: The diagnoses differed by technique for each grader in 18% to 46% of eyes, resulting in 38.5% of eyes diagnosed with glaucoma by film photography that "lost" their diagnosis on the digital images, whereas 18.7% of eyes diagnosed as nonglaucomatous by film photography were considered to have glaucoma on the digital images. CONCLUSIONS: Although there is consistency between 35-mm film stereoscopy and digital stereoscopy in determining the cup/disc (C/D) ratio, in all other parameters large differences exist, leading to differences in diagnosis. Differences in capturing images between digital and film photography may lead to loss of information and misdiagnosis. Further studies are needed to determine the reliability of the new digital techniques.


Subject(s)
Glaucoma, Open-Angle/diagnosis , Optic Disk/pathology , Optic Nerve Diseases/diagnosis , Photography/instrumentation , Diagnostic Techniques, Ophthalmological , Humans , Image Processing, Computer-Assisted , Observer Variation , Ocular Hypertension/diagnosis , Reproducibility of Results , Sensitivity and Specificity
8.
Retina ; 30(6): 938-44, 2010 Jun.
Article in English | MEDLINE | ID: mdl-20168273

ABSTRACT

PURPOSE: The purpose of this study was to report our experience with intravitreal bevacizumab for inflammation-related choroidal neovascularization in two tertiary centers. METHODS: This study was a retrospective analysis of patients with choroidal neovascularization related to inflammatory diseases, treated with intravitreal bevacizumab injections (1.25 mg/0.05 mL). RESULTS: Ten eyes of 10 patients (range, 14-78 years; mean age, 44 years) with underlying uveitis were treated with intravitreal bevacizumab for inflammation-related choroidal neovascularization from 2006 to 2008. Mean follow-up time was 13 +/- 8 months, and the mean number of injections was 2.7 +/- 2. Resolved leakage on fluorescein angiography and resolution of subretinal fluid on optical coherence tomography occurred in all patients, with improvement in visual acuity in 9 of 10 eyes and no change in visual acuity in 1 of 10 eyes. Seven patients received additional treatment based on the underlying condition. Mean macular thickness on optical coherence tomography decreased from 394 +/- 116 microm to 254 +/- 52 microm (P < 0.01). Mean visual acuity improved from 0.87 +/- 0.74 logarithm of the minimum angle of resolution to 0.38 +/- 0.63 (P = 0.005). Seven patients reached a visual acuity of 0.2 logarithm of the minimum angle of resolution (Snellen 6/9) or better. CONCLUSION: Intravitreal bevacizumab is an effective treatment for choroidal neovascularization related to inflammatory diseases when inflammation is controlled.


Subject(s)
Angiogenesis Inhibitors/administration & dosage , Antibodies, Monoclonal/administration & dosage , Choroidal Neovascularization/drug therapy , Uveitis/drug therapy , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Adolescent , Adult , Aged , Antibodies, Monoclonal, Humanized , Bevacizumab , Choroidal Neovascularization/diagnosis , Choroidal Neovascularization/physiopathology , Drug Therapy, Combination , Female , Fluorescein Angiography , Glucocorticoids/administration & dosage , Humans , Immunosuppressive Agents/administration & dosage , Injections , Male , Middle Aged , Retrospective Studies , Tomography, Optical Coherence , Treatment Outcome , Uveitis/diagnosis , Uveitis/physiopathology , Visual Acuity/physiology , Vitreous Body , Young Adult
9.
Int Ophthalmol ; 30(4): 345-51, 2010 Aug.
Article in English | MEDLINE | ID: mdl-20127140

ABSTRACT

We report our experience with photodynamic therapy (PDT) in the treatment of choroidal neovascularization (CNV) in young adult patients. This was a retrospective study of young adults with CNV treated with PDT. Data collected included age, diagnosis, type and size of CNV, number of treatments, visual outcome, and side effects. Ten patients (11 eyes) were included in the study (mean age 27.2 +/- 13.3 years). Etiologies included multifocal choroiditis (3 eyes), idiopathic CNV (5 eyes), central serous chorioretinopathy (1 eye), and toxoplasma (2 eye). The mean number of treatments was 2 +/- 0.7 and the mean follow-up time was 13.1 +/- 9.5 months. Initial visual acuity (VA) ranged from 20/25 to 20/1,200 (mean logMAR 0.6 +/- 0.5), and improved to 20/20 to 20/250 (mean logMAR 0.46 +/- 0.4) (P = 0.51). Of the four eyes that received additional treatment with oral steroids, one of which also received intravitreal bevacizumab (Avastin) injections, all had visual acuity improvement of 2 or more lines, while only two of seven eyes that received PDT alone showed such improvement. PDT can improve visual outcome in a subgroup of young patients with subfoveal CNV especially when supplemented with oral steroid and bevacizumab injections.


Subject(s)
Choroidal Neovascularization/drug therapy , Photochemotherapy , Administration, Oral , Adolescent , Adult , Angiogenesis Inhibitors/administration & dosage , Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal, Humanized , Bevacizumab , Central Serous Chorioretinopathy/complications , Choroidal Neovascularization/diagnosis , Choroidal Neovascularization/etiology , Choroidal Neovascularization/physiopathology , Choroiditis/complications , Female , Fluorescein Angiography , Humans , Male , Middle Aged , Retrospective Studies , Toxoplasmosis/complications , Treatment Outcome , Visual Acuity/drug effects , Young Adult
10.
Retina ; 28(9): 1302-7, 2008 Oct.
Article in English | MEDLINE | ID: mdl-18664935

ABSTRACT

OBJECTIVE: To study the effect of intravitreal bevacizumab for the treatment of long-standing exudative age-related macular degeneration (AMD) and low visual acuity. METHODS: Forty-seven patients (48 eyes) aged 57 to 90 years with AMD for 5 months or more and visual acuity of 20/150 or less were treated with one or more injections of bevacizumab 1.25 mg/0.05 mL between December 2005 and March 2007. The files were reviewed for background data, visual acuity, fluorescein angiography, retinal thickness, and complications. RESULTS: Thirty-two eyes were treated previously with photodynamic therapy. Mean duration of symptoms was 17.9 +/- 17.5 months; mean number of bevacizumab injections was 3.41 +/- 2; and mean follow-up was 27 +/- 15 weeks. Snellen visual acuity improved from 20/150 to hand movements (mean logMAR 1.34 +/- 0.29) to 20/50 to counting fingers (mean logMar 1.2 +/- 0.42) (P = 0.003, paired t-test). Visual acuity improved by> or =3 lines in 12 eyes (25%); showed no change in 9 eyes (19%); and deteriorated by > or =3 lines in 4 eyes (8.3%). Visual acuity was at least 20/150 in 16 eyes (33.3%) at the end of follow-up compared with 4 eyes (8.3%) before treatment (P = 0.02, McNemar test). Mean central retinal thickness (measured in 22 eyes) decreased from 324 +/- 121 mum to 264 +/- 65 mum (P = 0.02, paired t-test). CONCLUSIONS: Patients with chronic exudative AMD and low visual acuity may benefit from intravitreal bevacizumab injections.


Subject(s)
Angiogenesis Inhibitors/administration & dosage , Antibodies, Monoclonal/administration & dosage , Macular Degeneration/complications , Vision, Low/drug therapy , Aged , Aged, 80 and over , Angiogenesis Inhibitors/adverse effects , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal, Humanized , Bevacizumab , Chronic Disease , Female , Follow-Up Studies , Humans , Injections , Macular Degeneration/pathology , Male , Middle Aged , Retina/pathology , Tomography, Optical Coherence , Vision, Low/physiopathology , Visual Acuity/drug effects , Vitreous Body
11.
Ophthalmic Surg Lasers Imaging ; 37(6): 455-61, 2006.
Article in English | MEDLINE | ID: mdl-17152538

ABSTRACT

BACKGROUND AND OBJECTIVE: To report the outcome of combined verteporfin photodynamic therapy (PDT) and intravitreal triamcinolone acetonide (IVTA) for the treatment of choroidal neovascularization (CNV) with serous pigment epithelium detachment (PED) due to age-related macular degeneration (AMD). PATIENTS AND METHODS: The files of all consecutive patients with CNV and serous PED who received PDT and IVTA either primarily (primary treatment group) or following previous unsuccessful PDT (secondary treatment group) were reviewed for visual and angiographic results. RESULTS: Ten patients (11 eyes) were included. Mean number of PDT sessions was 3.18; 8 eyes received one IVTA injection and 3 eyes received two IVTA injections. Thirty-six percent of patients retained their initial visual acuity after a mean follow-up of 15.3 months. Loss of 3 or more Snellen lines was noted in 2 of 3 eyes in the primary treatment group and 5 of 8 eyes in the secondary treatment group. Increased intraocular pressure developed in 3 patients and was controlled by topical medications. CONCLUSIONS: Although combined PDT and IVTA may be considered for CNV with serous PED in patients with poor prognosis with PDT alone, the regimen as administered in this small series was not beneficial. Further studies are required to determine whether alternate sequences, timing, or doses would yield a better outcome.


Subject(s)
Choroidal Neovascularization/drug therapy , Glucocorticoids/administration & dosage , Macular Degeneration/drug therapy , Photochemotherapy/methods , Pigment Epithelium of Eye/pathology , Retinal Detachment/drug therapy , Triamcinolone Acetonide/administration & dosage , Aged , Aged, 80 and over , Choroidal Neovascularization/complications , Choroidal Neovascularization/pathology , Drug Therapy, Combination , Female , Fluorescein Angiography , Follow-Up Studies , Fundus Oculi , Humans , Injections , Macular Degeneration/complications , Macular Degeneration/pathology , Male , Middle Aged , Photosensitizing Agents/therapeutic use , Porphyrins/therapeutic use , Retinal Detachment/complications , Retinal Detachment/pathology , Retrospective Studies , Treatment Outcome , Verteporfin , Visual Acuity , Vitreous Body
12.
Am J Ophthalmol ; 138(4): 602-7, 2004 Oct.
Article in English | MEDLINE | ID: mdl-15488787

ABSTRACT

PURPOSE: To evaluate the visual outcome of patients with myopic subfoveal choroidal neovascularization (CNV) given photodynamic therapy (PDT) in a clinical setting, and to identify potential relation between the visual outcome and the age at treatment. DESIGN: Interventional case series. METHODS: Retrospective comparative study. SETTING: Outpatient ophthalmology clinic. PATIENTS: Twenty-nine consecutive patients (30 eyes) with subfoveal CNV caused by pathologic myopia who were treated with verteporfin PDT from January 2000 to May 2003. INTERVENTION: All the patients received verteporfin PDT and were followed clinically and with fluorescein angiography (FA). Review of the medical records and angiograms was performed. Patients were divided into two groups by age, using the median age (60 years) as the cutoff. MAIN OUTCOME MEASURES: Visual acuity (VA) at the end of follow-up in the older-patient group compared with the younger-patient group. RESULTS: The mean age was 63.1 years. Mean follow-up was 11.5 months. Patients received a mean of 3.48 treatments. Mean VA improved in the younger group from 0.63 to 0.39 logMAR (P = .02, paired t test) and deteriorated in the older group from 0.71 to 0.99 logMAR (P = .03, paired t test). In the whole cohort, 33% of eyes lost 3 or more lines of Snellen best-corrected VA; in the older age group, 50% of eyes lost 3 or more lines, whereas in the younger age group, only 8% of eyes did so (P = .024, Fisher's exact test). CONCLUSIONS: In our consecutive case series, visual prognosis of myopic CNV after PDT was found to be influenced by age at treatment.


Subject(s)
Choroidal Neovascularization/drug therapy , Myopia/complications , Photochemotherapy , Photosensitizing Agents/therapeutic use , Porphyrins/therapeutic use , Visual Acuity/physiology , Adult , Age of Onset , Aged , Aged, 80 and over , Choroidal Neovascularization/etiology , Fluorescein Angiography , Fovea Centralis , Humans , Middle Aged , Retrospective Studies , Treatment Outcome , Verteporfin
13.
Arch Ophthalmol ; 122(4): 453-9, 2004 Apr.
Article in English | MEDLINE | ID: mdl-15078661

ABSTRACT

OBJECTIVE: To study the visual and angiographic outcome of eyes with neovascular age-related macular degeneration associated with pigment epithelium detachment (PED) treated by photodynamic therapy. METHODS: Review of the medical charts and the fluorescein and indocyanine green angiograms of all consecutive patients with age-related macular degeneration associated with choroidal neovascularization and serous PED of at least 1 disc diameter, who received photodynamic therapy from January 1, 2000, to August 31, 2002. RESULTS: Thirty patients (34 eyes) met the study criteria. Each underwent 1 to 8 treatments (mean, 4); duration of follow-up was 12 to 36 months (mean, 19 months). Nineteen eyes (56%) lost 3 or more Snellen lines of visual acuity, 7 eyes (21%) lost 1 or 2 lines, 6 eyes (18%) maintained their initial acuity, and 2 eyes (6%) gained 1 or 2 lines. Subretinal hemorrhage occurred in 5 eyes and retinal pigment epithelium tears in 4 eyes. In 4 eyes, visual acuity decreased to counting fingers, hand motions, or light perception. CONCLUSIONS: Although 44% of the 34 eyes with age-related macular degeneration and PED lost fewer than 3 Snellen lines in acuity, severe visual loss to counting fingers or less occurred in 4 eyes, 3 of them with choroidal neovascularization inside the PED. Further studies and treatment modalities are required to improve prognosis of neovascular age-related macular degeneration with serous PED.


Subject(s)
Choroidal Neovascularization/drug therapy , Macular Degeneration/drug therapy , Photochemotherapy , Pigment Epithelium of Eye/pathology , Retinal Detachment/drug therapy , Aged , Aged, 80 and over , Choroidal Neovascularization/etiology , Choroidal Neovascularization/physiopathology , Coloring Agents , Female , Fluorescein Angiography , Humans , Indocyanine Green , Macular Degeneration/complications , Macular Degeneration/physiopathology , Male , Middle Aged , Photosensitizing Agents/therapeutic use , Porphyrins/therapeutic use , Retinal Detachment/etiology , Retinal Detachment/physiopathology , Treatment Outcome , Verteporfin , Visual Acuity/physiology
14.
Ophthalmic Surg Lasers Imaging ; 35(2): 139-45, 2004.
Article in English | MEDLINE | ID: mdl-15088824

ABSTRACT

BACKGROUND AND OBJECTIVE: To evaluate indocyanine green imaging of choroidal changes in pathologic myopia and to compare it with fluorescein angiography. PATIENTS AND METHODS: The angiograms of all consecutive patients with pathologic myopia photographed with confocal indocyanine green angiography using a scanning infrared laser or ophthalmoscope from March 1997 to December 1999 were reviewed. RESULTS: Twenty-one patients (35 eyes) were included. Indocyanine green angiography was performed in 35 eyes and immediate sequential fluorescein angiography and indocyanine green angiography in 25 eyes. The lacquer cracks were demonstrated to radiate from the disc, at the papillomacular bundle, through the macula, and around the macula. Lacquer cracks were identified in 89% and 28% of the eyes, respectively. Choroidal neovascularization (CNV) was demonstrated in 57% of eyes by indocyanine green angiography and in 56% by fluorescein angiography. All of the CNVs were classic and were located within 300 microm of the foveal center. Seventy percent of the CNVs were delineated in lacquer cracks by indocyanine green angiography. Overall, 124 lacquer cracks were identified by indocyanine green angiography and only 14 by fluorescein angiography. Lipids or serous detachment were not observed. Retinal hemorrhages were noted in 22% and 28% of eyes with indocyanine green angiography and fluorescein angiography, respectively. CONCLUSION: Confocal indocyanine green angiography offers better delineation of lacquer cracks and the localization of the CNV in lacquer cracks than does fluorescein angiography.


Subject(s)
Choroidal Neovascularization/diagnosis , Coloring Agents , Fluorescein Angiography , Indocyanine Green , Myopia/pathology , Female , Humans , Male , Middle Aged , Retinal Hemorrhage/diagnosis
15.
Am J Ophthalmol ; 137(2): 258-64, 2004 Feb.
Article in English | MEDLINE | ID: mdl-14962414

ABSTRACT

PURPOSE: To evaluate the visual outcome of patients with subfoveal choroidal neovascularization due to age-related macular degeneration, who received photodynamic therapy (PTD) in a clinical setting and to identify potential predictive visual and angiographic factors. DESIGN: Interventional case series. METHODS: The study included 74 patients with subfoveal choroidal neovascularization who underwent PDT from January 2000 to March 2001 and completed at least 1 year follow-up. All patients received verteporfin PDT and were followed clinically, with fluorescein angiography (74 eyes), and with indocyanine green angiography (65 eyes). A review of the medical records and angiograms was performed. RESULTS: Mean follow-up was 15.6 months. Patients received a mean of 3.4 treatments per year. Sixty-six percent lost less than 3 Snellen lines of visual acuity. Three patients (4%) experienced profound visual acuity loss to finger counting. Final visual acuity was positively correlated with lesion size and visual acuity at presentation. Visual outcome was worse in the presence of cystoid macular edema. On indocyanine green angiography, a round hypofluorescent spot was seen at the site of the PDT, with maintenance of medium and large choroidal vessels. CONCLUSION: Smaller lesion size and better visual acuity at presentation were good predictive signs, whereas cystoid macular edema was found to be a poor prognostic sign for visual outcome following PDT.


Subject(s)
Fluorescein Angiography , Macular Degeneration/drug therapy , Photochemotherapy , Visual Acuity/physiology , Aged , Aged, 80 and over , Choroidal Neovascularization/diagnosis , Choroidal Neovascularization/etiology , Coloring Agents , Female , Follow-Up Studies , Humans , Indocyanine Green , Macular Degeneration/complications , Macular Degeneration/physiopathology , Macular Edema/diagnosis , Macular Edema/etiology , Male , Middle Aged , Photosensitizing Agents/therapeutic use , Porphyrins/therapeutic use , Retrospective Studies , Verteporfin
16.
Ophthalmology ; 109(9): 1726-36, 2002 Sep.
Article in English | MEDLINE | ID: mdl-12208724

ABSTRACT

OBJECTIVE: To identify the angiographic features of retinal choroidal anastomoses (RCAs) in patients with newly diagnosed occult choroidal neovascularization (CNV) in the setting of age-related macular degeneration (AMD) and to determine the sequence of flow between the RCA and the CNV. DESIGN: Retrospective cross-sectional study. PARTICIPANTS: The angiograms of 205 eyes of 153 consecutive patients with occult CNV on fluorescein angiography (FA) and focal hot spots on indocyanine green angiography (ICGA) were evaluated retrospectively. METHODS OF TESTING: Red-free photographs and sequential digital fluorescein and indocyanine green angiograms obtained by confocal scanning laser ophthalmoscope (the Heidelberg Retina Angiograph; Heidelberg Engineering GmbH, Dossenheim, Germany). MAIN OUTCOME MEASURES: The angiograms were evaluated for the presence of RCA. The following angiographic characteristics were recorded: number and type of anastomoses, location, distance from fovea, area of CNV, presence of pigment epithelium detachment (PED), cystoid macular edema on FA, and intraretinal leakage on ICGA. The direction of flow between the RCA and the CNV was identified by analyzing high-speed angiograms. RESULTS: Retinal choroidal anastomoses were identified in 57 eyes (28%), in 49 of 154 eyes with PED (32%), and in 8 of 51 eyes without PED (16%). Of 109 anastomoses, 70% were venous and 30% were arterial. Ninety-six percent of the eyes had at least one venous anastomosis, 49% of the eyes had an arterial anastomosis, and 46% of the eyes had both. Cystoid macular edema was seen on FA in 37 eyes (65%), and intraretinal indocyanine green leakage was noted in 52 eyes (91%). Twenty-two eyes that underwent high-speed ICGA were analyzed for the direction of flow. All 15 eyes having arterial and venous anastomoses demonstrated a filling pattern from the retinal arteriole to the CNV, followed by the retinal venule. Seven eyes with venous RCA showed flow sequence from the CNV to the collecting retinal venule. CONCLUSIONS: Our study supports the presence of RCA in the early stages of acute exudative AMD with occult CNV, mainly with serous PED. High-speed angiography helps to identify the filling sequence of the RCA and the CNV, and therefore may guide the clinician in planning treatment strategies.


Subject(s)
Arteriovenous Anastomosis/pathology , Choroid/blood supply , Choroidal Neovascularization/etiology , Macular Degeneration/complications , Retinal Vessels/pathology , Aged , Choroidal Neovascularization/diagnosis , Cross-Sectional Studies , Female , Fluorescein Angiography , Humans , Indocyanine Green , Macular Degeneration/diagnosis , Macular Edema/diagnosis , Macular Edema/etiology , Male , Regional Blood Flow , Retrospective Studies
17.
Retina ; 22(4): 406-11, 2002 Aug.
Article in English | MEDLINE | ID: mdl-12172105

ABSTRACT

PURPOSE: To evaluate alterations in the retinal vasculature overlying pigment epithelial detachments (PED) in exudative age-related macular degeneration (ARMD) using indocyanine green and fluorescein angiography. METHODS: Forty-one patients (41 eyes) with a clinical diagnosis of exudative ARMD with PED underwent simultaneous fluorescein and indocyanine green angiography, also under high (10 degrees ) magnification. Vascular abnormalities in the retina were compared between patients with vascularized (n = 34, group 1) and nonvascularized (n = 7, group 2) PED on indocyanine green angiography and correlated with the size of the PED and the presence of serous retinal detachment. RESULTS: In all, 67 vascular abnormalities were found by indocyanine green angiography and only 22 by fluorescein angiography; this finding was statistically significant (P < 0.0001). The finding of retinal vasculopathy (32 patients in group 1 and two patients in group 2) was directly correlated with the presence of choroidal neovascularizations (P = 0.002). There was also a direct correlation between the presence of choroidal neovascularization and size of the PED (P = 0.03). The number of retinal vascular findings was not significantly correlated with serous elevation of the retina. CONCLUSIONS: Retinal vasculopathies may be observed in eyes with PED and are detectable by indocyanine green and fluorescein angiography.


Subject(s)
Macular Degeneration/complications , Pigment Epithelium of Eye/pathology , Retinal Detachment/etiology , Retinal Diseases/etiology , Retinal Vessels/pathology , Aged , Fluorescein Angiography , Humans , Indocyanine Green , Macular Degeneration/diagnosis , Middle Aged , Retinal Detachment/diagnosis , Retinal Diseases/diagnosis , Retrospective Studies
SELECTION OF CITATIONS
SEARCH DETAIL
...