Histological findings of a surgically excised myopic choroidal neovascular membrane after photodynamic therapy. A case report.

BACKGROUND: The authors describe a myopic choroidal neovascular membrane excised 4 months after photodynamic therapy (PDT). METHODS: A 68-year-old woman with classic choroidal neovascularization (CNV) due to pathologic myopia underwent PDT with verteporfin in the left eye. Four months after treatment a full-thickness macular hole was diagnosed in the same eye and the patient underwent vitrectomy with submacular membranectomy. The subfoveal membrane was studied by light microscopy and immunohistochemical techniques. RESULTS: Light microscopy showed a thin fibrovascular membrane covered by residual retinal pigment epithelium. The membrane contained homogeneous matrix with small collagen bundles, fibroblasts and small blood vessels. The distribution of blood vessels was nonuniform: extravasated red blood cells, macrophages and other inflammatory elements were not present in the fibrous matrix. Endothelial cells were highlighted by CD34 immunostaining and did not show any significant alteration. There was no evidence of inflammatory cells or thrombosis inside vascular lumina. CONCLUSIONS: Histologic examination of the neovascular membrane showed features similar to those of surgically excised myopic CNV without PDT treatment. Our findings suggest that PDT-induced occlusion is temporary. Fluorescein leakage from CNV after a single PDT treatment can be considered as an sign of blood vessel regrowth or recanalization indicating that multiple treatments are necessary.

Natural history of macular subretinal hemorrhage in age-related macular degeneration.

PURPOSE: To define the natural course of extensive submacular hemorrhage in age-related macular degeneration (AMD). PATIENTS AND METHODS: The clinical charts of 54 patients (60 eyes) older than 55 years with subretinal hemorrhage larger than 1 disk diameter and extending beneath the fovea were retrospectively reviewed. The age of the patient, the use of antihypertensive or anticoagulant medication, visual acuity, biomicroscopic and fluorescein and indocyanine green (in 33 cases) angiographic data were recorded at presentation and during follow-up. RESULTS: At the initial examination, average visual acuity was 20/240 (range from 20/70 to light perception). During follow-up (mean 24 months) visual acuity worsened in 80% of the eyes with a mean final visual acuity of 20/1, 250 (range from 20/100 to light perception). The initial size and thickness of hemorrhage were correlated with initial and final visual acuity. Recurrence of hemorrhage resulted in an important impact on final visual acuity. Anatomic outcome showed fibrous tissue proliferation in 23 eyes (38.3%), atrophic scar in 15 eyes (25%) and occurrence of a retinal pigment epithelium tear in 13 eyes (21.6%). CONCLUSION: The visual outcome in eyes with submacular hemorrhages due to AMD is very poor. Size and thickness of the hemorrhage influenced negatively the natural prognosis. A surgical approach can be considered although it has not yet a widespread use.

Iris diaphragm implantation in post-traumatic aniridia and tractional retinal detachment.

The implantation of an artificial iris diaphragm is described in a case of aniridia and traumatic aphakia with a relapsed, tractional retinal detachment. The addition of heparin and dexamethasone to the infusion liquid is useful to reduce the fibrinous exudation which seems to be the main cause of diaphragm obliteration.

Trans-scleral krypton laser cyclophotocoagulation: our experience of its use on patients with neovascular glaucoma.

Trans-scleral cyclophotocoagulation is an efficacious method in neovascular glaucoma (NVG) treatment. We have used it with krypton laser on 12 eyes of 12 patients affected by NVG with algetic symptoms. Six months after treatment, intraocular pressure was down enough for the pain to disappear. Executional simplicity and the possibility of modulating the intensity of the treatment are grounds for the encouragement of the technique's use in NVG.