Conjunctival displacement to the corneal side for oblique-parallel insertion in 25-gauge vitrectomy.

PURPOSE: To assess the usefulness of the method of oblique-parallel trocar insertion with conjunctival displacement to the corneal side in 25-gauge (G) transconjunctival vitrectomy. METHODS: 25-G vitrectomy was performed in 77 consecutive eyes. Before making obliqueparallel trocar insertions, the conjunctiva was conventionally displaced superiorly in 35 eyes, but was displaced toward the corneal side in 42 eyes. After surgery, the distance between the scleral and conjunctival wounds was measured with calipers. The frequency of scleral wound exposure was assessed. RESULTS: After cannula removal at the end of surgery, inferior repositioning of the superiorly displaced conjunctiva was observed, while marked posterior repositioning of the corneal side caused displacement of the conjunctiva due to gravity. The superior displacement distances between the sclera and conjunctival wounds were 2.4+/-0.3 mm at the infusion port, 2.0+/-0.4 mm at the superior temporal port, and 1.9+/-0.4 mm at the superior nasal port, while the corresponding distances for corneal side displacement were 3.6+/-0.5, 3.5+/-0.5, and 2.5+/-0.5mm, and were all significantly (p<0.0001) greater with corneal side displacement. The frequency of scleral wound exposure due to conjunctival damage around the cannula (infusion port) was significantly (p=0.0164) lower for corneal side displacement (0/42; 16.7%) than superior displacement (5/35; 14.3%). There was no postoperative endophthalmitis in all 77 patients studied. CONCLUSIONS: In 25-G transconjunctival vitrectomy, using oblique-parallel trocar insertions with the conjunctiva displaced toward the corneal side results in marked posterior repositioning of the conjunctiva after cannula extraction. Corneal side conjunctival displacement is technically easy and completely covers the scleral wound. This method is expected to be effective in preventing endophthalmitis.

Vitreous prolapse through the scleral wound in 25-gauge transconjunctival vitrectomy.

PURPOSE: To examine the effectiveness of excising peripheral vitreous until the cannula tip is exposed to prevent vitreous prolapse through the scleral wound in 25-gauge transconjunctival vitrectomy. METHODS: Twenty-five-gauge vitrectomy was performed in 60 consecutive eyes. Peripheral vitrectomy was conducted until the cannula tip was exposed in 30 eyes and with conservation of the vitreous around the cannula in 30 eyes. Vitreous prolapse through the scleral wound was examined using a suction stick. RESULTS: Vitreous prolapse through the scleral wound was transparent, fine and short, and detectable only with the suction stick. The incidence of vitreous prolapse through the scleral wound was 0% (0 of 30 eyes) when peripheral vitreous was excised until the cannula tip was exposed, and 20% (6 of 30 eyes) when the vitreous around the cannula was conserved, with a significant difference between two groups (p=0.0237). In two of six eyes with vitreous prolapse, the scleral wound was open, but there was no leakage of intraocular fluid and normal ocular pressure was maintained. CONCLUSIONS: If peripheral vitrectomy is performed without excising the vitreous surrounding the cannula, there is a 20% risk of the vitreous prolapsing through the scleral wound. Vitreous prolapse through the scleral wound is difficult to detect because it is transparent, fine and short, and there is no intraocular fluid leakage. Therefore, detecting vitreous prolapse with a suction stick and appropriate intervention are important for preventing endophthalmitis.

Needle-shaped deposits on retinal surface in a case of ocular amyloidosis.

PURPOSE: To report a case in which optical coherence tomography (OCT) showed needle-shaped deposits on the retinal surface oriented toward the vitreous cavity and immunohistochemical findings suggested light chain-related amyloidosis. METHODS: A 59-year-old man with no systemic complications had bilateral neovascular glaucoma and vitreous opacities in the right eye. Vitrectomy was conducted on the right eye and the excised vitreous was examined histopathologically. RESULTS: Glass wool-like opacities were observed during vitrectomy. Postoperative fundus examination of the right eye showed retinal hemorrhage and white deposits around blood vessels and on retinal surface. Fluorescein angiography revealed hyperfluorescence of the optic disc, non-perfusion areas, and vascular focal staining. OCT depicted needle-shaped deposits perpendicular to the retinal surface oriented toward the vitreous. Histologic examination of deposits revealed positive reaction for Congo red stain, and immunohistochemical examination demonstrated positive reactivities for anti-lambda and anti-kappa light chains (precursors of amyloid protein), suggesting a diagnosis of light chain-related amyloidosis. CONCLUSIONS: In this case, OCT showed needle-shaped deposits perpendicular to the retinal surface. Special staining with Congo red revealed the deposit to be amyloid deposition. Immunohistochemical staining suggested light chain-related amyloidosis. Vascular obstructive lesions and neovascular glaucoma secondary to retinal vascular damage in amyloidosis warrant particular attention.

25-Gauge peripheral iridectomy during vitrectomy.

PURPOSE: To report peripheral iridectomy using a 25-gauge vitreous cutter in a 42-year-old man with pupillary block due to adhesion of the internal iris surface to the continuous circular capsulorhexis. METHODS: A corneal opening was made at 10 o'clock during vitrectomy. A 25-gauge vitreous cutter was inserted into the anterior chamber with the port facing downward, and peripheral iridectomy at the 12 o'clock position was performed. The vitreous cutter was set at a cutting speed of 2500 cpm and the aspiration pressure at 600 mmHg. RESULTS: A 25-gauge vitreous cutter with a fine shaft could easily be inserted into the peripheral anterior chamber, and there was no contact with the corneal endothelium even when the anterior chamber became shallow in association with iridectomy. In this patient, pupillary block resolved with peripheral iridectomy, and ocular pressure was also controlled. CONCLUSIONS: 25-gauge peripheral iridectomy is a simple technique that permits iridectomy of appropriate size at any desirable location.

The origins of polypoidal choroidal vasculopathy.

BACKGROUND/AIM: There are two theories on the pathogenesis of polypoidal choroidal vasculopathy (PCV): variants in choroidal neovascularisation (CNV) and inner choroidal vessel abnormalities. On indocyanine green angiography (IGA) with a video camera system, PCV has a characteristic appearance, but inadequate image quality has made detailed interpretation difficult. This study aims to improve imaging, using confocal scanning laser ophthalmoscopy (SLO), to elucidate the pathogenesis of PCV. METHODS: High speed IGA with confocal SLO of 45 eyes (44 patients) showed typical PCV findings of a branching vascular network and polypoidal lesions. RESULTS: Vessels comprising branching networks began to fill simultaneously with the surrounding choroidal arteries in 38 eyes. Small numbers of vessels filling within a branching network, in the arterial and arteriovenous phases of IGA, showed focal dilatation, constriction, and tortuousity. Vessel abnormalities, corresponding to polypoidal lesions, existed within a network in eight eyes and included loops similar in calibre to network vessels, and numerous microaneurysmal dilatations of small vessels. Vessel pulsation was seen in 24 eyes. CONCLUSION: PCV is caused by inner choroidal vessel abnormalities, not CNV.

Roles of outcome expectations and self-efficacy in preschoolers' aggression.

The present study examined preschool boys' beliefs for the outcome of aggression and their perceptions of self-efficacy for aggressive behaviors. 23 preschoolers (mean age 6.3 yr.; 12 aggressive boys and 11 nonaggressive boys) were presented stories about provocative situations and asked about three expectations for aggression: positive outcomes, peer rejection, and morality. Another 18 preschoolers (mean age 6.3 yr.; 9 aggressive boys and 9 nonaggressive boys) rated their self-efficacy for four strategies: aggression, verbal persuasion, seeking help from a teacher, and withdrawal. Aggressive preschoolers did not expect a negative outcome in the form of peer-rejection in response to aggression as much as nonaggressive boys, although the groups did not differ in their expectations of positive outcomes and morality. Also, aggressive preschoolers were more confident about aggression in situations including teasing or criticism but less confident about verbal persuasion than nonaggressive preschoolers.

Effects of word length on young children's memory performance.

The standard working model that accounts for word length effects in young children has been questioned. This study explored two hypotheses suggested by Gathercole and Hitch (1993). In three experiments with serial recall tasks, the word presentation interval was adjusted so that participants could repeat both long and short words subvocally the same number of times in the intervals between the words presented. As a result, among children from 3 to 6 years of age, the word length effect was significantly reduced, whereas the same manipulation of the word presentation interval did not affect the word length effect in adults. These results suggest that the word length effects in young children reflect the process of retaining auditory information in the interval between presentations as well as readout of the phonological representation.

[A case of subacute bacterial endocarditis showing acute macular neuroretinopathy-like lesions].

PURPOSE: We report one case of mimic fundus lesions with acute macular neuroretinopathy due to subacute bacterial endocarditis. CASE: A 55-year-old male had about a 1 DD reddish petal-shaped lesion at the level of the retinal pigment epithelium in the macula and a white lesion about 1/6 DD at the level of the retinal pigment epithelium in the upper fovea. Fluorescein angiography showed the reddish lesion to be hypofluorescence due to a filling defect and indocyanine green angiography showed the hypofluorescence was due to a circulatory disturbance of the choriocapillaris. Additionally, we found that there was a severe choroidal circulatory obstruction in the white lesion on the retinal pigment epithelium. After the disappearance of the white lesion, secondary retinal pigment epithelium atrophy remained. CONCLUSION: The macular lesions of acute macular neuroretinopathy were ischaemic lesions of the retinal pigment epithelium formed because of a disturbance at the level of the choriocapillaris.

Factors Influencing Visual Acuity Following Vitrectomy for Exudative Age-related Macular Degeneration.

Purpose: We investigated the influence of various factors on visual results in patients undergoing surgical removal of choroidal neovascular membranes (CNVM) caused by age-related macular degeneration (AMD).Subjects and Methods: This study was performed in 55 eyes of 55 patients who underwent surgical removal of CNVM for AMD and followed them for 6 months or more. The criterion for surgical eligibility was active subfoveal choroidal neovascular membrane of 0.5 or more disc diameter above the retinal pigment epithelium with visual acuity of 0.3 or worse. We investigated the influence of various factors on the logarithm of the minimum angle of resolution (log MAR) final visual acuity. The factors were age, symptom duration, preoperative log MAR visual acuity, CNVM diameter, mean deviation with visual field analyzer, previous laser treatment, posterior vitreous detachment, findings of indocyanine green angiography, operative complications, and recurrence of CNVM.Results: Better preoperative visual acuity, shorter symptom duration, and smaller CNVM diameter were correlated with better postoperative final visual acuity.Conclusions: Surgical excision of subfoveal CNVM may be the better therapeutic choice in selected cases with AMD.

Indocyanine green angiographic findings of chorioretinal folds.

PURPOSE: To analyze indocyanine green (ICG) angiographic findings of chorioretinal folds. METHODS: Eight patients (9 eyes) in whom chorioretinal folds had been diagnosed were enrolled in this study. Color photography, fluorescein angiography (FA) and ICG angiography (IA) were performed. RESULTS: Indocyanine green angiography demonstrated choroidal venous congestion and a filling delay of the choroidal vessels in one case with an orbital tumor. In one posterior scleritis case, IA showed a filling delay of choroidal vessels in the early phase and multiple patchy hypofluorescent lesions scattered in the posterior pole during the late phase. Idiopathic cases showed choroidal venous dilatation. No abnormalities of the choroidal vasculature in the form of radial folds, were revealed in two cases of AMD. Linear hyperfluorescent areas suggestive of chorioretinal folds seen on IA were less numerous and wider than those observed on FA in some eyes. On the other hand, they were equally numerous and wider on IA than those on FA in other eyes. CONCLUSION: Indocyanine green angiography is useful for evaluating both pathological conditions of the choroidal vasculature and the width of chorioretinal folds at the level of the choroidal vasculature.

Surgical excision versus laser photocoagulation for subfoveal choroidal neovascular membrane with age-related macular degeneration: comparison of visual outcomes.

PURPOSE: This study was designed to compare visual acuity after laser photocoagulation with visual acuity after surgical excision of the subfoveal choroidal neovascular membrane in patients with age-related macular degeneration (AMD). METHODS: We studied 54 patients (56 eyes) who underwent laser photocoagulation and 52 patients (52 eyes) who underwent surgical excision for new subfoveal choroidal neovascular membrane occurring with AMD. We compared mean log of minimal angle of resolution (MAR) visual acuity, and the percentages of eyes showing visual improvement and a visual acuity of 0.1 or better, between the two treatment groups at 12 months after treatment. The groups were also compared according to choroidal neovascular membrane size, ie, 1 disc diameter (DD) or smaller vs larger than 1 DD. RESULTS: Mean corrected visual acuity (P <.01), percentage of eyes with improved vision (P <.01), and percentage with a visual acuity of at least 0.1 (P <.01) were higher in surgically treated eyes. The differences in mean log MAR visual acuity and the percentages were significant only for choroidal neovascular membrane of one DD or less in size. CONCLUSIONS: Postoperative eyes, especially those with choroidal neovascular membranes 1 DD or less in size, had better visual outcomes. Patients who meet our eligibility criteria, especially with small choroidal neovascular membranes 1 DD or less in size, should undergo surgical excision.

Correlation of Indocyanine Green Angiography Findings and Expression of Vascular Endothelial Growth Factor in Surgically Excised Age-related Macular Degeneration-related Choroidal Neovascular Membranes.

Purpose: We investigated the relationship between clinical classification by indocyanine green angiography (IA) and pathologic findings including the expression of vascular endothelial growth factor (VEGF) in age-related macular degeneration-related choroidal neovascular membranes.Subject and Methods: The subjects were 15 patients with age-related macular degeneration who underwent surgical excision for choroidal neovascular membrane. The patients were classified into 4 types: Type I, hyperfluorescence in both early and late phases (n = 7); Type II, hyperfluorescence in the early phase only (n = 2); Type III, hyperfluorescence in the late phase only (n = 3); and Type IV, no hyperfluorescence in any phase (n = 3). The excised choroidal neovascular membranes were fixed and stained by hematoxylin-eosin and azan. They were also examined by immunohistochemical staining for VEGF.Results: VEGF was expressed markedly in vascular endothelial cells and fibroblast-like cells of interstitial tissue of Types I, II and III. Its expression was weak in Type IV.Conclusion: Clinical classification by IA for age-related macular degeneration is consistent with the pathologic findings including the expression of VEGF.

Effects of dosing time and schedule on cisplatin-induced nephrotoxicity in rats.

Renal dysfunction induced by a single injection of cisplatin depends on the timing of the dose. However, the effects of repeated administration of cisplatin on time-dependent toxicity have not been evaluated despite the fact that in clinical practice high doses are repeatedly injected at intervals or low doses are administered daily. We studied chrononephrotoxicity in rats after weekly or daily cisplatin injections. Weekly high doses (5 mg kg(-1)) or daily low doses (1.2 mg kg(-1)) of cisplatin were injected at four time points (3, 9, 15 and 21 h after the light was turned on (HALO)) for 3 weeks. Changes in body weight after weekly cisplatin administration were independent of the timing of the doses. In the group that received daily cisplatin, the loss in body weight in the 3 HALO group was smaller than in animals receiving injections at 15 and 21 HALO (P < 0.05 and 0.001, respectively). The blood urea nitrogen and serum creatinine levels in the control rats showed a significant circadian change (peak at 15 HALO and trough at 9 HALO), but these parameters were markedly elevated in both trials and their circadian variations were disturbed. In conclusion, cisplatin-induced nephrotoxicity was the lowest at 3HALO compared with other time points of both dose regimens.

Choroideremia associated with subretinal neovascular membrane.

PURPOSE: To report two Japanese patients with choroideremia, one male and one heterozygous female, who developed subretinal neovascular membrane and/or subretinal fibrosis in the intermediate stage of the disease, and, in addition, to describe marked clinical manifestation in a heterozygous carrier female. METHOD: Two patients were examined by slip-lamp biomicroscopy, ophthalmoscopy and other ophthalmoloscopic examinations. RESULTS: Two cases showed moderately advanced ophthalmoscopic and functional abnormalitities compatible with choroideremia, and in addition, subretinal lesion in the fovea and/or midperiphery. CONCLUSION: The intermediate stage of choroideremia may occasionally be complicated with choroidal neovascular membrane in the fovea, the midperiphery, or both, which resolves spontaneously and results in subretinal fibrous scarring. The occurrence of this complication in the fovea leads to episodic central visual loss, while midperipheral lesion may remain unrecognized.

Indocyanine green angiography and histopathology of choroidal neovascular membrane in age-related macular degeneration.

PURPOSE: Histopathological investigation of the choroidal neovascular membrane (CNM) in age-related macular degeneration (AMD) patients who showed various findings in indocyanine green angiography (IA). METHODS: Before surgery, 20 eyes of 20 patients were classified into four types based on IA findings (Type I: both early and late phase hyperfluorescence; Type II: hyperfluorescence only in the early phase; Type III: hyperfluorescence only in the late phase; Type IV: virtually no hyperfluorescence in any phase). Seventeen surgically excised specimens stained with hematoxylin-eosin and azan, were examined by light microscopy. Three other specimens were examined by electron microscopy. RESULTS: Type I membrane showed many vascular channels not present in the surrounding retinal pigment epithelium (RPE) cells, and little fibrous tissue. Type II membrane had many vascular channels but RPE cells surrounded the CNM. Type III membrane showed few vascular channels and RPE cell proliferation. Type IV membrane showed dense fibrous tissue. CONCLUSION: The IA findings in AMD agreed with the CNM membrane structure in regard to the number of vascular channels, maturity of vessels, the extent of envelopment of RPE cells and the amount of fibrous tissue.

[Factors influencing visual acuity following vitrectomy for exudative age-related macular degeneration].

PURPOSE: We investigated the influence of various factors on visual results in patients undergoing surgical removal of choroidal neovascular membranes (CNVM) caused by age-related macular degeneration (AMD). SUBJECTS AND METHODS: This study was performed in 55 eyes of 55 patients who underwent surgical removal of CNVM for AMD and followed them for 6 months or more. The criterion for surgical eligibility was active subfoveal choroidal neovascular membrane of 0.5 or more disc diameter above the retinal pigment epithelium with visual acuity of 0.3 or worse. We investigated the influence of various factors on the logarithm of the minimum angle of resolution (log MAR) final visual acuity. The factors were age, symptom duration, preoperative log MAR visual acuity, CNVM diameter, mean deviation with visual field analyzer, previous laser treatment, posterior vitreous detachment, findings of indocyanine green angiography, operative complications, and recurrence of CNVM. RESULTS: Better preoperative visual acuity, shorter symptom duration, and smaller CNVM diameter were correlated with better postoperative final visual acuity. CONCLUSIONS: Surgical excision of subfoveal CNVM may be the better therapeutic choice in selected cases with AMD.

[Correlation of indocyanine green angiography findings and expression of vascular endothelial growth factor in surgically excised age-related macular degeneration-related choroidal neovascular membranes].

PURPOSE: We investigated the relationship between clinical classification by indocyanine green angiography (IA) and pathologic findings including the expression of vascular endothelial growth factor (VEGF) in age-related macular degeneration-related choroidal neovascular membranes. SUBJECT AND METHODS: The subjects were 15 patients with age-related macular degeneration who underwent surgical excision for choroidal neovascular membrane. The patients were classified into 4 types: Type I, hyperfluorescence in both early and late phases (n = 7); Type II, hyperfluorescence in the early phase only (n = 2); Type III, hyperfluorescence in the late phase only (n = 3); and Type IV, no hyperfluorescence in any phase (n = 3). The excised choroidal neovascular membranes were fixed and stained by hematoxylin-eosin and azan. They were also examined by immunohistochemical staining for VEGF. RESULTS: VEGF was expressed markedly in vascular endothelial cells and fibroblast-like cells of interstitial tissue of Types I, II and III. Its expression was weak in Type IV. CONCLUSION: Clinical classification by IA for age-related macular degeneration is consistent with the pathologic findings including the expression of VEGF.

Comparison between indocyanine green angiography and outcome of surgical removal of choroidal neovascular membrane in age-related macular degeneration

Purpose: To review the outcome of surgical removal of choroidal neovascular membranes in age-related macular degeneration as classified by indocyanine green angiographic findings.Subjects and Method: Surgery was performed in 42 eyes. They were divided into four types by indocyanine green angiographic findings prior to surgery. Type I comprised 29 eyes showing hyperfluorescence throughout the angiographic phases. Type II comprised 3 eyes showing hyperfluorescence during the early phase only. Type III comprised 5 eyes showing hyperfluorescence in the late phase only. Type IV comprised 5 eyes without hyperfluorescence throughout the angiographic phases. The results were evaluated according to the visual acuity expressed as log MAR before and after surgery.Results: Visual acuity improved significantly in Types I, II, and III after surgery. Visual acuity did not improve in Type IV.Conclusion: The findings of indocyanine green angiography are thought to reflect the histological characteristics of the choroidal neovascular membrane. Neovascular membranes of Type IV may contain a smaller number of vessels and abundant fibrous tissue. Eyes of Type IV will have atrophies in the neurosensory retina, retinal pigment epithelium, and choriocapillaris. Surgical removal of the choroidal neovascular membrane in Type IV is not effective in improving visual acuity.

[Treatment of exudative age-related macular degeneration].

I PROPHYLACTIC TREATMENT: We followed 75 eyes contralateral to eyes with exudative age-related macular degeneration (AMD), using indocyanine green angiography (IA), for more than one year. Hyperfluorescent areas in the late phase of IA were seen in 19 eyes at the initial examination, and in 25 eyes during follow-up. Exudative AMD developed in 9 of the 25 eyes. Using timetable analysis, we estimated that 11% of these 27 eyes developed AMD within one year and 55% within three years. The hyperfluorescent areas seen on IA appeared to be latent choroidal neovascularization (CNV) under the retinal pigment epithelium. We propose that photocoagulation aimed at hyperfluorescent areas should be considered in such cases. We performed prophylactic laser photocoagulation in 21 eyes, which were then followed up for at least six months. These eyes all had 10 or more serous drusen within 1,500 microns of the fovea and did not show hyperfluorescence, suggesting latent CNV in the late phase of IA. The majority or a small fraction of the serous drusen disappeared in 48% and 18% of the 21 eyes, respectively. CNV appeared adjacent to the laser scar in one eye (5%). Judging from these results, it is important to establish a method of definitively abolishing drusen and preventing the development of CNV. II TREATMENT OF CNV: Of 229 eyes which showed occult CNV in fluorescein angiography (FA), 124 eyes (54%) showed classic CNV outside the fovea on IA. One hundred and two of the 124 eyes (45%) underwent laser photocoagulation. We evaluated indocyanine green guided laser photocoagulation of extrafoveal CNV in 139 eyes. The success rate was 81% at 3 months after laser photocoagulation. This was estimated using timetable analyses to have decreased to 78% at one year and 71% at three years. Eighty percent of successfully treated eyes showed maintained or improved visual acuity. These results did not differ significantly from those obtained with laser photocoagulation based on FA findings. When classic CNV is not detected on FA, IA is indicated and if classic CNV is detected outside the fovea, photocoagulation should be performed aggressively. We compared the histological findings of removed subfoveal CNV with the IA findings prior to removal. IA findings of CNV before removal were divided into four types. Types I and II showed numerous vascular lumina in von Willebrand factor staining. Prominent proliferation in types I and II was demonstrated with Ki-67. Vascular endothelial growth factor (VEGF) showed strong staining in types I, II and III. Therefore, CNV in eyes with types I, II and III, and especially type I, requires urgent treatment. We compared visual outcomes one year after treatment between 52 eyes that underwent removal and 56 eyes that underwent laser photocoagulation of subfoveal CNV. When CNV size was one disc diameter or less, mean visual acuity, the percentage of eyes with improved vision and with a visual acuity of 0.1 or more, was significantly greater in operated eyes than in coagulated eyes. Removal is therefore superior to photocoagulation in subfoveal CNV of one disc diameter or less in size. We evaluated preoperative factors influencing the best corrected visual acuity at least six months after removal of subfoveal CNV in 67 eyes. Factors influencing the best corrected visual acuity were IA findings, feeder vessel ingrowth sites and CNV sizes. Good indications for removal included types I, II and III IA findings, extra foveal location feeder vessel ingrowth sites, and small CNV. III LOW VISION CARE: We performed reading tests using the MN read J chart for 90 eyes with the scar stage of CNV. Reading speed profiles of the 90 eyes were classified into two groups: 48 eyes showing a plateau with a relatively constant reading rate at the maximum level; and 42 eyes showing steadily increasing reading rate without a plateau. Eyes without a plateau had worse visual acuity, worse reading acuity, and slower reading speed. We evaluated newspaper reading performance by comparing conventional versus new methods based on the critical print size of the MN read J chart. Magnification power based on the critical print size were similar to those finally chosen as the best aid by the patients. On the other hand, magnification power was lower when conventional methods were used. The critical print size of the MN Read J chart appears to be valuable for determining low vision aids which facilitate reading by AMD patients.

[Hyperfluorescent areas observed in late-phase indocyanine green angiography (IA) of IA findings in fellow eyes of unilateral age-related macular degeneration].

PURPOSE: To evaluate abnormal findings of indocyanine green angiography (IA), predisposing to exudative age-related macular degeneration (AMD) in fellow eyes of unilateral exudative AMD. METHODS: We categorized 83 fellow eyes of unilateral exudative AMD into two groups, i.e. 55 eyes with early age-related maculopathy, and 28 eyes with normal aging. We performed IA. RESULTS: The late phase of IA demonstrated hyperfluorescent areas in 27 of the 83 fellow eyes, which included 22 of the 55 eyes with early age-related maculopathy and five eyes of 28 eyes with normal aging. The prevalence of the late-phase hyperfluorescence was statistically significant in early age-related maculopathy. Eight of the 22 eyes with early age-related maculopathy and one of the five eyes with normal aging progressed to exudative AMD. CONCLUSIONS: Hyperfluorescent areas observed in late-phase IA before the manifestation of exudative AMD suggested the possible presence of choroidal neovascular membrane in the subretinal pigment epithelial space.