Polypoidal choroidal vasculopathy: incidence, demographic features, and clinical characteristics.

OBJECTIVE: To clarify the incidence, demographic features, and clinical characteristics of polypoidal choroidal vasculopathy (PCV) in Japanese patients. METHODS: Consecutive patients with presumed neovascular age-related macular degeneration (AMD) who met the eligibility criteria were examined between January 1, 1999, and October 31, 2001. All patients underwent complete ophthalmologic examination and fluorescein and indocyanine green angiography. RESULTS: Among 471 eyes of 418 patients who met the criteria, 110 eyes (23%) of 100 patients were diagnosed as having PCV and 361 eyes (77%) of 318 patients as having neovascular AMD. Mean age of patients with PCV was 68.4 years, with a male preponderance (63% of patients); involvement was mostly unilateral (90% of patients), and polypoidal vascular lesions were located mainly in the macula (85% of eyes). Retinal manifestations of PCV were characterized by serous macular detachment (52% of eyes), submacular hemorrhage (30% of eyes), and retinal pigment epithelium degeneration (10% of eyes). There were few subretinal fibrovascular proliferations (7% of eyes). Mean visual acuity was 0.31 in eyes with PCV and 0.18 in eyes with AMD. The incidence of severe visual loss (0.2 or worse) was 35% in PCV and 53% in AMD. CONCLUSIONS: The incidence of PCV in Japanese patients is high, and the incidence and demographic features vary in different ethnic groups. The clinical manifestations of PCV and AMD resemble each other; however, PCV is characterized by low incidence of subretinal fibrovascular proliferation, slow progression of vascular abnormality, and minimal association with conventional choroidal neovascularization. These factors seem to lead to a more favorable visual outcome in PCV compared with neovascular AMD.

[A case of sympathetic ophthalmia secondary to silicone oil granuloma].

BACKGROUND: Sympathetic ophthalmia occurred after removal of silicone oil(SO) from a blind eye with chronic retinal detachment for 20 years. The enucleated eye was examined histopathologically. CASE: A 22-year-old man had been diagnosed with traumatic retinal detachment from blunt trauma to his left eye when he was 3 years old. Pars plana vitrectomy with SO injection was performed at that time, but he lost the sense of light in that eye. Twenty years later, he experienced ocular pain because of absolute glaucoma. Sympathetic ophthalmia has occurred after pars plana vitrectomy with removal of SO and cyclophotocoagulation. The left eye was enucleated and examined histopathologically. RESULT: Histopathological study of the enucleated eye revealed necrosis of the ciliary body due to cyclophotocoagulation. Multiple small round empty spaces which may have been SO droplets were observed in the preretinal membrane, the subretinal space, and the choroidal stroma. In the choroid, diffuse granulomatous inflammation which could be called "silicone oil granuloma" was observed. Calcified drusens were seen at the peripheral fundus. DISCUSSION: An eye containing injected SO for a long period might develop SO granuloma in the choroid and such condition could be the basis for subsequent sympathetic ophthalmia if a second operation with uveal damage was added.

Unbalanced vitreous levels of pigment epithelium-derived factor and vascular endothelial growth factor in diabetic retinopathy.

PURPOSE: To determine the levels of pigment epithelium-derived factor (PEDF) and vascular endothelial growth factor (VEGF) in the vitreous of patients with diabetic retinopathy (DR). DESIGN: Experimental study of PEDF and VEGF levels in vitreous samples collected during vitrectomy. METHODS: The levels of PEDF and VEGF were measured by enzyme-linked immunosorbent assay in the vitreous of 46 eyes of 43 patients who underwent vitrectomy with diabetic retinopathy (DR) (32 eyes of 29 patients) and an idiopathic macular hole (MH) (14 eyes of 14 patients). RESULTS: The vitreal concentration of PEDF was significantly lower at 1.11 +/- 0.14 microg/ml (mean +/- standard error) in eyes with DR than in eyes with MH at 1.71 +/- 0.22 microg/ml (P =.021). The VEGF level was 1799 +/- 478 pg/ml in eyes with DR and not detectable in MH. The PEDF level in proliferative DR (PDR) (0.94 +/- 0.12 microg/ml) was lower than that in nonproliferative DR (NPDR) (2.25 +/- 0.32 microg/ml), and that in active DR (0.85 +/- 0.14 microg/ml) was significantly lower than that in inactive DR (1.59 +/- 0.24 microg/ml; P =.01). The VEGF level was 2025 +/- 533 pg/ml in PDR and 215 +/- 201 pg/ml in NPDR and that in active DR (2543 +/- 673 pg/ml) was significantly higher than that in inactive DR (395 +/- 188 pg/ml; P =.0098). CONCLUSIONS: These results suggest that lower levels of PEDF and higher levels of VEGF may be related to the angiogenesis in DR that leads to active PDR.

Inverse levels of pigment epithelium-derived factor and vascular endothelial growth factor in the vitreous of eyes with rhegmatogenous retinal detachment and proliferative vitreoretinopathy.

PURPOSE: To determine the vitreous levels of pigment epithelium-derived factor and vascular endothelial growth factor in eyes with rhegmatogenous retinal detachment and proliferative vitreoretinopathy. DESIGN: Prospective, noncomparative case series. METHODS: Pigment epithelium-derived factor and vascular endothelial growth factor concentrations were measured by enzyme-linked immunosorbent assay in 26 eyes with retinal detachment, 6 with proliferative vitreoretinopathy, and 14 with an idiopathic macular hole. RESULTS: Pigment epithelium-derived factor concentration in proliferative vitreoretinopathy (0.57 +/- 0.05 microg/ml) was lower (P =.0069), and retinal detachment (2.37 +/- 0.34 microg/ml) was higher (P =.16) than that in macular hole (1.71 +/- 0.22 microg/ml). Vascular endothelial growth factor concentration (168 +/- 139 microg/ml) in proliferative vitreoretinopathy was significantly higher than that in retinal detachment (11 +/- 11 microg/ml, P =.0084) and macular hole (not detectable, P =.0095). CONCLUSION: Lower levels of pigment epithelium-derived factor and higher levels of vascular endothelial growth factor may be related to ocular cell proliferation.