[Relationship between central visual acuity and retinal volume of macular fovea accessed by spectral domain optical coherence tomography in Stargardt disease].

OBJECTIVE: To assess the relationship between central visual acuity and retinal volume of macular fovea in patients with Stargardt disease by spectral-domain optical coherence tomography (SD OCT). METHODS: It was a retrospective case series study. Twenty eyes of 10 patients with Stargardt disease were investigated by three-dimensional spectral-domain optical coherence tomography. SD OCT images were obtained and retrospectively analyzed. The retinal volumes of macular fovea were measured by SD OCT, whose diameters were set as 3 mm and 1 mm separately (volume 3 and volume 1). The retinal thickness of macular fovea (macular thickness) and the width of IS/OS conjunction loss of macular fovea (IS/OS loss) were also measured by SD OCT. We correlated the logMAR BCVA with IS/OS loss, macular thickness, volume 3 and volume 1 by linear regression analysis. RESULTS: LogMAR BCVA was from 0.3 to 1.22. IS/OS loss was from 847 µm to 5306 µm. Macular thickness was from 20 µm to 126 µm. Volume 3 and volume 1 was from 1.06 to 1.76 mm(3) and 0.06 to 0.13 mm(3). LogMAR BCVA correlated with the IS/OS loss (r = 0.695, P < 0.05), macular thickness (r = -0.601, P < 0.05), and volume 3(r = -0.725, P < 0.05). LogMAR BCVA did not correlate with volume 1(r = -0.364, P > 0.05). CONCLUSIONS: SD OCT could demonstrate the retinal structure of Stargardt disease clearly. The retinal volume of macular fovea accessed by SD OCT correlated with the visual acuity of Stargardt disease.

[Clinical manifestation and follow-up of melanocytoma of the optic disc].

OBJECTIVE: To investigate the clinical manifestation and follow-up of melanocytoma of the optic disc. METHODS: Retrospective case series study was taken to study the clinical data of the cases with melanocytoma of the optic disc at Peking Union Medical College Hospital from 1978 to 2007. The examination included direct and indirect ophthalmoscopy, fundus photography, fundus fluorescein angiography (FFA), fundus indocyanine green angiography (ICGA), optical coherence tomography (OCT) and B-scan. The clinical manifestation and the outcome in follow-up period were analyzed. RESULTS: Ten cases aged 31-58 years (mean 43 years) were included in this study. Among them, 9 cases were male, 1 case was female. All cases were unilateral involved, 5 cases were right eye, 5 cases were left eye. The distribution of the visual acuity was follows: light perception in 2 eyes, 20/200 in one eye, 20/20 or above in 7 eyes. The tumor mass at the optic disc with extensive serous detachment of retina was detected on B-scan in one eye. The benign melanocytoma was diagnosed by vitreous fine needle biopsy for this eye. In other case, the tumor was found to be enlarged, visual field defect deteriorated, pigment granules appeared in the vitreous adjacent to the tumor during on year follow-up period. On the patient request, enucleation was performed to rule out the malignancy of the tumor. Pathologic study showed that the tumor cells were active, but benign state. The tumor size and visual acuity in other eight eyes remained stable in the follow-up period with one to 18 years (mean 3.5 years). On FFA and ICGA, bilateral choroidal nevi were found in one eye. CONCLUSIONS: Melanocytoma of the optic disc is a benign tumor that rarely causes visual impairment. However, visual acuity may be impaired due to enlargement of the tumor or necrosis in tumor. It is important to follow-up every case with melanocytoma of the optic disc as long as possible.

[Follow-up and management of Coats disease diagnosed in childhood].

OBJECTIVE: To investigate retrospectively the clinical manifestation and the final visual prognosis through a long-term fellow-up study. METHODS: It was retrospective case series study. Twenty four patients (26 eyes) were diagnosed with Coats disease from 1962 through 2006 at the Department of Ophthalmology, Peking Union Medical Hospital, Chinese Academy of Medical Sciences. Age, visual acuity, time of initial visit, method of treatment and the condition of eye fundus for each patient were documented. The time of follow-up ranged from 1-44 years, averaged 5 years. RESULTS: Age of the patients at initial visit ranged between 1 to 18 years old, 7 years on average. Eighteen patients (75%) were male and 6 were female (25%). Twenty two cases were unilateral and only 2 female patients were bilateral. In 26 eyes, 7 eyes exhibited capillary irregular dilatation, miliary aneurysms and nonperfusion area on fluorescein angiography located at peripheral fundus; 15 eyes were complicated with exudative retinal detachment. Four eyes reached end stage with no light perception or only finger count. Laser photocoagulation was performed in 21 eyes. In 10 eyes, retinal exudates and hemorrhages were absorbed with improvement of visual acuity. Ten eyes with extensive retinal detachment including macula underwent closed vitrectomy, the best visual acuity was 0.1 after surgery. CONCLUSIONS: The onset of Coats disease is in early young childhood. Abnormal vascular lesions and military aneurysms appeared at peripheral fundus with early retinal exudation involving the macula. Early treatment with laser coagulation could obtain good visual prognosis. The supplement treatment is required for new lesions occurring during the long- term follow-up period.

[Long-term follow-up and management of choroidal osteoma].

OBJECTIVE: To report the clinical characteristics, long-term follow-up and management of choroidal osteoma. METHODS: Eighteen eyes of 12 cases (5 male and 7 female) of choroidal osteoma were studied. Best corrected vision, intraocular pressure, perimetry, anterior segment and eye fundus were examined routinely. Special tests included phytochrome of eye fundus, fluorescein angiography and/or indocyanine green angiography; B-ultrasonogram, CT, perimetry and electrophysiology. (1) Eight eyes of 6 cases treated with vitamins and anti-inflammatory drug and followed-up periodically for 1-26 years (median 2.5 years). (2) Four eyes of 2 cases were treated with Krypton laser photocoagulation, 2 of them were superimposed with transpupillary thermotherapy (TTT). (3) TTT was given primarily for 6 eyes of 4 cases with infrared dione laser; the spot size was 3 mm, 1-5 spots were conducted conjunctly to cover the tumor surface. Power was 800-1200 mw at 60-90 seconds. The procedure was completed in 1-3 recessions with an interval of 4-6 weeks. RESULTS: (1) In the medical treatment group, gradual growth of the tumor with pseudopodium along the margin was disclosed. One eye showed spontaneously regression during the long-term follow-up. (2) Laser photocoagulation was effective for 2 eyes, but residual flat serous detachment around the optic disc persisted in another 2 eyes and subsided with TTT. (3) Choroidal osteoma complicated with CNV treated primarily with TTT, prominent improvement was demonstrated. CONCLUSIONS: Choroidal osteoma grows gradually in the natural course and shows pseudopodial margin. Laser photocoagulation was effective for certain cases. TTT is a method of choice either used primarily or supplementary after laser photocoagulation, it is recommended for cases complicated with CNV.

[Anticardiolipin antibodies and ocular diseases].

Anticardiolipin antibodies are a group of autoantibodies. It has been found that these antibodies were associated with thrombosis, recurrent spontaneous abortions and thrombocytopenia. This paper reviews the latest findings about the epidemiology, the mechanism for immunopathology, main systemic features, ocular features, diagnosis, differential diagnosis, prevention and treatment of anticardiolipin antibodies syndrome.

[Clinical trial of verteporfin photodynamic therapy in Chinese age-related macular degeneration with subfoveal predominant choroidal neovascularization patients].

OBJECTIVE: To determine the safety and efficacy of verteporfin (visudyne) photodynamic therapy in age-related macular degeneration patients with subfoveal predominant choroidal neovascularization in China. METHODS: Multicenter, open-label, non-controlled clinical study. The included patients are diagnosed AMD patients with predominant classic CNV. The included patients received verteporfin intravenously followed by 689 nm laser light administration 15 minutes after the infusion start. The patients were be followed up for 24 weeks (+/-12 days) after initial verteporfin PDT treatment. Clinical follow-up was done at the end of week 12 (+/-12 days) and week 24 (+/-12 days) after the initial treatment. Additional treatment was given after 12 weeks from initial treatment if leakage from CNV was observed on fundus fluorescein angiogram. The visual acuity with ETDRS visual chart and the retinal lesion changes were documented and compared with baseline. The adverse events both in the process of treatment and in the follow-up were recorded throughout the entire study period. RESULTS: Thirty-one patients (31 eyes) were included and completed the trial with verteporfin PDT treatment. During the 24 weeks of the trial, 38.7% of the treated eyes had a vision gain more than 5 letters, 83.9% of the treated eyes had less than 15 letters vision loss. At week 12 after the initial treatment, 12.9% of the treated eyes had no leakage; 61.3% of the treated eyes had leakages, but limited to the former lesion, 25.8% of the treated eyes had increased leakage. The results at week 24 after the initial treatment were similar to those at week 12. At week 24 after the initial treatment, there were only slight enlargements in the lesion size, area of retinal lesion, the lesion surrounding area, and greatest linear dimension (GLD) of the lesion, but no statistical significant difference was found between baseline and week 12 after initial treatment (P = 0.65, 0.31, 0.12, respectively). No obvious progress of the fibrosis was detected in most of the PDT treated eyes. Eleven cases of adverse events (AE) occurred in our trial and the incidence was 34.4%. Among the 11 patients with reported adverse event, 7 (21.9%) had mild adverse event; 3 (9.4%) had moderate adverse events; 1 (3.1%) had a serious adverse event. During the study period, no abnormal changes were found in most of the laboratory tests including serum and urine biochemistry, hematology and Electrocardiogram. CONCLUSIONS: The results of this trial showed positive efficacy of PDT with verteporfin in the treatment of predominantly subfoveal CNV secondary to AMD by reducing the risk of vision loss. The incidence of serious adverse events was only 3.1%. It is highly safe to use PDT with verteporfin in Chinese AMD patients with subfoveal predominant classical CNV.

[Transpupillary thermotherapy for circumscribed choroidal hemangioma].

OBJECTIVE: To evaluate the efficacy of transpupillary thermotherapy (TTT) on circumscribed choroidal hemangioma. METHODS: Ten eyes of 10 cases with circumscribed choroidal hemangioma (age 16-48, average 34.4) were included in the present study. Six cases had previous green laser (4 argon and 2 krypton) photocoagulation, TTT as a primary treatment was used for other 4 cases without previous laser application. Fluorescein angiography, visual acuity, anterior segment and fundus examination, perimetry test, FFA/ICGA and ultrasonography were performed in all patients before the treatment. One to five infra red diode laser spots (810 nm with power of 800-1200 mW, diameter of 3 mm) were delivered on the surface of tumor with 60 seconds exposure, additional 10-20 seconds exposure was used in some cases. Second treatment was given 1-3 month later if there was active leakage demonstrated by fluorescein angiography. The followed-up period was 6-36 months (averaged 14.5 month). RESULTS: After transpupillary thermotherapy, 9 eyes (90%) showed partial regression of the tumor. Average visual acuity was 0.25 and 0.6 before and after TTT, respectively. Six patients showed improvement of vision acuity, but vision acuity in 4 patients with cystic macular degeneration remained unchanged. No recurrences were observed within follow-up averaged 14.5 months. Transpupillary thermotherapy did not associate with any significant complications. CONCLUSION: Transpupillary thermotherapy is effective to treat circumscribed hemangioma of choroid either as a primary treatment or supplementary therapy to previous laser photocoagulation.

[Krypton laser photocoagulation at low power setting for age-related macular degeneration complicated with subfoveal choroidal neovascularization].

OBJECTIVE: To evaluate the efficacy of krypton laser photocoagulation for treatment of age-related macular degeneration (AMD) complicated with mainly subfoveal classic choroidal neovascularization (CNV). METHODS: Seventeen eyes of 17 cases, aged 50 - 74 years (averaged 60.8 years) with mainly subfoveal classic choroidal neovascularization were treated with krypton laser at lower power setting. The treatment was completed in one session. Another course of treatment was given 4 weeks later if there was active leakage demonstrated at the CNV area. Visual acuity, anterior segment and fundus examination, perimetry test, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were performed before and after treatment. The follow-up period was 3.5 years on average (1 - 8 years). RESULTS: There was no immediately decrease of visual acuity after treatment. All treated eyes showed absorption of hemorrhages and/or exudates and diminished leakages. Visual acuity was stable in 8 eyes; improved in 6 eyes (>/= 2 lines), and decreased in 3 eyes (

[Natural course and prognosis of visual acuity in patients of age-related macular degeneration with occult choroidal neovascularization].

OBJECTIVE: To investigate the natural course and the final visual acuity in patients of age-related macular degeneration with choroidal neovascularization. METHODS: Thirty five eyes of 29 patients diagnosed as AMD with occult choroidal neovascularization were studied. The eyes which had laser, radiation therapy or surgical treatment were excluded. Visual acuity, fundus examination, fluorescent angiography (FFA) and perimetry test were performed at the first time visit and 5 years following-up at an interval of 1 to 3 months. The average following-up period of time was 8 years (range from 5 to 16 years) which started in 1985 and ended in 2001. RESULTS: Initial visual acuity 0.1 or less was shown in 10 eyes (28.5%, only hands movement can be seen in 4 of 10 eyes), 23 eyes (65.7%) with visual acuity of 0.1 or less (14 eyes with vision acuity of hands movement) on the last visit. 7 of 35 eyes, the final visual acuity improved more than 2 lines, 12 eyes remained the same and 16 eyes had been lost vision more than two lines. At the baseline examination, 25 eyes had macular hemorrhages and 4 eyes had vitreous hemorrhages. The fundus hemorrhages occurred repeatedly 1 to 4 times in 23 eyes during following-up, the macular hemorrhages was detected in 7 eyes at the last visit. At the initial fundus examination, fibrotic membranes were found in 7 eyes; all 35 eyes had disc form scarring with various size in most recent following-up. CONCLUSION: The natural course of Age-related macular degeneration with choroidal neovascularization is prolonged and the final visual prognosis was poor especially in the cases with recurrent macular hemorrhages.