1/35. The development of choroidal neovascularization in pregnancy.PURPOSE: To evaluate the possible association between the development of choroidal neovascularization (CNV) and pregnancy. methods: A retrospective review was performed of the clinical records of three patients who were pregnant at the time a choroidal neovascular membrane (CNVM) was diagnosed. The clinical presentations and treatment of the CNVM occurring in association with the pregnancies are described. RESULTS: Each patient had a decrease in visual acuity during her pregnancy: one in the first trimester, one in the second trimester, and one in the third trimester. Two patients were diagnosed with CNV related to presumed ocular histoplasmosis syndrome (POHS) and one with an idiopathic CNVM. The two-patients with POHS showed progression of CNV after childbirth. All patients received laser photocoagulation directly to the site of the CNV. The two patients with ocular histoplasmosis experienced recurrence after treatment; one received further photocoagulation treatment, and the other underwent vitrectomy with removal of the CNVM. CONCLUSIONS: pregnancy and the immediate postpartum period may be associated with development or recurrence of CNV in POHS or idiopathic cases. This may be related to hormonal changes during pregnancy, or the cases described may reflect only a coincidental association. This report discusses possible causal factors and mechanisms.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
2/35. choroidal neovascularization with granulomatous inflammation in ocular histoplasmosis syndrome.PURPOSE: To report pathologic examination of an excised choroidal neovascular membrane in a patient with ocular histoplasmosis syndrome that demonstrated granulomatous inflammation. METHOD: Case report. A 50-year-old woman with sudden vision loss in her left eye demonstrated clinical and fluorescein angiographic findings characteristic of choroidal neovascularization secondary to ocular histoplasmosis syndrome. RESULTS: Histopathologic examination of the surgically excised choroidal neovascular membrane disclosed granulomatous inflammation. CONCLUSIONS: This case suggests an important role of mononuclear phagocytic cells as primary mediators of angiogenesis or modifiers of choroidal neovascularization. This association of choroidal neovascularization with granulomatous inflammation did not respond to treatment with systemic corticosteroids.- - - - - - - - - - ranking = 2keywords = membrane (Clic here for more details about this article) |
3/35. Surgical removal of subfoveal choroidal neovascularization without removal of posterior hyaloid: a consecutive series in younger patients.PURPOSE: Subfoveal choroidal neovascularization (CNV) remains a common and important cause of visual loss. Previous studies have suggested that submacular surgery may improve or maintain visual acuity, particularly in younger patients. The majority of reported cases included removal of the posterior hyaloid during vitrectomy. The authors present a consecutive series of patients age 55 or younger with subfoveal CNV removal without posterior hyaloid removal. methods: Seventeen patients without age-related macular degeneration (ARMD), with subfoveal CNV from choroiditis, presumed ocular histoplasmosis syndrome, myopia, or idiopathic causes, underwent a small retinotomy technique to extract the membranes after vitrectomy without posterior hyaloid removal. RESULTS: Median improvement in visual acuity was from 20/320 to 20/50. Eleven patients (65%) experienced an improvement of three or more lines of Snellen acuity (average 7.5), 4 (23%) were within two lines of preoperative acuity, and 2 (12%) had decreased acuity, with an average follow-up of 12 months (range 3-31). Choroidal neovascularization recurred in six patients (35%). Postoperative retinal detachment, epiretinal proliferation, or macular hole did not occur. CONCLUSIONS: In this series of younger patients with subfoveal CNV not from ARMD, visual acuity was improved in the majority after submacular membrane removal. Omission of removal of the posterior hyaloid did not adversely affect outcome.- - - - - - - - - - ranking = 2keywords = membrane (Clic here for more details about this article) |
4/35. Subretinal, viscoelastic-assisted, endoscope-guided photothermal ablation of choroidal neovascular membranes by erbium:YAG laser.BACKGROUND AND OBJECTIVE: The efficacy of endoscope-guided erbium:YAG laser, assisted by viscoelastic macular detachment, in subretinal ablation of choroidal neovascular membranes (CNVs) is evaluated. patients AND methods: A high-repetition, midinfrared erbium:YAG laser was used subretinally to ablate CNVs in 2 patients. Ablation followed pars plana vitrectomy and macular retinal detachment using a viscoelastic substance, and was guided by a high resolution endoscope. RESULTS: visual acuity improved from 6/90 to 6/20, six months after treatment in 1 patient, and from finger counting from 1 meter to 6/30, three months after treatment in the other. The membranes showed no angiographic signs of activity postoperatively. However, a zone of stippled hyperfluorescence appeared in both patients, corresponding with the macular detachment area. This gradually diminished in size in both patients. CONCLUSIONS: The surgical procedure was found effective in our preliminary research. The use of viscoelastic substance and endoscope is felt to contribute to the favorable outcome. The cause and significance of the retinal pigment epithelium damage are yet to be determined.- - - - - - - - - - ranking = 6keywords = membrane (Clic here for more details about this article) |
5/35. Subretinal fibrous membrane following argon laser photocoagulation of presumed histoplasmic maculopathy.Following an initial improvement after argon laser slit-lamp photocoagulation of histoplasmic choroiditis, progressive visual loss occurred. Histopathological examination showed a dense fibrous membrane between Bruch's membrane and the sensory retina. There was no recurrence of hemorrhage or subretinal fluid. This case report provides an explanation for visual loss in the absence of recurrent inflammation or vascular leakage.- - - - - - - - - - ranking = 6keywords = membrane (Clic here for more details about this article) |
6/35. Ill-defined choroidal neovascularization within ocular histoplasmosis scars.Seven patients with scars typical of ocular histoplasmosis syndrome presented with new symptoms of decreased vision or metamorphopsia. In each patient the symptoms corresponded to an atrophic or "punched-out" histoplasmosis scar in the macula. Clinically, a small amount of subretinal fluid overlying the scars and slight hyperfluorescence were seen on fluorescein angiography. These findings were due to a choroidal neovascular membrane growing within the margins of the atrophic scar. The membranes were difficult to diagnose because of the absence of hemorrhage, pigmentation, or growth of vessels beyond the margins of the scar. Clinicians should be aware that these patients may have early and growing choroidal neovascularization and may need to undergo photocoagulation or to be followed closely.- - - - - - - - - - ranking = 2keywords = membrane (Clic here for more details about this article) |
7/35. Surgical management of subfoveal choroidal neovascularization.BACKGROUND: Subfoveal choroidal neovascularization (CNV) usually is associated with a poor visual prognosis. Laser photocoagulation of certain subfoveal membranes secondary to age-related macular degeneration (ARMD) appears preferable to observation based on recent Macular Photocoagulation Study (MPS) findings but is associated with decreased vision. The authors explored the use of vitreoretinal surgical techniques as an alternative method of eradicating subfoveal CNV. methods: After vitrectomy, a small retinotomy technique was used to extract or disconnect from the choroidal circulation subfoveal CNV in 58 eyes. There were 33 eyes with ARMD, 20 eyes with presumed ocular histoplasmosis, and 5 eyes with miscellaneous etiologies. Five eyes also received subfoveal RPE patches. RESULTS: With limited follow-up, significant improvement in vision (defined as 2 Snellen lines) was achieved in 7 of 22 eyes with ARMD CNV removal (1 eye 20/20), 0 of 4 eyes with ARMD CNV removal and RPE patches, and 1 of 7 eyes with ARMD CNV disconnection. Significant improvement was achieved in 6 of 16 eyes with presumed ocular histoplasmosis removal and 0 of 4 eyes with presumed ocular histoplasmosis CNV disconnection. In 5 eyes with miscellaneous CNV, 2 improved (20/20 and 20/40). CNV recurred in 29%. CONCLUSIONS: Some patients with subfoveal CNV appear to benefit from surgical removal. Only rarely do eyes with ARMD improve. Longer-term follow-up and refined case selection are required before this approach can be widely recommended.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
8/35. choroidal neovascularization after laser in situ keratomileusis in a patient with presumed ocular histoplasmosis syndrome.PURPOSE: A 44-year-old patient with presumed ocular histoplasmosis syndrome (POHS) who developed a choroidal neovascular membrane (CNV) after laser in situ keratomileusis (LASIK) surgery is presented. methods: A 44-year-old male patient with moderate myopia and POHS who underwent LASIK surgery complained of distorted vision after the procedure. He had a quiet POHS lesion prior to refractive surgery. Fundus examination and fluorescein angiography revealed subfoveal CNV after the LASIK surgery. He underwent 2 sessions of photodynamic therapy (PDT). RESULTS: Subfoveal CNV involuted after PDT and his vision improved from 20/300 to 20/25 at 13 months follow-up. CONCLUSIONS: CNV can be triggered by LASIK surgery in patients with POHS. Those patients should be made aware of and closely followed up postoperatively for this complication.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
9/35. Clinical application of rapid serial fourier-domain optical coherence tomography for macular imaging.PURPOSE: To introduce and examine the utility of a retinal imaging technique using high-speed optical coherence tomography (OCT) for creating a more complete retinal structural map to aid in the evaluation of patients with macular pathology. DESIGN: Prospective observational case series. PARTICIPANTS: Five patients with a variety of macular pathologies. methods: patients were imaged with a Fourier-domain high-speed high-resolution OCT system built at our institution. A sweeping serial OCT B-scan of the macula was acquired to create a detailed retinal structural map. The data were then used to make individual clinical observations. RESULTS: Rapid serial OCT B-scans produced detailed macular maps for all 5 patients. Diagnoses of imaged patients included macular hole, lamellar macular hole, regressed macular hole or macular microhole, choroidal neovascular membrane (CNV) from age-related macular degeneration, and CNV from presumed ocular histoplasmosis syndrome. Reconstructed B-scans and C-scans are shown for selected patients to illustrate the additional perspectives gained by obtaining a detailed retinal map. CONCLUSIONS: Rapid serial Fourier-domain OCT B-scanning can be used to create a detailed retinal structural map. This technique provides additional information that can be missed on single OCT images and provides an accurate way to image large or complex lesions, and allows B-scan and C-scan reconstructions to be made that provide additional perspectives into retinal structures that may be missed using traditional imaging methods.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
10/35. Visual results after laser treatment for peripapillary choroidal neovascular membranes.To investigate the potentially harmful effects of laser photocoagulation in the papillomacular bundle (PMB), the records of patients treated for idiopathic neovascular membranes or membranes secondary to histoplasmosis extending into the PMB were reviewed. Twenty-eight eyes of 27 patients were identified. Most eyes (75%) were treated with the krypton red laser, while the remainder (25%) were treated with either argon green (18%) or a combination of the two (7%). After treatment 21 eyes (75%) had stable or improved visual acuity and three eyes (11%) lost more than three lines. Four eyes (14%) had changes in the optic disc and one eye developed a permanent arcuate scotoma. These data suggest that severe visual loss and extensive visual field defects occur rarely after photocoagulation of peripapillary choroidal neovascular membranes.- - - - - - - - - - ranking = 7keywords = membrane (Clic here for more details about this article) |
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