1/120. Macular translocation with retinotomy and retinal rotation for exudative age-related macular degeneration.PURPOSE: To determine the effectiveness of macular translocation with retinotomy and retinal rotation in exudative age-related macular degeneration. methods: After written informed consent was obtained, 20 patients underwent macular translocation. We created a 180-degree retinotomy superior, inferior, and temporal to the macula near the equator. The hinged retinal flap was rotated superiorly or inferiorly to place the center of the fovea over an area of healthy retinal pigment epithelium. The retina was flattened under silicone oil and laser photocoagulation was placed. RESULTS: The fovea was moved 425 to 1,700 microm (965 /-262 microm) superiorly or inferiorly. Follow-up time was 2 to 12 months (median 8 months). Complications included macular pucker (3 eyes), subfoveal hemorrhage (2 eyes), macular hole (1 eye), and progression of cataract in phakic eyes (3 eyes). Thirteen of 20 eyes showed various degrees of proliferative vitreoretinopathy with epiretinal membrane formation over the inferior peripheral retina with the inferior retinal detachment stabilized by the silicone oil. One eye progressed to phthisis bulbi. Initial visual acuity ranged from 20/80 to 20/800 (median 20/150) and final visual acuity ranged from light perception to 20/200 (median 20/1000). CONCLUSION: The fovea can be moved up to 1,700 microm with retinotomy and retinal rotation; however, there is a high rate of complications. Proliferative vitreoretinopathy is the major complication of this technique and is probably related to the extensive retinotomy and subretinal irrigation inherent in the technique. Other techniques such as scleral shortening may have fewer complications.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
2/120. Improvement in macular function after retinal translocation surgery in a patient with age-related macular degeneration.PURPOSE: To assess focal electroretinographic findings before and after retinal translocation surgery in a patient with age-related macular degeneration. METHOD: Case report. A 79-year-old man with a well-defined subfoveal choroidal neovascular membrane from age-related macular degeneration underwent preoperative and postoperative focal electroretinography. RESULTS: After retinal translocation surgery, best-corrected Snellen visual acuity improved from 9/200 to 20/60. A significant increase in mean foveal amplitude, from 0.08 microV to 0.16 microV (P = 0.008) was recorded. CONCLUSION: Age-related macular degenerative changes in visual acuity and foveal electroretinogram amplitude may be reversible after retinal translocation surgery.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
3/120. ICGA-guided laser photocoagulation of feeder vessels of choroidal neovascular membranes in age-related macular degeneration. indocyanine green angiography.PURPOSE: To report the ability of indocyanine green angiography (ICGA) with a confocal scanning laser ophthalmoscope (SLO) to identify feeder vessels of choroidal neovascular membranes (CNVM) secondary to age-related macular degeneration (ARMD) and to show the feasibility of inducing complete closure of the CNVM by photocoagulation targeted exclusively to the feeder vessels. methods: Five consecutive patients with exudative ARMD in whom ICGA with the confocal SLO showed extrafoveal feeder vessels supplying choroidal neovascular nets had laser photocoagulation done only to the feeder vessels. In two patients, two separate membranes were seen. RESULTS: Laser photocoagulation resulted in closure of the feeder vessels and the CNVM in four patients. Complete closure was achieved with one treatment in one patient and with two treatments in three patients. In one patient, two treatments failed to close the feeder vessel and the CNVM, but a third, more intense laser treatment resulted in temporary closure of the feeder vessel and CNVM, which recanalized 2 to 4 weeks later with development of a large rip in the retinal pigment epithelium. In one patient, two separate CNVMs grew from the edge of the laser scars, but they were not directly related to the original CNVM and its feeder vessel, and were treated successfully. The same eye later developed subfoveal occult CNVM with gradual deterioration of visual acuity. In the other four patients, visual acuity improved in two and was unchanged in two. CONCLUSIONS: indocyanine green angiography with the confocal SLO can identify choroidal feeder vessels supplying CNVM secondary to ARMD. Laser treatment to such extrafoveal feeder vessels, particularly in membranes that are large or subfoveal, may be effective in closing the feeder vessel and CNVM with preservation of the fovea and central vision. More than one treatment may be required, however, and failures and complications may be expected with this treatment modality.- - - - - - - - - - ranking = 7keywords = membrane (Clic here for more details about this article) |
4/120. Choroidal retinal anastomosis in age-related macular degeneration as demonstrated by fluorescein angiography--a case report.Pathological choroidal retinal anastomosis is relatively rare. It has been described in age-related macular degeneration (AMD) with fibrous scarring or occult pigment epithelial detachment or actively proliferating classic choroidal neovascular membrane (CNV). We report a case of disciform macular scar with the occurrence of a choroidal retinal anastomosis, which directed blood flow from an occult choroidal neovascular membrane into a retinal vein through the fovea in a 52-year-old female with unilateral AMD. fluorescein angiography (FA) clearly demonstrated the anastomosis.- - - - - - - - - - ranking = 2keywords = membrane (Clic here for more details about this article) |
5/120. Scleral outfolding for macular translocation.PURPOSE: To report experimental study and clinical observation of scleral outfolding for macular translocation.methods: In six human cadaver eyes, circumferential mattress sutures to create sclera infoldings were compared with radial-interrupted mattress sutures to create scleral outfoldings. In a 75-year-old man with macular degeneration and choroidal neovascular membrane, radial-interrupted mattress sutures were used for macular translocation.RESULTS: In the human cadaver eyes, circumferential mattress sutures for scleral infolding created an average decrease in corresponding internal anteroposterior retinal contour of 0.36 mm. Radial-interrupted mattress sutures for scleral outfoldings created an average decrease in the corresponding internal anteroposterior retinal contour of 4. 61 mm. The statistical significance of the difference between infoldings of the sclera versus outfoldings of the sclera had a P value of.0001. CONCLUSIONS: Initial experimental and clinical study suggests that radial-interrupted mattress sutures may generate more shortening of the internal scleral surface and greater macular translocation than circumferential mattress sutures. Additional studies are needed to evaluate the long-term effects of radial-interrupted mattress sutures and macular translocation for treatment of subfoveal choroidal neovascularization secondary to age-related macular degeneration.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
6/120. Clinicopathologic correlation of fluorescein and indocyanine green angiography in exudative age-related macular degeneration.PURPOSE: To correlate the clinical and histopathologic features of an eye with age-related macular degeneration studied with fluorescein (FA) and indocyanine green (ICG) angiography 4.5 months before the patient's death. methods: Histopathologic features from serial sections through the macula of a 76-year-old man with occult choroidal neovascularization (CNV) were reconstructed in a scaled two-dimensional map and compared with FA and ICG angiogram images obtained 4.5 months before his death. RESULTS: The region of prior laser photocoagulation was identified as a well-demarcated hypofluorescent region in the early frames of the FA and the early and late phases of the ICG angiogram. This corresponded histopathologically to a well-circumscribed area of absence of the choriocapillaris, loss of the outer retina and retinal pigment epithelium, and scarring of the choroid. Occult CNV characterized by elevated late hyperfluorescence on the FA and intense well-defined hyperfluorescence on the ICG angiogram corresponded to a thick fibrovascular membrane in the subretinal space and within Bruch's membrane. Thin extensions of both the subretinal and intra-Bruch's membrane fibrovascular membrane components corresponded to nonelevated stippled late hyperfluorescence on the FA and mild late hyperfluorescence on the ICG angiogram. CONCLUSION: Histopathologic mapping revealed a large fibrovascular complex located subretinally and within Bruch's membrane with thin and thick components that correlate well with findings of occult CNV on FA and ICG angiography.- - - - - - - - - - ranking = 5keywords = membrane (Clic here for more details about this article) |
7/120. Intravitreal injection of tissue plasminogen activator and gas bubble for treatment of subretinal hemorrhage in ARMD.BACKGROUND: Subretinal hemorrhage (SRH) can arise from any number of underlying etiologies and can stem from either the choroidal and/or retinal circulation. It is most commonly associated with age-related macular degeneration (ARMD), in which a choroidal neovascular membrane is the usual source of bleeding. Vision loss resulting from SRH can be secondary to toxic, tractional, and barrier effects from persistent blood. To minimize long-term visual loss from SRH, several treatment modalities have evolved over the past few years. The most-recent therapeutic techniques involve treatment with the thrombolytic agent tissue plasminogen activator The value of surgical removal of subretinal hemorrhage to improve visual outcome remains unsubstantiated, as definitive studies have not been completed. CASE REPORT: A 73-year-old man manifested a 1-day history of decreased vision in his right eye. A large submacular hemorrhage had developed as a result of exudative age-related macular degeneration. Treatment included intravitreal injection of tissue plasminogen activator, followed by intravitreal injection of SF6 gas, which displaced the subretinal hemorrhage away from the fovea and resulted in clearance of the submacular blood. This case describes a new treatment for submacular hemorrhage secondary to ARMD. CONCLUSIONS: Subretinal hemorrhage secondary to ARMD can cause significant permanent visual loss. A thorough understanding of the pathogenesis of vision loss and the treatment options available are essential in successful management of these patients. Intravitreal injection of tissue plasminogen activator and gas bubble may provide an effective treatment for subretinal hemorrhage in age-related macular degeneration.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
8/120. adult-onset foveomacular pigment epithelial dystrophy: clinicopathologic correlation of three cases.PURPOSE: The authors describe the clinicopathologic features of three patients with adult onset foveomacular pigment epithelial dystrophy (AOFPED). methods: The eyes of three patients were studied ophthalmoscopically and by fluorescein angiography, and obtained postmortem and studied by light and electron microscopy. RESULTS: Histopathologic study of the three patient's eyes disclosed central loss of the retinal pigment epithelium and photoreceptor cell layer with a moderate number of pigment-containing macrophages present in the subretinal space and outer retina. To either side, the retinal pigment epithelium was distended with much lipofuscin. Basal laminar and basal linear deposits were present throughout the central area. No discontinuities of bruch membrane were present. CONCLUSION: The findings in the eyes of three patients with AOFPED included marked aging changes that are similar to those seen in age-related macular degeneration. Pigmented cells with lipofuscin in the subretinal space account for the vitelliform appearance.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
9/120. Polypoidal choroidal vasculopathy pattern in age-related macular degeneration: a clinicopathologic correlation.PURPOSE: To report the histopathologic features of surgically removed submacular tissue from an elderly patient with a pattern of polypoidal choroidal vasculopathy on indocyanine green angiography. methods: Clinical examination including fluorescein and indocyanine green angiography and light microscopy of surgical specimen. RESULTS: A thick yellow proteinaceous subretinal fluid was seen in the right macula of an 81-year-old white man. fluorescein angiography indicated progressive leakage from undetermined source apart from a few focal hyperfluorescent points. indocyanine green angiography showed several polyps as well as dilated choroidal vessels in the macula and along the superior temporal arcade. A large plaque was visualized in the late phase. Microscopically, the specimen consisted of a thick fibrovascular membrane located on the choroidal side of the retinal pigment epithelium (RPE). The RPE layer was discontinuous whereas on its choroidal side an almost intact layer of diffuse drusen was observed. A group of dilated thin-walled vessels were found that appeared to be saccular on serial sections. Some of these were located almost immediately under the diffuse drusen. CONCLUSION: Histologic examination of submacular tissue removed from an eye with polypoidal choroidal vasculopathy showed several aneurysmal dilatations located directly under diffuse drusen within a sub-RPE, intra-Bruch's fibrovascular membrane.- - - - - - - - - - ranking = 2keywords = membrane (Clic here for more details about this article) |
10/120. Clinicopathological correlation in exudative age-related macular degeneration: recurrent choroidal neovascularization.PURPOSE: To report the pathology of surgically removed submacular tissue in recurrent choroidal neovascularization after laser photocoagulation of classic choroidal neovascularization in age-related macular degeneration. methods: A recurrent subfoveal choroidal neovascular membrane was surgically removed in two patients. The recurrence was identified as a classic membrane on fluorescein angiography at the foveal border of the laser scar. A net was visualized in the early venous phase of the indocyanine green angiogram, with associated late hyperfluorescence. Both patients had undergone laser photocoagulation for a classic interpapillomacular choroidal neovascular membrane about 1 1/2 years earlier. The specimens were serially sectioned and stained with hematoxylin-eosin, periodic acid-Schiff, Masson trichrome and phosphotungstic acid-hematoxylin. RESULTS: The two specimens consisted of subretinal fibrovascular tissue with fibrin exudation. Fibrovascular tissue bordered subretinal fibrous tissue adherent to Bruch's membrane and remnants of the choroid in one patient. The fibrovascular portion most likely corresponded to the recurrence, whereas the fibrous portion represented the original membrane, being obliterated after photocoagulation. Some peripapillary tissue was additionally removed in the other patient. The latter lesion was invisible on fluorescein angiography but stained in the late phase of indocyanine green angiography and corresponded histopathologically to poorly vascularized intra-Bruch's fibrovascular tissue. Granular deposits, periodic acid-Schiff positive and metachromatically purple on Masson trichrome stain, representing diffuse drusen (basal laminar/linear deposits), were identified in the three specimens. CONCLUSION: A subretinal fibrovascular membrane corresponded with the classic recurrent choroidal neovascularization.- - - - - - - - - - ranking = 6keywords = membrane (Clic here for more details about this article) |
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