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1/27. optic disk neovascularization in a patient with cytomegalovirus retinitis associated with renal transplantation.

    PURPOSE: To report the development of optic nerve head neovascularization during the recovery phase of cytomegalovirus (CMV) retinitis in a renal allograft recipient. CASE REPORT: A 46-year-old male renal allograft recipient developed CMV retinitis seven months after transplantation. At the time of the diagnosis, the patient was being immunosuppressed with prednisone, cyclosporine, and azathioprine, and was treated with repeated intravitreal and intravenous ganciclovir. Six weeks after the initiation of therapy, optic disk neovascularization developed. This was confirmed by fluorescein angiography, which showed no areas of retinal capillary nonperfusion. At this stage, active retinal lesions were partially resolved. Apart from intraocular inflammation, no other cause of neovascularization was detected. Over the following six months, optic disk neovascularization regressed spontaneously without causing vitreous hemorrhage or visual loss. There was no recurrence of CMV retinitis during follow-up. CONCLUSION: optic disk neovascularization may develop in the healing phase of CMV retinitis in renal transplant recipients.
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2/27. thalidomide effectiveness for bilateral chronic idiopathic anterior uveitis in a three-year-old child.

    The authors report their experience with thalidomide in the treatment of a bilateral chronic idiopathic uveitis, in a 3-year-old female. This case was complicated by the presence of a cataract and an iris neovascularization in the right eye; furthermore it was partially unresponsive to a conventional anti-inflammatory and immunosuppressive therapy. Oral thalidomide induced slow but dramatic regression of the inflammation, and a significant reabsorption of neovascular tufts, both in slitlamp examination and on iris fluorescein angiography. The authors emphasize the efficacy of thalidomide as anti-inflammatory agent and as inhibitor of neoangiogenesis, reporting the recent literature about the use of this drug in ophthalmology.
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3/27. Pyogenic granuloma following oculoplastic procedures: an imbalance in angiogenesis regulation?

    BACKGROUND: Pyogenic granuloma is a vasoproliferative inflammatory response composed of granulation tissue. The pathogenesis is not entirely clear. We describe a series of patients with pyogenic granulomas occurring following common oculoplastic procedures and propose a common etiology. methods: Sixteen cases of pyogenic granuloma that occurred after various oculoplastic procedures from 1991 to 2000 were collected from the files of two oculoplastic surgeons. RESULTS: Pyogenic granulomas were found to occur at surgical and nonsurgical sites associated with tissue irritation or inflammation or both. INTERPRETATION: capillaries are a predominant component of wound healing and pyogenic granulomas. The growth and development of new capillaries follows an orderly sequence of events that is highly regulated by a variety of angiogenic factors. We postulate an imbalance in angiogenesis regulation as the common pathway for pyogenic granuloma development.
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4/27. genetic linkage of autosomal dominant neovascular inflammatory vitreoretinopathy to chromosome 11q13.

    Autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV) is an inherited eye disease characterized by retinal and iris neovascularization, abnormal retinal pigmentation, anterior chamber and vitreous inflammation, cystoid macular edema, vitreous hemorrhage, and traction retinal detachment. Some of these clinical features are shared by more common, potentially blinding, conditions including diabetic retinopathy, uveitis, and retinitis pigmentosa. Elucidation of the molecular pathogenesis of ADNIV has the potential to provide insight into the mechanisms of these common disorders. One hundred and sixteen members of an eight generation family affected with ADNIV were examined. A combination of slit lamp biomicroscopy, ophthalmoscopy, and electroretinography was used to establish the diagnosis and 34 family members were found to be affected. Blood samples were obtained from thirty-three of these individuals and nine spouses and used for chromosome linkage analysis with denaturing gradient gel and short tandem repeat polymorphisms. Two markers that map to chromosome 11q13 were found to be significantly linked to the ADNIV phenotype. There were no recombinants between the disease phenotype and marker D11S527 and multipoint analysis yielded a maximum lod score of 11.9 centered on this marker.
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5/27. Preliminary results of colour Doppler-guided intratendinous glucocorticoid injection for Achilles tendonitis in five patients.

    BACKGROUND: It is debated as to whether Achilles tendonitis (AT) has an inflammatory component. The intratendinous hyperaemia demonstrated with colour Doppler has been interpreted as neovascularisation. Glucocorticoid injection around the tendon is a common therapeutic procedure. HYPOTHESES: The intratendinous hyperaemia seen with ultrasound (US) colour Doppler represents an inflammatory background. Glucocorticoid injections will be effective if administered inside the tendon where the inflammation seems to be. STUDY DESIGN: An uncontrolled, prospective study with a minimum follow-up of 3 months. methods: Six tendons in five patients were evaluated with grey-scale US and colour Doppler before and after US-guided intratendinous glucocorticoid injection. pain at rest and at activity was evaluated on a visual analogue scale. RESULTS: With colour Doppler all tendons had intratendinous flow. pain and colour Doppler activity decreased during a mean follow-up of 182 days (range 92-309 days). One tendon relapsed after 199 days. CONCLUSION: Intratendinous glucocorticoid injections seem to have a marked effect on both symptoms and colour Doppler findings, which may be taken as an indication of an inflammatory component in the disease. Colour Doppler adds significant information to grey-scale US with regard to diagnosis, location and follow-up of AT.
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6/27. Central retinal vein occlusion: a prospective histopathologic study of 29 eyes in 28 cases.

    The clinical and histopathologic features of 29 eyes from 28 patients with central retinal vein occlusion (CRVO) are reported. A fresh or a recanalized thrombus was observed in each eye. This study considers the temporal aspects of the cases, and it notes the different morphologic features of the occlusion. These observations explain most of the variability of the changes observed in previous reports. We believe these different features representthe various stages in the natural evolution of such a thrombus. The interval between CRVO and histopathologic study in our series ranged from six hours to more than ten years. Local and systemic factors were reviewed and were found to be important in the pathogenesis of thrombus formation. Local diseases with a predisposing effect on CRVO included: glaucoma, papilledema, subdural hemorrhage, optic nerve hemorrhage, and drusen of the optic nerve head. Associated systemic diseases included: hypertension, cardiovascular and cerebrovascular disease, diabetes mellitus, and leukemia with thrombocytopenia. A fresh thrombus in the CRVO was observed in three (10.3%), and a recanalized thrombus in 26 eyes (89.7%). Endothelial-cell proliferation was a conspicuous feature in 14 (48.3%) of the eyes. Chronic inflammation in the area of the thrombus and/or vein wall or perivenular area was observed in 14 (48.3%) of the eyes. Arterial occlusive disease was observed in seven eyes (24.6%). Cystoid macular edema was found in 26 (89.7%) of the eyes.
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7/27. Chronic pyonephrosis associated with renal neovascularisation.

    The spectrum of renal tract infections is wide. When the kidney has been severely damaged, the radiological findings may suggest a malignancy. To report a case of chronic pyonephrosis, which even at exploration appeared to be a malignancy. The case record of the patient as well as the literature were reviewed and reported. A 25 year-old woman presented with a 5-year history of left lumbar pain, urinary frequency and intermittent total haematuria. The intravenous urography showed non-function in the left kidney harbouring a calculus. Treatment was delayed for poor finances. At laparotomy a huge renal mass invading the colonic mesentery and showing neovascularisation was removed. The final diagnosis was chronic pyonephrosis. She recovered from postoperative septicaemia. Neovascularisation is a feature of malignant disease mediated by angiogenesis factors. These factors are probably present in chronic inflammation. It is suggested that for nephrectomy, prophylactic antibiotics should be used. There is also a need for histopathological examination of every specimen removed at operation.
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8/27. Intracameral bevacizumab for iris rubeosis.

    PURPOSE: To determine whether intracameral bevacizumab decreases vascular leakage from iris rubeosis in patients with neovascular glaucoma. DESIGN: Interventional case series. methods: The study included six eyes of three patients with secondary neovascular glaucoma due to proliferative diabetic retinopathy (n = 2) or ischemic central retinal vein occlusion (n = 1). All patients received an intracameral injection of 1.0 mg bevacizumab. Morphologic changes and vascular leakage were investigated prospectively by iris fluorescein angiography. RESULTS: Decrease in leakage was detected as early as one day after injection. No inflammation was observed. No relapse was seen within the follow-up of four weeks. CONCLUSION: Intraocular injection of bevacizumab may provide an additional strategy for the treatment of iris rubeosis in neovascular glaucoma.
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9/27. Distant angiogenesis in a patient with glioblastoma multiforme.

    The case of a 42-year-old man with a cerebral glioblastoma multiforme associated with marked neovascularization of the arachnoid of the brain stem and spinal cord is reported. All of the neurological symptoms and signs were referrable to the glioblastoma and resultant craniotomies. The arachnoid contained a proliferation of well differentiated blood vessels. This neovascularization occurred in the absence of local tumor or inflammation. We suggest that the neovascularization resulted from release of a tumor angiogenesis factor into the cerebrospinal fluid.
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10/27. Rubeosis capsulare.

    Two patients with diabetes had extracapsular cataract extraction with intraocular lens (IOL) implantation. Both developed rubeosis iridis and neovascularization within the lens capsule supporting the IOL, a condition we have termed rubeosis capsular. argon laser treatment was ineffective in both patients. One patient was successfully treated by virectomy with endophotocoagulation. The other patient had a vitrectomy which was followed by a fibrinoid reaction, continued inflammation, rubeosis, and phthisis bulbi.
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