11/24. Intravenous pulse methylprednisolone therapy for acute treatment of serpiginous choroiditis.PURPOSE: To evaluate the safety and efficacy of high-dose intravenous steroid therapy (HDIST) for the acute treatment of vision-threatening serpiginous choroiditis. methods: Retrospective review of the records of five patients with serpiginous choroiditis who were treated with HDIST (1 g methylprednisolone for three days) in addition to their standard immunosuppressive treatment. The visual acuities and improvement of ocular signs after HDIST were evaluated. RESULTS: Twelve episodes of macula-threatening choroiditis in five patients with serpiginous choroiditis were treated during a seven-year period. All patients responded to HDIST with evidence of a decrease in intraocular inflammation immediately after and complete restoration of visual acuity within 10 days of commencing treatment. In one patient, medical intervention was required because of gastric distress. During the follow-up, three out of five patients experienced new attacks and two patients developed subretinal neovascularization. CONCLUSION: HDIST is effective in controlling severe vision-threatening serpiginous choroiditis and in improving visual function in a short period of time. However, the effect of this treatment in long-term disease control is uncertain.- - - - - - - - - - ranking = 1keywords = neovascularization (Clic here for more details about this article) |
12/24. Photodynamic therapy with verteporfin for juxtafoveal choroidal neovascularization in serpiginous choroiditis.The authors describe a patient who underwent successful photodynamic therapy with verteporfin for juxtafoveal choroidal neovascularization complicated by serpiginous choroiditis. A 41-year-old woman presented with decreased vision and metamorphopsia in her right eye, which was diagnosed as a recurrence of serpiginous choroiditis at the first visit. Within a month, visual acuity had diminished to 20/1000 despite immunosuppressive treatment. At that time, indocyanine green angiography and optical coherence tomography revealed choroidal neovascularization in the juxtafoveal area. Photodynamic therapy with verteporfin was administered twice, after which juxtafoveal choroidal neovascularization regressed and her visual acuity improved to 20/20.- - - - - - - - - - ranking = 7keywords = neovascularization (Clic here for more details about this article) |
13/24. Recurrent multifocal choroiditis.The authors examined 11 young adult, moderately myopic female patients who presented with visual loss secondary to a newly described disorder consisting of multiple small discrete lesions at the level of the retinal pigment epithelium and choriocapillaris. The condition appears to be inflammatory and occurs primarily in the macula and posterior pole. Disc edema and a mild vitritis may be present. The condition was bilateral in five patients, although the fellow eye was asymptomatic in each case. Multiple recurrences are common, with new sites developing adjacent to old ones. Four of the 11 patients had subretinal neovascularization develop from parafoveal lesions. The inflammatory lesions, as well as the subretinal neovascularization, regressed with corticosteroid treatment, and most patients recovered excellent visual acuity. Systemic laboratory studies were noncontributory.- - - - - - - - - - ranking = 2keywords = neovascularization (Clic here for more details about this article) |
14/24. Macular serpiginous choroiditis.The authors describe in seven eyes of four patients a form of serpiginous choroiditis beginning in the macula without initial peripapillary activity. Eyes with macular serpiginous choroiditis often had a poor visual prognosis and sometimes developed subretinal neovascularization. fluorescein angiography of the acute lesions showed hypofluorescence; some cases were thus initially diagnosed as having choroidal ischemia. fluorescein angiography in one eye, however, suggested that at least some of the hypofluorescence seen acutely in eyes with serpiginous choroiditis is secondary to blocked fluorescence from "opaque" retinal pigment epithelium.- - - - - - - - - - ranking = 1keywords = neovascularization (Clic here for more details about this article) |
15/24. Clinicopathologic findings in a patient with serpiginous choroiditis and treated choroidal neovascularization.We present the ocular clinicopathologic features of the left eye of a patient who, during a 29-year period, developed the characteristic features of progressive serpiginous choroiditis. Two areas of choroidal neovascularization were successfully treated by laser photocoagulation. The larger area of neovascularization, located in and inferior to the maculopapillary bundle area and treated with argon laser, resulted in a scar composed of hyperplastic retinal pigment with persistence of neovascularization and full-thickness destruction of the retina. A smaller area of neovascularization, located temporal to the fovea and treated by krypton laser, resulted in a fibrous scar with obliteration of the new vessels and preservation of the inner retinal layers. A diffuse and focal infiltrate of lymphocytes was present in the choroid. Often, larger aggregates of lymphocytes were present at the margin of the serpiginous lesions. The serpiginous lesions were characterized by loss of retinal pigment epithelium and the photoreceptor cell layer. The margins of most lesions had variable degrees of hyperplastic retinal pigment epithelium and some had defects in Bruch's membrane, through which fibroglial scar tissue extended into the choroid.- - - - - - - - - - ranking = 8keywords = neovascularization (Clic here for more details about this article) |
16/24. Multifocal choroiditis associated with progressive subretinal fibrosis.Five patients (all female, 14 to 34 years old) had an unusual form of multifocal choroiditis resulting in progressive subretinal fibrosis. This condition differed from other multifocal choroidal diseases such as acute multifocal placoid pigment epitheliopathy, birdshot retinochoroidopathy, and punctate inner choroiditis. Instead of forming atrophic or pigmented chorioretinal scars, the acute lesion healed with the formation of discrete, sharply angulated subretinal scars. In the macula the lesions coalesced, forming broad zones of subretinal fibrosis. Serous and hemorrhagic macular detachment may occur during the course of the disease with fluorescein angiographic features suggesting subretinal neovascularization. Subretinal neovascularization could not, however, explain the widespread scarring. Although progressive subretinal fibrosis may be considered an unusual outcome for a variety of other diseases, we believe that it is a distinct clinical entity distinguishable from other multifocal choroidal diseases. Retinal pigment epithelial hyperplasia may cause the condition.- - - - - - - - - - ranking = 2keywords = neovascularization (Clic here for more details about this article) |
17/24. choroidal neovascularization in long-standing case of Vogt-Koyanagi-Harada disease.The eyes in a case of Vogt-Koyanagi-Harada disease (VKH) with long-standing uveitis for 26 years after the onset were studied histopathologically. It was found that typical granulomatous inflammation was persistent in the uveal tract and the choroidal neovascularization occurred in the peripheral fundus accompanied by proliferation of the retinal pigment epithelial cells (RPE). Some of the new vessels under the pigment epithelium extended into the vitreous. It was concluded that the ocular inflammation of VKH was essentially granulomatous even in this long-standing case. Disappearance of choroidal melanocytes, existence of epithelioid cells containing pigment granules, and accumulation of lymphocytes and plasma cells in the lesion indicated that the inflammation was an autoimmune reaction against uveal melanocytes, although the trigger initiating the disease remains unknown. It was further concluded that the peripheral fundus as well as the peripapillary and macular areas was a predilected site for choroidal neovascularization in chronic uveitis. The choroidal neovascularization may develop in such a way that the uveal inflammation damages the Bruch's membrane and choriocapillaris and consequently causes retinal ischemia, thus stimulating the endothelium of the choriocapillaris and the overlying RPE to proliferate. There is a close relation between choroidal neovascularization and proliferation of RPE. choroidal neovascularization may cause reactive proliferation of the RPE and vice versa.- - - - - - - - - - ranking = 9keywords = neovascularization (Clic here for more details about this article) |
18/24. Focal macular choroidopathy.The clinical and angiographic findings in 2 patients with focal macular choroidopathy (FMC) are described. Follow-up fluorescein angiography revealed that the initial lesions consisted of multifocal, whitish spot-like areas of choroidal infiltration with hyperfluorescence in the late phase angiogram. At a later stage of the disease, the developing disciform macular lesion showed subretinal neovascularization. The disease was bilateral with poor visual prognosis. There was no evidence of infection with histoplasma capsulatum. Early oral corticosteroid treatment could not prevent the progressive nature of the disease.- - - - - - - - - - ranking = 1keywords = neovascularization (Clic here for more details about this article) |
19/24. Unusual findings in serpiginous choroiditis.Retinal pigment epithelial detachment and optic disk neovascularization developed in two men, 51 and 49 years old, who had serpiginous choroiditis. Fluorescein angiograms demonstrated loss of pigment epithelium and choriocapillaris in the late stages in both cases. Both men sustained permanent visual loss. In one case the final visual acuity of the affected eye was 20/200. In the second case the final visual acuity was R.E.: counting fingers at 4 feet and L.E.: 20/70.- - - - - - - - - - ranking = 1keywords = neovascularization (Clic here for more details about this article) |
20/24. The long-term course of multifocal choroiditis (presumed ocular histoplasmosis).We studied 40 patients with the presumed ocular histoplasmosis triad for ten to 15 years. Another patient developed the choroidal features of the syndrome in previously normal eyes. The basic lesion is a nodular choroidal infiltrate that evolves from clinically and angiographically normal retina. It is initially hypofluorescent and has an overlying serous detachment. It evolves through episodes of serous detachment and hyperfluorescence into a choroidal scar with breaks in Bruch's membrane and occasional subretinal neovascularization. Seven of 42 eyes (16.6%) developed new choroidal infiltrates in choroid and retina that were clinically and angiographically normal more than ten years ago. After ten years about 50% of eyes with central scars will have visual acuity changes of 3 or more lines because of progressive remodeling and extension of the disciform scar. Nine of 40 fellow eyes (22.5%) sustained a disciform process during the entire follow-up period. One patient developed typical choroidal lesions in previously normal fundi. Results of extensive physical and laboratory tests for histoplasmosis and other diseases were normal.- - - - - - - - - - ranking = 1keywords = neovascularization (Clic here for more details about this article) |
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