11/25. 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 = 1keywords = neovascularization (Clic here for more details about this article) |
12/25. 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 = neovascularization (Clic here for more details about this article) |
13/25. 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 = 0.8keywords = neovascularization (Clic here for more details about this article) |
14/25. Photodynamic therapy with verteporfin in ocular histoplasmosis: uncontrolled, open-label 2-year study.OBJECTIVE: To evaluate the safety, effect on visual function, and fluorescein angiographic appearance of subfoveal choroidal neovascularization (CNV) through 2 years after photodynamic therapy with verteporfin (Visudyne; Novartis AG, Basel, switzerland) in patients with ocular histoplasmosis syndrome (OHS). DESIGN: Open-label, 3-center, uncontrolled clinical study. PARTICIPANTS: Ocular histoplasmosis syndrome patients with subfoveal CNV (N = 26) with a greatest linear dimension no larger than 5400 microm with classic or occult CNV extending under the geometric center of the fovea, and best-corrected visual acuity letter score of approximately 20/40 to 20/200. methods: The methods were similar to those described in the 1-year results with follow-up examinations every 3 months continuing through the second year. During the second year, additional therapy was recommended if fluorescein angiography showed leakage at a scheduled visit. MAIN OUTCOME MEASUREMENTS: Visual function measurements included the changes from baseline in visual acuity and contrast sensitivity scores. Lesion size and leakage from classic and occult CNV were assessed at month 12 and month 24. safety assessments also were made. RESULTS: A 24-month examination was completed in 22 of the 26 enrolled participants (85%). At the 24-month examination, median improvement from baseline in visual acuity of the 22 patients evaluated was 6 letters; median contrast sensitivity improved by 3.5 letters. At the 24-month examination, 10 patients (45%) gained 7 or more letters of visual acuity from baseline, whereas 4 patients (18%) lost 8 or more letters, including 2 patients (9%) who lost at least 15 letters. There was absence of fluorescein angiographic leakage from classic CNV in 17 of the 20 evaluable lesions (85%), and leakage from occult CNV was absent in all eyes. No serious ocular adverse events were reported, and no serious systemic event was considered to be associated with treatment. CONCLUSIONS: Median visual acuity improved and fluorescein angiographic leakage decreased after verteporfin therapy in this small, uncontrolled clinical study of patients with subfoveal CNV resulting from OHS. Verteporfin therapy seemed to be relatively safe in these patients. The selected cases feature fluorescein angiographic examples of CNV that are important in determining when to apply verteporfin therapy.- - - - - - - - - - ranking = 0.2keywords = neovascularization (Clic here for more details about this article) |
15/25. Clinicopathologic studies of treated choroidal neovascular membranes. A review and report of two cases.The previously reported and two additional clinicopathologic studies of treated choroidal neovascular membranes were reviewed. Laser photocoagulation can obliterate choroidal neovascular membranes, but persistent and recurrent neovascularization contiguous with the treated area or the development of a new area of neovascularization contiguous or not contiguous with the treated area was seen histopathologically in nine of 12 (75%) lesions of 10 eyes. The scar that ensues after photocoagulation resembles the naturally occurring scar associated with choroidal neovascularization. Portions of the scar are comprised of hyperplastic retinal pigment epithelium. The inner retinal layers are more likely to be preserved after krypton red photocoagulation. Full-thickness destruction of the retina occurs with argon blue-green and argon green photocoagulation at levels of energy in which the end point is a uniform, white lesion.- - - - - - - - - - ranking = 0.6keywords = neovascularization (Clic here for more details about this article) |
16/25. Surgical removal of subfoveal neovascularization in the presumed ocular histoplasmosis syndrome.We treated two patients with presumed ocular histoplasmosis, subfoveal neovascular membranes, and progressive visual acuity loss to 20/400. Vitreoretinal surgical techniques were used to remove the subfoveal membranes. visual acuity returned to 20/20 with seven months of follow-up in one patient (Case 1) and to 20/40 with three months of follow-up in the other patient (Case 2). No evidence of persistent or current subretinal neovascular membranes in either patient have been noted. These preliminary results suggest that vitreoretinal surgical techniques may be successful in mechanically removing subfoveal neovascular membranes with preservation of overlying neurosensory retina and thus preservation of central visual acuity.- - - - - - - - - - ranking = 0.8keywords = neovascularization (Clic here for more details about this article) |
17/25. Spontaneous involution of subfoveal neovascularization.We studied five patients who maintained or spontaneously regained significant central vision despite the presence of a subfoveal neovascular membrane. Sequential photographs and fluorescein angiograms showed a pattern of development common to these patients and not observed in patients who lose all central vision. The pattern involves formation of a pigmented ring around the subfoveal neovascular membrane followed by alteration of the membrane from one that leaks fluorescein to one that stains but does not leak. This pattern is associated with gradual resorption of subretinal fluid and apparent limitation of subretinal hemorrhage and fibrosis. This course suggests the occurrence of spontaneous involution of some subfoveal neovascular membranes and implicates the retinal pigment epithelium in this process.- - - - - - - - - - ranking = 0.8keywords = neovascularization (Clic here for more details about this article) |
18/25. Presumed chronic ocular histoplasmosis syndrome: a clinical-pathologic case report.An eye of a patient with clinically typical presumed ocular histoplasmosis was studied by light microscopy, electron microscopy and immuno-fluorescence techniques. There was clinical and pathological evidence of anterior segment involvement. The posterior segment showed granulomatous and nongranulomatous chorioretinal lesions with and without subretinal neovascularization. Immunohistopathological staining for histoplasma antigens revealed positive staining at sites of lymphoid inflammation. Organisms were not identified.- - - - - - - - - - ranking = 0.2keywords = neovascularization (Clic here for more details about this article) |
19/25. Macular lesions in blacks with the presumed ocular histoplasmosis syndrome.Six black patients had fundus lesions diagnostic of the presumed ocular histoplasmosis syndrome. All patients had peripapillary changes or peripheral punched-out chorioretinal lesions, or both. Five of the six had macular subretinal neovascularization, disciform scarring, or an atrophic macular lesion, and one patient had a macular hole; four of five patients tested had a positive histoplasmin skin test. The macular involvement was bilateral in three of the six cases. HLA B-7 was present in one of four patients who had HLA typing. Macular involvement can occur in blacks with the presumed ocular histoplasmosis syndrome.- - - - - - - - - - ranking = 0.2keywords = neovascularization (Clic here for more details about this article) |
20/25. Presumed ocular histoplasmosis syndrome. A clinicopathologic correlation of a treated case.A patient with bilateral presumed ocular histoplasmosis had been successfully treated in his symptomatic right eye with laser photocoagulation for subretinal neovascularization in two areas of the macula. The left eye also showed neovascularization clinically and histopathologically but was not treated because there was no detectable leakage and the vision was not affected. There was no change in the left eye over a two-year period. Clinicopathologic correlation of the treated and untreated macular lesions and the peripapillary and peripheral lesions is presented.- - - - - - - - - - ranking = 0.4keywords = neovascularization (Clic here for more details about this article) |
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