11/64. 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.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
12/64. Progression of diabetic retinopathy during improved metabolic control may be treated with reduced insulin dosage and/or somatostatin analogue administration -- a case report.It is well known that intensified insulin treatment of poorly controlled type 1 diabetic patients may worsen an existing diabetic retinopathy (DR). This observation has been explained by an insulin-induced stimulation of the GH/IGF-I axis. Here, we report on three cases, where the progression of DR during intensified metabolic control was treated with manipulation of insulin therapy and/or by administration of octreotide. serum concentrations of IGF-I, IGFBP-3, insulin, cystatin c, creatinine, endogenous creatinine clearance and HbA1c-levels were assessed by routine laboratory methods; serum IGF-I bioactivity was estimated by a highly specific kinase receptor activation assay. visual acuity and retinopathy stage was assessed by established clinical methods including fluorescein angiography. After glycaemic control was improved by intensified insulin therapy, serum IGF-I levels acutely increased. Subsequently, DR progressed to an advanced stage ("florid retinopathy"), with macular edema, and proliferation of new vessels (in two cases). Immediate reduction of insulin dosage and administration of octreotide lowered serum total IGF-I levels (and IGF-I bioactivity as measured in one patient). Subsequently, macular edema resolved partly, and visual acuity improved, allowing laser photocoagulation to be performed. In conclusion, in poorly controlled type 1 diabetic patients, intensified insulin therapy is able to cause florid DR with acute macular edema. These sight-threatening changes may improve by short-term reduction of insulin dosage or by administration of octreotide, and we speculate that this may be related to down-regulation of (serum) IGF-I.- - - - - - - - - - ranking = 266.00138181964keywords = diabetic (Clic here for more details about this article) |
13/64. Clinicopathological features of severe corneal blood staining associated with proliferative diabetic retinopathy.A 54-year-old man with a history of severe proliferative diabetic retinopathy in both eyes and profound visual impairment presented with severe corneal blood staining in the left eye secondary to a "spontaneous" total hyphaema and raised intraocular pressure in an eye with iris neovascularization. Despite anterior chamber washout, the cornea remained virtually opaque and thickened. The subject subsequently underwent pars plana vitrectomy with endolaser using a temporary keratoprosthesis, insertion of a Morcher iris-surround intraocular lens and penetrating keratoplasty. Histopathology of the excised corneal button revealed fine eosinophilic granules composed of aggregations of haemoglobin and its breakdown products dispersed throughout the stroma, with occasional foci of weakly positive Perl staining for intracellular haemosiderin. fluorescence confocal microscopy revealed a marked increase in fluorescence throughout the corneal stroma and the basal epithelial layer. This case highlights the microstructural features and aspects of the surgical management of severe corneal blood staining.- - - - - - - - - - ranking = 190.00098701403keywords = diabetic (Clic here for more details about this article) |
14/64. 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.- - - - - - - - - - ranking = 38.000197402806keywords = diabetic (Clic here for more details about this article) |
15/64. choroidal neovascularization after laser photocoagulation for diabetic macular edema.Choroidal neovascular membranes (CNVMs) developed in eight patients after photocoagulation for clinically significant diabetic macular edema (DME). The CNVMs developed in areas where Bruch's membrane was ruptured and were diagnosed 2 weeks to 5 months after treatment. Only six patients had symptoms. The CNVMs were treated in four patients; final visual acuity was poor in all eight patients. This serious complication that follows laser treatment for DME may be related to the use of repeated small-size, short-duration laser or intense laser burns, or both.- - - - - - - - - - ranking = 190.00098701403keywords = diabetic (Clic here for more details about this article) |
16/64. iris neovascularization after central retinal artery obstruction despite previous panretinal photocoagulation for diabetic retinopathy.Five consecutive patients with proliferative diabetic retinopathy who were treated successfully with panretinal photocoagulation subsequently developed a central retinal artery obstruction. iris neovascularization developed in the affected eye within one to three months after the obstruction in four of the five patients despite the previous laser treatment. Additional retinal ischemia, as occurs in central retinal artery obstruction, appears to promote marked iris neovascularization in a large percentage of patients, even when successful photocoagulation for proliferative retinopathy has been previously administered.- - - - - - - - - - ranking = 190.00098701403keywords = diabetic (Clic here for more details about this article) |
17/64. Accelerated ocular neovascularisation in diabetics following posterior chamber lens implantation.Two well controlled non-insulin dependent diabetics with background retinopathy underwent endocapsular lens extraction with in-the-bag posterior chamber implantation. In the postoperative period rubeosis iridis set in abruptly. The fellow eyes showed no progression of retinopathy and the diabetic status showed no deterioration. The cause of neovascularisation and the role of intra- versus extracapsular extraction with implantation are discussed.- - - - - - - - - - ranking = 228.00118441683keywords = diabetic (Clic here for more details about this article) |
18/64. Combined branch retinal artery and central retinal vein obstruction.We observed seven patients with the unusual combination of a central retinal vein obstruction in conjunction with a simultaneous branch retinal artery obstruction. The patients presented with sectoral retinal whitening, as well as diffuse peripapillary and superficial retinal hemorrhages. In five of the seven patients, the retinal hemorrhages appeared most florid in the territory of the obstructed arteriole, resulting initially in the consideration that these cases represented a combined branch retinal artery and branch retinal vein obstruction. In all cases, however, the presence of dilated, tortuous veins with diffuse retinal hemorrhages, in addition to generalized delay in arteriovenous transit on fluorescein angiography, localized the venous blockage to the central retinal vein. No intra-arterial retinal emboli were visualized. Initially, five of the seven patients suffered markedly diminished visual function; although visual acuity returned to near normal in all but two patients. In the two patients with non-resolving, markedly impaired visual acuity, neovascularization of the iris complicated the clinical course. Both of these patients were treated with panretinal photocoagulation, with resolution of the iris neovascularization. These seven patients highlight another variation of combined arterial and venous retinal vascular disease.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
19/64. Intravitreal bevacizumab (Avastin) in the treatment of proliferative diabetic retinopathy.PURPOSE: To report the biologic effect of intravitreal bevacizumab in patients with retinal and iris neovascularization secondary to diabetes mellitus. DESIGN: Interventional, consecutive, retrospective, case series. PARTICIPANTS: Forty-five eyes of 32 patients with retinal and/or iris neovascularization secondary to diabetes mellitus. methods: patients received intravitreal bevacizumab (6.2 microg-1.25 mg). Ophthalmic evaluations included nonstandardized Snellen visual acuity (VA), complete ophthalmic examination, fluorescein angiography, and optical coherence tomography. MAIN OUTCOME MEASURES: Change in fluorescein angiographic leakage of the proliferative diabetic retinopathy (PDR). Secondary outcomes included changes in Snellen VA. RESULTS: No significant ocular or systemic adverse events were observed. All patients with neovascularization demonstrated by fluorescein angiography (44/44 eyes) had complete (or at least partial) reduction in leakage of the neovascularization within 1 week after the injection. Complete resolution of angiographic leakage of neovascularization of the disc was noted in 19 of 26 (73%) eyes, and leakage of iris neovascularization completely resolved in 9 of 11 (82%) eyes. The leakage was noted to diminish as early as 24 hours after injection. In addition to the reduction in angiographic leakage, the neovascularization clinically appeared to involute in many patients with a reduction in the caliber or presence of perfused blood vessels. In 2 cases, a subtle decrease in leakage of retinal or iris neovascularization in the fellow uninjected eye was noted, raising the possibility that therapeutic systemic levels were achieved after intravitreal injection. recurrence of fluorescein leakage varied. Recurrent leakage was seen as early as 2 weeks in one case, whereas in other cases, no recurrent leakage was noted at last follow-up of 11 weeks. CONCLUSIONS: Short-term results suggest that intravitreal bevacizumab is well tolerated and associated with a rapid regression of retinal and iris neovascularization secondary to PDR. A consistent biologic effect was noted, even with the lowest dose (6.2 microg) tested, supporting proof of concept. The observation of a possible therapeutic effect in the fellow eye raises concern that systemic side effects are possible in patients undergoing treatment with intravitreal bevacizumab (1.25 mg), and lower doses may achieve a therapeutic result with less risk of systemic side effects. Further study is indicated.- - - - - - - - - - ranking = 190.00098701403keywords = diabetic (Clic here for more details about this article) |
20/64. Opaque coating of an intraocular lens and regression of iris neovascularization following injection of triamcinolone acetonide into the anterior chamber.A pseudophakic patient presented with a vitreous haemorrhage and iris neovascularization associated with proliferative diabetic retinopathy. vitrectomy with panretinal photocoagulation and intraocular gas tamponade of an iatrogenic break was performed. As an alternative to intravitreal injection into a gas-filled eye, triamcinolone acetonide was injected into the anterior chamber. Postoperatively, the visual acuity was reduced to light perception by an opaque coating of triamcinolone particles on the intraocular lens and iris which resolved over 2 months. By 4 months, the iris neovascularization had regressed completely. The use of intracameral triamcinolone in pseudophakic eyes may be associated with a transient loss of vision and prevent fundal visualization owing to triamcinolone coating of the intraocular lens.- - - - - - - - - - ranking = 38.000197402806keywords = diabetic (Clic here for more details about this article) |
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