1/10. Fluorescein angiographic abnormalities after prophylactic macular photocoagulation for high-risk age-related maculopathy.PURPOSE: Initial studies suggest that drusen associated with age-related maculopathy resolve in response to laser photocoagulation; there are conflicting reports regarding whether this treatment might prevent neovascular complications and blindness. The goal of the Drusen Laser Study is to maintain good visual acuity in eyes at the highest risk for neovascular complications of age-related maculopathy. In this report, we alert the ophthalmic community to possible laser-induced complications in patients treated within the context of this clinical trial. methods: A double-masked, randomized, controlled clinical trial of prophylactic macular photocoagulation for high-risk age-related maculopathy is in progress. patients randomly assigned to treatment received a ring-type distribution of 12 light spots of argon laser photocoagulation. Drusen were treated directly only if they were present at the protocol treatment locations. fluorescein angiography was performed in all patients at yearly review, and at nonprotocol visits if symptoms or clinical examination were suggestive of choroidal neovascularization. RESULTS: Fluorescein angiographic abnormalities suggestive of choroidal neovascularization have been seen in treated eyes only: one patient in the pilot study and six patients in the Drusen Laser Study. No fluorescein angiographic abnormalities were seen in eyes of control subjects. CONCLUSIONS: Laser photocoagulation in high-risk age-related maculopathy may induce choroidal neovascularization and, therefore, is not recommended outside the context of a randomized, controlled clinical trial.- - - - - - - - - - ranking = 1keywords = neovascularization (Clic here for more details about this article) |
2/10. Findings on retinal topography and thickness mapping in age-related macular degeneration.PURPOSE: To report alterations in the retinal topography and thickness in typical cases of age-related macular degeneration (ARMD). methods: An optical imaging system was applied to patients with ARMD with alterations in the retinal structures. The system generates a series of 20 optical section images that encompass a 2 mm x 2 mm retinal area. The optical sections are digitized and analyzed to provide topographic maps of the vitreo-retinal and chorio-retinal surfaces and the retinal thickness. RESULTS: Retinal topography and thickness mapping in a normal eye corresponded to normal anatomy. Topographic mapping in a patient with confluent drusen indicated elevation of the vitreo-retinal surface. Retinal topography in a patient with retinal pigment epithelium detachment displayed localized elevation of the chorio-retinal surface. The thickness map in a patient with geographic atrophy of the retinal pigment epithelium revealed retinal thinning. In the patients with choroidal neovascularization, the vitreoretinal and chorio-retinal surfaces were elevated. The chorio-retinal surface map in a patient with evolving disciform scar displayed topographic variations corresponding to the fibrovascular tissue underlying the serous detachment. CONCLUSION: Retinal topography and thickness mapping is useful for visualization and evaluation of pathologic alterations in retinal structures due to ARMD.- - - - - - - - - - ranking = 0.33333333333333keywords = neovascularization (Clic here for more details about this article) |
3/10. Photodynamic therapy with verteporfin in mallatia leventinese.OBJECTIVE: To describe a case of a patient with documented genetic mallatia leventinese who developed a classic choroidal neovascular membrane and underwent photodynamic therapy (PDT) with verteporfin (Visudyne; CIBA Vision Corp., Duluth, GA). DESIGN: Interventional case report. INTERVENTION: The patient underwent a complete ophthalmologic evaluation and fluorescein angiography. Photodynamic therapy with verteporfin was performed. MAIN OUTCOME MEASURES: Clinical and angiographic records were analyzed for evidence of changes in visual acuity, clinically evident subretinal fluid and the extent of fluorescein leakage from choroidal neovascularization (CNV). RESULTS: Three weeks after treatment, a fluorescein angiogram showed closure of the neovascular membrane, no evident subretinal fluid was seen, and visual acuity had improved from 20/60- to 20/40. Nine weeks after the application, fluorescein angiography demonstrated a microscopic hyperfluorescent spot at the site of the previously active CNV at which a small area of shallow subretinal fluid was observed, and visual acuity was 20/50. Thirty-four weeks after PDT, visual acuity was 20/60, subretinal fluid resolved, and fluorescein angiography did not show any further changes. CONCLUSIONS: Photodynamic therapy with verteporfin may be considered as a possible treatment in patients with mallatia leventinese who develop classic CNV.- - - - - - - - - - ranking = 0.33333333333333keywords = neovascularization (Clic here for more details about this article) |
4/10. Focal inner retinal hemorrhages in patients with drusen: an early sign of occult choroidal neovascularization and chorioretinal anastomosis.PURPOSE: To present evidence that superficial retinal hemorrhage in the macula of patients with age-related macular degeneration (ARMD) may be an early sign of occult chorioretinal anastomosis (OCRA) and type 1 occult choroidal neovascularization (OCNV). methods: Retrospective follow-up study of 16 patients presenting with a small focal area of superficial retinal hemorrhages and drusen in the juxtafoveolar area in 24 eyes. RESULTS: OCRA and OCNV occurred in an older subset of patients with ARMD (mean age, 75 years). Of 22 eyes with the early stages of chorioretinal anastomosis (CRA), 18 had evidence of a piggyback neovascular complex, with the smaller subsensory retinal type 2 complex lying anterior to the larger subretinal pigment epithelial type 1 complex. At initial presentation, three patients had OCRA and OCNV bilaterally, and three patients had large disciform cicatricial lesions with overt CRA in the fellow eye. Nine patients had one or more laser photocoagulation treatments for early stages of CRA. Only one patient maintained visual acuity of better than 20/200 for >1 year. At the last follow-up, 24 of 26 eyes with CRA had visual acuity of 20/200 or less. CONCLUSION: Superficial retinal hemorrhage in the paracentral area of patients with drusen is the earliest sign of OCRA and OCNV. fluorescein angiography and indocyanine green angiography are important in detecting the dual nature of the subretinal neovascular network. Photocoagulation and photodynamic treatment is usually unsuccessful in preserving central vision.- - - - - - - - - - ranking = 1.6666666666667keywords = neovascularization (Clic here for more details about this article) |
5/10. Bilateral midperipheral large drusen and retinal pigment epithelial detachments associated with multifocal areas of choroidal neovascularization: a histopathologic study.PURPOSE: The ocular histopathologic features of a patient with bilateral multiple midperipheral areas of choroidal vascularization, large drusen, and detachments of the retinal pigment epithelium (RPE) are presented. methods: The eyes were obtained at autopsy and fixed in 4% buffered formaldehyde. Serial sections through the macula area and inferior segments were prepared. light as well as electron microscopy was performed. RESULTS: Microscopic examination disclosed numerous large drusen measuring up to 200 micro m in height and 280 micro m in diameter and areas of serous RPE detachments in the midperiphery of both eyes. Some of the large drusen had choroidal vascularization. Areas of sub-RPE neovascularization that measured up to 6.5 mm in diameter were present in the midperiphery of both eyes. The choroidal origin for neovascularization was evident in 10 areas. A 1-mm area of hemorrhagic detachment of the RPE contiguous with choroidal neovascularization (CNV) was present in the immediate postequatorial area temporally in the left eye. No drusen, basal deposit, or CNV was present in the macular area. CONCLUSION: Multifocal midperipheral RPE detachments and CNV can occur in the absence of significant age-related macular disease.- - - - - - - - - - ranking = 2.3333333333333keywords = neovascularization (Clic here for more details about this article) |
6/10. Sequential observation of fundus changes in patients with long standing membranoproliferative glomerulonephritis type II (MPGN type II).Specific fundus changes have been reported in patients with membranoproliferative glomerulonephritis type II (MPGN type II). We studied the clinical course of this retinopathy in four patients who all had a long follow-up with several fundus examinations. Sequential observation was indicative of a slow progression of the retinopathy. Most eyes maintained in the chronic stages a nearly normal visual acuity, and a full visual field despite the existence of marked drusen and atrophic changes. The prognosis however must be somewhat guarded, since choroidal neovascularization developed in three eyes and caused bilateral severe visual loss in one patient.- - - - - - - - - - ranking = 0.33333333333333keywords = neovascularization (Clic here for more details about this article) |
7/10. Reticular pseudodrusen. A risk factor in age-related maculopathy.BACKGROUND: Reticular pseudodrusen refer to a yellow interlacing network 125 microns to 250 microns wide appearing first in the superior outer macula and then extending circumferentially and beyond. Unlike true drusen, they do not fluoresce on fluorescein or indocyanine green angiography, and are best seen in red-free light or with the He-Ne laser of the scanning laser ophthalmoscope. methods: One hundred patients have been seen in our retinal practice with this clinical feature in the past 3 years. RESULTS: All had some manifestation of age-related maculopathy (arm), and 66% had or subsequently developed subretinal new vessels in one or both eyes. The appearance is attributed to changes in the choroid. CONCLUSIONS: Reticular pseudodrusen are an easily recognizable clinical sign, and may be an important risk factor for choroidal neovascularization in arm.- - - - - - - - - - ranking = 0.33333333333333keywords = neovascularization (Clic here for more details about this article) |
8/10. Characteristics of exudative age-related macular degeneration determined in vivo with confocal and indirect infrared imaging.PURPOSE: To evaluate the current and future interventions in age-related macular degeneration (AMD), it is essential to delineate the early clinical features associated with later visual loss. The authors describe the retinal pigment epithelium (RPE)/bruch membrane region in ten patients with advance exudative AMD using current angiographic techniques and a noninvasive method: infrared (IR) imaging with the scanning laser ophthalmoscope. methods: Ten patients with exudative AMD, evidence by choroidal neovascularization (CNV), fibrovascular scar formation, pigment epithelial detachment, or serous subretinal fluid,were examined using IR imaging, fluorescein angiography, indocyanine green angiography, and stereoscopic viewing of fundus slides. The authors determined the number and size of drusen and subretinal deposits and the topographic character of the RPE/bruch membrane area and of CNV. RESULTS: In all patients, IR imaging yielded the greatest number of drusen and subretinal deposits. Sheets of subretinal material, but few lesions consistent with soft drusen, were seen. Infrared imaging provided topographic information of evolving CNV. choroidal neovascularization appeared as a complex with a dark central core, an enveloping reflective structure which created a halo-like appearance in the plane of focus, and outer retinal/subretinal striae. CONCLUSIONS: Infrared imaging provides a noninvasive, in vivo method to image early changes in the RPE/bruch membrane. It offers advantages over current imaging techniques by minimizing light scatter through cloudy media and enhancing the ability to image through small pupils, retinal hyperpigmentation, blood, heavy exudation, or subretinal fluid. It provides additional information regarding early CNV, and the character of drusen and subretinal deposits.- - - - - - - - - - ranking = 0.66666666666667keywords = neovascularization (Clic here for more details about this article) |
9/10. Optical coherence tomography of age-related macular degeneration and choroidal neovascularization.OBJECTIVE: The authors used optical coherence tomography (OCT), a new technique for cross-sectional imaging of the retina, to morphologically study eyes with nonexudative and exudative age-related macular degeneration (AMD). In patients with untreated exudative AMD, OCT was compared with fluorescein angiography in the identification and classification of choroidal neovascularization (CNV). methods: Optical coherence tomography imaging is analogous to ultrasound, except that the use of light rather than sound enables higher longitudinal resolution with a noncontact and noninvasive measurement. Optical coherence tomography was performed on 391 patients with the clinical diagnosis of AMD and was compared with conventional clinical examination to establish the cross-sectional morphology of different lesions and to develop a classification scheme for CNV. Optical coherence tomograms and fluorescein angiograms then were reviewed and correlated independently in 90 eyes of 86 patients who had exudative AMD without previous laser treatment. RESULTS: Pigmentary changes, soft drusen, and detachments of the neurosensory retina and retinal pigment epithelium all had distinct presentations on OCT. Subretinal and intraretinal fluid caused changes in retinal thickness or elevation that could be quantified directly from the images. choroidal neovascularization was evident in the tomograms as a thickening and fragmentation of a reflective layer, which corresponded to the retinal pigment epithelium and choriocapillaris. Changes in the reflection from this layer were observed during the progression of neovascularization, and after laser photocoagulation treatment. Classic CNV consistently presented with well-defined boundaries on OCT, whereas occult CNV had a variable cross-sectional appearance. CONCLUSIONS: Optical coherence tomography was useful in quantitatively evaluating subretinal and intraretinal fluid, assessing possible subfoveal involvement of neovascularization, and in monitoring CNV before and after laser photocoagulation. Optical coherence tomography was unable to detect CNV beneath serous pigment epithelial detachments. Optical coherence tomography may have potential in accurately defining the boundaries in a subset of angiographically occult CNV.- - - - - - - - - - ranking = 2.6666666666667keywords = neovascularization (Clic here for more details about this article) |
10/10. Hyperfluorescent plaque lesions in the late phases of indocyanine green angiography: a possible contraindication to the laser treatment of drusen.PURPOSE: To highlight the possible role of indocyanine green angiography in predicting future exudative changes in eyes that are candidates for drusen laser treatment. methods: In a 56-year-old woman, fluorescein and indocyanine green angiography were performed before drusen laser treatment. RESULTS: The treated eye had a suspicious lesion at baseline indocyanine green angiography and a nonsuspicious fluoroangiographic pattern. Seven months after treatment, the patient developed choroidal neovascularization and pigment epithelial detachment in the treated eye. CONCLUSION: To decrease the risk of macular exudative changes that may be related to laser treatment, eyes that are candidates for drusen laser treatment should be examined before treatment, not only by fluorescein angiography, but also by indocyanine green angiography.- - - - - - - - - - ranking = 0.33333333333333keywords = neovascularization (Clic here for more details about this article) |
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