A common detection and classification system is needed for epidemiologic studies of age-related maculopathy (ARM). Such a grading scheme for ARM is described in this paper. ARM is defined as a degenerative disorder in persons > or = 50 years of age characterized on grading of color fundus transparencies by the presence of the following abnormalities in the macular area: soft drusen > or = 63 microns, hyperpigmentation and/or hypopigmentation of the retinal pigment epithelium (RPE), RPE and associated neurosensory detachment, (peri)retinal hemorrhages, geographic atrophy of the RPE, or (peri)retinal fibrous scarring in the absence of other retinal (vascular) disorders. Visual acuity is not used to define the presence of ARM. Early ARM is defined as the presence of drusen and RPE pigmentary abnormalities described above; late ARM is similar to age-related macular degeneration (AMD) and includes dry AMD (geographic atrophy of the RPE in the absence of neovascular AMD) or neovascular AMD (RPE detachment, hemorrhages, and/or scars as described above). Methods to take and grade fundus transparencies are described.

Aged↗

PubMedDate not supplied

Birdshot retinochoroidopathy: measurement of the posterior fundus spots and macular edema using a retinal thickness analyzer, before and after treatment.

PURPOSE: To measure the retinal thickness in the macular area and at the typical fundus spots in a patient with birdshot retinochoroidopathy, using the retinal thickness analyzer (RTA), a new image analyzer involving laser-slit biomicroscopy, and to quantify the changes after systemic corticosteroid therapy. CASE REPORT: A 54-year-old man with posterior uveitis underwent visual acuity measurement, fluorescein and indocyanine green (ICG) angiographies, optical coherence tomography (OCT) and RTA measurements before and after steroid treatment. RESULTS: The thickness at the birdshot spots measured with RTA remained unchanged after treatment, but the thickness at the fovea decreased in both eyes. Fluorescein and ICG angiographies and OCT showed no change with treatment. CONCLUSIONS: RTA seems a more sensitive method for assessing changes in macula thickness in the course of birdshot retinochoroidopathy and can help document the effect of treatment.

Chronic Disease↗

PubMedDate not supplied

A quantitative in vivo study of retinal thickness before and after laser treatment for macular edema due to retinal vein occlusion.

PURPOSE: To evaluate quantitatively the effect of grid laser photocoagulation in macular edema due to central and branch retinal vein occlusion, using the retinal thickness analyzer. METHODS: Five patients with cystoid and non-cystoid macular edema were studied before and after argon grid laser treatment. All were examined clinically, with fluorescein angiography, and measurement of retinal thickness. Macular thickness was correlated to visual acuity measured on the ETDRS chart. RESULTS: Laser-slit images obtained with the retinal thickness analyzer in patients with macular edema disclosed discrete intraretinal changes after photocoagulation. Biomicroscopy and fluorescein angiography were insensitive to these small changes in the retinal thickness. No patient had any change in visual acuity after three months, but the retinal thickness was greater at this interval. The retinal thickening may be explained by a postoperative inflammatory response or by altered retinal blood flow or, in two of the eyes, by the effect of combined peripheral photocoagulation. CONCLUSIONS: The retinal thickness analyzer offers a refined tool for the diagnosis of subclinical changes of macular edema in retinal vein occlusion and is therefore also useful for assessing the effects of treatment.

Aged↗

PubMedDate not supplied

Central retinal vein occlusion and sudden deafness: a possible common pathogenesis.

CASE REPORT: A 31-year-old woman complained of blurred vision in the right eye due to a well-perfused central retinal vein occlusion (CRVO) and two months later, of sudden deafness (SD) in her right ear. Her visual acuity and hearing recovered almost completely within a few months. Medical evaluation disclosed the combination of slight coagulation abnormalities (moderate decrease in protein S, slightly elevated lipoprotein (a)), and elevated fibrinogen, with plasma hyperviscosity. DISCUSSION: The occurrence of CRVO then SD suggests that the same underlying conditions can be considered as risk factors for both diseases and shows up some similarities in the pathogenesis of these acute impairments of microvascular blood flow in the retina and the cochlea.

Adult↗

PubMedDate not supplied

Surgical removal of subfoveal choroidal neovascularization: visual outcome and prognostic value of fluorescein angiography and optical coherence tomography.

PURPOSE: To study the functional results of macular surgery and determine pre-operative features associated with better final visual outcome. METHODS: Forty-two consecutive patients underwent surgical removal of subfoveal choroidal neovascularization (CNV), related to age-related macular degeneration (AMD) in 8 eyes, degenerative myopia in 14 eyes, multifocal choroiditis (MFC) in 10 eyes, idiopathic CNV in 6 eyes and other etiologies in 4 eyes. Mean age was 49 years. Pre-operative visual acuity (VA) was 20/200 or less in 30 eyes (71.4%) and never better than 20/40. Fluorescein angiography was analyzed before and after surgery. Pre-operative optical coherence tomographs (OCT) were studied in a masked fashion. Mean follow-up was 12 months (range 4-48 months). RESULTS: Final VA was 20/200 or less in 25 eyes (60%). According to the CNV etiology, the percentage were 87.5%, 80%, 57.1% and 20% respectively in eyes with AMD, MFC, high myopia, and idiopathic or other diseases. Post-operative VA improved in 21 eyes (50%) but subsequently declined in 7% by the final examination. Patients younger than 50 years had better functional results (p=0.006). Lack of retinal pigment epithelium (RPE) changes on pre-operative angiography was correlated with good visual outcome (p<0.001). The OCT study confirmed some features already described and showed some different CNVpatterns: above and usually separated from the RPE, below and not separated from the RPE, and ungradable. Eyes with the first OCT pattern had the best visual outcome. Main complications included 4 (10%) retinal detachments and 9 (21%) recurrences. OCT was also useful to confirm CNV recurrences post-operatively. CONCLUSIONS: CNV surgical excision results vary depending on the underlying disease, the RPE and choriocapillaris function, and the features observed on pre-operative OCT images.

Adolescent↗

PubMedDate not supplied

Fluorescein angiography--is it safe to use in a pregnant patient?

We sent questionnaires to 424 retina specialists in order to compile information on the use of fluorescein angiography in pregnant women. Four-hundred and three specialists responded. Of these, 313 (78%) had never performed fluorescein angiography on a pregnant woman. Ninety specialists (22%) had performed at least one fluorescein angiogram on a pregnant woman; detailed information was obtained on 105 patients. Authors of previous reports that included fluorescein angiography during pregnancy provided information on an additional 11 patients. Substantiated side effects were nausea and/or vomiting in seven patients. Anomalies at birth, an undescended testicle and syndactyly, were reported in two children. There was one stillbirth with pathologic findings classic for toxemia and one fetal death not related in time to fluorescein angiography. One therapeutic abortion was performed for complications in toxemia. One spontaneous abortion occurred 3 days after fluorescein angiography in a patient who was four weeks pregnant. Eight children born to toxemic mothers had low birth weights. Based on our data, we conclude that fluorescein angiography does not offer a high rate of birth anomalies or complications during pregnancy.

Adult↗

PubMedDate not supplied

Full-thickness macular hole and retinal detachment complicating Best's disease.

The unusual association of Best's vitelliform macular dystrophy and a full-thickness macular hole causing retinal detachment is reported. Successful reattachment was achieved with pneumatic retinopexy and postoperative laser photocoagulation. The mechanisms underlying the combination of full-thickness macular hole and retinal detachment in Best's disease remain to be elucidated.

Adult↗