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PubMed2004

Secondary retinal changes associated with choroidal naevi and melanomas documented by optical coherence tomography.

AIMS: To establish the characteristics of secondary retinal changes associated with the presence of choroidal melanomas and choroidal naevi as documented by optical coherence tomography (OCT). METHODS: Twenty patients with untreated choroidal melanoma and 40 patients with presumed choroidal naevi managed by regular observation were included in the study. OCT scans across the surface of the tumour and surrounding tissue were acquired for all participants. The appearance of retinal tissue on the OCT scans was considered to be abnormal if it did not display the well defined band structure characteristic of normal tissue on OCT scans. RESULTS: Serous retinal detachments were observed in all patients with choroidal melanoma and 18 out of 20 also had abnormal retinal structure or intra-retinal splitting in the tissue overlying the tumour. Out of the 40 patients with presumed choroidal naevi, 12 had serous detachments and three had either abnormal retinal structure or intra-retinal splitting overlying the lesion. CONCLUSIONS: Secondary retinal changes associated with choroidal lesions can be documented by OCT. These changes were observed in most patients with choroidal melanoma included in the study group but were far less prevalent in the patients with presumed choroidal naevi. OCT is also able to identify the presence of small serous detachments before they become clinically visible. Follow up of these patients is required to determine whether the OCT results may be of use in the differential diagnosis of small choroidal lesions.

Adult↗
PubMed1994

Effect of endogenous vasopressin on blood flow to choroid plexus during hypoxia and intracranial hypertension.

Exogenous vasopressin decreases blood flow to the choroid plexus and production of cerebrospinal fluid. Some studies indicate that hypoxia and increases in intracranial pressure (ICP) produce increases in circulating vasopressin. We examined the hypothesis that endogenous release of vasopressin decreases blood flow to the choroid plexus during hypoxia and increased ICP. Blood flow to the choroid plexus was measured in anesthetized rabbits using microspheres. Hypoxia increased cerebral blood flow more than twofold but had little effect on blood flow to the choroid plexus. In contrast, hypoxia produced a marked increase in blood flow to the choroid plexus in the presence of a vasopressin V1-antagonist, [d(CH2)5Tyr(Me)]AVP. During intracranial hypertension, blood flow to the choroid plexus decreased from 409 +/- 42 to 295 +/- 25 ml.min-1 x 100 g-1 (means +/- SE; P < 0.05 vs. control) when ICP was increased from 1 to 40 mmHg. The vasopressin antagonist inhibited the decrease in blood flow to the choroid plexus in response to increased ICP. Thus release of vasopressin during hypoxia and increased ICP have a constrictor effect on blood vessels of the choroid plexus. Plasma levels of vasopressin increased minimally during hypoxia and increased ICP, which suggests that sources of vasopressin other than plasma affect blood vessels of the choroid plexus. We propose that endogenous vasopressin may play a protective role during hypoxia and intracranial hypertension by a negative feedback mechanism to reduce blood flow to the choroid plexus.

Animals↗
PubMed1996

Intraretinal oxygen distribution and choroidal regulation in the avascular retina of guinea pigs.

O2-sensitive microelectrodes were used to measure PO2 as a function of depth through the retina and choroid of anesthetized and artificially ventilated guinea pigs. The guinea pig retina is of particular interest, because it has a typically mammalian structure but no retinal circulation; it relies totally on choroidal delivery of O2 and other nutrients. Measurements of intraretinal O2 distribution in an avascular mammalian retina have not previously been reported. Under normal ventilation conditions, PO2 decreased monotonically from the choroid (33.6 +/- 2.9 mmHg, n = 11) to near zero (0.4 +/- 0.1 mmHg) at the retina-vitreous boundary. The inner half of the retina had an average PO2 of only 0.6 +/- 0.1 mmHg. Stepwise increases in inspired O2 (from 20 to 40 to 60 to 80 to 100%) had surprisingly little effect on choroidal PO2. Rapid changes (20-100%) produced overshoot-type responses in the choroid before recovery to levels only slightly above those found in normoxia. This indicates the presence of an active O2-regulatory mechanism in the guinea pig choroid. Addition of CO2 (5%) to O2 ventilation appeared to break down this control mechanism and led to dramatic and sustained increases in PO2 throughout the retina and choroid. The demonstration of an O2-regulating mechanism in the guinea pig choroid that maintains choroidal PO2 well below that in the systemic arterial blood, coupled with the observation of very low O2 levels throughout the inner retina, suggests that the O2 requirement of the inner retina in the guinea pig is small and that O2 levels in the choroid are deliberately constrained.

Animals↗
PubMed2000

Regulation of endothelial nitric oxide synthase by PGD(2) in the developing choroid.

We investigated if prostaglandins might regulate the increased choroidal endothelial (e) nitric oxide synthase (NOS) expression in the perinate. Prostaglandins, eNOS mRNA, immunoreactive protein and activity, and nitrite [stable metabolite of nitric oxide (NO)] production were markedly higher in newborn (1 day old) than juvenile (6-8 wk old) pig choroid. Treatment of isolated newborn choroids with the prostaglandin synthase inhibitor ibuprofen for 24 h reduced eNOS mRNA and nitrite production to values in juveniles. This effect was equally observed with the PGD(2) receptor (DP) blocker BW A868C and was prevented by cotreatment with PGD(2) but not other prostaglandins; similar observations were made on NOS activity in vivo. PGD(2) also increased eNOS expression on choroids of juveniles, and this effect was blocked by BW A868C. The manifestation of this upregulation of eNOS by PGD(2) on the control of choroidal vasomotor response was tested by using NO-dependent vasorelaxants, ACh, bradykinin (Bk), and substance P (SP). ACh-, Bk-, and SP-elicited choroidal vasorelaxation was greater in saline-treated newborn than juvenile pigs. Ibuprofen (24 h) decreased ACh-, Bk-, and SP-evoked vasorelaxation in newborns, whereas PGD(2) increased that in juveniles and prevented the ibuprofen-induced attenuated relaxation in newborns; infusion of N(omega)-monomethyl-L-arginine in choroids of those animals treated with PGD(2) reversed the augmented vasorelaxation to ACh, Bk, and SP. Finally, PGD(2)-induced upregulation of NOS in the perinate was also reflected by curtailed choroidal blood flow autoregulatory response to increased perfusion pressure. In conclusion, PGD(2) exhibits a major role in upregulating eNOS expression and activity in the choroid, which in turn results in greater NO-mediated vasorelaxation; a new mechanism for eNOS regulation via DP is hereby disclosed. The relationship between PGD(2) and eNOS in the developing subject provides an explanation for the interactive role of these two factors in the absent choroidal blood flow autoregulation in the perinate.

Aging↗
PubMed2004

Structural and elemental evidence for edema in the retina, retinal pigment epithelium, and choroid during recovery from experimentally induced myopia.

PURPOSE: The purpose of this study was to monitor temporal changes in the retina, retinal pigment epithelium (RPE), and choroid of chick eyes using biometric, ultrastructural, and elemental microanalysis techniques as a means of visualizing more detailed signs of the physiological processes underlying choroidal expansion and refractive normalization during recovery from form deprivation. METHODS: Axial dimensions and refractions were measured on form-deprived and fellow eyes of 117 experimental chickens reared with monocular translucent occlusion from days 1 to 15 and given different lengths of visual experience (T = 0-144 hours) before death. Tissue was analyzed ultrastructurally by electron microscopy and relative sodium (Na) and chloride (Cl) ion abundances, by using x-ray microanalysis to determine changes in the presence of these indicators of tissue hydration. RESULTS: Refractive error decreased from more than 20 D of myopia almost linearly over the first 144 hours after occlusion. Concurrent changes in thickness in the retina, RPE, and choroid were seen as a series of thickness increases and edema, which returned to normal thickness, first in the retina, and did not reach maximum until 3 days after occluder removal in the choroid. In freeze-dried tissue, Na and Cl ion concentrations were greatest in the RPE photoreceptor outer segments and extravascular choroid at T = 0, decreasing toward fellow eye levels by T = 48 in the RPE and choroid. Na and Cl ion abundances in the frozen lymph of choroidal lymphatics were nearly at control levels (T = 0) and increased later as the vessels became more distended after the extravascular edema became significant. CONCLUSIONS: The results suggest that occluder removal induces edema across the retina and choroid and that this fluid may be the vector eliciting choroidal expansion during recovery from form deprivation possibly driven by the hyperosmolarity in the choroid, RPE, and photoreceptor outer segments that accompanies deprivation.

Animals↗
PubMed2003

Sonography of fetal choroid plexus cysts: detection depends on cyst size and gestational age.

OBJECTIVE: To establish diagnostic criteria for the diagnosis of fetal choroid plexus cysts across gestation. METHODS: Prenatal sonographic images of 166 fetuses without choroid plexus cysts were prospectively collected from 13 weeks to term. Texture characteristics of the choroid plexus regions were analyzed to quantify changes as a function of gestational age. A set of 20 fetal sonographic images with choroid plexus cysts were used to create cyst prototypes (1.5-2.5 mm), which were randomly embedded into normal choroid plexus images from varying gestational ages. A test set of 544 images was created, which included 408 images with choroid plexus cysts and 136 images without choroid plexus cysts. Four observers following a blinded study design evaluated the presence of choroid plexus cysts in the images. The influence of cyst size and gestational age on the detection of cysts was measured with receiver operating characteristic analysis and analysis of variance. Observer agreement was characterized by agreement kappa statistics. RESULTS: Texture analysis indicated greater echo texture heterogeneity at earlier gestational ages. The receiver operating characteristic analysis showed a corresponding decrease in diagnostic accuracy for cyst detection at earlier gestational ages. The cyst detection threshold (area under the receiver operating characteristic curve, 0.8) was 2.4 mm (SE, 0.2 mm) for 13 to 21 weeks' gestation and decreased to 1.9 mm (SE, 0.17 mm) for 22 to 38 weeks' gestation. Average interobserver and intraobserver kappa statistics were 0.37 and 0.53, respectively. CONCLUSIONS: Because of the changing echo texture of the choroid plexus through gestation, choroid plexus cysts must be at least 2.5 mm in diameter for confident diagnosis before 22 weeks' gestation and at least 2 mm after 22 weeks.

Adult↗
PubMed2000

Metabolic dependence of photoreceptors on the choroid in the normal and detached retina.

PURPOSE: This article assesses the hypothesis that the high blood flow rate and low O(2) extraction associated with the choroidal circulation are metabolically necessary and explores the implications of the spatial relationship between the choroid and the photoreceptors for metabolism in the normal and detached retina. METHODS: The O(2) distribution across the retinal layers was previously measured with O(2)-sensitive microelectrodes in cat. Profiles were fitted to a diffusion model to obtain parameters characterizing photoreceptor O(2) demand. This was a study of simulations based on those parameters. RESULTS: Photoreceptor inner segments have a high O(2) demand (QO(2)), and they are far (20 to 30 microm) from the choroid. These unusual conditions require a large O(2) flux to the inner segments, which in turn requires high choroidal oxygen tension (PO(2)), high choroidal venous saturation (ScvO(2)), low choroidal O(2) oxygen extraction per unit volume of blood, and a choroidal blood flow (ChBF) of at least 500 ml/100 g-min. Movement of the inner segments further from the choroid, which occurs in a retinal detachment, severely reduces the ability of the inner segments to obtain O(2), even for detachment heights as small as 100 microm. Depending on detachment height and assumptions about choroidal and inner retinal PO(2) during elevation of inspired O(2) (hyperoxia), hyperoxia is predicted to partially or fully restore photoreceptor QO(2) during a detachment. CONCLUSIONS: The choroid is not overperfused, but requires a high flow rate to satisfy the normal metabolic demand of the retina. Because the oxygenation of the photoreceptors is barely adequate under normal conditions, detachment has serious metabolic consequences. Hyperoxia is predicted to have clinical benefit during detachment.

Animals↗
PubMed2000

An ICG angiogram-based clinical method for characterizing the choroidal circulation used to assess the hemorrheologic effects of pentoxifylline.

PURPOSE: To demonstrate an indocyanine green (ICG) angiography-based clinical method for characterizing choroidal blood flow and for detecting changes in choroidal circulation patterns, and by use of that method, to demonstrate that pentoxifylline affects choroidal blood flow. METHODS: High-speed ICG angiography was performed in rhesus monkeys before and after intravenous administration of pentoxifylline or saline (which served as a control) while monitoring blood pressure and heart rate. From these data, three-dimensional surface maps indicating the instantaneous relative distribution of choroidal blood flow during the peak of intra-ocular pressure pulse systole in a 30 degrees field, centered on the macula, were generated to characterize the state of the choroidal circulation at various times during the experiments. RESULTS: Comparisons of the 3-dimentional surface maps consistently indicated an increase in sub-macular choroidal blood flow occurring within 5 to 10 minutes post-pentoxifylline injection, with a gradual return to baseline level 20-40 minutes later. Injection of equal volumes of saline produced no changes in choroidal blood flow. CONCLUSIONS: Posterior-pole choroidal blood flow can be characterized as by a three-dimensional surface representing the instantaneous relative distribution of choroidal blood flow during the peak of intra-ocular pressure pulse systole. Pentoxifylline does, at least transiently, increase sub-macular choroidal blood flow.

Animals↗
PubMed2002

[Effect of choroid plexus on sequestering cadmium and its pathomorphological change].

To investigate whether choroid plexus can sequester cadmium(Cd) and its pathomorphological change, rabbits were given the injections of 1.0, 2.0 and 4.0 mg CdCl2/kg through ear vein, respectively. 4 and 24 hours after Cd administration, animals were sacrificed, the samples of blood, cerebrospinal fluid (CSF), choroid plexus of lateral ventricle, cerebral cortex, liver and kidney were collected and the concentration of Cd in these tissues were measured. Samples of choroid plexus were rushed in saline thoroughly, then fixed. Pathomorphological changes of choroidal epithelial cells were observed in light microscopy and electron microscopy. The result showed that concentration of Cd in choroid plexus was higher than that in blood, CSF and cerebral cortex. In high-dose group, concentration of Cd in CSF was higher than that in other groups. Choroidal epithelial cells appeared vacuolation and granuler degeneration in light microscopy. Choroidal epithelial cells lost their normal slight to moderate convex luminal profiles, and appeared the loss of microvilli, shaped nuclei, increased cytoplasmic vacuolation, increased number of lysosomes, dilated rough endoplasmic reticulum, and widening of the gaps between adjacent cells. Choroid plexus could accumulate and sequester Cd to protect cerebral cortex from the fluxes of Cd in blood cadmium. When concentration of cd reached a certain level, sequestering action of choroid plexus was weak, or disappeared. Choroid plexus of lateral ventricle appeared pathomorphological change.

Animals↗
PubMed1987

Characterization of the choroidal mast cell.

The experimental studies performed on nonpigmented rat choroids and the review of the important literature covered in this thesis seem to justify the following statements: 1. Mast cells are present in the choroid in significant numbers. 2. Mast cell numbers vary considerably from one individual to another and from one location in the choroid to another. 3. The major concentration of mast cells in the uvea is in the posterior choroid. 4. The mast cells of the choroid have a preferential location along arterial vessels. 5. Choroidal mast cell population density apparently decreases with senescence. 6. Mast cell products are present in sufficient quantity to exert substantial effects on physiologic, immunologic, and inflammatory responses in the choroid. 7. Choroidal mast cell products are released with appropriate stimulation and share some properties with the connective-tissue mast cell. 8. Choroidal mast cell demonstrate enough differences to suggest that a local differentiation may be present and may represent a locally controlled modulating effect for choroidal physiologic, immunologic, and inflammatory reactions.

Aging↗
PubMed1975

The human choroid plexus and autoimmune nephritis.

The choroid plexus resembles the glomerular basement membrane (GBM) and may be a site of injury or source of antigen in Goodpasture syndrome. Immunohistologic studies were performed on the choroid plexus of a patient with auto-immune nephritis and pulmonary hemorrhage. The studies showed linear deposition of host IgG, IGM, and beta1c. Antibody eluted from the diseased kidney fixed in a linear pattern to normal choroid plexus and could be absorbed by either choroid plexus or GBM. Antibody to choroid plexus fixed to GBM and the linear staining was no longer observed after absorption with GBM or choroid plexus. Antibody to GBM fixed to normal choroid plexus and was obsorbed by both choroid plexus and glomerular basement membrane. The studies suggest an immunologic relationship between choroid plexus and GBM and a role for the choroid plexus in autoimmune nephritis.

Animals↗
PubMed1995

Microsurgical anatomy of the posterior choroidal arteries.

In this study, we analysed the microanatomy of the medial and lateral posterior choroidal arteries, which supply vital central nervous system structures to the brainstem and choroids plexus. We traced the anatomical course of the medial and lateral posterior choroid arteries, their origin, diameter, number of branches, length, and anatomical variations. Twenty-six human unfixed brains were injected through the vertebral and carotid arteries with silicon rubber. Fifty-one out of a total of 129 vessels were medial posterior, and 78 were lateral posterior choroidal arteries. We divided the medial posterior choroidal artery into three segments: around the brainstem, quadrigeminal-pineal, and choroidal. The mean length of the medial posterior choroidal artery was 77.6 +/- 15 mm on the right side, and 77.1 +/- 15 mm on the left; the mean outer diameter observed was 0.8 +/- 0.5 mm on the right side, and 0.8 +/- 0.4 mm on the left. The number of branches arising from the medial posterior choroidal arteries averaged 25 +/- 9. In the lateral posterior group, the mean length observed was 49.5 +/- 26 mm on the right, and 58.0 +/- 23 mm on the left. There were instances of duplication and triplication of the lateral posterior choroidal vessels. The outer diameter averaged 0.72 mm on the right, and 0.6 mm on the left. The posterior choroidal arteries are clearly an important vascular component. A comprehensive knowledge of their anatomy will aid the neurosurgeon during surgery of the brainstem, pineal region, and third ventricle, and will limit complications resulting from injury to these arteries.

Arteries↗
PubMed1996

ICAM-1, VCAM-1, and MAdCAM-1 are expressed on choroid plexus epithelium but not endothelium and mediate binding of lymphocytes in vitro.

The expression of cell adhesion molecules (CAMs) in the choroid plexus was studied in normal brain and during experimental autoimmune encephalomyelitis (EAE) in the SJL/J mouse during inflammation induced by intracerebral injection of killed Corynebacterium parvum in the C3H/He mouse. Both ICAM-1 and VCAM-1, but not MAdCAM-1, were constitutively expressed on choroid plexus epithelium but not on the fenestrated capillary endothelial cells within the choroid plexus. During EAE, we observed an up-regulation of ICAM-1 and VCAM-1 and de novo expression of MAdCAM-1 on choroid plexus epithelial cells. In contrast, endothelial cells in the choroid plexus were not induced to express any of the investigated CAMs. In in situ hybridization analysis we demonstrated that ICAM-1, VCAM-1, and MAdCAM-1 were locally synthesized and that the amount of their mRNAs increased in the inflamed choroid plexus. In vitro, primary choroid plexus epithelial cells could be induced to express ICAM-1, VCAM-1, and MAdCAM-1 on their surface after treatment with proinflammatory cytokines such as tumor necrosis factor-alpha, interleukin-1, interferon-gamma, and lipopolysaccharide. To investigate the functional status of the expressed CAMs we performed Stamper-Woodruff binding assays on frozen sections of inflamed and naive brains. ICAM-1, VCAM-1, and MAdCAM-1 expressed in choroid plexus epithelial cells mediated binding of lymphocytes via their known ligands LFA-1 and alpha4-integrin, respectively. The expression of ICAM-1, VCAM-1, and MAdCAM-1 on choroid plexus epithelial cells together with the lack of their expression on the fenestrated choroid plexus endothelium raises the possibility that the epithelial blood-cerebrospinal-fluid barrier plays an important role in the immunosurveillance of the central nervous system.

Animals↗
PubMed1997

Widespread choroidal insufficiency in primary open-angle glaucoma.

PURPOSE: The purpose of this study was to investigate choroidal perfusion in glaucoma, using histological and angiographic techniques. METHODS: We examined the choroidal vasculature in clinicopathological slides from 25 cases of primary open-angle glaucoma, five cases of optic atrophy, and 18 normal eyes. We measured choroidal thickness at fixed distances from the disk margin with light microscopy. Using a quantitative computer image analysis system, we established the depth of all vessels and the best fitting diameter and width-to-length ratio for each vessel in three pairs of eyes. Separate statistical analyses were done on the parapapillary area and the whole choroid. We compared standard fluorescein angiographic measures to peak choroidal filling time in a further 78 glaucoma and 84 normal eyes. RESULTS: Choroids were significantly (approximately 50 microns) thinner in glaucoma than in normal or optic atrophy irrespective of fundal position. Vessel frequency and mean diameter, relative to normal, showed greatest decrease near the choriocapillaris. Peak choroidal filling was the only fluorescein angiographic measure that was significantly delayed in glaucoma irrespective of age. CONCLUSIONS: Reduced choroidal thickness in primary open-angle glaucoma is primarily due to loss of the innermost choroidal vessels. Overall size decreases without significant flattening. These changes are not seen with optic atrophy alone and may be correlated with the delayed choroidal perfusion seen in fluorescein angiography.

Aged↗
PubMed1997

Relationship of polymorphonuclear leukocytes to capillary dropout in the human diabetic choroid.

Capillary dropout is an initial event in diabetic retinopathy, but the etiology is unknown. Recent evidence suggests that similar events may occur in the diabetic choroid. We have developed a method to evaluate the relationship between the polymorphonuclear leukocytes (PMNs) and capillary dropout in the human diabetic choroid using alkaline phosphatase (APase) histochemistry to label blood vessels and nonspecific esterase activity to identify PMNs. The number and distribution of PMNs in diabetic and nondiabetic choroidal capillaries (choriocapillaris) were analyzed in the flat perspective and the tissue then flat embedded in glycol methacrylate for histological sectioning. The total number of PMNs was increased within the choriocapillaris in five diabetic eyes (170.9 +/- 12.9 PMNs/mm2 of choroid) compared with five nondiabetic eyes (84.2 +/- 16.9 PMNs/mm2; P < 0.001). PMNs were almost always within blood vessel lumens and not in interstitial tissue. In the diabetic choroid, increased numbers of PMNs were present in areas of choriocapillaris with pathological changes (loss in APase activity and choroidal neovascularization) compared with nonpathological choriocapillaris (205.1 +/- 46.9 PMNs/mm2 in pathological versus 152.3 +/- 23.4 PMNs/mm2 in nonpathological areas; P < 0.001). PMNs were often queued up within the lumens of capillaries, demonstrating loss in APase activity. We have observed an increased number of PMNs in diabetic choroid compared with control nondiabetic choroids, and PMNs in diabetic choroid were associated with loss in APase activity, which was related to loss in viable endothelial cells. The results suggest that PMNs contribute to vaso-occlusive processes and endothelial cell injury in the diabetic choroid.

Aged↗
PubMed1991

Comprehensive lectin histochemistry of normal and neoplastic human choroid plexus cells: alternation of lectin-binding patterns through neoplastic transformation.

Lectin histochemistry of the normal and neoplastic human choroid plexus cells [six choroid plexus papillomas (CPPs) and three choroid plexus carcinomas (CPCs)] was performed using eight representative lectins to study the development of sugar chain structures and also to determine whether lectins were useful for a histopathological diagnosis of choroid plexus neoplasms (CPNs). The normal choroid plexus cells reacted with Ricinus communis (RCA-I). Canavalia ensiformis (Con A), Limax flavus (LFA) and Triticum vulgaris (WGA), while Arachis hypoaea (PNA) stained them only after the removal of sialic acid. Human fetal choroid plexus cells at 8 weeks gestation already showed the same lectin-binding patterns as adult ones. All CPNs were stained by RCA-I and Con A in a similar manner as the normal choroid plexus cells. Although seven CPNs were positive for LFA, two CPCs were not stained by LFA, which bound to sialic acid. Two LFA-positive CPPs were stained by PNA before the removal of sialic acid. Moreover, unlike the normal choroid plexus cells, Ulex europaeus-, Glycine maximus- and Dolichos biflorus-binding sites often appeared, and WGA-binding sites of three CPNs remained even after sialic acid removal. In conclusion, the glycosialylation in normal choroid plexus cells was completed during the early embryonic stage. The lectin-binding patterns of CPNs were heterogenous in each case. The alternation of the glycosialylation and/or acquisition of binding sites for some lectins was sometimes observed through a neoplastic transformation.

Adult↗
PubMed2006

Choroidal vein and artery occlusion following photodynamic therapy in eyes with pathologic myopia.

PURPOSE: To describe highly myopic patients in which either the large choroidal veins or arteries were occluded following PDT treatment. METHODS: Demographic features of two highly myopic patients in which large choroidal vessels were occluded at 1 week following PDT, among a total of 23 patients who received PDT due to choroidal neovascularization (CNV) caused by high myopia, were demonstrated. RESULTS: In case 1, ICG angiography demonstrated the complete occlusion of several large choroidal veins within the laser-applied area at 1 week after PDT. In case 2, ICG angiography demonstrated an occlusion of choroidal artery emanating from beneath the CNV. One month after PDT, re-perfusion of the occluded choroidal vessels was noted in both patients. CONCLUSION: Occlusion of choroidal veins has never been reported in eyes with CNV treated by verteporfin therapy. Although further studies are necessary, occlusion of large choroidal vessels might happen in highly myopic eyes more commonly than expected. ICG angiography at 1 week after PDT was useful to evaluate the impact of PDT on large choroidal vessels.

Aged↗
PubMed2006

Multifocal choroiditis with panuveitis incidence of ocular complications and of loss of visual acuity.

PURPOSE: To estimate the incidences of ocular complications and vision loss in patients with multifocal choroiditis with panuveitis (MFCPU) and to describe the association between therapy and the incidences thereof. DESIGN: Retrospective cohort study. PARTICIPANTS: Sixty-six patients (122 eyes) with MFCPU evaluated from January 1984 through June 2005 at a single-center academic practice. METHODS: Demographic and clinical information on patients diagnosed with MFCPU was collected and entered into a computerized database for statistical analyses. MAIN OUTCOME MEASURES: Development of ocular complications, including choroidal neovascularization, epiretinal membrane, and cystoid macular edema (CME), and loss of visual acuity (VA) to 20/50 or worse and to 20/200 or worse. RESULTS: Among affected eyes of patients with MFCPU, frequencies of VAs of 20/50 or worse and of 20/200 or worse at presentation were 55% and 38%, respectively. Choroidal neovascularization was observed in 22% of affected eyes at presentation and was the leading cause of poor VA at presentation. The incidence rates of vision loss to 20/50 or worse and to 20/200 or worse were 0.19/eye-year (EY) and 0.12/EY in affected eyes and 0.07/person-year (PY) and 0.04/PY in better-seeing eyes. Choroidal neovascularization was the most common cause of incident vision loss, with approximately 45% of incident vision loss attributed to new-onset or recurrent choroidal neovascularization. Presence of epiretinal membrane and CME also was associated with the development of vision loss during follow-up. When taken in combination, the incidence of any posterior pole complication was 0.13/EY in affected eyes. Use of immunosuppressive drug therapy (but not low-dose corticosteroid therapy) was associated with an 83% reduction in the risk of posterior pole complications (P = 0.004) and with a 92% reduction in the risk of 20/200 or worse VA in affected eyes (P = 0.05). Of the 6 eyes with recurrent choroidal neovascularization, only one recurrence was observed, in a patient receiving immunosuppressive drug therapy. CONCLUSIONS: Treatment with immunosuppressive drugs may improve VA outcomes among patients with MFCPU by reducing the risk of sight-threatening posterior pole complications, including new-onset choroidal neovascularization and recurrent choroidal neovascularization among eyes with existing choroidal neovascularization.

Adolescent↗