Subretinal neovascularization following multiple evanescent white-dot syndrome.
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Adult↗
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Results for “Retinal Neovascularization”
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Optic disc and peripheral neovascularization in a young male.
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Child↗
Review of severe vaso-occlusive retinopathy in systemic lupus erythematosus and the antiphospholipid syndrome: associations, visual outcomes, complications and treatment.
PURPOSE: To discuss the pathogenesis of severe vaso-occlusive retinopathy in systemic lupus erythematosus (SLE), the association with antiphospholipid antibodies, and its implications for management and prognosis. METHODS: An illustrative case history of a woman with SLE and severe vaso-occlusive retinopathy in the presence of antiphospholipid antibodies is presented. A literature review of previously reported cases and previously published data on the topic was performed and forms the basis for discussion. RESULTS: This is a rare form of retinopathy in SLE as distinct from the more common, benign form, being classically a microangiopathy with diffuse capillary non-perfusion and small arterial or arteriolar occlusions in the retina. Poor visual outcomes with visual loss are reported in 80% of cases with neovascularization occurring in 40% of cases. It is associated with antiphospholipid antibodies, typically characterized by microthrombosis and immune complex mediated vasculopathy rather than a true vasculitis. There is a strong association between this severe form of retinopathy and central nervous system manifestations of SLE. Anticoagulation has a role in the secondary prevention of thrombosis in the presence of antiphospholipid antibodies, but the role of aspirin and immunosuppression is unclear in the treatment of this condition. Vigilant ophthalmic follow up and aggressive treatment of neovascularization and vitreous haemorrhage can prevent further visual loss. These points are highlighted in the brief case report presented. CONCLUSION: Severe vaso-occlusive retinopathy is a rare form of retinopathy in SLE often associated with poor visual prognosis and neovascularization. It may be a manifestation of the antiphospholipid syndrome. Treatment is aimed at preventing further thrombosis and complications arising from neovascularization.
Adult↗
Detection of subretinal neovascular membranes with indocyanine green and an infrared scanning laser ophthalmoscope.
We studied 80 patients with subretinal neovascular membranes to demonstrate the features and limitations of indocyanine green angiography. Indocyanine green increased the detection of ill-defined membranes or those in larger exudative maculopathies. Each membrane had a characteristic small dark rim that demarcated it from surrounding choroidal tissue. Nevertheless, the complex vascular structures of the choroid and retina, which are displayed at one time, can sometimes render the separation of new vessels difficult when displayed at the same time. The results of our study indicate that indocyanine green angiography may be suggested as an additional diagnostic tool in cases of ill-defined or exudative subretinal neovascular membranes.
Aged↗
[Laser treatment of macular subretinal neovascularization in angioid streaks].
The authors examined 17 eyes with macular subretinal neovascularization in angioid streaks treated by direct laser photocoagulation. Two eyes were treated with dye laser (590 nm), two with blue-green argon, three with green argon and ten with red krypton laser. At twelve-month follow-up, the visual acuity was of 0.21, a statistically significant decrease respect to the presenting vision. Poor functional results are due to the frequent recurrences of neovascularization.
Adult↗
[Vitreous surgery for subretinal neovascular membrane and hemorrhage].
OBJECTIVE: To study the indications, techniques and therapeutic effects of vitreous surgery for subretinal neovascular membranes. METHODS: 6 cases of subretinal neovascularization and subretinal hemorrhage were treated by vitreoretinal surgery. The surgical techniques consisted of three port pars plana vitrectomy, intraocular laser, retinotomy, subretinal neovascular membrane resection or hemorrhage removal, air-fluid exchange, etc. The pre and post-operative examinations included fundus fluorescein angiography (FFA), Humphry visual field to evaluate the therapeutic effects of the surgery. RESULTS: The postoperative follow-up ranged from 4 to 7 months. The visual acuities of 4 cases improved, 0.3 or over in 2 cases and unchanged in 2 cases. CONCLUSION: Subretinal operation may be a safe and effective method to treat subretinal neovascularization if the indication was well mastered.
Adult↗
A prospective study of acute central retinal artery obstruction. The incidence of secondary ocular neovascularization.
We conducted a prospective study to determine the incidence of ocular neo-vascularization following acute central retinal artery obstruction. Only patients initially evaluated within 7 days of visual loss were eligible. Any patient with pre-existing ocular neovascularization or clinical evidence of the ocular ischemic syndrome noted at the initial evaluation was excluded. During the 18-month study, 33 consecutive patients were enrolled. Six patients subsequently developed neovascularization of the iris, an incidence of 18.2%. In these six patients, neovascularization of the iris appeared as early as 12 days to as late as 15 weeks following the artery obstructions. Five of the six patients (15.2% of the total) later developed neovascular glaucoma. Another patient in this series developed neovascularization of the optic disc without neovascularization of the iris, an incidence of 3.0%. Only two of the seven patients with ocular neovascularization had ipsilateral hemodynamically significant carotid artery disease as determined by noninvasive carotid artery testing. This study confirms results of previous retrospective studies that the incidence of ocular neovascularization after central retinal artery obstruction is higher than commonly thought. It also shows that, in the majority of cases, carotid artery disease is not responsible for the neovascularization seen after central retinal artery obstruction.
Acute Disease↗
Inactive subretinal neovascularization in age-related macular degeneration.
Inactive subretinal new vessels (SRNVs), showing minimal leakage by fluorescein angiography and little progression, were observed in 15 eyes of 12 patients with age-related macular degeneration. In 8 (57%) of 14 eyes followed for longer than 6 months, the new vessels involuted and produced circumscribed areas of retinal pigment epithelium and choriocapillaris atrophy; 6 (43%) showed a further decrease in the fluorescein leakage during the follow-up period (average, 30.1 months). None of the new vessels organized into an exudative fibrovascular scar. Visual acuity was improved or unchanged during the entire follow-up period in 12 (86%) eyes and deteriorated in 2 (14%). Nine patients (75%) were 80 years of age or older; three (25%) were between 65 and 70 years of age. These observations suggested that SRNV showing minimal fluorescein leakage, particularly when it occurs in patients older than 80 years, do not require photocoagulation because they are usually self-limited.
Aged↗
Bilateral foveal neovascularization in a patient with insulin-dependent diabetes mellitus.
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Adult↗
Enhanced pathological angiogenesis in mice lacking beta3 integrin or beta3 and beta5 integrins.
Inhibition of alphavbeta3 or alphavbeta5 integrin function has been reported to suppress neovascularization and tumor growth, suggesting that these integrins are critical modulators of angiogenesis. Here we report that mice lacking beta3 integrins or both beta3 and beta5 integrins not only support tumorigenesis, but have enhanced tumor growth as well. Moreover, the tumors in these integrin-deficient mice display enhanced angiogenesis, strongly suggesting that neither beta3 nor beta5 integrins are essential for neovascularization. We also observed that angiogenic responses to hypoxia and vascular endothelial growth factor (VEGF) are augmented significantly in the absence of beta3 integrins. We found no evidence that the expression or functions of other integrins were altered as a consequence of the beta3 deficiency, but we did observe elevated levels of VEGF receptor-2 (also called Flk-1) in beta3-null endothelial cells. These data indicate that alphavbeta3 and alphavbeta5 integrins are not essential for vascular development or pathological angiogenesis and highlight the need for further evaluation of the mechanisms of action of alphav-integrin antagonists in anti-angiogenic therapeutics.
Animals↗
Subretinal endophotocoagulation. A new model of subretinal neovascularization in the rabbit.
The disciform response of age-related macular degeneration and other diseases is determined by the development of subretinal neovascularization (SRN). Experimental animal models of SRN based on disruption of Bruch's membrane have been studied extensively during the past decade. Argon laser photocoagulation-induced SRN in primates is one such model, but this is associated with extensive retinal damage. Because the injured retina could be angiogenic, and is not present in clinical SRN, this model might be more relevant if this factor could be eliminated. The current study was conducted with the primary aim of producing a rabbit model of SRN that minimizes retinal damage. Argon laser endophotocoagulation was applied beneath the retina of albino rabbits to achieve this goal. Although argon photocoagulation does not cause clinically apparent SRN (i.e., associated with leaking and pooling of fluorescein) in the rabbit, all laser lesions produced in the current study contained microscopic SRN. A rabbit SRN model would be highly desirable as a step toward other animal models, perhaps involving nonhuman primates, which might ultimately be clinically more relevant.
Animals↗
Endoscopic fluorescein angiography.
BACKGROUND AND OBJECTIVE: To assess features of various retinal and choroidal disorders by endoscopic fluorescein angiograms (EFAs) obtained intraoperatively. PATIENTS AND METHODS: One hundred patients undergoing vitrectomy were studied intraoperatively by injecting 5 ml of 10% fluorescein intravenously. Up to 110 degrees field of view high-resolution angiograms were obtained endoscopically. Characteristics of diabetic retinopathy, retinal vein occlusion, retinal vasculitis, exudative macular degeneration, and neovascular glaucoma were recorded. RESULTS: Capillary nonperfusion, retinal vascular occlusion or incompetence, and neovascularization of the disc, retina, subretinal space, and posterior iris could be delineated. CONCLUSION: EFA defines pathologic retinal/choroidal areas intraoperatively, which may permit more selective surgical management during vitrectomy.
Choroid Diseases↗
Choroidoretinal vascular anastomoses after blunt trauma to the eye.
Six weeks after blunt ocular trauma in a 38-year-old white man, choroidoretinal vascular anastomoses occurred at the site of choroidal and retinal rupture. Neovascularization was not observed. Anastomoses of this type have been documented in other cicatrizing and granulomatous disease processes.
Adult↗
Photocoagulation with continuous wave ND:YAG laser for neovascular maculopathy.
Twenty-two eyes in 22 cases of neovascular maculopathy were treated with continuous wave (CW) Nd:YAG laser and followed up for 6 to 24 months. The effect of the treatment was evaluated by repeated visual acuity testing, fundus photography, fluorescein angiography and automated static perimetry. In 91% of the patients visual acuity remained unchanged or improved. Fluorescein angiography revealed that the neovascularization disappeared in 91% of the patients. In 40% of the patients the central visual field showed improvement by automated static perimetry. These results indicate that CW Nd:YAG laser photocoagulation is useful for the treatment of neovascular maculopathy.
Aged↗
Posterior vitreous detachment: clinical correlations.
BACKGROUND: To evaluate the frequency of, and the factors which are primarily and secondarily associated with, posterior vitreous detachment (PVD), and to correlate the presence of PVD with various demographic and ophthalmic entities. METHODS: The clinical prospective observational cohort study included 1,481 subjects (740 women, 741 men) with a mean age of 63.45 +/- 14.97 years (mean +/- SD; range, 10.3-94.9 years) and a mean spherical equivalent refractive error of +0.68 +/- 2.13 dpt (range, -14.25 to +13.50 dpt). The presence of PVD was assessed by indirect and direct ophthalmoscopy, fundus biomicroscopy and by using a Hruby lens upon pharmacologically dilated pupil. Main outcome measures were frequency of PVD, association with age, refractive error, cataract surgery, diabetes mellitus, arterial hypertension, history of ocular trauma, vitreous hemorrhage, various retinal disorders, nonarteritic anterior ischemic optic neuropathy (AION) and open-angle glaucoma. RESULTS: The occurrence of PVD was significantly correlated with increasing age (p < 0.001), myopic refractive error (p < 0.001), female gender (p < 0.001), and surgical aphakia (p < 0.001). PVD occurred significantly more often bilaterally than unilaterally (p < 0.001). Patients with unilateral PVD were significantly (p < 0.001) younger than the patients with bilateral PVD. PVD was seen significantly (p = 0.038) less frequently in AION than in the remaining study population. The frequency of PVD was lower in eyes with than without diabetic retinopathy (p = 0.095), optic disc neovascularization (p = 0.07) and retinal neovascularization (p = 0.09). There was no significant association between the presence of PVD and macular hole, macular edema, retinal vascular occlusive disorders, age-related macular degeneration and open-angle glaucoma. CONCLUSIONS: These data of a large prospective study of PVD confirm some of the findings of previous smaller and retrospective studies. They also provide new information which may be helpful for the understanding of the pathophysiology of PVD and the role of PVD in the pathogenesis of various retinal and optic disc lesions.
Adolescent↗
[Fundus-controlled microperimetry with the scanning laser ophthalmoscope in macular diseases].
BACKGROUND: Scanning laser microperimetry allows focal sensitivity testing of any localization of the retina under direct visual control. Physiological or involuntary fixation shifts can be corrected by manual fundus-tracking. METHODS: For static fundus-controlled microperimetry we used a confocal scanning laser ophthalmoscope equipped with a helium-neon laser as light source for background illumination and for generating the stimuli by acousto-optic modulation. Fundus imaging was achieved by an infrared diode laser scanning synchronous with the helium-neon laser. In comparison computerized static projection perimetry was performed using the Humphrey Field Analyser, program 10-2. RESULTS: On the basis of four exemplary cases (macular hole, juxtafoveal pigment epithelium atrophy, subretinal neovascularization secondary to age-related macular degeneration) it is shown that extension and depth of scotomas can be recorded more precisely with scanning laser microperimetry than with conventional projection perimetry. Microscotomas can be detected. By using infrared laser for fundus imaging choroidal structures such as subretinal neovascular membranes can be visualized, even when moderate intra- or subretinal hemorrhages secondary to age-related macular degeneration are present. Thus focal sensitivity testing of the retina overlying neovascular membranes is possible. Simultaneous registration of fixation allows precise localization of the fixation point and its relationship to neovascular membranes. CONCLUSION: The advantage of fundus-controlled microperimetry is a precise examination of the impact of morphological changes on psychophysical functions of the macula. Due to its simultaneous registration of fixation fundus-oriented microperimetry is a very informative aid in the indication of laser therapy and the selection of different laser procedures in the treatment of subretinal neovascularizations.
Adult↗
Neovascular growth following photodynamic therapy for choroidal hemangioma and neovascular regression after intravitreous injection of triamcinolone.
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Adolescent↗
Subretinal neovascularization in anterior ischemic optic neuropathy.
A 66-year-old man with typical anterior ischemic optic neuropathy in one eye suffered from edema of the optic disc without functional changes in the fellow eye. However, 7 months later, a reduction in visual acuity, a change in the visual field and a worsening of the contrast-sensitivity curve demonstrated the development of typical anterior ischemic optic neuropathy in this eye as well. After another 6-month period, in addition to these changes, an extensive subretinal neovascular membrane developed in the papillomacular area, which further reduced the patient's visual acuity and required treatment with laser photocoagulation. To our knowledge, this is the first case report of the occurrence of a subretinal neovascular membrane as a complication of anterior ischemic optic neuropathy.
Aged↗