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PubMed1993

[Quantitative study of diabetic retinopathy by computerized image analysis].

Composite fluorescein angiographic pictures of 66 eyes with diabetic retinopathy and nonperfusion areas were studied by computerized image analysis, and the ratio of the nonperfusion area to the disc area was calculated. There were 49 eyes with neovascularization (NV), in which the mean ratio +/- standard error was 46.33 +/- 7.01 (8.15 to 298.26), and the corresponding value in the other 17 eyes without NV was 6.90 +/- 1.31 (2.20 to 21.37), the difference being very significant. When the ratios were under 10, from 10 to 30, or over 30, the percentages of eyes manifesting NV were 13.3%, 81.8% and 100% respectively. In the 49 eyes with NV, the majority of the total 267 neovascular clusters were distributed 4-6 DD away from the optic disc, which itself was involved only in 18 eyes.

Adult↗
PubMed1997

[Detection of subretinal neovessels with indocyanine green videoangiography].

PURPOSE: To evaluate the ability of indocyanine green videoangiography to delineate the subretinal neovascular membranes and to compare with fluorescein angiography. METHODS: Between August 1993 and November 1994, digital fluorescein and indocyanine green videoangiography was performed in 214 eyes of 108 cases. Of the 108 cases, 96 had age-related macular degeneration, 6 had angioid streaks and 3 had degenerative myopia. RESULTS: On fluorescein angiography, 47 of the 214 eyes had well-defined and 42 had occult subretinal neovascular membrane. Occult membranes were clearly delineated with indocyanine green angiography. Using these two angiographies, we could detect subretinal neovascular membrane in 89 eyes. These membranes were in 79 of the 181 eyes with age-related macular degeneration, 5 of the 12 eyes with angioid streaks and 2 of the 6 eyes with degenerative myopia. In addition, 3 eyes of the 3 cases had idiopathic subretinal neovascular membranes. CONCLUSION: The results of this study indicate that ICG videoangiography is an adjunctive diagnostic tool to fluorescein angiography in the detection of subretinal neovascular membranes in age-related macular degeneration and in other chorioretinal pathologies.

Adult↗
PubMed2000

Neovascularization grading methods in a rat model of retinopathy of prematurity.

PURPOSE: The method of counting cell nuclei above the internal limiting membrane in histologic sections is considered the standard when quantifying neovascularization (NV) in rodent oxygen-induced retinopathy (OIR). An alternative, more rapid method of counting clock hours in flatmounted adenosine diphosphatase (ADPase)-stained rat retinas is analogous to clinically scoring retinopathy of prematurity (ROP). In the present study, the validity of counting clock hours was evaluated by a direct comparison of these techniques. The intereye correlation of NV score and retinal vascular area were also studied. METHODS: Newborn Sprague-Dawley rats were exposed to cycles of O2 (80-10%) for 7 days, followed by 5 days of room air recovery. Preretinal NV was quantified by three masked observers counting clock hours in flatmounted ADPase-stained retinas of both eyes. Retinal vascular and total retinal areas were calculated using computer-assisted analysis. Representative retinas that had been scored positive (n = 10) and negative (n = 3) for NV and room air control retinas (n = 3) were embedded in paraffin. Each entire peripheral retinal quadrant was serially sectioned at 6 microm and stained with hematoxylin and eosin. Nuclei above the internal limiting membrane were then counted in a masked manner. The total number of nuclei counted per retina was defined as the nucleus count (704-938 sections per retina; 12,900 sections). Correlations were evaluated using Spearman rank coefficients. RESULTS: The nucleus count was 0 to 44 in room air control retinas, 0 to 40 in negative OIR retinas, and 250 to 5634 in positive OIR retinas. The nucleus count was highly correlated with the clock hour score (r(s) = 0.95, P = 0.0001). For the paired retinas, there was a significant correlation between right and left eyes in the severity of NV (clock hours; r(s) = 0.76, P = 0.0001) and the ratio of retinal vascular area to total retinal area (r(s) = 0.81, P = 0.0001). CONCLUSIONS: The more rapid method of counting clock hours in flatmounted ADPase-stained retinas is valid for quantifying NV in rat models of ROP. Incidence and severity of NV and vascularized areas were similar between left and right eyes, which permits the use of paired retinas for complementary research techniques.

Animals↗
PubMed1992

Digital overlay of fluorescein angiograms and fundus images for treatment of subretinal neovascularization.

A system for comparing sequential fundus photographs and angiograms has been developed using a personal computer and commercially available image processing software. This process provides rapid results and a high degree of accuracy in image correlation, even when images come from different cameras with different magnifications. Though no concentrated effort was made to compare the superiority of this method to the manual technique, the value of the manual results is fully acknowledged, and this technique is offered as another method of achieving the same end. This technique can be used to determine the adequacy of treatment of subretinal neovascularization, recurrence of subretinal neovascularization in subsequent angiograms, pigment epithelial creep, and changes in fundus lesions.

Adult↗
PubMed1994

Aqueous flare in eyes with age-related macular degeneration.

It is unknown whether aqueous flare is increased in eyes with prominent fundus lesions other than choroidal malignant melanoma. Therefore, we studied the aqueous flare in eyes with age-related macular degeneration (ARMD) using the laser flare-cell meter. Forty-three eyes of 27 patients with ARMD (age 67.0 +/- 14.0 years, range 43-81 years), and 41 healthy eyes of 41 randomly selected age- and gender-matched control patients (age 68.9 +/- 9.8 years, range 43-89 years) were examined. The macular degeneration was diagnosed and classified using fluorescein angiograms. Flare values in eyes with ARMD were 0.28 +/- 0.18 mg/ml, being significant in comparison with the control (0.12 +/- 0.05 mg/ml). The differences among the subgroups of ARMD were not statistically significant (P > 0.5): macular drusenosis (0.21 +/- 0.05 mg/ml, n = 6), subretinal neovascularization without marked subretinal hemorrhage (0.27 +/- 0.15 mg/ml, n = 19), subretinal neovascularization with marked subretinal hemorrhage (0.29 +/- 0.24 mg/ml, n = 7), and disciform scar (0.31 +/- 0.24 mg/ml, n = 9).

Adult↗
PubMed2005

Nonhuman primate models for diabetic ocular neovascularization using AAV2-mediated overexpression of vascular endothelial growth factor.

Neovascularization leads to blindness in numerous ocular diseases, including diabetic retinopathy, age-related macular degeneration, retinopathy of prematurity, and sickle cell disease. More effective and stable treatments for ocular neovascularization are needed, yet there are major limitations in the present animal models. To develop primate models of diabetic retinopathy and choroidal neovascularization, rhesus monkeys were injected subretinally or intravitreally with an adeno-associated virus (AAV)-2 vector carrying the cDNA encoding human vascular endothelial growth factor (VEGF). Overexpression of VEGF was measured by intraocular fluid sampling over time. Neovascularization was evaluated by ophthalmoscopy through angiography, optical coherence tomography, and ultimately histopathology. Overexpression of VEGF through AAV2 results in rapid development of features of diabetic retinopathy or macular edema, depending on the targeted cell type/mode of production of VEGF and diffusion of VEGF. Nonhuman primate models will be useful in testing long-term safety and efficacy of novel therapeutic agents for blinding neovascular diseases.

Adenoviridae↗
PubMed1998

Reactivation of inflammatory lesions in ocular histoplasmosis.

BACKGROUND: Active inflammation has not been traditionally associated with the ocular histoplasmosis syndrome. OBJECTIVE: To investigate the occurrence of presumed inflammatory chorioretinal lesions in patients with the ocular histoplasmosis syndrome. METHODS: Patients seen with acute symptoms and a clinical picture of ocular histoplasmosis were observed prospectively between August 13, 1993, and December 2, 1997. Symptoms, visual acuity, and fluorescein sodium angiography were used to document changes in inflammatory loci. RESULTS: Twelve patients were seen with active inflammatory lesions. Eleven had resolution of the loci with lessening of symptoms and improvement in acuity and angiographic findings. A typical subretinal neovascular membrane developed in 1 patient 8 months after the onset of symptoms. CONCLUSIONS: Inflammatory chorioretinal lesions can reactivate in the ocular histoplasmosis syndrome. In most of these patients, neovascularization did not develop and visual acuity was preserved.

Acute Disease↗
PubMed2004

Association of neovascular age-related macular degeneration and hyperhomocysteinemia.

PURPOSE: To assess the relationship between plasma homocysteine levels and exudative neovascular age-related macular degeneration (AMD). DESIGN: Cross-sectional study. METHODS: A prospective comparative cross-sectional study was conducted in outpatient ophthalmology clinics in a university-affiliated medical institution. The cohort consisted of 59 patients (25 male, 34 female) with a mean age of 78 years (standard deviation [SD] = 8.4) with neovascular AMD who were candidates for photodynamic treatment. Patients were compared for plasma homocysteine levels with 58 patients who had dry AMD (24 male, 34 female) with a mean age of 76.3 years (SD = 8.4) and with a control group of 56 age-matched subjects (27 male, 29 female), with a mean age of 77.3 years (SD = 8.2). A 3-ml venous blood sample was obtained from each participant after an 8-hour fast. Levels of plasma homocysteine were measured by high performance liquid chromatography. The main outcome measure was hyperhomocysteinemia, defined as a plasma homocysteine level above 15 micromol/l. RESULTS: Homocysteine levels were higher by 27.9% in the neovascular AMD than in the dry AMD group, and by 21.9% than in the control group (P <.02). Hyperhomocysteinemia was found in 44.1% of the study group, in 22.4% of the dry AMD group, and in 21.4% of the control group (P =.011). CONCLUSIONS: This study suggests an association between an elevated plasma level of homocysteine and exudative neovascular AMD but not dry AMD.

Aged↗
PubMed1990

Occult subretinal new vessels in age-related macular degeneration. Natural History and early laser treatment.

Little information is available on the natural history and no data have been published on laser treatment for occult neovascularization in age-related macular degeneration. The visual and angiographic outcomes were analyzed in 156 patients (82 untreated eyes; 81 treated eyes) with occult neovascularization who were followed for 1 to 8 years. Early laser treatment decreased visual acuity to less than 20/200 in 31 of the treated eyes (38%) compared with 20 of the untreated eyes (25%). Three years after the onset of symptoms, 24 treated eyes (29%) and 31 eyes untreated eyes (38%) retained 20/50 visual acuity or better, whereas their respective initial visual acuities were not statistically different. Severe loss of vision (6 or more lines of visual acuity) occurred in 43 treated eyes (53%) and in 33 untreated eyes (40%) at the end of follow-up (range, 12-84 months). A slow and gradual increase of the disciform lesion was demonstrated on fluorescein angiography in 60 untreated eyes, with subfoveal involvement noted in 39 eyes at the end of follow-up. In the treated group, subfoveal involvement occurred in 53 eyes, after a relatively short time (mean, 4 months). Only 28 of the 81 treated eyes had successful anatomic results. These findings suggested that laser treatment of occult neovascularization immediately after the onset of symptoms should not be recommended.

Aged↗
PubMedDate not supplied

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.

Adult↗
PubMed2002

Cultivation of retinal pigment epithelial cells from human choroidal neovascular membranes in age related macular degeneration.

A method is described for cultivating retinal pigment epithelial cells from choroidal neovascular membrane (CNV) specimens that were surgically removed in patients with age-related macular degeneration (AMD). CNV specimens of 43 patients were available for cultivation. They were incubated in supplemented DMEM/Ham's F12 cell culture medium on microporous semipermeable filter membranes. Thirty-four specimens gave rise to cell cultures, 28 of which could be subcultivated for up to 15 passages. The membrane type as classified by fluorescence angiography was compared with cellular growth in vitro. Immunocytochemistry revealed a uniform expression of cytokeratin 18 and vimentin, while factor 8, glial fibrillary acidic protein and alpha smooth muscle actin were absent in all 21 cultures stained. The expression of RPE markers cellular retinaldehyde binding protein (CRALBP) and RPE65 was detected by RT-PCR in all cultures tested. An epithelial character of the cultures was supported by the presence of apical microvilli as determined by electron microscopical studies. Therefore, the cell cultures from CNV in AMD bear characteristics of retinal pigment epithelial cells. For the first time, this cell culture system holds the potential to study human RPE cells in the context of neovascular AMD in vitro.

Aged↗
PubMed2002

Long-term follow-up of central serous chorioretinopathy (CSCR).

We studied retrospectively the clinical files of 6 patients (11 eyes), who were diagnosed as CSCR between 1968 and 1986. They were all males, aged from 28 tot 46. The initial diagnosis of CSCR was based on the clinical symptoms and ophthalmic findings. It was supported by fluorescein angiography and later also by ICG angiography. Eight eyes have been treated by laser. After a follow-up of at least 15 years: 2 of the treated eyes and one untreated eye developed subretinal neovascularization; 6 of the treated eyes and one untreated eye progressed to diffuse pigment epitheliopathy; Final visual acuity was less than 2/10 in 6 eyes.

Adult↗
PubMed2000

Hypertension, cardiovascular disease, and age-related macular degeneration. Age-Related Macular Degeneration Risk Factors Study Group.

OBJECTIVES: To describe a case-control study of risk factors for neovascular and non-neovascular age-related macular degeneration (AMD) and to present findings on associations with systemic hypertension and cardiovascular disease. METHODS: Participants with and without neovascular and non-neovascular AMD were recruited from 11 ophthalmology practices in the New York, NY, metropolitan area. Comprehensive data collection included (1) a standardized interview, (2) blood pressure measurements, and (3) blood samples. Cases and controls were classified from fundus photograph gradings. Polychotomous logistic regression analyses were used to evaluate associations. RESULTS: Classification of 1222 sets of available photographs resulted in the inclusion of a neovascular case group (n = 182), a non-neovascular case group (n = 227), and a control group (n = 235). Neovascular AMD was positively associated with diastolic blood pressure greater than 95 mm Hg (odds ratio [OR] = 4.4), self-reported use of potent antihypertensive medication (OR = 2.1), physician-reported history of hypertension (OR = 1.8), use of antihypertensive medication (OR = 2.5), combinations of self-reported and physician-reported data on hypertension and its treatment (OR = 1. 7), high-density lipoprotein level (OR = 2.3), and dietary cholesterol level (OR = 2.2). Non-neovascular AMD was unrelated to hypertension or cholesterol level. No associations were found between either AMD type and other definitions of hypertension or other cardiovascular disease. CONCLUSIONS: These findings suggest that neovascular AMD is associated with moderate to severe hypertension, particularly among patients receiving antihypertensive treatment. They also support the hypotheses that neovascular and non-neovascular AMD may have a different pathogenesis and that neovascular AMD and hypertensive disease may have a similar underlying systemic process.

Aged↗
PubMed2000

Radiotherapy for subfoveal neovascularisation associated with pathological myopia: a pilot study.

BACKGROUND/AIM: Limited treatments are available for this disease process. A pilot study was performed to determine the toxicity and efficacy of external beam radiotherapy for subfoveal neovascular membranes and subretinal haemorrhage associated with pathological myopia. METHODS: A randomised, prospective study was carried out on 39 patients with subfoveal neovascularisation associated with high myopia. 20 patients underwent radiotherapy and the remaining 19 were observed as a randomised comparison group. All patients were followed up for at least 24 months. Subfoveal choroidal neovascular membranes (CNVMs) were treated with a single lateral 6 MV photon beam to a dose of 10 Gy in five fractions over 5-7 days. Post-treatment measurements included corrected visual acuity, area of CNVM, and occurrence of radiotherapy related complications, and adverse reactions. To assess changes of area of CNVM, the initial (pretreatment) size of the CNVM was set to 100%, and all post-treatment measurements were normalised relative to the initial size. RESULTS: No significant acute morbidity was noted. There was no significant difference in age, sex, refractive error, visual acuity, and area of CNVM at baseline between the treatment group and control group. The mean change of the size of the CNVM for 2 years was 155% (SD 156%) in the treatment group and 249% (124%) in the control group. The increase in the size of CNVM in the treatment group was significantly smaller than that in the control group (p = 0.0452). In the treated eyes, the visual acuity before and 1 and 2 years after radiotherapy were 0.111 (22.2/200), 0.091 (18.2/200), and 0.086 (19.2/200), respectively. In the control eyes, visual acuity before and 1 and 2 years after the start of the follow up were 0.141 (34.2/200), 0.089 (17.8/200), and 0.063 (12.6/200). The patients in the treatment group showed no significant change for 2 years, and those in the control group showed a significant decrease in the visual acuity (p = 0.0033). The changes of logMAR of visual acuity for 2 years after the start of the follow up were +0.019 (0. 443) in the treatment group and +0.347 (0.374) in the control group. There was a statistically significant difference between them (p = 0. 0173). Multiple regression analysis on the treatment group showed that the most significant predictive variable for the visual acuity 2 years after the treatment was the combination of pretreatment visual acuity and refractive error. CONCLUSIONS: Radiotherapy appeared to have a favourable treatment effect in eyes with subfoveal neovascular membranes and haemorrhage associated with pathological myopia. Further investigation is needed to evaluate the efficacy of radiotherapy for subfoveal neovascularisation associated with pathological myopia.

Aged↗
PubMed1991

Subretinal neovascularization in systemic lupus erythematosus.

Choroidal involvement in systemic lupus erythematosus (SLE) occurs infrequently. We describe a patient with unusual manifestations of lupus oculopathy: prominent choroidal vasculopathy associated with multiple chorioretinal scars and subretinal neovascularization in the macular area. Choroidal disease was the primary feature of ocular involvement. SLE should be considered in the differential diagnosis in patients with inflammatory choroidal lesions.

Aged↗
PubMed1990

Sympathetic ophthalmia and subretinal neovascularization.

We report a case of sympathetic ophthalmia with subretinal neovascularization of the macula. The subretinal neovascularization developed after penetrating trauma to the fellow eye. The occurrence of subretinal neovascularization in sympathetic ophthalmia is not surprising since disintegrative changes and breaks in Bruch's membrane have been reported in sympathetic ophthalmia. Subretinal neovascularization has also been reported in Vogt-Koyanagi-Harada syndrome, which is histopathologically similar to sympathetic ophthalmia.

Adolescent↗
PubMed2005

Retinal pigment epithelial tear following photodynamic therapy for choroidal neovascularization secondary to AMD.

PURPOSE: To describe retinal pigment epithelial tear following photodynamic therapy (PDT) for subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). DESIGN: Retrospective interventional case series. METHODS: A retrospective study in an institutional practice. We describe seven cases of retinal pigment epithelial (RPE) tear, which developed in seven eyes of seven patients following PDT. All eyes had subfoveal CNV secondary to AMD. RESULTS: Six eyes had occult subfoveal CNV, and one eye had recurrent classic subfoveal CNV. In five patients, the eye that developed the tear was the second eye, whereas the first eye had a disciform scar. In four eyes, the RPE tear developed after one PDT, in one eye the RPE tear developed after the second PDT, and in two eyes the RPE tear developed after the third PDT. In five of seven cases, there was a significant visual deterioration following the RPE tear. CONCLUSIONS: RPE tear is a complication that may occur following PDT in particular when the PDT is applied to an occult subfoveal CNV.

Aged↗
PubMed2002

Enhanced S-cone syndrome with subfoveal neovascularization.

PURPOSE: To report a case of enhanced S-cone syndrome associated with subfoveal neovascularization. DESIGN: Observational case report. METHODS: A 23-year-old man, who was first examined at age 9 years, was found to have enhanced S-cone syndrome by clinical, electrophysiological, and molecular genetic examinations. RESULTS: At 9 years of age, a subfoveal neovascularization was present in his right eye and corrected visual acuity was RE: 0.15 and LE: 1.0. After he was 20 years old, cystoid changes in the macula of the left eye appeared and visual acuity, in the left eye, decreased from 1.0 to 0.02. CONCLUSION: The clinical course of enhanced S-cone syndrome is progressive, and we suggest that the subretinal neovascularization is a phenotypic variation of enhanced S-cone syndrome.

Adult↗